This past May, the World Health Organization included burnout in its “International Classification of Diseases” as an occupational phenomenon. This move speaks to the recognition of burnout as a rising epidemic. It is particularly pronounced in the medical profession. Burnout affects 1 in 2 physicians in the United States. It not only leads to high rates of substance abuse , depression and suicide, but also results in decreased patient satisfaction and an increased risk of medical error. This is far from a cost neutral problem for the healthcare industry. Stanford University estimates the cost of burnout to be $7.75 million per year within just its own hospitals, estimating the national economic impact at $4.6B annually. Research has tested and retested theories on interventions that reduce burnout. Support groups, yoga, mindfulness, meditation, and the like have shown promising effects on reducing burnout in the medical profession. However, this research was conducted upwards of 10 years ago and we are still aren’t seeing major benefits from that work. Healthcare systems need to try new methods to address burnout.
The human centered design (HCD) practice enables people to address “wicked problems” – complex socio-cultural problems that affect multiple stakeholders. What distinguishes the HCD process from other problem-solving tools is the active involvement of the relevant user and customer at every stage of the design practice. For burnout in healthcare, this includes everyone from the front-line ER nurses to the doctors to the administrative leaders. The HCD practice tackles problems in three iterative phases: 1) Understanding the users 2) Defining the problem(s) 3) rapidly testing a wide range of solutions. This practice results in desirable, feasible and viable solutions.
Gaining empathy for the users is an important first step to understanding both the systemic and individual challenges of burnout. Extensive interviews and observations are the designer’s core tools in this phase. Based on ethnographic and anthropological work, the obvious root causes of burnout in healthcare show up. These include keeping up with electronic health records (EHR), internal system politics, being understaffed and overworked. However, the HCD practice lends itself to understanding the problem from the human perspective, and help surface how people behave, feel and think. For example, clinicians have been trained to always push themselves and be self-reliant in the face of problems, leading them to feel guilty when they want to pursue personal goals such as taking time away from work to focus on their own wellbeing and mental health.
The knowledge gained from the empathy phase leads to the definition phase. Breaking mental models, developing new conceptual underpinnings and re-framing the problem is common in this stage of the HCD practice. For example, one way to define the burnout problem is to narrow it to the administrative-to-clinical time spent by physicians today. Another frame for the problem on burnout is to focus on the loss of trust between the clinical leadership and the business-administrative leadership inside a health system. The frame of the problem drives most solution space decisions in the following stages.
Based on the problem definition, teams brainstorm solutions. This is where radical collaboration is critical. Including everyone from physicians and nurses to patients and administrators leads to success. It is also important to encourage wild and crazy ideas. Not too long ago, getting into a stranger’s car was unthinkable and now people do so every day through Uber and Lyft. Another essential rule for brainstorming is to go after quantity over quality of ideas. 9 times out of 10, the first idea isn’t the one that will be successful.
Finally, ideas generated from the brainstorming session are narrowed and taken into the next stage of rapid testing. Designers believe in the power of prototype-testing. The basic premise that makes rapid prototyping invaluable is that “showing” the user the idea as opposed to “telling” the user the idea. A prototype can be something as small as a hand drawn sketch of a website or as big as performing a new service. The fidelity of a prototype only needs to be high enough to give people a sense of what it is so they can give feedback, which should occur as quickly as possible. Walk the halls of a hospital with your new idea, stop people in the cafeteria, or setup a testing station in the breakroom. This rapid iteration allows you to throw out what doesn’t work quickly, and identify a solution that can have a lasting impact. Rapid prototyping is invaluable because it “shows” the user the idea as opposed to “telling” the user the idea. The beauty of the HCD practice is that it is highly iterative. Often learnings from one stage require going back to a previous stage and changing an assumption or a point of view.
Burnout in the medical industry is a challenge that won’t solve itself without creative thinking and hard work. HCD strategies greatly increase the odds that an implemented solution will be successful.
If your organization is interest in learning more about the HCD practice, especially as it can be leverage in healthcare, feel free to reach out to us!
KATIE NEVILLE – Katie currently works as a medical device designer at Phoenix DeVentures. She has a Masters of Engineering Design from Stanford University and an undergraduate degree in mechanical engineering from the University of Illinois. While at Stanford, she co-founded the company Code Coral in an effort to address the challenges of physician burnout. Katie also has a background in the aerospace industry from her time with the Boeing Company as a product development engineer. She also has done consulting work and hosted Design Thinking workshops for a variety of companies including San Francisco General Hospital, Honda, and Kaiser Permanente.