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Wednesday
Feb 18 , 2009

An iteration a day keeps the doctor away

Medicine has long been one of the most fertile areas for design because of the stakes – life or death – and because the insurmountable burden of care placed on doctors and nurses means any help is a godsend.

There are wonderful examples of innovation in high tech medical equipment, from IDEO’s insulin pen (this is how it works) to the many great entries in competitions like the International Design Excellence Awards and the more specialised Medical Design Excellence Awards.

However, it is small, low tech changes that can make just as much of a difference. There is a great passage in Atul Gawande’s wonderful book Better: A Surgeon’s Notes on Performance, about exactly this. One of the big problems in medicine is the spread of infections through hospitals – according to the US Centers for Disease Control, two million Americans catch these every year and 90,000 go on to die from them. The good news: all doctors and nurses need to do to slash this number by an order of magnitude is to wash their hands. The bad news: they don’t, because it would occupy about a third of their working day if they did.

Maybe there were smarter ways:

“A few years ago, Paul O’Neill, the former secretary of the Treasury and CEO of aluminium giant Alcoa, agreed to take over as head of a regional health care initiative in Pittsburgh, Pennsylvania. And he made solving the problem of hospital infections one of his top priorities. To show it could be solved, he arranged for a young industrial engineer named Peter Perreiah to be put on a single forty-bed surgical unit at a Pittsburgh veterans hospital.

“When he met with the unit’s staff”, a doctor who worked on the project told me, “Peter didn’t ask, ‘Why don’t you wash your hands?’ He asked, ‘Why can’t you?’” By far the most common answer was time. So, as an engineer, he went about fixing the things that burned up the staff’s time. He came up with a just-in-time supply system that kept not only gowns and gloves at the bedside but also gauze and tape and other things the staff needed, so they didn’t have to go back and forth out of the room to search for them. Rather than make everyone clean their stethoscopes, notorious carriers of infection, between patients, he arranged for each patient room to have a designated stethoscope on the wall. He helped make dozens of simplifying changes that reduced both the opportunities for spread of infection and the difficulties of staying clean. He made each hospital room work more like an operating room, in other words. He also arranged for a nasal culture to be taken from every patient upon admission, whether the patient seemed infected or not. That way the staff knew which patient carried resistant bacteria and could preemptively use more stringent precautions for them- “search-and-destroy” the strategy is sometimes called. Infection rates for MRSA – the hospital contagion responsible for more deaths than any other – fell by almost 90 percent, from four to six infections a month to about that many in an entire year.”

“Two years later, however, despite encouragement and exhortation, the ideas had spread to only one other unit in the hospital. Those other units didn’t have Perreiah. And when he left the original unit for a different project elsewhere, performance for that unit began to slide, too. O’Neill quit the project in frustration. Nothing fundamental had changed.”

Every single company and individual should look at ways they can improve – Kaizen is not just for car manufacturers.  Atul puts it with great eloquence:

“Ingenuity is often misunderstood. It is not a matter of superior intelligence but of character. It demands more than anything a willingness to recognize failure, to not paper over the cracks, and to change. It arises from deliberate, even obsessive, reflections on failure and a constant searching for new solutions. These are difficult traits to foster – but they are far from impossible ones.”

Though beautifully put, this ignores one thing. It’s not just a question of character and personality. The methodology of design contains all the tools to help anyone on this path.

Yet another reason why design thinking is so crucial.

  • http://shakeoutblog.com/2009/03/26/unintended-effects-blue-lights-vs-heroin/ Unintended effects: blue lights vs heroin « Shakeout’s Blog

    [...] This makes it extra important to put yourself in the shoes of your users (no pun intended) to work out what they need and iterate until you can provide it. [...]

  • http://shakeoutblog.com/2009/05/10/19-20-21/ 19.20.21. « Shakeout’s Blog

    [...] Around the world, virtually every child born in a hospital had an Apgar score recorded at one minute after birth and at five minutes after birth. It quickly became clear that a baby with a terrible Apgar score at one minute could often be resuscitated—with measures like oxygen and warming—to an excellent score at five minutes. Spinal and then epidural anesthesia were found to produce babies with better scores than general anesthesia. Neonatal intensive-care units sprang into existence. Prenatal ultrasound came into use to detect problems for deliveries in advance. Fetal heart monitors became standard. Over the years, hundreds of adjustments in care were made, resulting in what’s sometimes called “the obstetrics package.” And that package has produced dramatic results. In the United States today, a full-term baby dies in just one out of five hundred childbirths, and a mother dies in one in ten thousand. If the statistics of 1940 had persisted, fifteen thousand mothers would have died last year (instead of fewer than five hundred)—and a hundred and twenty thousand newborns (instead of one-sixth that number). (Atul Gawande in the New Yorker – also a story in his incredible book, Better) [...]

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