DESIGN THINKING COMES TO (Some) HEALTHCARE – From Guest Blogger Kelly Kelleher, MD
Healthcare in general, and child healthcare in particular, has a design problem. Rapid advances over the past thirty years in technology, quality improvement methods, safety, and science, combined with huge increases in the cost of healthcare in our society, brought about marked enhancements to diagnosis and treatment provided at our largest and best health systems. As a result, operating room safety, specialty treatment outcomes, and earlier diagnoses all occurred.
Unfortunately, in Columbus as elsewhere, infant mortality, child suicide rates, asthma, depression, anxiety, and gun violence have all remained stubbornly high or worsened. Equally problematic, the rates of these problems among communities of color and those from neighborhoods of concentrated poverty are three and four times those from our wealthier suburbs. The inequities in health outcomes are a stark reminder of our past and current racism. It is increasingly clear that the current healthcare system can create beautiful buildings and impressive care for acute problems, but it is failing to bring us healthier communities and failing to address child inequities.
The initial response to the growing mountain of data about the lack of effects of US healthcare on community health caused many large healthcare systems to begin screening their patients for social factors that might affect health like housing insecurity, food insecurity, violence exposure, or problems with transportation; this screening is aimed at subsequently linking individual patients up with resources to address those problems so they can follow up more effectively with health. To date, these efforts are largely untested in their outcomes and do not address the many community-based origins of the core problems that create poor health such as violence in schools, environmental exposures to toxins, housing shortages, and others.
After years without any improvements, something new was needed. Here in Columbus, we were fortunate to have several key players searching for better answers. They included the Mayor and County Commissioners, the CEOs and boards of some of the large healthcare systems, the United Way, and important faith leaders, all with a key interest in a couple of neighborhoods most affected by years of racism and neglect. Having this much commitment was a first step, but we needed a process that would change our approach since traditional medicine was not changing things. US healthcare systems grew from a legacy history of caring for individual patients to maximize income for clinicians and hospitals, not from a history of considering population health outcomes. New considerations required a new lens to find solutions.
Design thinking is one process for addressing such wicked problems as the failure of huge expenditures and large healthcare systems to markedly improve population health. There are many descriptions of design thinking, but several authors describe the steps as empathize, define, ideate, prototype, and test. Design thinking provided us with that new approach to addressing population health outcomes. It allowed us to more inclusively consider the communities we wanted to help and work with them to find solutions.
With this design process in mind, the South Side collaborative of Healthy Neighborhoods, Healthy Families began meeting in 2010 to follow some of those new design steps. Church for All People, the United Way, the City, and Nationwide Children’s Hospital joined residents in meetings that formed relationships and the beginning of trust. Through that process we truly empathized with the community residents, realizing that the greatest asset of the South Side was its people and residents, and more clearly defined the problems from the community’s perspective. As a result, we began to understand that the neighborhood was the patient and that the churches, hospitals, and social agencies were integral parts of that neighborhood. We already had many of the resources we needed to address the health challenges we were seeing IF we worked across sectors.
The complex story of the remarkable transformation of Columbus’ South Side from the most blighted part of the city to the winner of the Heart Foundation Population Health Prize is complex and too long for this blog. Much of it is summarized in Reverend John Edgar’s recently released new book (Front Porch for All People by John W Edgar) where he discusses the neighborhood prescriptions employed such as innovative affordable housing development, novel employment tactics, home visiting for families, and other integrated programs set up to accompany people in the community. However, suffice it to say, that design thinking was a key element in true innovation, and a novelty to many of us brought up in the healthcare sector.