Free ideas from a human-centered designer for hospitals that want to be (or make it seem like they are) patient-centric.

I had the recent misfortune of watching my husband in severe pain and as a result stay in the hospital for a week. As a human-centered designer, it’s hard for me to turn off my observational and ideation skills so I figured I’d channel my frustrations and provide some free consulting.

(This is part 1 of a 3 part series of rants about the healthcare system. Read part 2 here. Part 3 is on it’s way.)

Fucking introduce yourself already.

Who are you? You walk into the room and we don’t know your level, specialty, name, or role. Should we listen to you? What questions can we ask you? Who the fuck knows?

If you are too busy/self-important to introduce yourself, hand over a laminated sheet with a picture, name, and specialty like this:

If it’s too hard to use your words, use a yearbook-like sheet.

We will waste your time much less with our annoying, time-consuming questions if we know who you are.

Decouple decision making from communicating.

Upon asking a simple question: who was in charge of my husband’s care, the head of a certain specialty (in front of all her silent and obedient resident ducklings) told me:

“We are like a five-wheeled car being driven by five drivers”.

I responded:

“Well, cars don’t have five wheels or five drivers for a reason.”

She then responded:

“Well, we all may argue but we come to one conclusion at the end of it.”

That wasn’t what I was asking. I wanted to know WHO we should listen to for the final word, not HOW they make decisions. Before this gaggle of 8 people entered the room without knocking, waking up my husband and sucking all the air out, a DIFFERENT group of 5 doctors do the same thing and give us DIFFERENT information. I simply wanted to know who to listen to. Just trying to understand what the fuck is going to happen with the person I’ve decided to share my life with who is in intense pain that’s all. NO BIG DEAL.

If they don’t want to have a hierarchy for decision making, fine. There should still be a designated point person for communication of next steps. Argue and make your decisions behind the scenes, and then send that decision off to ONE person who can come into the room and explain it clearly to the patient.

Stop defaulting to the nurse.

After going back and forth with the arrogant 5-driver/5-wheel car doctor and not getting anywhere (just like an actual 5-driver/5-wheeled car), she said “well, the nurse should have all the information.”

Yes, the nurse is often the more patient-centric person in the hospital. However, relying on the nurse is a band-aid solution to doctors who are too busy or important to stay on top of shit. It’s an inaccurate assumption that the nurse is available to communicate what is going on and what the next steps are. Why? Well, we have a different nurse almost every day and every night. The only way she knows what’s going on is if she has the time to thoroughly scrutinize the electronic medical records (assuming they’ve been updated). The thing is that she has ~30 other needy patients to attend to so I’m not sure that’s a good solution. The nurse knows what needs to be done in the moment, but can’t stay on top of the possible future scenarios. That’s the job of the doctor.

Maybe as empathy training, doctors should shadow and/or do everything the nurses do for a month. Ever see the show Undercover Boss? It’s a shitty show, but it’s all about getting CEOs to ACTUALLY understand what is involved at the lower levels of their organization and the impact is has on the bigger picture. For example, McDonalds separates the order taking/change-giving role from the food-assembly role because it’s too much cognitive load for one person. They know that giving too many tasks to one person can mean order mistakes and result in lower customer satisfaction. They actually care about customer satisfaction! So they’ve optimized their operations to deliver as accurately as possible. BECAUSE THEY ACTUALLY CARE ABOUT CUSTOMER SATIFACTION.

Okay, so now there are people who play the role of PCT (Patient Care Technicians? No one ever told us what the acronym means) And again, their presence is just a reminder that the nurses are OVERWORKED.

I don’t know if I have an easy solution here, but assuming the nurse handles everything is an indicator you need to take a long, hard look at your operations.

Decide which is more important to do in front of the patient: teaching or providing medical service.

I understand and realize that residents shadowing doctors is an important way that they learn. However, their presence is disruptive. In one day, we had 5 different groups of residents and their arrogant leaders come by and wake my husband up to ask the same set of questions that have been documented in his chart (that 5-wheel car doctor seems to think everyone is reading).

If patients are in pain, had a rough night of sleep (all of this documented, RIGHT?) then give them a fucking break and pick on the other patients who slept better and are more in the 1–5 pain range.

Really understand why you became a doctor & adjust accordingly.

Do you REALLY want to help people or do you like solving medical problems? If it’s the latter, maybe you should stay behind the scenes and let the people who are good at caregiving and communicating do what they are good at.

Ok, but you are still a control freak and want to stroke your ego by talking with the patient in front of all your resident minions? Fine, but then adjust your comunication style when you cross the threshold. Don’t use acronyms, don’t assume we understand medical terminology, let us speak occasionally…etc.

When a patient is on a shit-ton of pain meds, provide the same information to the caregiver.

I can’t even believe I have to write this. Duh.

Apologies aren’t good enough.

We were in the hospital for an extra day because of a misscheduling/miscommunication about a surgical procedure (long story for another time). To the hospital’s credit, the doctor who was in charge of the floor was very, genuinely apologetic.

Although I was appreciative, I couldn’t help but think that if this was a different kind of service provider, like a restaurant or hotel, they would have offered to take it off our bill. I understand that hospitals are not restaurants or hotels, but small actions can go along way. How about offering to buy lunch? Pay for parking? Bring in a masseuse? $5 Starbucks gift card? Okay, that might feel cheap. But like I tell my 6 year old son, it’s not enough to say you are sorry. You also have to ask “how can I make it right?”

Identify and learn the secrets from the good ones.

After two days, I can tell you who the best nurses, PCTs and doctors are. The ones who are good with patients — who actually behave and deliver in a patient-centric manner. What are their secrets? How does one nurse manage to always be on time with the pain medication whereas the other nurse is consistently 30–40 minutes late? I’m going to guess the good nurse has figured out in her head a prioritization of tasks, or has created solutions/workarounds to manage her work load so she can be available for what’s important. I bet she has secrets that others can learn from.

Sure, I recognize I am not seeing the whole picture. She might be shitty at some behind-the-scenes task, but then why not make her the “front-stage” nurse and let the other ones do all the shit behind the scenes where they can be loud and gossip and ignore patients.

In the field of Service Design, we call this the line of visibility. Sometimes you don’t want the customer to see how the sausage is made so you keep it behind the scenes. Sometimes, it’s helpful for the customer to see the sausage made because it helps them set expectations or value the process. Medical service providers need to figure out where the line of visibilty is and adjust roles and operations accordingly. Of course, that is if they actually care about providing meaningful service.

I recognize that all of this is naive. These observations and ideas are based on one experience, one hospital, one week. I also recognize that medical care isn’t as easy as ensuring a cheeseburger gets delivered out a window in a timely fashion. I just think that it’s disingeniune to say you have patient-centric care when you actually have medical education-centric care, or cost-minimizing-centric care, or ego-stroking-centric care.