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Design at the Point of Care: Hard-Won Wisdom from the SPARC Innovation Program at Mayo Clinic

Slide Presentation from the AHRQ 2008 Annual Conference

On September 8, 2008, Matt Maleska made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (2.5 MB).

Slide 1

Design at the Point of Care: Hard-Won Wisdom from the SPARC Innovation Program at Mayo Clinic

Matt Maleska
Design Manager
SPARC Innovation Program
Mayo Clinic Center for Innovation
AHRQ Annual Conference 2008
Promoting Quality, Partnering for Change
Bethesda, MD—September 8, 2008

Notes:

Hello my name is Matt Maleska, I am the Design Manager at Mayo Clinic's SPARC Innovation Program. I am here today to share with you some of our group's hard-won wisdom from researching and designing new health care products and services at the point of care.

Slide 2

Key Messages

A Case for Change.
SPARC Characteristics.
Prototyping as Research.
Recent Work.
Hard-Won Wisdom.

Notes:

To do so, I'll first introduce you to what initially started Mayo Clinic down the path of health care service innovation.
I'll continue by describing some of the unique qualities of the SPARC program . with particular emphasis on how we use prototyping to conduct research.
I'll conclude with some examples of our work and some messages that might be pertinent to those of you who are looking to build your own innovation programs.

Slide 3

A Case for Change

The colored photograph shows people walking and sitting in a hospital lobby.

Notes:

So, let me begin with the case for change . or providing some context about our efforts, where we are now and where we hope to be in the future.

Slide 4

Mayo Clinic

Mayo Clinic is the largest not-for-profit physician led integrated practice in the world.

Founded 126 Years ago.
More than 51,000 employees.
2.2 Million outpatient visits a year.
Occupies +15 million square feet.
The "Choice of last resort" for complex acute care.
U.S. News & World Reports Highly Ranks Mayo.

Notes:

As you may know, Mayo is the largest not for profit physician led integrated practice in the world.
But neither its size, its history, nor its reputation protects it from the very hard realities that all academic medical centers face right now.

Slide 5

A Case for Change

Delivering health care services is increasingly complex.
- Increasing costs, competition, regulations.
Health care system is not patient centered.
- Patients traditionally left out of the creation of health care services.
- Service expectations in all industries are rising.
Basic science research.but little research on health care delivery.

Notes:

Of course there are the increasing costs, competition and regulations that make it so complex to deliver health care.
But I think what really motivates us to change, is simply the knowledge that we can always do better for our patients.
The challenge though, is that in a profession that believes in evidence-based decision-making.
There is very little research about how to improve the delivery of health care services.

Slide 6

Spectrum of Innovation

Sustaining; Doing what we do today better; Comfort Zone.
Innovation.
Transformative; Developing what we will be doing tomorrow; Risk Taking.

Notes:

As a result, most health care service innovation efforts normally begin here on the 'sustaining' side of the innovation spectrum.
Why . because it is within our comfort zone.
It is easier to identify a small piece of the system that needs to be fixed . one that normally falls within one department, one division, or the influence of one work group.
And it is easier to employ a common and established methodology such as six sigma and lean thinking.
And we go about looking at ways to reduce errors, reduce the time of delivery, and reduce costs.
These are all extremely important efforts to improve the quality and safety of how we deliver care today.
But .what happens when we recognize that we must do something all together different than what we are doing today?
What happens when we need to take some risks and try something totally new?
So as we move our way across the spectrum of innovation, in order to develop what we will be doing tomorrow.
We leave the comfort zone of a common methodology, of smaller quantifiable changes, and we need to employ skills, tools, and expertise that traditionally has not found in health care administration.

Slide 7

Need for New Approaches

Need in health care for a generative and creative problem-solving approach.
An approach that allows for rapid and comprehensive exploration of opportunity areas for change.
An approach that researches and understands the need for innovation from the 'customers' point of view.
Three circles overlapping:
- Feasible.
- Viable.
- Desirable.

Notes:

Therefore, it becomes apparent that what is really needed is a new set of approaches to design and deliver disruptive forms of innovation. In other words.
There is a need in health care for.
An approach.
Understand.
I want to pause on this last point, B/C most innovation in health care delivery commonly comes about through trying to introduce a new technology into the clinical setting, in which most of the research looks to measure if an innovation is feasible? . meaning will it work? . Is it viable? . will it continue to work and achieve the goal for which it is intended.?
But the research into. what patients really want, or what providers will actually use . the desirability of any innovation . is rarely researched and even more rarely understood.

Slide 8

SPARC Innovation Program

A colored photograph showing staff brainstorming ideas with colored post-it notes on glass.

Notes:

So it is with this point that I would like to introduce to you the SPARC innovation program at Mayo Clinic.

