We often see a disconnect between the way innovators and clinicians think and approach change across the industry. How do we design health care thoughtfully for physicians and patients? Where is the disconnect between design thinking and health care? Join the conversation with our experts for answers to these questions and more.
Lots of different ways to determine whether an innovation, an implementation, or any sort of change is worthwhile.
Ethnographies, user studies, focus groups, and surveys can help collect feedback from people on whether a change has provided a morale boost, subjective increased efficiencies, and overall satisfaction.
From a financial viewpoint, Return on Investment (ROI) analyses can determine whether the change yields a larger financial return. And from a time viewpoint, some newer electronic health record features provide individualized "provider efficiency profiles" that demonstrate whether someone is staying at work late, working on reports.
It starts with defining innovation linkedin.com/pulse/10-things-p...
Great question..I think the 'value' almost always lands on your users. Let them help you prioritize your opportunities (features, configuration, are they accepting to the innovation, etc...) Sometimes innovation can be 'before it's time' and you will need to determine if you want to boldly leap into the future. If it's innovation, technology etc, that is directly linked to a user's need and/or desire you may want to take a strong look at the opportunity space.
If you look at companies that are truly innovative, I believe they take this approach and distinguish themselves in the marketplace.
Physicians I work with really don't favor "ROI" as a concept, usually countering discussions of value creation with "don't forget that its about the 'right thing to do'." - or similar themes.
I get more traction with the idea of value than return on investment.
All in all, however the key is to understand the value proposition in terms that are sustainable... the title of "translation" for this panel is particularly relevant. It takes time and working with our finance team to really get to that translation. We literally work in committee with a diverse group including finance and risk to shape the shared understanding of value.
By the way we do monitor intrinsic and extrinsic measures of value...
When the patient/consumer is the user, is the value or worth of innovation measured differently?
In the field of healthcare, all innovation efforts must start with the primary stakeholder—the patient. What value will innovating provide to the patient? Will the innovation achieve the desired outcomes to promote the highest level of patient health and wellness possible? And, will the innovative initiative be designed in a way that is easy to engage. Once these questions are addressed, then it is important to focus on the physicians, clinicians, and/or caregivers that may be the primary providers of the innovative method or technology. Does the technology create greater efficiencies which will allow physicians and providers to focus on the high-value and humanistic aspects of their role? Lastly, does the return on investment (whether in money, time, or experience) make sense? This often requires clear metrics, both qualitative and quantitative, to evaluate if the effort of innovation will truly drive transformation and better outcomes.
How we evaluate innovation would depend on the goal. What are we trying to achieve through innovation? User satisfaction? Competitive edge? Operational effectiveness? Financial performance? How much innovation is enough versus too much? How do we balance the outcomes with cost - use of limited human and financial resources, stress, or change for change sake, among others? We might consider how much has been created in terms of a 'new' market, while recognizing that innovations don't typically happen with an 'aha' moment. They more often go through an evolution that looks 'more obvious' through the lens of hindsight bias.
Totally agree. See what is gaining traction with your users, understand why, and then build on that.
Keep in mind that there are multiple sickcare stakeholders and that each one requires a different value proposition
Patients and their families/informal caregivers, physicians (primare care and specialties), non-physician providers/clinicians, inpatient facilities, administrators, payors, researchers (public health and otherwise), educators, health systems, technicians. What am I missing or added incorrectly?
pcori.org/about-us/our-program... They left out investors
PCORI does have a comprehensive list ... And very good point about neither of our lists including investors!
Seems to me that the best way to answer our question is to define the specific value/worth metrics of innovation for each stakeholder group. I’ll post a new question about this issue.
Interesting point: assessing the value of innovation from each stakeholder's perspective.
Value in innovation can often be supported by the innovation’s ability to support the four pillars of the quadruple aim, measurably improving population health, reducing cost, enhancing the patient experience, and improving the work life of healthcare providers. I would also add patient reported outcomes (PROs) to make sure that patient value is not merely limited to the experience of the innovation alone. Focusing on these pillars has served well in my own prior work in the digital health startup industry because they address the value to many of the key stakeholders, and to the healthcare industry at large.
Often it is more a matter of timing and nothing at all to do with the innovation being good or bad. Other times, it is about how the innovation is presented...good idea - wrong target audience.
