Don’t Just Improve the Patient Experience—Design It

Providing patients with a favorable imaging experience has never been more important, yet it has never been more difficult to achieve. Measures like patient satisfaction now complement more technical aspects of care as quantifiable indicators of overall quality. 

Meanwhile, though, patients are accustomed to ever-improving technological convenience outside the hospital, where businesses grow increasingly receptive to their wants and needs. The standards patients expect therefore act as moving targets. 

Further, identifying the problems that curb patient satisfaction can prove as elusive an exercise as formulating the remedies. 

Enter design thinking. 

Although not a panacea for the ills of healthcare, design thinking—or “DT”—is an excellent tool that healthcare organizations, including radiology departments, can use to improve the patient experience and meet the growing expectations of patients in an increasingly consumer-driven and patient-centric society.

Ultimately, design thinking is a method of reframing a problem and allowing for diverse, creative solutions while maintaining enough structure to ensure progress. 

A popular 2013 book, Creative Confidence: Unleashing the Creative Potential Within Us All, looks at the discipline specifically in light of medical imaging. The authors describe how design thinking guided a medical-equipment manufacturer as it sought to help imaging centers alleviate patient anxiety during pe-diatric imaging studies. 

After observing scanners consistently terrifying kids, the DT team not only spoke to child-life specialists, workers at a children’s museum, doctors and other hospital staff but also observed children at local daycare centers. The team members’ aim was to better understand, in a well-rounded way, how kids think and behave.

The case study illustrates how design thinking draws from empathy. It does so by starting with an effort to deeply understand the thoughts and feelings of customers (or patients) as well as all other involved parties. (In DT vernacular, all involved parties are called “stakeholders.”) The design thinker collects information from stakeholders in a process that might be called “social data mining.” 

Essential to the process is the suspension of preconceived notions regarding the nature of the problem and, later, the efficacy of the proposed solutions. Th is allows the human-centered approach to work. An honest, unbiased review of the collected information keeps the project centered on the end goal: the emotions evoked in the stakeholders.

Many variations of the DT framework exist, but the differences usually encompass only small adjustments to the same general format: 

Discover → Define → Develop → Deliver (Credit for this particular formulation goes to the UK Design Council.)

Throughout the process, feedback flows from stakeholders, and the design thinker must note “inflection points” along the way. In design thinking, this term refers to leads the team can follow to discover new problems, ideas or solutions. 

All Minds on Board 

The process remains flexible and nonlinear at all stages. True to the dictionary definition of design—to create, fashion, execute or construct according to plan—it calls for findings to be presented with rich visuals and prototypes. Why? To communicate ideas as clearly and as possible.

In a complex, highly constrained healthcare system, design thinking allows organizations to identify and target areas in which innovation can and should move at a faster pace. 

Here’s an example direct from radiology. The REACH project at Johns Hopkins—the acronym stands for Radiologists Engaging and Collaborating in Healthcare—yielded the development of an app through which ordering physicians can use a tablet at the bedside to consult with radiologists. 

This not only allows closer and more efficient collaboration between clinicians and radiologists but also provides an additional point of interaction between radiologists and patients. Rads might see the clinical picture more clearly, while patients can participate more fully in their care. 

Modern medicine’s digital system of careful checks and balances facilitates observance of the Hippocratic Oath to a degree unimaginable to earlier generations of practitioners. We cannot rush the process of discovering and testing core components of patient care. However, we often can uncover more peripheral aspects of care with disproportionately large impacts on the patient’s overall experience. 

Many times, those components offer great potential benefits yet comparatively mild risks. The quick, iterative nature of design thinking equips the DT team with the agility to match the pace of innovative technology and to use it to improve the patient experience as a whole.

The ambiguity of what makes a patient’s experience favorable or unfavorable positions design thinking as an especially suitable method for improving that experience. 

The field of medicine favors the assortment of signs, symptoms and diseases into categories. The popular maxim warns to look for “horses, not zebras” when forming a differential diagnosis. In analyzing why a patient reports emotional unease while waiting for a chest x-ray, though, that wisdom no longer applies. Design thinking props the door open for zebras, so the design thinker can non-judgmentally observe their behavior. 

Feedback and Flexibility 

Although design thinking often also includes standard forms to collect specific information from stakeholders, other manners of data collection, like shadowing patients and allowing patients to voice their own narratives, capture themes that might have otherwise gone unnoticed. These themes might better reflect the emotional response of the stakeholders to perceived problems as well as proposed solutions.

In seeking solutions as an architect drafts a blueprint, for example, design thinking circumvents the herculean task of finding a lasting, reproducible way to define and quantify the patient experience. 

This is important, as there is still no consensus in academia as to the definition of “patient satisfaction,” and studies have bemoaned a failure to meet scientific standards among various proposed and in-use measures.

The pursuit of standardized data-sets regarding patient satisfaction remains crucial for comparing healthcare organizations, tracking internal trends and executing incentive programs. 

In terms of framing problems and generating functional solutions from within an organization, though, design thinking has the unique advantage of allowing patients and staff to point to specific areas of concern and provide feedback in real time, throughout the entirety of the episode of care.  

The efficacy of possible solutions generated from more standardized surveys depends largely on the validity of the data collected at one point in time. Design thinking, on the other hand, keeps the process flexible enough to continuously reshape strategies and prototypes until all stakeholders are satisfied. 

Thus the frustrations of reaching for the elusive, perfect standardized survey bear less importance for the design thinker.

In summary, design thinking offers a unique and useful method by which radiology departments can recognize the issues most important to patients and deliver targeted, meaningful improvements. It merits consideration in any imaging-related quality improvement conversation. 

Vidovich is a fourth-year medical student at the University of Cincinnati, where Vagal is a neuroradiologist with the school’s Gardner Neuroscience Institute.