Dr. Consulta: Designing to engage 100 million healthcare ‘homeless’ in Brazil

We are in São Paulo and IIT Institute of Design’s Strategy World Tour is about to begin. As guests and participants arrive at the hotel restaurant for a warm welcoming breakfast, I come across Kat Wendelstadt, former CMO of São Paulo’s emerging healthcare clinic Dr. Consulta. She seems quite happy about the results their social business is achieving. She radiates satisfaction with Dr. Consulta’s growth rate. She adds, “The Brazilian economical crisis is actually helping us grow, because people see the need for affordable and high quality healthcare options. A hundred million people in Brazil are ‘medically homeless’.”

The law states that all Brazilian citizens are entitled to free public healthcare. Although there is legal enforcement and a massive state-sponsored system, the quality of service delivery shifts drastically across urban and rural areas. Long lines and constant complaints of lack of infrastructure are recurrent across the board. On the other side, private insurance companies tap into an elite market that can afford high monthly fees for private healthcare. However, as we learned at Dr. Consulta, these insurance plans usually come with services a patient may never use, increasing cost considerably with unnecessary fees.

With the staggering growth of the Brazilian middle class, new options for healthcare are needed. That is where Dr. Consulta expects to leverage their growth and create a lasting social and economical impact. We learned five core design lessons from Dr. Consulta during our visit to their local clinics and headquarters in São Paulo.

Fig.1: Dr. Consulta’s clinic in São Paulo.

1. Applying Design Without Calling it Design

If you are a designer and come into one of Dr. Consulta’s clinics, you may think they spent months on journey mapping and service design. The patient flow is clearly printed on the walls, and every touchpoint is designed to be a “humanizing” interaction. However, it can come as quite a surprise that the managing team–most of whom have a business background–never actually called it service design. Rather, they say, “When we were doing it, we never called it design. We called it ‘good sense’. It is good sense to include the patient’s voice in everything we do.”

2. Re-framing the True Issue

A core design principle is to frame and re-frame problems. For designers, re-framing is critical to generate new angles and points of view from which to explore a situation. Without re-framing, it is likely a solution will create similar results as previous attempts. At Dr. Consulta, they re-framed the premise that healthcare is about illnesses to it being about helping patients manage their health. This new frame shifts the patient’s behavior from constantly in need of help to taking responsibility for their long-term health.

3. Transdisciplinary: Bringing in Knowledge from Across Sectors, Fields, and Systems

When asked about which healthcare benchmarks Dr. Consulta had looked at before designing their services, one of the directors said, “We completely dropped the idea of looking at other healthcare institutions. We actually learned more from the systems in an airport than from a hospital.” What he meant was that they spent long periods of time learning and copying features from other industries in ways that the healthcare industry had not anticipated. For instance, the entire patient arrival at the clinic emulated someone’s experience of checking in at the airport. A core aspect of creative and open innovation is to observe outside one’s silos. Knowledge can be broken down into parts, and these parts can be incorporated in new services, products, and systems.

4. Experimenting Off of Core Principles

Dr. Consulta management consistently shared that a core aspect of their work is their culture. One aspect of their culture is a mindset behind how new projects and services are born. When creating new projects, they are constantly experimenting off of their core principles to create possible solutions. The idea here is that there’s no master plan defining every single step of how the clinic will move forward. They simply define a set of core principles (such as “all interactions with patients should be humanizing”) and experiment with services that are born from those ideas. Experimentation is a key part of their growth and capacity to be imaginative while responding to ongoing feedback and emerging needs. In this context, there’s no innovation department as such. They re-framed it to an understanding of innovation as culture, not as a role.

Fig. 2: One of Dr. Consulta’s directors explains how they experimented with a constant demand to have a clinic only for women — an idea that over time gave birth to a beautiful space within one of their clinics.

5. Leveraging Business Principles to Boost Social Impact

The team at Dr. Consulta is a great example of business-oriented companies that have a social mission at their core. They are clear about the healthcare crisis in the country and eager to work with a constant sense of urgency to deliver affordable, humanizing, and high quality healthcare. To achieve that, they set their foundations on business engines.

From that angle, some interesting features were developed. For example, all decisions are highly data-driven. For instance, if a patient does not come, their name is added to a database of no-shows. Sooner or later, someone is investigating why there are so many no-shows. Another example of a business application is how they are working with networks of hospitals and other clinics to provide a larger integration of services, not limiting the patient to depend on a single clinic.

Ricardo Dutra is a designer working at the intersection of design, education, and social innovation. He cofounded Flip it Forward, an institute for social dreaming working within K-12 education. He also consults with organizations such as the Education Design Lab, and MIT’s Presencing Institute. www.ricardo-dutra.com

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