After the latest Healthcocreation post about hospital design with patient involvement, Dr. Gabriel Heras published in his very useful blog about humanization of intensive care a post suggesting intensivists should design intensive care units (ICU) together with their families and caregivers. And he asks his readers, how they would like intensive care to be.
Thanks God I had only two recent experiences in the ICU. One in Alicante, where an intern of the clinic I work for had brucellosis (not identified as such when he entered). The second in Madrid due to an arrhythmia I suffered. In both cases two things have to be highlighted: the speed of admission and tests despite the amount of people also waiting (and also quickly attended as I could see in the first case), as well as the high professionalism of all the staff. Not only doctors and nurses, but also auxiliary nurses, watchmen and other care staff.
In this sense, there were not many things to improve in the service design. But in both cases what was common were the lonely hours while the diagnosis was made. In my case diagnosis was quick, but for the intern it took days: there were neurological tests to make, as well as consultations with German doctors (were the intern came from). All these hours, company of family was very limited. There are for sure medical reasons: I can imagine the risks in the case of patients with infectious diseases.
To the contrary, things that bother other people, like the fact that there are many beds only separated by a curtain, did not bother me. Yes, you could hear people suffering. This was certainly not pleasant. I can imagine, if you enter in the ICU with a severe case or you are old, that suffering from other people can provoke fear. But in my case I was glad that all patients were so close to nurses and doctors so that it was easy to attend a sudden worsening. Regarding suffering of the other patients, the stay in the ICU made me think about that pain and suffering are part of life … we make them so often invisible, that we are no vaccine against them. Pain is the more intense, the more we have kept it away from our life.
Far away from making us more empathic (one could argue, that being more exposed to suffering you lose sensitivity), not being exposed to suffering makes us less compasive and more ostrich like.
From the letter to Santa Claus to action
Being a patient gives us without any doubt a great know how to participate in hospital design, but it gets us in the role of children writing to Santa Claus. In my case, the wish letter would ask that families and caregivers could stay with non-infectious patients and that hospitals ban for ever those horrible terrazzo floors. Other patients will fore sure bring more qualified ideas than mine.
Yet, wishing is easy. But which demands are really reasonable? Is there budget? What unexpected disadvantages do good ideas have? For this reason, when getting into action good ideas are not enough.
Design thinking vs crowdsourcing
In order to obtain a great amount of ideas and opinions, crowdsourcing is a popular tool. Yet, crowdsourcing projects should not work very well, as we saw in the case of osteoporosis (see the three posts consumers or patients in this blog http://wp.me/pzi2r-pO). Health is not a consumer product, even if healthcare services and products are consumed. What works when designing new Lego games or new BMW models, does not work well with healthcare.
To the contrary, participative projects that involve all stakeholders with participative action research methodologies obtain a great amount of patient insights. Yet, many of these projects involving patients and stakeholders remain unfortunately on diagnosis and idea generation. It is already a great advance.
I remember a project for a pharmaceutical company in Germany that never imagined how difficult it was for the final customer to get the product and how great the indirect prescription power of nurses via care, dialogue and patient education was.
But like happens with the IT guys when taking user requirements, when it comes to implementation, solutions drift away from real life. For this reason, technology companies work with design thinking and user centred design (already discussed in the post about healthcare technology). Think like the user thinks and include them in usability testing is very important … but not enough.
Healthcare service blueprint: cases in Germany and Denmark
Results are far more relevant, implementable and effective –also from cost point of view- when patients and stakeholders join design teams. An example I love: reducing waiting time and creating meaningful experiences in the Maria Hilf Hospital nearby
Cologne by Kwan Phonghanyudh. It is fascinating how this Thai designer who lives in Germany becomes a hospital staff member and involves relevant actors. The Lego prototypes are worth seeing. Here the final patient is not so much involved as desirable and I believe this is why the project is not perfect.
In this sense, the case of the midwife centre Aarhus at Skejby Hospital by the guys of Design It is a much more in depth work. Yet, Mrs Phonghanyudh’s contribution looks fresher and one can see that once patients are closer involved results will improve
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