Design Thinking, Tim Brown, Harvard Business Review, June, 2008

Rachel Block, the Executive Director of the New York eHealth Collaborative (NYeC - pronounced “nice” - get it?) alerted me to this article in the June, 2008 issue of the Harvard Business Review. It’s available for free on their Web site now, so waste no time in getting it.

The article is written by the CEO and President of IDEO, Inc., and talks about several projects that created value for customers using design thinking. The first project described is one at Kaiser Permanente, where, through this approach, nurses changed their rounding strategy to “at the patient’s bedside” instead of “at the nurse’s station.” This in and of itself was striking to me, because it’s exactly the approach that other national leaders in patient and family centered care are pursuing. How great that the same conclusion was reached about where nurses can best serve patients.

Beyond the great health care example, there are other examples that demonstrate the same thing:

Many of the world’s most successful brands create breakthrough ideas that are inspired by a deep understanding of consumers’ lives and use the principles of design to innovate and build value.

As Diana Forsythe discussed in her article on creating a patient education system for migraine sufferers, the most valuable innovations are the ones that understand the lives of the people they will touch, and then support those lives with the product/service/technology to make things better, rather than the other way around. To me, understanding the lives of the people that innovations touch means going to where those lives’ experience happen, and bringing the people who feel the impact into the design of the innovation.

I happen to have been to the Kaiser Permanente Garfield Innovation Center in Oakland, California (here’s a post about it and a little about its namesake, Sidney Garfield, MD), where we received a demonstration of the IDEO process underway on a project in one of the Kaiser Permanente Hospitals. I brought my most critical LEAN goggles with me to assess the process for respect for patients and those who serve them, and I was very favorably impressed. The Garfield Center is an impressive place in general, if you look at the photos in the post, or get a chance to visit yourself.

The theme of patient (and community) involvement in the design and leadership of systems has been on my mind in the next phase of work I am doing, hence these posts. I am glad that there are people like Rachel who know me well enough to add the right fuel to the fire….Enjoy the article and please post your thoughts on what it means for what you do.

• Human Resources and Lean - Commentary on what HR is. And what it could be - the foundation for renewal and success in organizations, instead of a compliance function.

• Essay - Fed Up With the Frustrations, More Doctors Change Course - NYTimes.com - I am sympathetic, and this is the reason I champion LEAN wherever I go - the processes we use in health care can be changed, and we can involve patients and our families so that everyone works together to be healthy. The challenge for physicians is that we are not trained at all in process improvement, so we usually enter environments with broken processes, and manage these situations with the training we have been given, which doesn’t lend to collaboration. See this blog entry for examples of extreme challenges in our medical education system today. I sometimes say that we’re all actors in a play that has a script we didn’t write. Let’s rewrite the script (patients and their families included).

  If anyone wants to collaborate on a medical student rotation looking at LEAN concepts / process improvement / patient centered care / respect for staff and customer, let me know. This presumes that there’s a medical school either teaching this or interested in this. Is there?

• PDF Plugin now available for Firefox 3.0 on Mac - If you're a Firefox Mac user, you'll know what a huge thing this is. Finally, PDF's viewable in the browser using Mac's native PDF display functionality in Firefox. Thanks Google code!

• Intel Launches Web Site To Connect Caregivers - iHealthBeat - Some social networking for caregivers with chronic illnesses. High blood pressure isn't listed, but forms of heart disease are.

• American Journal of Hypertension - Abstract of article: Out-of-pocket and Total Costs of Fixed-dose Combination Antihypertensives and Their Components - This study looks at the costs of medications alone for high blood pressure, borne by patients themselves. I haven’t yet found an article that describes total costs, to the patient, in terms of time, productivity, quality adjusted life years, etc.

As chief blogger for Project Health Design and colleague Lygeia Riccardi notes in her post, Project Health Design Blog: The PHR as a mirror of daily life, project teams for this initiative to inform the next generation of personal health records was in Washington, DC, this week to work with policy makers and collaborate across teams, and I was invited along with Lygeia to meet the teams on one of their first nights here, at a reception.

I was epecially happy to catch up with colleague James Ralston, MD, MPH, from Group Health Cooperative’s Center for Health Studies, who is leading one of the teams, and of course, one of my first questions to him was, “how have you involved patients in this work?” His answer was a great one: “Well, Ted, I’ve brought a patient with me.”

As you can see from Lygeia’s post, there was a patient (participant was the term she used) from another team as well. Both are supported by the Robert Wood Johnson Foundation in attending and improving the efforts of these teams. Kudos.