Interviews with Christine Chastain, Senior Consultant at Customer Centered Solution Design and Innovation, Cigna; Izac Ross, Design Lead at Collective Health; Kyle Vice, Creative Director of Service and User Experience at Philips; Mark Ciesko, Americas Manager, Global Design & UX at GE Healthcare; Molly Fuller, Former Director of Design, Service Designer at Harken Health
By Thomas Brandenburg
“Getting beyond our device mentality and considering the whole continuum of care will lead to better experiences for clinicians and the patients they serve.”
“The biggest challenge I face is not within the four walls of my organization—it’s navigating the fragmented world of U.S. healthcare and developing services within it.” —Izac Ross
What are the biggest challenge(s) you face applying Service Design to Healthcare?
Christine Chastain: The biggest challenges are the mechanisms by which to integrate Service Design into existing organizational infrastructures. That includes everything from portfolio planning cycles, sourcing, funding challenges between business units and so forth. And when one extends that into the larger ecosystem, many barriers still exist.
Izac Ross: I am so lucky to work at an organization that values service design methods and processes—that’s not a given in the world of U.S. healthcare, or frankly anywhere. Service design is not a common term or process, but it’s made a lot of strides in the past 10 years with strong case studies and the adoption of the methods within management consultancies’ design departments.
The biggest challenge I face is not within the four walls of my organization—it’s navigating the fragmented world of U.S. healthcare and developing services within it.
Kyle Vice: I find the biggest challenge is balancing between standardized processes and tools while also being flexible enough to meet the nuanced needs of specific customers. Every healthcare provider organization or health system is slightly different –they have different roles, unique structures, and their own processes. Knowing what to standardize because it is critical to achieve results, and what to adapt for a particular customer is a continual question.
Mark Ciesko: Because I work for a healthcare equipment manufacturer, the challenge is usually getting others to consider the whole ecosystem and not just the device and its functionality alone. Not to knock engineers, and we have some very talented ones, but typically their charge is to deliver a device that creates a great diagnostic image, and at a certain cost. The quality of the user experience is not always paramount. Even more so for patients—the quality of their experience and their comfort was not part of the equation. But, that’s changing and our Design team is a key part of delivering better user and patient experience.
Molly Fuller: The biggest challenges I think and most other Service Designers in healthcare face are misunderstanding, measurement and implementation. Service Design is not a common profession, especially in the United States, and the majority of people within healthcare don’t understand the discipline and how it’s different from the process improvement team. I think Service Design appears to be more of a fun break from reality for providers when they participate in prototyping workshops and experiments, however Service Designers don’t always get the initial credibility they deserve. I think you really have to show and prove that you can deliver exceptional work before care providers necessarily take you seriously. The measurement aspect of Service Design is also a challenge when talking to providers who are used to clinical trials and very controlled research. It’s important to be able to explain why, but sometimes it can be hard to capture all the metrics needed in rapid prototypes to be able to convince a provider of one idea over the other. The third challenge is implementation. Healthcare is a creature of habit and tries to protect the status quo, it can be a pretty big uphill battle that requires creativity and perseverance to get a great idea implemented into an existing system and culture.
“Clinical outcomes—measurably healthier people—is the main performance indicator for our work. That could be measured by how stable someone’s health measurements are, or by how often they have to go to a hospital or emergency department.” —Kyle Vice
What framework(s) and/or key performance indicators have you found useful to measure the impact of service design?
Christine Chastain: We’re still trying to figure that out because some of the traditional Service Design measures just don’t match up with, for example, NPS scores. For the moment, we’re linking all Service Design efforts to a traditional innovation process and are measuring perceived value, return on value, number of exploratory programs that moved from an exploratory to in-market pilots and for those that do, clinical outcomes as compared with a base case.
Izac Ross: What’s great about working at Collective Health is that the whole organization understands the impact design can have on outcomes. Our main focus is on the impact we have on our clients and members. At a top level we use Net Promoter Score, but that only gives us insight into whether people like our services. To supplement, we use a variety of perception metrics, transactional metrics, and design research to see the impact of our work or where we need to build new services.