I don't know if there is an easy way at the outset to tell if an innovation is good or bad. It is hard to predict how any innovation is going to affect the whole ecosystem - because there are just too many variables. Who would have guessed that the iPhone would unravel so much of the social fabric we took for granted. All we can do is be as thoughtful as we can at the outset, and observant as it plays out. It is very easy to be seduced by a sexy new innovation! I think a good guiding principle is to truly care about the people we are innovating for rather than fall in love with whatever product we produce. This allows us to pivot to better meet their needs!
As mentioned, the outcome will be defined by the multiple of user defined value created when compared to the competitive offering or the status quo. My back of the envelope hurdle (and Google's) is 10 x.
Great suggestions!
I don't think you can go wrong with an innovation that supports the quadruple aim, is present to the right audience at the right time, and impacts target ecosystems in the desired manner. Being able to do all this requires much more than creativity, market intelligence, a well-built and flexible product with great UX, and self-confidence. There is likely to be many unknowns, conflicting incentives and metrics for judging value, ever-changing technologies, evolving clinical knowledge, competitors with deeper pockets, shifting political focus, etc. All this means significant risk and uncertainty.
Nevertheless, I suggest (from personal experience) that innovators should focus on:
• Doing what’s right/good for the wellness and well-being of patients’ and clinicians’
• Building a network of ecosystem partners (as necessary) to deliver a complete and differentiated product with clear value to the target stakeholders
• Spending the time and effort to design a product delivers a delightful user experience
• Having a mind-set that realizes you may have to be in it for a long haul journey with many frustrations and disappointments along the way.
And, be lucky
Agreed. What many startups fail to do is to involve in house clinicians early on (improving clinical work life, improving outcomes, and making sure to identify and tackle a real clinical problem, rather than being a technology looking for a problem), and good designers and engineers (enhance patient experience to make a delightful application, interoperability, etc), health economics expert (reduce costs). I’ve seen many companies where only one or two of these critical stakeholders are present, and the company lays the incorrect foundation. Was fortunate in my prior company to have hit on all cylinders on the quadruple aim and to have published peer reviewed papers in the literature demonstrating efficacy. But it takes thoughtfulness up front, and often, in the rapid pace of startups, the approach all too frequently is to “run fast and think later.” Creating time to be thoughtful may feel like a luxury in the startup world, but it’s critical.
Can't argrue with that logic in the broadest of terms, although Pesonality/Temperment and Values also come into play..
Chief success factors are domain expertise, strategic vision and money
Our experience leads me to the conclusion that the human connection is the key to building trust to allow openness, and further that simple communication between those people is what is so often lacking.
Consider the VC pitch.
VCs want not only to know that the team is technically "Correct" but that they can communicate their vision, (to each other, to their team, to customers, to investors), and that the team and members of the team are people that the VCs have confidence in. Even in these high-pressure encounters, its the people and how they communicate which is important.
We spend a fair amount of time socializing ideas- literally in social events and symposia designed for networking and refinement of ideas. This works, but it does take time.
Physicians need the gift of time, support to deal with the emotional trauma and moral injury of working in sick care environments, technologies and innovations that improve workflow, provide seamless access to pertinent information, and bringing back joy to practicing medicine. Hospitals have bottom-lines they need to meet, investor expectations to exceed. The alignment between the 2 is clearly not always there.
So, given the present status of Sickcare USA, how do we resolve the ethics of business with the ethics of medicine? linkedin.com/pulse/bioentrepre...
Healthcare systems have an abundance of scale and can exist in the wild for centuries.
Physicians are finite.
It's like a Venn diagram. They overlap in a few areas, but have very distinctly separate areas too (not necessarily mutually exclusive). If health systems got smart they would realize that they would be much better served by increasing that area of overlap to include more of physician's needs.
We created some awesome rooms in Radiology to help families get over the anxiety speed bump of scary healthcare imaging equipment. We listened to children and explored their anxiety journey from home to the hospital experience and then back home. We had a blast working with the kids, sketching, making models of the rooms, and crafting awesome stories for each experience. The attached picture is the 'Coral City- Underwater adventure'... CT scanner at Children's hospital in Pittsburgh/ UPMC. Take a submarine ride through the coral reef, walk on bubbles, find the angle fish... We call the experience Adventure Series
I love that story! Such a smart idea!
