One of my two favorite conferences in the world closed a couple of weeks ago – Mayo Clinic’s Transform, hosted by the Clinic’s Center for Innovation (CFI). If you remember, I covered this conference last year, after what can only be described as three days of awe inspiring conversations. This year, I had the very distinct pleasure of talking with Dana Ragouzeos, a designer with the CFI about the work she has been doing there over the last 18 months and the process the CFI uses as an embedded design team to transform health from the inside out (and back again too ☺).
Sterena: First of all Dana, can you tell us a little about your background and how you came to be doing the work you do now?
Dana: I started out studying writing, but moved into architecture. I liked studying people and patterns and telling stories through both pictures and words. I ended up choosing pictures (and models, and diagrams). I studied at a liberal arts college (Smith College), so design was always something more to me than what I put down on paper (we didn’t use the computer yet). It was about the process, the observations, the trial and error that got me there.
After school I worked in landscape architecture and urban planning offices and moved into a research role. I was researching aging facilities one day and realized I could make a bigger impact working in product and interactive design, where the timelines (from conception to implementation) were shorter and there was more of a premium on design research. So I began getting experience in product design and eventually went back to school. I chose Calif. College of the Arts (CCA) because they had an interdisciplinary program, and I knew I’d have the flexibility to pursue studies in design/medicine/and aging while there. My thesis work was on developing interactive tools for caregivers of dementia patients to connect and share resources. After engaging in that work, I knew I wanted to work in design for health and health care. Mayo Clinic was the only place I knew of that had invested in an embedded design group that could really get at the roots of our complicated medical systems and create solutions from the inside out. I love what we get to do here and with whom we get to work.
Sterena: So user centered and patient centered design are pretty hot right now, how would you describe the ways in which they differ?
Dana: At its core, “human-centered design” it is about putting yourself, the designer, second, leaving yourself open to be surprised, to be taught. Yes, we come to the table with years of training and experience, with preconceived notions, with some really great ideas. And in some cases those ideas find their way into the final design, but only once they’ve been fully vetted through the needs of the people who will ultimately interact with and rely on what it is you are creating. Design training at its best cultivates empathy, and in user-centered design that empathy is our most valuable tool.
Patient-centered design is not necessarily different, but there are elements of human-centered design that are heightened when working with patients. For example, there are parts of the patient experience that have not changed for decades or that have changed in surprising ways. There are reasons for everything, and there is a lot of history with many stakeholders attached to it. In every project, it’s critical to know that history or we quickly get dismissed as out of touch.
Another element of patient-centered design is that we have to constantly remind ourselves to not just address the needs of the patient, but their hopes, dreams, desires, and goals. It is easy to lose sight of that in medicine where it is crucial to identify and address the needs of the patient in the most timely and accurate manor. A third element of patient-centered design is the role of the team: the design team, the care team, and the patients’ teams. No one has all the answers in medicine, and no one person has all of the answers designing for medicine. An intelligent team to rely on, that will listen and contribute, is critical. Successful communication and teamwork are difficult and have to be practiced, no matter how much we try to convince ourselves otherwise.
Sterena: How do these design ideas interact with other principles in healthcare design such as evidence based design or even experience based design then?
Dana: You can’t really have one without the others. Our approach naturally covers all of these. We have financial experts, medical providers, IT analyst/programmers, project managers and administrators integrated into our design team to make our approach truly holistic.
Sterena: What are some of the Clinic’s projects that you have seen emerge from this commitment?
Dana: In one project, called the Toolkit, we turned our focus on Mayo Clinic employees. Innovative concepts emerge all over the clinic, but it can be hard to see them to fruition if doing so is not integrated into your day-to-day job and rhythm of work. We wanted to make our tools and methods available clinic-wide so that concepts didn’t die and people felt empowered and equipped to move them forward. Instead of just making some templates and videos to post online, we conducted individual and group discussions and observations throughout the clinic. We concluded, among other things, that people needed a place (both physical and online, but mostly physical) where they could come together, and they wanted to connect with other people with whom they wouldn’t otherwise connect. This was more important than any tools or templates. We built out a physical space, along with some online tools, that would help them do that. The key is that the Toolkit is never done. It was built collaboratively through experimentation with Mayo employees, and it continues to evolve according to their needs and wants.
Another is the Outpatient Practice Redesign project we’re working on. It’s a long-term project aimed at improving the patient experience and reducing cost. We’re using experimentation as part of our research, which is a very human-centered way to work. We discover patient and practitioner needs, like more flexible scheduling or a team-based approach to patient education. We then work with our stakeholders (providers, patients, allied health staff…) to conduct lo-res experiments around how that might happen. That’s one of the things that makes our work different. We experiment, and we do so alongside our stakeholders. The most sustainable healthcare solutions are those that recognize and address the integration of people, information, and systems in a nimble way. We are successful when we include stakeholders in our research, experimentation, and design. So, our experimentation involves long hours in the clinic, working alongside staff and adjusting our approach when we learn that’s necessary.
Sterena: So what do you think are the challenges and limitations of such design solutions? What evidence do we have that user focused or centered design works?
Dana: Getting buy-in takes time. All projects need momentum to be successful, and it is hard to maintain momentum when it is equally important to include key stakeholders in the process. That is also why it is valuable to be an embedded group. Because we understand the culture and have relationships, we can move faster. That’s why it’s such a valuable investment that Mayo has made in CFI.
The evidence that our approach as an embedded human-centered design group works exists in people’s language. We work with people that understand and embrace the concept of prototyping. The word “experience” has found its way into our institutional visioning language. People seek us out and understand the value of design research and visioning in their projects. These things were not as evident a few years ago. Those are huge wins. Our biggest successes are not only in 3D or 2D solutions, they exist in language.
Sterena: In closing, tell me, what would be your dream project?
Dana: I have a lot. Here are two. If you need me to really just pick one I can. Or if you want a few more, I can do that too ☺ :
1. Redesigning medical education and training
Medical training is thorough and produces some excellent practitioners that go into this work out of a genuine desire to help people. But as we look at the current big problems in how we practice medicine, it becomes evident that we have to turn our focus onto how we educate, train, and cultivate our care teams. There is a lot written about how we could redesign medical education so that we don’t have to put band-aids on our current systems. It’s a huge undertaking, but I believe in our methodology of starting fast and small, and I believe in the passion and excitement that exists in educating and learning.
2. End of life care
I believe strongly that we owe it to ourselves as a society to completely rethink and create widely available, accessible, and acceptable ways to thrive through this part of life.
I couldn’t agree more! (and look forward to attending Transform 2012 
)
With many thanks to fdecomite, katerha, wonderlane, and hello, I am Bruce for their beautiful images!
Kirsti
Patricia Moore, design heroine, who wants to shatter the myths we have about the elderly and like many designers, wants us to reconsider how design excludes and fails many demographic groups. I bow to her as an ethnographer for her awesome work traveling the country as an elderly woman for 3 years to ground her practice.
