Designing the Healthcare Experience

A Philips Design Healthcare leader talks about remaking an entire healthcare environment and experience.

Advice for designing a highly adoptable medical device is not in short supply here at MD+DI. We're covered the topic extensively, including how to develop products for competitive advantage, how physicians have a key role to play in the process, how to take on usability testing, and why designers should consider consumer trends.

As difficult as designing a medical device is, the task looks manageable compared to the challenge Sean Hughes, head of Design Consulting at Philips, undertakes in his role. Hughes and his team design operating suites, hospital wings, and in some cases, entire hospitals.

We spoke with Hughes recently about the areas of the hospital that are ripe for new design, what it takes to ensure all stakeholders have input, and how connected health devices have impacted his designs. Read on for more, including the major way he thinks hospitals of the future will differ from today's centers.

Editor's note: This interview has been edited slightly for clarity and brevity.

MD+DI: Tell me about some areas of the hospital that are most in need of design changes.

Sean Hughes: When I think about design, I think very broadly about it because at Philips we have a very wide range of design capabilities which we then bring to clinical spaces to redesign them.

You can think about a hospital--there's the physical building itself, there's the architecture, and there's the interior design, which is quite often in need of refurbishment, repair, or even rethinking. Then you might consider how a hospital actually connects and communicates with its patients. There might be some digital interface, as increasingly patients will be connecting to schedule their appointments online, use their digital tools to connect and manage their medications. There's a whole connectivity part of design that needs to be thought about. And then there's the way care is delivered, where you might think about redesigning the care process as well. Leveraging technology so that we can have patients treated in their home or have patients monitored remotely rather than having to come in, or video connect with them over long distance so that you can make a diagnosis or check their vitals.

When I think about designing in the healthcare space, it's across all of those different areas where as a design team at Philips, we can intervene and help craft a better experience.

When I think about an experience, it has to work for three people in all cases. You've got the patient and the patient's care provider, the healthcare professionals who have to deliver that service, and then you have the business people who run the hospital. So whenever we're designing anything in the healthcare space, we try to take these three stakeholders' perspectives into consideration so that we can create a win for everybody, and not just a win for the administration.

MD+DI: What recent projects has Philips been involved in? We wrote about the team's redesign of an infusion center here.

SH: I think the infusion center is nice because it's not necessarily tied to an awful lot of Philips equipment, but it's about delivering the patient experience.

Now, we're working on projects which range from designing a hospital in the Middle East from the ground up--where it's a greenfield site and they're looking to us to help them conceive what would be a world-class medical tourism destination--which is a wonderful design project and fantastic medical delivery site. That's on a very grand scale.

We just completed a project for which there was a ribbon cutting only [a few] weeks ago in Chicago. It's a new cath[eterization] lab suite that we designed. We installed all the interventional equipment from Philips and we also completely redesigned the recovery bay and the waiting area. We worked on what the experience is like, going from reception to a concierge-type approach. We thought about the whole service delivery on top of providing them with world-class equipment.

That's a very nice example of where the full spectrum of capabilities from Philips has been brought in to develop a total experience for the customer.

MD+DI: How long do these projects usually take?

SH: Just the construction phase alone, if you're building a brand new greenfield hospital, the construction phase can be 18-24 months. You have a whole phase before that, which is, what kind of structures do we want to build, who do we want to serve as a patient population, what kind of clinical programs would be appropriate for the demographic that we're addressing, and how do we want to differentiate this facility from the facilities nearby? So you've got a lot of questions that you need to spend time addressing up front. That's difficult. It's hard to put a timeline on that, because how much research do you want? It's very open ended. Also, it depends on the customer and how well prepared they come to you.

I think the challenging bit is answering the strategic questions up front about what are we building, for whom, how are we going to deliver care, how is it going to be best differentiated, what are the core clinical specialties that we have, and how is this facility going to last and be relevant over time?

MD+DI: What are priorities for each of the three stakeholder groups?

SH: The administrators are very much focused on patient throughput and patient yield. They have been talking more and more about patient experience . . . there are sort of the immeasurable things they are looking for.

I think sometimes the patient experience, when we talk to the patient, is much more qualitative. They want to be seen quickly when they arrive, they want to be calmed by the facility, they want to be sure they're getting attention. It's the more qualitative, experiential things.

Of course, the physical environment should look appropriate. It should look like they expect a hospital to look in many cases, not like a nightclub . . . Friendly, inviting, and comfortable given that who knows what kind of experience they're going to have when they go in.

I think a big frustration a lot of people have is it's just difficult. You have to make and get an appointment, you might get lost when you get there, you can't navigate around the campus, the parking is difficult to find or is on the wrong side of the building. If you think about it as an end-to-end experience and try to design it as such . . . you end up with fundamental problems. Many healthcare facilities have evolved over time and all the departments just have to be where they are because that was the space they had left on the site, but it might not be the best space in terms of flow. The best solution here would be to knock it all down and start again. But you can't do that, so you have to try and find the best compromise.