This is amazing! Many adults would benefit from this too. Anxiety and fear surrounding imaging, especially in the context of a cancer diagnosis or other life-altering disease, is a real thing that patients and their loved ones struggle with. Why does everything need to become colorless and sterile as a consequence of being an adult?
As a proof of concept, we took computer jocks, engineers, teachers, and 3D modelers to the bedside at our children's hospital Childrens Hospital of Illinois.
They created this free app for kids to learn from as they recover in the hospital. It combines AR with an activity book.
pjstar.com/news/20190222/jump-...
What I learned is that delight in a sick child's face is remarkably valuable.
Right!? I love that we think that we have to make the experience better for kids! But speaking as a large child myself, I want to have a fun experience too!
I like the article on a study by MIT that shows more goes into being a physician than just analytics news.mit.edu/2018/doctors-rely...
Talk to them! I really do believe this is where design has the most value to bring to the healthcare field. As a designer it is my job to talk to doctors and better understand their problems, needs, and motivations. Without that knowledge there is no chance for a solution to be properly integrated. I have found doctors are more than willing to chat about these things and technologists should take every opportunity they can to do that.
Better to go and watch them work instead of them telling you how they do things.
Collaboration with all stakeholders involved in healthcare would be the winning hand ✨
Lisa discussed how doctors use more that data to make decisions. Paul suggested direct communications between doctor and technologist. Arlen added the importance of direct observation. Each of these approaches focus on capturing different types of knowledge.
Explicit knowledge can be readily expressed in words, numbers, and symbols and stored in books, computers, etc. A "gut feeling" that can be articulated but isn't is known as implicit knowledge. Its existence is implied by or inferred from observable behavior or performance. And tacit knowledge is a form of subjective insight, intuition, judgment, innovation, or inspiration that's acquired through experience, but cannot be reproduced or shared easily. It's a kind of distilled wisdom a person possesses, but doesn't know about it until specifically questioned.
How can relevant implicit and tacit knowledge of doctors be effectively captured and shared with technologists?
I agree with Paul... Seek stories to uncover their unmet needs and desires. 90% active listening (capture everything) and 10% or less talking. The best ideas come from the field so, get out there and immerse yourself in your user's world!
The idea is to find the job that doctors want you to do be it techical, social or emotional
I like all the answers above. And I will take it one step further.I agree that you must observe the work being performed I agree that you must interview systematically, and carefully probing for gaps and their potential solution.
The problem with watching clinical work however is the clinical work is exceptionally complex, and subject to the opportunity of the moment. Because patients come in in all different shapes sizes and conditions is very difficult for technologists Together the data they need to propose solutions.
I suggest adding clinical simulation to the mix of methodologies, because with clinical simulation you can control all the circumstances of a given case or presentation, pause the simulation, ask detailed questions,or Even perform a formal task analysis. All this can happen without encumbering the clinician(s) or putting real patients in jeopardy.
Medical simulation has become nearly ubiquitous.
Technologists should turn to their human-computer interaction (HCI) expert counterparts. HCI is defined as "human–computer interaction (HCI) researches the design and use of computer technology, focused on the interfaces between people (users) and computers" (from Wikipedia, but fairly accurate). There are a lot of methods to understand the needs of users — in this case, the physicians — by looking at:
- User-centered design methods — which often employ ethnographic studies in which people observe and study the users
- Activity theory. — studying the contexts of interactions
- Value sensitive design
This is one of the main disconnects that I have noticed between physicians and technologists. Sitting in a conference room reviewing an agenda, asking standard "out of the box" design questions, and "brainstorming" new technological approaches to clinical conundrums will not allow technologists to gain an appropriate amount of insight into the challenges, motivations, and workflows that make up a physician's clinical practice.
To truly design health technology that is relevant and impactful, technologists need to spend elbow-to-elbow time with physicians (and patients) to understand the current and ideal state of their clinical practice. In essence, find a physician champion or advisor. In addition, it is important for technologists to ask questions and not jump to assumptions based on previous experiences from other industries or clinical environments.
The best innovators (clinical and non-clinical) are those that study their customers and design thoughtful technology to achieve best experience, financial, and clinical outcomes possible.
