Healthcare Provider: Think Like a Designer!
Goal-Directed Design in Healthcare
I take care of children with type 1 diabetes in my clinic, and in comparison with other chronic diseases, there is an abundance of health data available about my patients. Blood glucose meters and continuous glucose monitoring systems provide anywhere from 4 up to 300+ blood glucose measures a day; insulin is being dosed anywhere from 4 to 12 insulin times a day, and carbohydrate information can be infinite with every meal and snack ingested. Furthermore, at the quarterly medical visits we have with our patients, there are additional measures available like Hemoglobin A1c, a blood test which provides the average blood glucose level over a 3 month period.
We as healthcare providers tend to come from scientific and statistical backgrounds, and we have very little training in the psychosocial and emotional management of diabetes. Therefore, we have a tendency to focus on the numeric aspects of diabetes. As a result, the typical interaction that happens between the healthcare provider and the patients and caregivers of individuals with type 1 diabetes goes something like this:
Patient Silent Thought Bubble:
Patient Silent Thought Bubble:
Two weeks ago, I had the great privilege of working with a diverse group of stakeholders (patients, caregivers, healthcare providers, researchers, designers, quality improvement specialists, technologists, and entrepreneurs, to name a few) to strategize on the high-level design of a transformed healthcare system for type 1 diabetes. (For more information about our work, check out the Storify from the design meeting and special thanks to the @T1DExchange and the @C3N Project for making this meeting happen!)
During the meeting, we broke up into small groups to create critical features for the system, and one of the groups created this intervention. It was called:
Patient-centric Goal Setting
Work towards true patient goals in partnership
Here are some patient goals that the group discussed:
I want to be able to sleep through the night.
I want to go to my friend’s sleepover.
I want my driver’s license.
The bottom line is that the goals of our patients may have nothing to do with the numbers, despite our tendency and desire to be mathematical and scientific. And I realized…
There are huge parallels between the work of a healthcare provider and the work of a designer, namely goal-directed design.
Through my design work this year, I have been learning about the method of goal-directed design, pioneered by the famous designer @mralancooper. Cooper started out as a business and productivity software developer, and recognized that he and his colleagues were creating lots of software “functionality” and “features” that weren’t working for the user.
As he describes it:
“When your approach is to simply create functionality to bestow on the masses, it doesn’t come through, it doesn’t work, and it doesn’t satisfy…So the essential revelation came to me that what mattered isn’t just knowing what people have to do, but answering, “what is their desired end state?” Where do they want to go?And I began to see this in terms of their goals and their motivations, breaking down the problem in order to understand it so that you can design the software to satisfy it. So it isn’t looking at what people do, but why they do it. And all of the sudden this gives you a completely different perspective. It gives you a completely different vision of how the product must behave.
Providers need to practice goal-directed design!
Instead of obsessing with the feature creep of diabetes management, we need to go well beyond a unidimensional look at the numbers and ask our patients what their goals are. For example, if the caregiver goal is: “I want to sleep at night”, then it totally changes the approach to problem solving. Should we adjust the insulin regimen to prevent overnight lows? Should we think about how to get more family members to share responsibility for overnight blood sugar checks? Should we prescribe a pump or continuous glucose monitoring system to better titrate insulin or detect episodes of nighttime hypoglycemia? If we ask and listen, we can solve the right problem for the right user at the right time.
My advice to Healthcare Providers:
Think Like a Designer!
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