Emergency physician Bon Ku, MD, MPP, is more than qualified to treat the patients at Thomas Jefferson University Hospital in Philadelphia, but he knew they and their physicians faced other problems that couldn't be solved by medical expertise. Burnout is rampant among EPs, and he knew they all needed a way to improve patients' experience by cultivating empathy in new physicians.
“All the education and training I received didn't prepare me to deal with overcrowding,” said Dr. Ku, an associate professor of emergency medicine at Sidney Kimmel Medical College (SKMC) at Thomas Jefferson. “No course in medical school teaches you how to do that. These are obstacles that prevent us from treating patients and making them healthier.”
Changing an educational framework that had remained fairly static for more than a century would not be an easy task, but he said he thought the complexities of life in the 21st century required new thinking. That novel theory? New designs led by “makers” who seek creative solutions. It was a change, Dr. Ku said, that would have to occur in the early stages of medical school.
Enter JeffDesign, a track in the medical education program at SKMC that focuses on teaching students how to apply design thinking to health care challenges. (http://bit.ly/2dFTejN.) The college also offers the Innovation & Design Application (IDeA) Program to qualifying Princeton University pre-med sophomores already granted early admission to SKMC who are interested in pursuing untraditional paths in architecture, engineering, and science. (http://bit.ly/2dFTwYa.)
“The idea behind JeffDesign is to take real-world challenges in health and look for innovative ways to solve them,” Dr. Ku said. He and his students, for example, spent a summer trying to fix the problem of medical reconciliation in the emergency department. The experience taught his students how to prototype solutions and test them out.
The Medical Education Gap
Lack of training in problem-solving is a major dilemma in medical education, according to Dr. Ku. “As physicians, we have a responsibility to focus on more than the patient in front of us,” he said. “We have to ask how we are going to make the experience better for the patients.”
Most emergency departments are often crowded with patients in the hallways, and personnel within the ED often don't communicate well. Dr. Ku had medical students partner with architects to map out the space to understand how doctors and nurses interacted in the ED with a geographic information system, which gave them a sense of how well they worked together.
“We found that doctors don't spend a lot of time in the patients' rooms,” Dr. Ku said. “They spent a lot of time on the computers outside the patient rooms.” Making matters worse, nurses were stationed in pods where they were isolated from doctors and patients.
Dr. Ku and his team of students wondered how they could change the physical reality to promote communication among patients, physicians, and nurses and to adopt a more team-based approach. The exercise helped them understand the structure of an emergency department and how to design it better.
This focus on design begins through workshops and lectures in the first two years of medical school and continues in the third and fourth years through individual projects. A video on the JeffDesign website showcases students' projects, from making blister packs at the patient's bedside and devising a nebulizer for patients in Panama to prototyping drones that deliver health kits to hikers in isolated areas.
Patient-Centered Problem Solving
Joyce Lee, MD, MPH, a professor of pediatrics with a focus on diabetes at the University of Michigan in Ann Arbor, converted to the maker movement when she and her family were on sabbatical in San Francisco and realized they needed to alert her children's teachers to their food allergies.
Dr. Lee and her son made a PowerPoint presentation on when and how to give him an antihistamine and epinephrine through an EpiPen. Since then, she has assumed the identity of a doctor as designer and blogs about her experience at www.doctorasdesigner.com. (Also follow her on Twitter @joyclee.)
Like Dr. Ku, Dr. Lee said the design movement is “a form of problem-solving that is user-oriented. We tend to make decisions about educational tools and policy without patients in the room,” she said. “What we decide will [affect] the lives of patients.”
Design, however, requires input from many disciplines as well as patients, and is aimed at improving new therapies to make them easier for patients to use. Such cooperation can overcome negativity that threatens good patient care. Design is also about optimism that negates the refrain of “I can't do this,” Dr. Lee said.
Dr. Ku agreed. “At the heart of design thinking is empathy and understanding the end-user, which includes all the patients we see in the emergency department,” he said. He incorporates this patient-focused theory into his project to redesign an emergency department with his students. Dr. Ku and his class work with architects to understand the physical space, temperature, sound, and lighting, factors that affect occupants of the ED but that are seldom acknowledged. “I think we underestimate how space can positively and negatively [affect] patients and providers,” Dr. Ku said. He said he hopes the redesign can eliminate disruptions that lead to errors in treating patients.
“Emergency departments are the face of the health care system,” said Dr. Ku. “They can't be a harsh environment. They should be a face that welcomes patients and providers.”
Perhaps the most recently recognized practitioner of design and innovation in health care is Rebecca Richards-Kortnum, PhD, a professor of bioengineering and electrical and computer engineering at Rice University in Houston. She recently received a MacArthur Fellowship for her innovative work with undergraduates to develop inexpensive health technology for the developing world.
Through her Rice 360° Institute for Global Health, students have developed inexpensive improvements on a homemade incubator and UV light to treat jaundice. (www.rice360.rice.edu.) Students in the program have also designed a backpack to take eye care into the developing world and another that provides the basic diagnostic tools needed in resource-limited places like Haiti. These and other designs promise to bring better health care to all parts of the world.
Dr. Ku said current thinking in the ED focuses on “the patient in front of you. But most emergency departments see 30,000 to 150,000 patients each year. How are we going to make that population healthier?” Design and problem solving may be the answer to that question.
Read more about how Drs. Bon Ku and Joyce Lee are integrating design thinking into medical school training and patient care at http://bit.ly/Ku-Lee.