Thank you so much for adding patients! ✨
Patients and their overall outcomes are the most important parts of these conversations!
These are all important points. I believe it is also important to understand the level of the healthcare system at which a particular technology will be implemented, how it would affect workflows, who the end-user will be, and who the decision-maker will be (as their needs/requirements may not be the same). Furthermore, knowing what the true gaps are with respect to patient care/outcomes need to be based on literature review, expressed needs of patients, and perspective of physicians on the front lines.
This is a complicated question. And Stephen you hinted at it's complexity. I have a slightly different perspective than most - principally because I was a designer/innovator first and became a physician solely to innovate in this space. Were I to design a pair of shoes for Nike, I would easily assume the role of a user and go for a run, wash them, figure out where the pain points are. I (simplistically) assumed I could do the same in healthcare. It was only over the course of med school that I realized the problem was much deeper. That is what lead me to turn down a role straight out of school, building the future of healthcare at MIT's Media Lab. As I suspected my understanding grew dramatically over the course of residency, chiefship, med directorship, being an attending and finally running my own clinic - 12+ years of 100+ hour weeks. How could any technologist/innovator be expected to understand that? So then it is up to us as physicians to communicate where our needs are.
G.B. Shaw said that unreasonable people drive all progress because they demand that the world meet their needs. As a designer I am inherently unreasonable - absolutely everything can always be better. As doctors, however, we are trained to be "very reasonable". To put up with 36 hour calls, make fun of sissy young doctors who would rather sleep, stand in surgery for 8 hours, give up our lives for decades, etc. If you don't want to do those things, you don't get to be a doctor. We are trained to accept things as they are and work around. So (as a group) we often don't even have the vocabulary, let alone understanding to expect better. Observation and ethnographic research are a great start - but as we know, if you ask someone after the fact why they did what they did, they will invent a rationale to justify their behavior. That is why my mission has been to teach clinicians to be designers, so they at least have some basic tools to innovate and communicate with innovators!
Here’s my attempt to summarize our conversation to this point:
There appears to be two main themes:
1. What do technicians need to know to build useful and usable tools and
2. What are ways they can learn from clinicians?
A technician should know a wide range of things (mentioned by Tiffany and others) important to physicians including knowledge they need to build tools that:
• Are designed to satisfy specific requirements of different healthcare systems
• Promote the capture and sharing of knowledge, including intuitive decisions
• Accommodate important workflows to avoid wasteful disruption and unnecessary effort
• Present information in a way that informs clinicians and emerges new insights without overload
• Focus on providing a delightful user experience (UX)
• Address gaps in care the may adversely affect patient outcomes
• Promote patient engagement and education.
Several overlapping ways to enable technicians to acquire this knowledge include:
• Douglas and Paul suggest active listening to physicians’ experiential stories
• Mendell and Arlen recommend direct observation of physicians
• John and Arlen point to prototyping and simulation
• Steven recommends applying user experience design research
• Andrew points to teaching clinicians how to be designers so they can best communicate with innovators.
Investing the time to understand the workplace environment, the bottlenecks, the moral injury, witnessing what creates bottlenecks, what works well are critical details to witness. Complementing that with partnering with doctors to listen to what the pain points are will give a good picture of what the landscape looks like. Highly recommend speaking with nurses. Nurses understand the pulse of the office, specialty, and department. They may offer exceptional insights on what is needed.
Very true! Adding that speaking and partnering with front-line caregivers, nurses, staff, can be extremely insightful to understand the various facets and complexities of a physician's day, unmet needs, pain points, technological needs. Partnering with patients and carepartners to hear what information and tools they wish their doctor had to make the doctor-patient relationship stronger, elevating trust is of essence.
Spending "a day in the life" sounds great. but privacy, confidentiality and policy and procedure concerns get it the way. E.g. suppose you wanted an engineer to spend some time in the ICU or OR to help identify problems on rounds. How would that work in your place?
Ethnographic research is a great way to gain such insights. Typically if the research is focused on areas of mutual interest and the organization is able to co-share the findings, they are often willing to participate. Research groups within the organizations will guide you, as there are common standard procedures for these forms of studies.
Your list of the 20 barriers faced by doctors interested in entrepreneurship cover many angles: innovationexcellence.com/blog/...
