by María Ana Barrera, Service Designer
Fourteen years ago I was at a crossroads: that moment in life when you ought to choose what (and who) you want to become. I was sure I wanted to be a doctor. Then again, I had a pretty romantic and naive idea of medicine and the (really devastating) influence of the healthcare system in which it is practiced. I knew very little of what being a doctor meant. Still, I embarked on the journey of becoming one. This enthusiastic spirit didn’t last very long. I took one detailed and heartbreaking look at the healthcare system and I was out the door. Well, not entirely, let’s just say I took a detour.
What was it that made me run away from medicine (the healthcare system)? Let me back up a bit…
A grim reality
During my second semester in med school, I had managed to gain the trust of my professors. I was allowed to assist during surgery and one professor, in particular, allowed me to accompany him during night rounds. One night I met a very endearing patient. Let’s call him Mr. Hope.
Mr. Hope was a humble elderly man, with dark freckles, and sparkling eyes. He had been sick for a while and kept moving back and forth between hospitals. One night, after having visited Mr. Hope’s room a couple of times, I sat down to discuss his case with my professor. Let’s call him Dr. Truth. We had a very down to earth talk and he mentioned that although he could recommend some treatment options that could potentially make him better, Mr. Hope’s insurance would probably reject them all. Given the situation, the best option for him was to go back home, and try to enjoy whatever time he had left (clearly, not much, and not in the proper conditions).
I was crushed. I understand that sometimes there’s nothing you can do. It’s a given that the human body ages and people eventually die. Death is inevitable. But, in this situation, there were options. Sadly, the hard truth is that the battle against the insurance company might have ended Mr. Hope’s life sooner; in addition to already being very sick, he would have suffered even more in the hands of insurance agents and under the piles of bureaucratic paperwork.
That night I did my homework. I thought maybe this type of thing only happened in Colombia (or developing countries). It didn’t. Healthcare systems all over the world have become complex and twisted, and dare I say a bit (very much) inhumane (some more than others). In the end, the very people that need, or are inevitably immersed in the healthcare system, have no chance of battling in the maze of players, policies, regulations, costs, and whatnot.
So, I made a life decision that I later questioned. But I made the right call, although sometimes I feel nostalgic about it. I left med school and decided to become a designer. Service design was still unknown in Colombia, and I knew so little about the difference between designing products and services… so my new career choice didn’t make as much sense then as it does now.
One day, I crossed paths with a brilliant professor, Mr. Wicked for the sake of this article. He introduced me to the world of system thinking. And like it had been meant to be, that’s when it all made sense: I had to study design to learn to address wicked problems. My romantic idea of caring for patients could have a broader scope. I could leave the fixing of diseases to doctors, while still caring for people in some of their worst moments. In a way… If you can’t fight the system, you have to actually try and fix it.
An unsettling comparison
Looking back, I’m amazed at how little the healthcare system has changed in the last fourteen years. A few years ago someone showed me a video that states what would happen if air travel worked like healthcare (check it out). If it did:
- No one would actually know the real price of a plane ticket (meaning: no transparency).
- It would be impossible to buy a ticket involving more than two destinations or airlines (meaning: no collaboration between providers).
- My bags would probably get lost between carriers (meaning: no communication between players), and, finally…
- I wouldn’t be able to fill out forms or make payments online because of the sensitive nature of the information and policies (meaning: old, complex and rigid systems).
This comparison is both hilarious and worrying, but it’s a valid example because it vividly demonstrates how incoherent and broken the healthcare system is.
Finding solutions in design
When you dig deeper to understand why this broken system hasn’t changed, many challenges appear. For example, at Designit, we recently worked with a client in the healthcare industry in Peru. After many discussions, we posed a commonly ignored question: How can an antiquated system survive, much less innovate, when all the key players involved have different — and competing — key performance indicators (KPIs)?
Scratch the surface and you’ll find a system composed by people, but defined by “archaic” technology, complicated processes, and systems. The terms fee for service, payment for value, deductible, margin, healthcare expenses, healthcare reform are not focused on people so really, this can’t be a human shaped system. Rather, it’s a disjointed maze with a myriad of players pulling towards different directions, mainly motivated by cost. This comes as no surprise though. After all, healthcare is expensive… for people, for payers, and for governments. This is largely due to the fact that innovation revolves around new treatments, technological breakthroughs, and new drug developments, but not innovations around service efficiency, simplification, access, and quality. And if funding doesn’t move in more human directions, it will be spent on infrastructure development alone, which overshadows the real intent of medicine: caring.
So, I thank Dr. Truth for being realistic and making me face the reality of the healthcare industry. I thank Mr. Wicked for helping me understand the big picture and the importance of addressing the challenges in healthcare with a systematic approach. And I thank Mr. Hope for being the face of the people that deserve a human-shaped healthcare system.
Although I’ve come a long way, I always feel nostalgic when walking through hospital hallways, but I keep my spirits high knowing that as a service designer I’m trying to fix what happens behind the curtains so people receive proper care. In the last years, I’ve worked with hospitals, insurance companies, and private practices around the world. I’ve met pioneers like Dr. Victor Montori and the Center for Innovation at Mayo Clinic, where service designers work among providers to solve issues like helping patients be part of the decisions around their own treatment. And I’m as lucky as I can be working at Designit, where the Oslo team changed the lives of breast cancer patients by reducing the diagnostic waiting time from up to three months to as short as three days. But, I’m still looking for those who will dare to try to change the healthcare system in Colombia, where billions of Mr. Hopes are in much need.