Kyle Vice: Since most of my work touches on some aspect of population health management, that has a big influence on what we measure and what we are trying to impact. Clinical outcomes—measurably healthier people—is the main performance indicator for our work. That could be measured by how stable someone’s health measurements are, or by how often they have to go to a hospital or emergency department. We also look at patient satisfaction and engagement, because we are building services that enable doctors and nurses to interact with individuals in their homes on an ongoing basis. It’s also important for us to track the efficiency of the doctors and nurses who use our solutions. Since our customers are managing large numbers of patients remotely, they need to be able to locate who needs their attention the most and make a clinical decision as quickly as possible.
Mark Ciesko: We are a highly regulated industry, so we have a lot of focus on usability requirements and meeting FDA guidelines. There are basic requirements to do no harm and minimize errors in the usage of our products, which sounds obvious, but we make some pretty complex technology, so it’s important. Efficacy and speed of completing tasks are always a consideration. Beyond that we’ve been exploring sensory design cues and the reaction of patients to different sensory stimuli during medical procedures. For example, if we change the lighting or add scent or music to a mammography exam, can it lessen the anxiety of the patient? It can. We have shown that we can design better auditory signals and alarms into our equipment if we understand how clinicians respond to certain tonal arrangements.
Molly Fuller: Most recently, I was a part of a team using Net Promoter Score as well as using the survey to identify the driving factors for that score. I use triangulations as a framework with a mixture of qualitative and quantitative metrics that are tailored to the specific experience I’m trying to impact.
“I think having skills or experience in business models is helpful. As the landscape of health insurance and healthcare is changing, new ways to be profitable while delivering exceptional care and not sending a patient into debt need to be designed.” —Molly Fuller
Besides having a mindset and the skill set for service design, what other knowledge, experience, or skills do you see as valuable for a designer to have in his or her repertoire today in the healthcare space?
Christine Chastain: Many young designers now have an MBA – having business understanding for context is important. Additionally important is some understanding around futures thinking – trending, scenario development and future strategy such that insights, concepts and implementation planning is future proofed. Last but not least, personal patience and flexibility are required.
Izac Ross: To be an effective service designer in the healthcare space, it’s critical to have a full understanding of the system you’re working in. Healthcare is a space where being objective means being double blind. Services are softer than that, but we need to be able to speak the languages of our peers to be the bridge between product, operations, care delivery, and risk. Being able to speak the language and understand where each of them is coming from is very critical, more so than in most industries. Outside of this, I think it’s important to have more than one skill. It’s very hard to just say you’re a service designer because at the end of the day you still have to be able to demonstrate tangible value when designing for intangible outcomes. Having a hard traditional skill such as graphic, interaction, industrial, architectural or interior design really helps you take your intangible proposals down to the tangible.
Kyle Vice: Understanding the business side of both healthcare and insurance is extremely valuable. Many individuals haven’t had to think too much about how insurance works and the resulting effect on how they receive care— though healthcare reform is changing everyone’s awareness. Having a working knowledge of changes in reimbursement and how risk is distributed makes it much easier to understand the goals and the challenges faced by health systems, individual healthcare providers, and the general public.
Mark Ciesko: We are big proponents of design thinking, so clearly empathy is an important attribute, particularly in the healthcare space. Healthcare is full of such emotional experiences, both positive and negative. So, you need to put yourself in their shoes, and not just the users, but the patients as well. What’s it like to be hooked up to our equipment or sometimes placed inside of it, like an MRI machine? It can be kind of scary, so you need to consider that.
Molly Fuller: I’m a fan of the more experiences and skills you have the better. I think specifically to healthcare having a deeper knowledge of ethnographic and anthropologic techniques are helpful for getting a profounder understanding of people within the context of a system than only using interviewing and observations. I think having an understanding of digital designs and capabilities is helpful to understand how digital and analog systems interplay. As well as helps design digital tools that are in context of their surroundings and enhance and fade seamlessly into the analog service. In addition, I think having skills or experience in business models is helpful. As the landscape of health insurance and healthcare is changing, new ways to be profitable while delivering exceptional care and not sending a patient into debt need to be designed.