Most new clients say that finding time to move an idea forward while still practicing is a big challenge. I make myself available 24 hours a day to keep momentum going with each project.
I think it is so important to pilot (prototype) something low fidelity and simple to check if you are on the same page as your users/ customers
Absolutely Douglas. Having something tangible helps get much more accurate feedback in the early stages of development.
My concern with clinical data is that most of the data collected and the electric medical record serves primarily a billing function.
I’m always a bit skeptical of “the data” because essentially clinicians Convert the following rich clinical context into some simplified and often templated version of “the truth”.
It’s not that the data isn’t correct. It’s just it doesn’t Tell the whole story
I will answer that question as a psychiatrist.... myself. I expect it to be perfect before I launch something. While I know in my head that isn't possible, nonetheless the fear of putting something out that isn't "perfect", unsinkable, etc, is really compelling.
After that it is about finding the resources and the champions to help drive it forward.
A key component of advancing new ideas includes understanding the real problem - not just the symptoms. We are often prone to jumping into 'solutions mode' too quickly, and absent the views of a diverse group of stakeholders, our results may include unintended consequences upstream or downstream in the process. As an example, an idea to improve medication delivery on a patient unit may entail a series of interventions that improve safety and efficiency on the unit, while creating an unexpected burden on the pharmacy. This highlights that new ideas have to be evaluated in the context of a system. in healthcare architecture, a functional program (or project brief) can be a vehicle to start the process for new ideas. The functional program can help a team with issues of complexity and systems thinking through consideration of the people (users from varying points of view - staff, patients, visitors, etc.), the organizational and operational characteristics (process, policy, culture, etc.), the physical environment (space, layout, experience, etc.), and perhaps most importantly, the interactions among those components of the system. It takes time on the front end but is essential in problem definition.
For me, the biggest obstacle has been to realize a vision I had 30 years before the market was ready for it.
In the early 80s, while practicing as a clinical psychologist, I envisioned a behavioral health information technology designed to improve care outcomes using a measurement-based biopsychosocial (whole-person) knowledge model. I soon began developing an application with the ability to integrate, analyze, and present diverse biomedical, psychological, and psychosocial data. It included patient-generated, observational, and other relevant data. I used the tool with my patients for treatment planning, delivery, and outcomes assessment and evolved it over the years.
I founded a company in the mid-90s around this product. Despite a few early wins, we soon discovered that the idea of using computerized data to inform the delivery, and evaluate the efficacy, of behavioral healthcare was not viewed as a priority (to say the least). So, we had to our focus to other vertical markets to keep the company afloat.
Only in the past few years—three decades after my entrepreneurial journey began—has the impact of behavioral (mental/psychological) and psychosocial/SDoH problems surfaced as truly important in patients’ overall health. Case in point is CMS’s recent program to compensate PCPs for the integration of primary practice with behavioral care (BHI). We are now focused on this new opportunity.
Bottom line: It’s fulfilling to have a vision that’s proven useful, but it’s painful to come to market much too soon. Nevertheless, it’s sometimes possible to persist and endure despite the nay-sayers and obstacles, though it’s certainly not for everyone!
From a patient and carepartners perspective, many of the unmet needs that we are able to clearly articulate are met with:
-"who is going to pay for that solution?"
-"the patient is not the customer, just the consumer"
-"investors aren't interested in pursuing these avenues"
This disconnect is a massive problem because if we aren't innovating to empower patients in their care, giving them access to the information and tools they need to make educated decisions about their wellbeing, we are setting them up for failure.
From the patient perspective, I would never allow a Silicon Valley techie or business major without a medical degree engage with me in determining any type healthcare management plan
I'd say the biggest difference is that tech has a culture of "move fast and break things" in order to learn by doing while for obvious reasons doctors need to be more methodical about how they approach things. I mean people's lives are at risk.
In general though I don't actually think they are all that different. Both are problem solvers at heart. I've found that doctors are very open and eager to using new technologies. Often the barriers come at the institutional level.
They both need to start by being problem seekers, not problem solvers. Move fast and break things doesn't work when lives are at stake. theguardian.com/global-develop...
One of the central pieces of work that we perform at our innovation center pairs clinicians with engineers To solve problems in Healthcare.
