Design Can Improve Healthcare; Can It Also Lead to New Cures?

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The kind of design thinking championed by Steve Jobs -- human-centered, iterative, and practical -- can fix more than just our gadgets

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Of all the areas of human endeavor touched by Steve Jobs, perhaps few stand to gain as much as healthcare, where the design principles he popularized and demonstrated remain so urgently needed. Yet, his tragic death at the age of 56 also challenges us to ask whether design principles can help drive medical science itself, and identify novel therapies.

The greatest legacy of Steve Jobs -- as many have observed (see here, here, and here) may be in design, and specifically, his ability, in the words of Steve Gage, "to take this enormous complexity and make something a human being could use." While Steve Jobs did not discover design thinking, he is probably the one person most responsible for our visceral appreciation of the concept.

Device makers are focusing on the user experience and hospitals are trying to pay more attention to the holistic needs of their inpatients.

Tim Brown, founder of the design consultancy IDEO, describes (PDF) design thinking somewhat formally as "a discipline that uses a designer's sensibility and methods to match people's needs with which is technologically feasible and what a viable business strategy can convert into customer value and market opportunity."

Brown also offers a more useful characterization of design thinking: an "approach to innovation" that is "human-centered, creative, iterative, and practical." Design is at once an approach and a sensibility (see this [PDF] useful "bootcamp bootleg" from the Stanford D-school, or most anything written by Donald Norman).

While in some circles (radiating concentrically from Palo Alto, one imagines), design is, if not quite passé, at least associated with irrational exuberance and extravagant expectations (see this 2009 posting by Peter Merholz, founder of the user experience consultancy Adaptive Path, and the energetic dialog his remarks engendered), these principles have made only very preliminary inroads into medicine and healthcare.

For starters, medicine is far less "human-centered" -- that is, patient-centered -- than most observers appreciate. In the exact same way that well-intentioned engineers often go awry by creating features based on their own perception of what they perceive users must want, medicine has spent a lot of effort focused on a physician's idea of a patient, rather than developing a more nuanced view of life from the perspective of the patients themselves.

Physicians have surprisingly little visibility into a patient's day to day health experience -- doctors typically have no idea whether a patient actually took their prescribed medication (data suggest the level of adherence can be shockingly low), took their medication correctly (video studies of patients taking injectible or inhaled medicines reveal remarkable variability), or adhered to behavioral recommendations (you have to ask?).

Doctors also have little sense of a patient's daily experience with their disease -- their daily blood pressure, say, or ability to inhale deeply -- to say nothing of less concrete but arguably more important parameters such as mood or quality of life. The physician's episodic assessment of a patient's health, an occasional snapshot, may not always capture all, most, or, in some cases, almost any of the patient's actual experience with disease. Worse still (as discussed here), the absence of more granular knowledge of patients means that doctors have virtually no idea of whether they are providing effective care or not -- are patients even following their advice, is the advice doing any good, and are the doctors even focused on the issues most important to patients?

To be sure, some change is in the air; device makers are focusing more intently than ever on the user experience; equipment makers are trying to focus on the use of affordances to reduce human error; a number of hospitals are trying to pay more attention to the holistic needs of their inpatients; and a slew of mobile health companies are developing products that offer the promise of more continuous monitoring and assessment.

I've no doubt that design principles can -- and, hopefully, soon will -- help us all do better utilizing the resources (personnel, institutions, therapeutics) we currently have: an enormous accomplishment.

But Steve Jobs didn't die at the age of 56 because he didn't like his hospital johnny, or because he accidentally took the wrong pill, or because he wasn't getting the levels of some hormone assessed frequently enough. He died because he had cancer, and he needed an effective drug -- or similar intervention. What does design thinking have to offer here? Can it lead to transformative medical discoveries, to an implementable cure for a particular disease?

The honest answer is that we really don't know yet. The jury's still out.

My hope -- and at this point, it's only a hope -- is that the more detailed analysis of patients could yield the sort of transformative insights that areas such as oncology so desperately need. I can imagine that if we could more carefully monitor a range of parameters in cancer patients and engage their participation in open data platforms (in a fashion similar to PatientsLikeMe, and as championed by organizations such as Sage), perhaps we would have a greater chance of discovering unexpected relationships, of finding hints of new uses for existing drugs, of developing a deeper appreciation for the underlying networks and relationships driving health and disease.

It's also likely that the opportunity to get closer to patients could help improve the total care we provide, a human-centric, iterative, pragmatic approach that is credited for playing a pivotal role in progress in diseases such as pediatric cancer and cystic fibrosis, where a magic bullet has remained elusive.

Perhaps most important, a design approach would ensure that we keep our focus on patients, rather than on dubious animal models that are often far more effective at generating research grants and advancing academic careers than they are at providing meaningful insight into a disease afflicting patients. It might also stimulate some of our smartest and most creative basic medical scientists -- researchers who have traditionally been drawn to reductive, highly simplified systems -- to start innovating around patients, trying to develop a far more detailed and relevant understanding of disease as it exists in the organism that ultimately holds our greatest interest and investment: ourselves.

Revolutionizing fundamental medical research may be an unreasonably audacious goal, but figuring it out -- finding a way to incorporate in a meaningful fashion the principles of design thinking in the approach and strategy of basic scientists -- is a worthy ambition, and one I suspect Steve Jobs would have felt proud to inspire. Let the conversation begin.

Image: IDEO.

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David A. Shaywitz, MD, PhD, is a director of strategic and commercial planning at a biopharmaceutical company based in San Francisco, and the co-author of Tech Tonics: Can Passionate Entrepreneurs Heal Healthcare With Technology? More

Trained as a physician-scientist and management consultant, Dr. Shaywitz has experience in clinical drug development and strategic and commercial planning. Dr. Shaywitz is co-founder of the Center for Assessment Technology and Continuous Health (CATCH), a Boston-based initiative to use improved real-world measurement to improve care and drive science. He also is co-founder of the Harvard PASTEUR program, a translational research initiative at Harvard Medical School, and a founding advisor of Sage Bionetworks, a non-for-profit medical research initiative focused on open innovation. He works at a biopharmaceutical company in San Francisco; the views expressed in his postings are his own and do not represent the views of his employer. Dr. Shaywitz is an adjunct scholar at the American Enterprise Institute. His personal website is: http://davidshaywitz.wordpress.com.

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