Saurabha Bhatnagar, MD, is an Instructor and Associate Residency Program Director at Harvard Medical School in the Department of Physical Medicine and Rehabilitation and faculty for the IHI Co-Design College. Andrea Ippolito, MS, MEng, is the VA Innovators Network Lead for the US Department of Veterans Affairs.
Health care has learned a great deal from other industries — aviation, car manufacturing, and technology.
What can it learn from a coffee place?
Health care can learn how other service industries have successfully incorporated co-design to improve the experience and enhance the value for their customers. Starbucks, for example, has leveraged aspects of co-design in its MyStarbucksIdea website where customers have a voice in the idea generation process. Starbucks has implemented customer ideas ranging from new coffee flavors to free Wi-Fi in their stores. This shared thinking with the customer enables them to work on what is valuable to their customers to develop the best possible experience.
What exactly is co-design?
Co-design is one of the essential tools in human-centered design (HCD). We’ve used it to help think about the Veteran experience across the Department of Veterans Affairs (VA) — both for patients and for staff. Co-designing goes beyond just designing with Veterans in mind, to actually designing with Veterans.
In general, for health care, this shifts the traditional design process where the health care team is independently coming up with ideas for problems. Co-design involves the patients in the design process and works with them to understand their met and unmet needs. Veterans then help the health care design team come up with different opportunities and test them to determine their desirability and feasibility in practice. This enables us to incorporate the patient perspective directly and immediately.
Like with any tool, there are situations where co-design is most appropriate. One of the benefits of co-design is that you have an in-depth customer experience as part of the design process. Co-design can help shift the mindset from being process-centric to patient-centric. One limitation is that it involves unique and individual experiences, which cannot always be generalized. While health care aims to provide high quality care to all patients, we know that there are aspects that have to be personalized for each patients’ needs. Co-design, then, is best used when it is paired with other tools of human-centered design or Lean.
Co-Designing with Your Staff
Additionally, the VA has found that co-design — and human-centered design — is a way to improve the employee experience. An effort called the Innovators Network was co-designed with employees. This was to fulfill the desire for a more networked organization that supported team innovation at the frontlines.
There are 22 Innovators Network sites with Innovation Specialists at each site working through a train-the-trainer approach to amplify the innovation knowledge base. Through this process, more than 2,000 VA employees have already been trained on innovation related competencies, including human-centered design. This, in turn, enhances the culture of innovation that already exists in our VA medical centers.
One example helps demonstrate the dramatic difference co-design can make. The Milwaukee VA Women’s Health Clinic looked at their data and found that, over the previous three years, they had only tested three women for HIV, a number they found unacceptably low.
If the team followed the traditional approach to solving problems at the VA, they might have mandated doctors ask about their patients’ sexual histories to determine if they ought to be tested. They might also have focused on adding an HIV-testing metric to the myriad of existing performance measures for VA doctors.
Instead, the team co-designed potential solutions with the providers. With new insights gleaned from interviewing stakeholders, the team developed a plan that now means licensed practical nurses ask patients about HIV testing at the beginning of their visits. In just three months, the Center tested over 400 women.
Equipping and training our employees with tools and approaches they can use is key to helping the VA focus on the challenges that affect our Veterans and improve the quality and availability of care and services. The goal is to leverage the energy and talents of our staff to improve the care for Veterans at scale.
Health care organizations can learn that the investment here is in both patients and employees. We would encourage other health care organizations to think about co-design and human-centered design when trying to improve a service experience for patients. This does not have to be a big leap initially. Start with one project or one service. And, just as with quality improvement, it is a continuous learning cycle to see how co-design and human-centered design fit with the larger improvement efforts already underway. The goal, of course, is universal: how to best serve patients and their families.