I cannot tell you the abundance of value that there is in pairing disciplines with divergent foci, on the shared goal of solution-making for Gaps in healthcare.
jumpsimulation.org/research-in...
Engineers have a studious approach to problems with math science and physics. Clinicians operate in a highly complex socio-technical system and often exhibit exceptional comfort with the notion “that’s just how it is.”
Two primary differences come to mind. I wrote about one in this article...
I'm both fascinated and perplexed by the many entrepreneurs I meet and hear who have developed a vast spectrum of solutions for physicians who have never had a healthcare encounter or cared for a patient. Innovating on your educated assumptions and the basis of your degree is not equivalent to holding the hand of a patient who has been told their heart is failing, their cancer is no longer responding to treatment, their surgery was not successful. Have you suffered with a patient and their loved ones? Have you grieved in their grief? Have you personally experienced the burnout and moral injury of the very physicians you are innovating for? Until "techies" can whole-heartedly say yes to these questions, there are long strides to be made and gaps in understanding to fill.
National "health spending" continues to contribute about 50% of our nation's annual Federal deficit. Among many associated population health attributes, our nation's longevity at birth has decreased 4 years in a row. It is likely that a combination of three strategies will be required to reduce health spending from 18% to 12% of our GDP AND reduce our nation's maternal mortality ratio by 70% to rank among the 10 OECD nations with the lowest maternal mortality incidence.
First, a re-oriented allocation of "health spending" dollars using a transparent and equitably distributed risk-responsibility among the "stakeholders" will be required that is associated with an increase allocated to Primary Healthcare. Second, the augmented Primary Healthcare should be associated with an improved level of 'medical TRIAGE' and the real-time availability of a Comprehensive Care Plan. Third, the equitable availability of this Primary Healthcare for each citizen should be managed through a locally managed, community by community, commitment to assure that the community's capabilities for improving its level of Social Capital will assure that each child enters Kindergarten with the capabilities to help care for others and to learn from their school experience.
The Design Principles for managing a common pool resource as defined by Nobel Prize winner, Elinor Ostrom apply. Regardless of our nation's political paralysis, we cannot wait. We must mobilize our commitment to each citizen's Stable HEALTH and take the lead. System design must accommodate the needs for justly efficient and reliably effective Primary Healthcare as a core process in association with community rejuvenation. The loss of Social Capital, community be community and neighborhood by neighborhood, is the over-riding cause of the cost and quality problems of our nation's healthcare. Mass shootings increased by 30% from 1984-1999 to 2000-2015.
From the patient perspective, please consider the end-users in healthcare application and technology ; )
I answered this one with a question:
What kinds of technologies could we develop if we spent more time addressing safety and quality and less time reporting data of questionable value?
A report produced for each Primary Healthcare Group of 3-5 FTE primary physicians with a Income Statement format based on three-age groups (based on the cumulative plans with covered persons using the Group for their Primary Healthcare) and sub-divided into a Primary Healthcare section and an all-other section. The report would assume an accrual layout as reported 10 weeks after the last 3 month interval. The annual April report would be quarterly and annual.
The funding of the REVENUE would follow a contract-based division of premium income: presumably 15% Payor, 25% Primary Physician, and 60% all other. Arrangements for accrual documentation of coordination of care, pharmacy rebate, and third party liability would follow contractural arrangements. Stop-loss processes to account for high utilization, covered persons.
Even though such a model could ultimately involve up and down side risk-sharing. However, the most important value of the report would be to compare various practices based on their utilization management. The "behavioral economics" concepts of Nobel Prize winner Richard H. Thaler apply. It is likely that certain groups already exhibit a high degree of efficiency and its associate high quality.
As a PCH Group with an HMO Risk contract 1984-1997, we never had a negative risk-sharing year. After looking at the quarterly reports for sever years, you figured out how to reduce Expenses as the basis for arranging the best possible healthcare. The only problem to prepare, in advance, is the quandry of managing free-rider groups. Ideally, this should be done by the Primary Physicians within each large PCP, hospital affiliated contractural group.
Medicine (Healthcare delivery) happens between the clinician/provider and the patient. (In this case I include everyone that interacts with the patient in a healing capacity - so yes the tech that takes the x-rays). These are the front lines of care. Everything else is there to support that interaction. If what you're designing/building/creating detracts from that, then we need to reconsider whether we should be making it.