I think ease of use and pleasure in use, are the sort of qualitative things that patients are looking for. And of course, they want to have a positive clinical outcome.

As for the clinicians, the thing that we try to do is make their life as easy as possible. They have challenging jobs. It can be a stressful environment in the high-pressure role that they have. Making sure that we design in a break room [where] they can relax, they can be themselves. Also, trying to reduce the number of steps that they might take. Sometimes we go in and we realize that if we lay out all the rooms in a particular way, we can reduce the average number of steps they take by 150 or 200 steps a day. They don't have to keep walking to that cupboard over there to get supplies, because the supply cupboard is right next to them, where it needs to be. So they don't need to navigate a very labyrinth approach. If we can reduce the number of steps they might take, fantastic.

We consider acoustic requirements. We can reduce alarms and work on managing alarms and sound absorption. We can also do a lot with lighting. We can make sure the lighting works for the patient and we can offer flexible lighting too.

So there are many things that you can do to try and make their challenging day just a little bit better. But you only find out what you can do by actually engaging them in the design process.

We use an immersive design approach. We go on site and we interview the various stakeholders in an exhaustive way to understand what are their current challenges, bottlenecks, what are the experiences that they're currently delivering. Then we ideate together with them--and we've run workshops and projects where we've had 50 care providers over three days in workshop sessions where we're asking them, how is your work going on today, how are you delivering, what's the handoff between that department and this department, how can we make it better, how can we make it smoother, how can we make it easier for you? Then, we ideate together. We come back based on that input with proposals: Okay, we could do this, we could do that.

I think bringing them into the process and co-creating the solutions with them is a great way to make sure what we deliver is appropriate. They're the people that have to work in it when we leave.

MD+DI: How on board are clinicians with the design input process?

SH: It's like anything, you get varying levels of enthusiasm. In most cases, they really see the benefit, in that we're helping them to design a better work environment for themselves so they can be more efficient, more effective, maybe get less stressed during the day so we can help them do their job better. By helping them do their job better, we're going to help patients have a better experience as well.

Usually, what we try to do is focus on the typical patient. Let's just take some of your typical patients that you might have coming through this space. If you take an emergency department you might have quite a lot of frail, elderly people who frequently end up in the emergency department for non-emergency requirements. Then you've got a mother turning up with a kid with a broken arm. You might have someone else with even more severe trauma. But if we ask them to think about how those typical patient experience workflows work, they get really engaged, because they recognize the patient persona. 

When we bring the patient persona in as the trigger for the conversation around the experience they'd like to deliver, they get really engaged because they recognize them.

MD+DI: I know Philips recently started selling connected health devices. What connected health efforts are your design teams working on and what role will connected health play in the hospital of the future?

SH: When a health care network has decided they'd like to treat some of their patient population at a distance, then you need to work out what that care delivery model is going to be. We use our service design skills to map out how to deliver care to all these patients in their home and not have them come to the hospital. What does that process look like? What is the new work that needs to be done?

The nurses may need to be mobile and visit patients rather than wait at the hospital for the patients to come to them, so you have to rethink their job. You want to think about the patient in their home. What kind of tasks are you going to want them to do through a tablet device or connected device? You need to design the on-screen user interface. You also need to design on the enterprise side the dashboard for someone who is monitoring all those patients remotely is going to look at. You might have a thousand patients connected remotely into a healthcare system. Someone has to look through that list and decide who is the most important patient today that I need to either contact, call, check in on? That patient and their home device needs to have the interface that takes them through the simple steps they might need to weigh themself, take their blood pressure, know what medication they have today.

So you need to design the user interface and the device infrastructure as well as the service blueprint. 

MD+DI: What is the biggest way the hospital of the future will be different from today's centers?

SH: So much more of the care that we deliver every day will be delivered remotely. You'll be able to talk to your doctor and he will be able to check your vital signs remotely. You just won't have to keep going to the hospital for every intervention. If you don't have to keep going for every intervention physically, but they can virtually get you there, then you don't need such a big space for clinical care. But what you might need is a much bigger space for doctors . . . They will do their jobs in a slightly different way. I think if you imagine a hospital today might have 600 beds, they could arguably in the future treat the same patient population with the same clinical program with a lot fewer beds. I think that's going to be the significant difference. It's going to be much more remote and hopefully much more connected.

MD+DI: Any final thoughts?

SH: Design has been a bit misunderstood. Always it's the application side of it, the output that people consider when they think about design. To me it's much more about process and about experience and then the output comes naturally. 

[Image courtesy of ARTUR84/FREEDIGITALPHOTOS.NET]