“Service Design is a unique opportunity to link front and back of house across organizational competencies in an alternative and/or complementary way to more traditional mechanisms with their origins in manufacturing e.g. lean, Six Sigma.”
Can you speak to how service design might be an agent of change in healthcare, anything from creating internal initiatives to reinventing policies?
Christine Chastain: Most organizations still follow a manufacturing approach to innovation. That isn’t always appropriate in healthcare. Service Design is a unique opportunity to link front and back of house across organizational competencies in an alternative and/or complementary way to more traditional mechanisms with their origins in manufacturing e.g. lean, Six Sigma. It means more comprehensive business cases based on early exploratory efforts, including co-creation and rapid prototyping.
Izac Ross: There are already case studies that prove service design can be that agent of change. Unfortunately, few are public or accessible. I hope as a community we can make more of these case studies available; they are authoritative, provide social proof, frame specific problems, and explain process. We too often speak in generalized terms in service design—something I am also guilty of—but our business peers want to see the outcome and how to get there.
Kyle Vice: Service design can be an agent of change when individuals are empowered to turn their knowledge into action through making. That could be as simple as mapping a workflow for a clinical procedure, as complex as defining a model of team-based healthcare delivery, or as emotional as understanding the journey of aging. In all of these instances the act of enabling others to share their experience and help shape a shared output brings the designer into the role of facilitator. In my experience, creating this space for others to have a voice is one of the most powerful ways to start change.
Mark Ciesko: Getting beyond our device mentality and considering the whole continuum of care will lead to better experiences for clinicians and the patients they serve. The devices and the technology are merely there to facilitate decisions about delivering better care and more positive outcomes. That’s hard to say for an industrial designer working for a large corporation making healthcare equipment, but I think it’s a reality we have to come to terms with sooner rather than later.
Molly Fuller: I definitely think service design is an agent of change in healthcare. I think it’s inspiring to see so many healthcare and health insurance companies starting to hire service designers internally. I have already seen how service design is making companies become more human with their customers through different modes of communication. Health insurance by its nature deals with population and the law of large numbers, whereas healthcare is typically a more one to one level of care, I think service design is able to bridge the gap of dealing with a population while not losing sight of the individual that can rethink business models, contracts, and shape policies.
“I’d like to see service designers not just in large institutions but in smaller clinics and organizations as well. I think service design can help create a radically different system than what we’re used to today.” —Molly Fuller
What would you like to see happen for the future of service design in healthcare?
Christine Chastain: Wouldn’t it be amazing if Service Design and associated methods could be used to drive corporate strategy and transformation more often?
Izac Ross: More of it. More people practicing it well is needed. However, I would love to see service design being applied at the level of state and national healthcare policy. It could be so powerful to link policy to the future vision of services that it could create.
Kyle Vice: I’d like to see service design continue to grow in governments at a national and local level. So much of health is dependent on where someone lives and the resources at their disposal. It would be great to see more service designers working to connect access to social and support services across government and private companies into seamless, considered experiences across the world.
Mark Ciesko: There are some emerging technologies in artificial intelligence and machine learning that hold immense potential to change how clinicians do their jobs today. The potential for computers to examine countless diagnostic images and identify areas of interest will outstrip the ability of today’s radiologists. This will change the face of medicine and it will change their role in it. We have to consider this reality as we think of service design in healthcare’s future. We can’t be stuck in today’s paradigms. That prospect scares some in the medical domain, but to me it’s an exciting proposition.
Molly Fuller: I’d like to continue to see the growth of service design embedded within healthcare and health insurance. I’d like to see service designers not just in large institutions but in smaller clinics and organizations as well. I think service design can help create a radically different system than what we’re used to today.
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