Don’t Drop The Patient! Examine the Entire System

I’ve been called back to the University of California, San Diego, to establish the design lab, we want this to be a unique laboratory, one that does design that’s different from what most people are doing.

So we are doing what we call complex socio technical problems, things that require thinking as a system, the most complex structures and how they might be enhanced.

Well, one of the big areas is health care. And we’re in San Diego, which turns out to be a center for a medical device, companies for pharmaceutical companies, for for biological research, for medical research. So a lot of the work we do is health care. So what can a behavioral designer do in health care? I’m not an expert in medicine. I’m not an expert on illness. What is it that we can do? We can look at the complex operations that occur in health care, for example.

Suppose I’ll take an example that we’ve looked at someone who gets cancer to pose as a little child, has a pain in the leg, doesn’t know what to make of it.

A few weeks later, tells her mother the mother doesn’t know what to make of it. Seems like a minor thing takes a little bit of time before the mother decides that’s might be a serious problem and goes to their general practitioner. And the general practitioner says, oh, I don’t know what it is, let’s get an x ray. And so you have to go and make another appointment and go get an x ray. And then the x ray has to be read by a radiologist.

The radiologist calls out the general practitioner and the general practitioner calls up the patient and says, come back and we’ll talk and then says, you know, we don’t know what this is.

We think you should get a biopsy, take take a little sample of tissue. And so off you go, get another appointment, have a biopsy taken. Then the sample has to go to the clinic and has to be read by a clinician. And then you call back to the general practitioner who calls you back and you go in and you are told, doesn’t look so good. We think you need an MRI. You go get another appointment and you get an MRI and get another consultation.

And no one looks like it might be cancer. So let’s send you to an oncologist, a cancer specialist, a pediatric oncologist, because this is a child and yet another set of appointments. And finally, they decide that you have cancer and they have to decide how to treat it. They decide, well, we probably will treat it with radiation. And so now you get to see a radiation oncologist and then you have to go to the radiation oncology clinic where you’re going to be examined by the radiation oncologist who has to consult with a medical physicist who consults with the psychiatrist who results, who consults with the various technicians who are going to administer.

And then you have to go back for more consultation and what’s called a simulation, and then you have to go back and get treatment.

And the treatment may very well be a 15 minute radiation dose every day for 30 times.

That’s six weeks of treatment every single day.

So look at all the transitions, every single transition from one person to another, one specialist to another, one clinic to another, for that matter, if you’re in the hospital when the shift changes, one shift to another.

Every transition is an opportunity for incomplete transmission of information, medical error, basically. And how do you solve that problem?

How can you reduce the number of transitions and reduce the amount of time it can take six, eight, 12 weeks from the time a patient first noticed something to the time they first get treated and most of that time is waiting for an appointment to come through.

How do you solve that problem?

That’s the sort of things that we are working on. And you can actually make dramatic enhancements if you sit back and say this is the system because it was never designed as a system, it was well, you know, the general practitioner has their practice and then there’s an x ray, which is some some clinic someplace else.

And then there’s the people who do the biopsy at someplace else. And the radiation oncology, that’s a specialized piece of equipment. It’s a ten million dollar device. And so that’s yet another location. And different technicians and different specialties have to do the different components of it. It was never really put together as one cohesive system and do that.

Guess what? There’s great opportunities for basically. It’s good, sensible design, human centered design, user experience, design, product design, system design, service design, all of.

Things that are part of our normal repertoire of tools and techniques turned out to be incredibly invaluable in the health care space. So that’s just one example. There’s actually many more I could tell you about, but one example is a good start.

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