Slide 9

SPARC's Mission

Research, re-imagine, and realize novel health care experiences.

Notes:

Simply stated, SPARC's mission is to.

Slide 10

SPARC's History

Approximately four years old.
Department of Internal Medicine—Program on Innovative Health Care.
A "laboratory model."
Intent: Bring new products/services into the practice.
Approach: See. Plan. Act. Refine. Communicate.
Initially based on workshop and small scale projects.
Hired designer/researchers and strategists (project managers) ~3 years ago.
Now part of the Mayo Clinic Center for Innovation.

Slide 11

SPARC's Approach

Design and deliver disruptive innovations

Conduct research & design projects of strategic importance.
Create new service, experience & interaction design concepts.
Advise on implementation.

Notes:

Conduct research & design projects of strategic importance . for the institution.
It creates . New service, experience & interaction design concepts . Related to the delivery of health care services.
Offer implementation and dissemination advising . To maintain the integrity and up-take of the concepts once they are handed off.

Slide 12

SPARC Designer/Researcher Team

Designer/Research Skill-sets.
- Service, Product, Interaction, Communication Designers, etc.
- Consumer, Market and Innovation Research.
Content Experts.
- Physicians, Administrators, Allied Health Staff and Patients.
Roles.
- Ambassador, Decoder, Bridge, Champion, Translator, and Advocate.

Slide 13

SPARC's Innovation Corridor

Design Studio.
Outpatient Practice.
Monitoring Equipment?
Flexible Space.

Notes:

One element of the SPARC program that gets a lot of attention is its innovation corridor.
Located within an active general internal medicine practice at Mayo, the corridor has some unique characteristics that help us conduct our research and design projects.
For example, our designers are situated in an active corridor where patients are seen by GIM docs daily.
We have monitoring equipment to video tape our research efforts.
And we have flexible space, with moveable walls to prototype such things as new exam rooms, new offices, new services. anything we want.

Slide 14

Access to Interactions

The colored photograph shows a staff employee speaking with a new mother and her baby.

Notes:

But I want to emphasize, though the physical space itself is a crucial element to our work in terms of being a constant and approachable and engage-able presence for patients, providers and staff.
What truly differentiates our efforts . and what I want to highlight as one of the key elements of our work.
Is the access that our research and design team has to clinical environments.
To understand desirability and usability you have to fundamentally understand hoe the practice works! The best way to do that is to be there!
You must have.

Slide 15

Access to Interactions

Two photographs of doctors interacting with their patients.

Our work is built around the interactions that happen between people; namely the patient and the provider.

Notes:

Access to the meaningful and powerful conversations that occur between patients and providers.
Access to all those quirky moments, awkward discussions, irrational behaviors and uncommon grace that makes the delivery of health care so complex and so compelling.

Slide 16

Access to Interactions

The slide shows two photographs: one of administrative staff and the other of a doctor and nurse working in their hospital environments.

Consistent access to these moments is one of the key elements of our work.

Notes:

First and foremost our roles as embedded designers is to have a fundamental understanding and appreciation of all this . for all that it means to deliver care to patients.
and to find inspiration in all this ambiguity and human complexity.
Most importantly not to reduce or detract from these interactions by thinking of people in terms of metrics or throughputs.

Slide 17

Design Thinking

The photograph shows a hand drawn diagram with colored post-it notes.

Notes:

So just how do we do that???
I've mentioned design a lot to this point, and what I'd like to do now is spend a minute clarifying exactly what I mean, and how it, as a discipline, and as an approach, is so valuable in addressing all the complexity and ambiguity associated with innovating health care services.

Slide 18

Characterizing Design

Design is a conscious decision-making process by which information about needs is transformed into new products or services that meet those needs.

Notes:

First, at SPARC we characterize design as . so it is about researching the user needs, and responding to those needs with new product and service concepts.

Slide 19

Characterizing Design

Result: Product Design, Interior Design, Graphic Design, Fashion Design.
Activity: Sketching, Drafting, Modeling, Prototyping (making and illustrating).
Process: Use of methodologies to either imagine and/or realize ideas.
Thinking: A mindset for creative and generative problem solving.

Notes:

Now usually when people hear the word design, they think about the end result . what was actually designed.
Or possibly how it was made.
Or maybe even the process or methodology that was used.
But what I want to spend one more minute on is the concept of design thinking.