Here is an article I wrote that feels somewhat pertinent.
I think many architects and designers would advocate for clients to better understand there are few black and white answers in complex systems. We need to understand "work as done" as compared to "work as imagined." The built environment is often seen as 'the given' but it can be an opportunity to elicit change on so many levels. the environment sets the stage for so much of what happens in healthcare delivery and it acts as a facilitator or barrier to goals. Next time you see a workaround, think about how the environment maybe contributing as a latent condition!
Patients an carepartners have valuable expertise and insights based on their lived experiences and interactions with the healthcare ecosystem. This wisdom is critical to include in the innovation process. Innovators need to acknowledge that there is a shift from traditional paternalist medicine to participatory medicine, where patients and their carepartners want to be part of the conversations and treatment planning process. We need information and tools to make educated decisions about our care. Many patients are not only extremely engaged in their care but are also advocates and trusted disseminators of information in their local communities and networks. These patients and carepartners have a deep understanding of patients unmet needs, the impact of poor health literacy, the barriers to access, the implications of financial toxicity, the effects of language barriers, social determinants of health, etc. We need to be included in the conversations and solution ideation, design, and delivery process. It isn't just a nice-to-have, it's solid business strategy.
Pending
The introduction begins during the ideation, design, and development of the innovation. End-users, (patients, careparters, doctors, nurses, etc), need to be proactively involved in the process upfront. Applying lived experiences and real-world expertise is essential to ensure the technology seamlessly incorporates into workflows or people's lives without adding friction or technical difficulties and bottlenecks. Innovators need to understand what specifically will be value to the end-user which is why a partnership and a continuous feedback loop is essential. It's also not enough to develop and launch an innovation or technology. The implementation process needs to be thoroughly vetted. Roles, responsibilities, costs, troubleshooting, etc all need to be carefully identified upfront as well as allocation of budgets and needs for more staffing (temporarily/long-term). Lastly, one of the most critical things after implementation is ensuring the end-user has real-time support for questions, difficulties, problems. This includes real-time support for patients and carepartners who may be trying to use a new technology at home.
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Ongoing education is key. Sometimes users lose sight of the value of the technology that is being introduced. A great example is VR. It is a form of entertain in the mainstream; however, in the clinical setting there is real clinical efficacy associated with many forms of VR therapy. Staff and even patients forget this at times. As a result there behaviors around the administration and consumption of the technology sometimes compromise the benefits to be gained. Having refresher training on the purpose and benefits are important.
In other instances it may be that features and functionalities are not being leveraged in a technology. This may not be because of a lack of benefit, but rather a lack of familiarity or discovery time. It is important to take time to draw attention to solution features.
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Reimbursement needs to be there. I would love to see VR regularly utilized in the clinic. SO many promising benefits and use cases. I currently only see it on the road at conferences. Not good enough!
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Great question!
With sensitivity...
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User-centered / usability evaluation. A framework was recently developed by Ratwani et al with the MedStar Health National Center for Human Factors in Healthcare: academic.oup.com/jamia/article...
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I agree with the VR use Grace. I beta tested VR at home for intractable pain and have only seen it being used in certain hospitals such as Cedars Sinai, Other hospitals are using VR as an aid to surgery & other procedures. It has been tested and proven to help for pain, inpatient status, pediatrics as well as mental health issues such as PTSD. So it's coming about but most patients will not be able to afford the monthly costs of VR subscriptions for at home use as well as the cost of the Occulus device itself. (or other types) So hopefully like you've stated before, this needs to be reimbursed and/or covered by health insurance.
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I agree Grace. Proactively involving end users in ideation and design can save the innovator a lot of angst. I'm a big believer in qualitative research for this phase.
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I agree 100% Grace. Lisa Davis Budzinski and I ( Central Pain Nerve Center ) tested VR equipment at home for Intractable Pain. We found that it provided great relaxation, diversion & distraction, which was a welcome addition to our typical pain treatments. Unfortunately, the up front cost keeps me from adding it to my pain toolbox permanently. How do we go about showing Insurance companies the real pain benefits of VR rather than having them see it as just a toy, or a hobby?