Slide 20

Characterizing a Design Thinker

Empathy. They can imagine the world from multiple perspectives - those of colleagues, client, end users, and customers.
Integrative thinking. They not only rely on analytical processes but also exhibit the ability to see all of the salient - and sometime contradictory - aspects of a confounding problem and create novel solutions that go beyond and dramatically improve on existing alternatives.
Optimism. They assume that no matter how challenging the constraints of a given problem, at least one potential solution is better than the existing alternatives.
Experimentalism. Design thinkers pose questions and explore constraints in creative ways that proceed in entirely new directions.
Collaboration. The increasing complexity of products, services, and experiences has replaced the myth of the lone genius with the reality of the enthusiastic interdisciplinary collaborator.
—Tim Brown, Design Thinking (Harvard Business Review, June 2008)

Notes:

A design thinker is often defined by these characteristics. ..empathy . and the values of experimentation and collaboration.
Though I don't have time to go into these characteristics in detail now, just by their headings.
One can imagine that in a field as traditional, silo-ed and hierarchical as health care, these characteristics are welcome additions to any innovation effort.

Slide 21

Design Thinking Tools and Activities

Observational Research.
"Fly on the Wall."
Shadowing.
Narration.
Behavioral Archeology.
Try it yourself.
Scenarios.
Behavioral Mapping.
Social Network mapping.
Role Playing.
Interviews.
Intercepts.
Focus Group.
Secondary Research.
Journaling.
Process Maps.
Storytelling.
Synthesis.
Brainstorming.
Formal Prototyping.
Personal Inventory.
Paper Prototyping.
Long-Range Forecasts.
Foreign Correspondents.
Five Whys?
Informance.
Historical Analysis.
Guided Tours.
Extreme User Interviews.
Error Analysis.
Experience Prototype.
Empathy Tools.
Draw the Experience.
Cultural Probes.
Be The Customer.
Cognitive Task Analysis.
Cross-Cultural Comparisons.
Still-Photo Survey.
Conceptual Landscape.
Competitive Product Survey.
Collage.
Cognitive Maps.
Character Profiles.
Card Sort.
Camera Journals.
Videoethnography.
Bodystorming.
Behavior Sampling.
Anthropometric Analysis.
Affinity Diagrams.
Activity Analysis.
A Day in the Life.

Notes:

There are a number of tools and activities that are used and that characterize design thinking as well.
What I want to focus on in my last few minutes today, are those activities related to prototyping.

Slide 22

Prototyping* as Research

The photograph shows a white desk, table, and three chairs covered with post-it notes.

Prototypes as (design) tools for organizational and behavioral change: A design based approach to help organizations change behaviors (Journal of Applied Behavioral Science, Vol. 43, No.1, March 2007, Coughlan, Suri and Canales).

Notes:

Difference between prototyping and piloting.
Piloting, in health care setting, is traditionally the vehicle to roll out new processes into the clinical practice.
Prototyping, in general is a method regularly employed in the design and development of products and services, and is a powerful means to facilitate and research organizational change and development.

Slide 23

Prototyping as Research—What?

The slide shows two photographs: one of a digital touch screen and the other of an electronic check-in kiosk.

People—Roles, Processes, Environments, Technologies, Content, Artifacts.

Notes:

Again, the power of prototyping, is that it is just not about creating new products, we use it at SPARC to research new people, processes, spaces, technologies, content and artifacts.
Here we prototyped a digital touch screen and an electronic check-in kiosk as a potential service to improve the patient experience.

Slide 24

Prototyping as Research—What?

The two photographs show people working together on projects.

Rough, Rapid, Right.

Notes:

Another way to characterize prototyping is that it is ROUGH, RAPID and RIGHT.
Rough—We use any of the resources we have available to us.
Rapid—We just make it. We make things that other people can respond to, critique or constructively criticize
Right—We use prototyping to answers questions? Did we get it right? Did we learn something from it?
Did it move an idea from a person's head and into their hand?

Slide 25

Prototyping as Research—What?

The slide shows two photographs: one of an early stage prototype education center and the other of the final design.

An iterative process.

Notes:

It is also an iterative process.
Keep working on it, refining it and make it better ..
Here was an early stage prototype we made for a new musculoskeletal patient education center to see how patients would use it, respond to it, like it.
. and here it is in its final iteration.

Slide 26

Prototyping as Research - What?

The slide shows two photographs: one of Dr. Victor Montori with designer, Maggie Breslin, and his diabetes medication decision aid prototypes, and the other of a group of residents prototyping new hospital services in the SPARC flex space.

Collaborative and User-Centered.

Notes:

It must be collaborative, participatory and user-centered.
Here we have Dr. Victor Montori with the prototypes of his diabetes medication decision aid designed by Maggie Breslin.
And here we have a group of internal medicine residents prototyping new hospital services in SPARC's flex space.

Slide 27

Prototyping as Research—Why?

The slide shows two photographs: one of a prototype out patient practice and the other of a resident with his idea for a new patient PDA.

Building to Think.

Notes:

So that is what prototyping is .. But why is it important? Why should it be used more frequently to research new Health care services?
Because creating tangible expressions of ideas enables organizations and individuals to develop their thinking concretely through actions, through making.
This in turn allows other to engage with and interact with an artifact, rather than argue or misunderstand an abstract idea.
Here is a prototype we built of an entirely new out patient practice—the other is resident and his idea for a new patient PDA.

Slide 28

Prototyping as Research—Why?

The slide shows two photographs: one of cards used to influence the way patients talk to their doctors and the other of people watching a presentation.

Giving Permission to Explore New Behaviors.

Notes:

Another reason why prototyping is important . gives permission to explore new behaviors, to change their daily habits.
Here we have cards that we used to influence the way that patients talk to their doctors . Kind of in a mad libs way . merely to see if we could change a dynamic . get people to talk to each other differently . and it worked!
And here is a demonstration of a new prototype intended to change the way the Emergency Department communicates with the Medical Intensive Care Unit in transferring patients . to challenge some long standing behaviors of both groups.

Slide 29

Prototyping as Research—Why?

Two photographs showing staff inputting patient information into their system.

Learning Faster by Failing Early (and Often).

Notes:

And finally, why is it important to prototype. because they help you learn faster.
In these pictures, we were working on a standardizing the process of gathering patient information.
The goal was to take patients' vitals, including height and weight, as well as to document medications, and family history.
What was so striking about this series of prototypes, was about how we did or did not meet the expectations of our patients depending on how we set those expectations with the variety of service prototypes we created.
Meaning, you get entirely different reactions from a patient if you ask them about their family history via a phone call two days ahead of time. vs. if it is part of the process from moving from the lobby into the exam room, or. if the clinical assistant asks the patient in the exam room before the doctor walks in.
And then. on the backstage of the experience. how a physician responds if any of the processes were conducted by a clinical assistant vs. a nurse.

Slide 30

Recent Work

Notes:

So hopefully you have a better sense of what prototyping is, and why it is valuable.
Now before I wrap up, here are some additional projects that we have used prototyping as a means for research and design.

Slide 31

Recent Work: Projects

Redefining Integration in the Outpatient Setting.
Nursing Team Communication.
Connecting Care Web site.
Nicotine Dependence Center.
Summary Visit Worksheet.
Advancing the Inpatient Model of Care.
Visual Patient History.
Informed Consent Process.
Mayo Customer Experience Project.
Innovations in Imaging (iViz).
GI and Orthopedics Exam Rooms.

Notes:

Redefining Integration in the Outpatient Setting: Enhancing a clinical lab for health care innovation.
Medical Intensive Care Unit: Developing novel tools for MICU/ED intra-departmental communications.
Nursing Communication: Developing new processes and environments for care team communications.
Connecting Care Web site: Prototyping an idea-sharing tool for best practices in health care delivery.
Decision Aids: Developing tools for patients to make better choices about medications or treatments.
Nicotine Dependence Center: Designed an environment for attracting people to treatment services.
Summary Visit Worksheet: Implementing patient-provider worksheets for medical guidance.
Advancing the Inpatient Model of Care: Recommended strategies for improving patient experience.
Musculoskeletal Patient Education Center: Developed processes and exhibits for educating patients.
Standardized Rooming Process: Developed check-in and interview processes for provider efficiency.

Slide 32

Hard-Won Wisdom

The photograph shows a white board full of ideas and data.

Notes:

In conclusion I want to share with you our hard-won wisdom.

Slide 33

Three Pieces of Advice

Approach innovation from the user's perspective.
- Desirability first, then feasibility and viability.
- Fundamental understanding of the "work."
- Grounded in the realities of the practice.
Prototype, Prototype, Prototype.
- Rough, Rapid and Right.
- Iterative.
- Collaborative.
Don't reduce human complexity from innovation.
- Find inspiration in it.

Notes:

In closing, I'll like to respectfully offer the three pieces of advice for those of you who are interested in researching and innovating health care services.
The key piece of advice is to not reduce the human complexity from innovation, from health care.
To find inspiration in human interactions.
Approach from the user's perspective.
Desirability.
Grounded.
Prototype, Prototype, Prototype.
Find inspiration by prototyping, by building something together.
Having approached health care innovation at the point of care over the past three years, I believe that at its very core, the delivery of health care is a human endeavor, an interaction between people, therefore, it should be researched, understood and innovated as such.

Slide 34

Thank you

Maleska.Matthew@mayo.edu
507.284.0932 (office)

Current as of January 2009

Internet Citation:

Design at the Point of Care: Hard-Won Wisdom from the SPARC Innovation Program at Mayo Clinic. Slide Presentation from the AHRQ 2008 Annual Conference (Text Version). January 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annualmtg08/090808slides/Maleska.htm