Design Thinker Profile: Capabilities for Driving Change in Healthcare

Emerging Need for Innovation and Change in Healthcare

The need for innovation in healthcare has been emerging over the past several decades. One factor driving the need for innovation in healthcare is the lack of productivity improvements while costs have continued to increase. In fact, according to a 2014 McKinsey study, “healthcare ranks near the bottom in terms of productivity improvements since 1990.”(1) Another factor is the shift in population demographics: as baby boomers (the largest generational cohort) reach retirement age, the need for healthcare services will grow, which, in turn, will increase the demand for healthcare services. A third factor is advances in digital technology—not just those technologies tied directly to medical advancements but also those that operate in the periphery, such as scheduling apps that enable patients to self-serve appointment making, or text messaging services that enable faster communication between service providers and patients. As more and more digital natives (i.e., those born and raised in the digital age) arrive at the age of making their own healthcare decisions, these technologies will have to become commonplace. We also cannot ignore advances in biomedical research. Those advances, such as the development of the artificial pancreas and CRISPR-Cas9 genome editing, to name just two, will transform the practice of medicine.

The innovations needed for transforming healthcare already exist.(2) These innovations not only will help address the challenges currently facing the industry but also can transform the quality of patient care. Healthcare leaders who can leverage these innovations to drive change have the potential to create thriving medical practices that improve how people live their lives.

Design Thinker Market Trends

The innovations to transform healthcare exist; the challenge for healthcare leaders is to develop the mindset and cultural shift to implement these innovations that can transform their organizations. However, change for the sake of change accomplishes very little. The ways an organization changes must align to fulfill unmet customer needs. This is where “design thinker capabilities” have provided many companies with a competitive edge by connecting the drivers for change with meeting the needs of customers, patients, clients, and even staff. Companies that have embraced the design thinker way of working have outperformed the Standard & Poor 500 by 219%, captured 1.5 greater market share, and increased sales by up to 17.5% (Figure 1).(3-5)

Figure 1. The return on investment of design thinking.

Forward-thinking organizations have used design thinker capabilities to drive organizational change. For example, the Australian Taxation Office used this approach to change its process to be easy to navigate for taxpayers.(6) Specifically of interest to healthcare executives are the examples of the National Health Service of the United Kingdom and Kaiser Permanente in the United States. The National Health Service of the United Kingdom used this approach to improve patient care,(7) and Kaiser Permanente has used this approach to improve the level of care it delivers to its network. One specific improvement related to administering medications resulted in $965,000 in cost avoidance related to medication errors.(8) This is one example related to one specific process within a large organization—imagine the impact this approach can have if employed across the entire organization or even an entire industry.

In taking a design thinker approach, teams in the examples above report experiencing a mindset shift in how they see change. These teams now view change as a central function needed to provide the best service for their stakeholders and understand the importance of change to organizational success. Teams that have made this mindset shift embrace and even champion change, because they no longer see it as something that is forced upon them, but as something with purpose and something they can play a part in creating. Organizations that have used design thinker capabilities have recognized the importance of developing these capabilities so they can further the use of this approach in their work. Companies such as Apple, Nike, Samsung, and IBM have leveraged design thinker capabilities to become iconic brands with strong customer loyalty. However, this success doesn’t have to be limited to these companies that have traditionally been thought of as creative powerhouses. Design thinker capabilities are accessible to any organization willing to foster and build them.

Although becoming a tech icon or growing market share may not be a top priority for healthcare leaders, cases such as Kaiser Permanente demonstrate how design thinker capabilities are applicable to driving real results within the healthcare industry.

The Six Design Thinker Capabilities

Design thinking stems from the study of how designers work. After observing designers at work, researchers found that designers approach their work very differently when compared with other professions, such as business managers, for example. These researchers observed that designers dig deep to understand the needs of people, and then use these needs as inspiration for solutions. They found that designers also explore an abundance of options and are not afraid to try something out to learn if it will work. As Boland and Collopy(9) describe it, the work of traditional management and how they are trained is to select the correct option from a list of existing options, whereas the work of designers and how they are trained is to develop new alternative options. The world today is facing unprecedented challenges with a level of complexity we have never before experienced. These challenges demand new, alternative ways of doing things. Solutions that have worked in the past will not carry us into the future, and, therefore, the designer’s way of working and specifically Design Thinker Capabilities are and will continue to be a growing need.

The concept of “design thinking” was popularized by the design firm IDEO in the early 2000s as an approach to innovation. Whereas design thinking focuses on how designers work (the process), design thinker capabilities focus on the skills that enable the designers’ way of working. The design thinker profile results from a 2017 research study involving 500+ participants across more than 20 industries.(10) The study found that design thinkers: engage optimistically, dialogue visually, explore empathetically, imagine possibilities, embrace collectively, and navigate uncertainty (Figure 2). These capabilities are core to the way designers work.

Figure 2. Design thinker profile.

These capabilities are not mystical gifts bestowed upon a select few. In fact, Chesson’s study found that many of these capabilities currently exist in organizations. For example, when participants were asked to describe the process used in their organizations to solve problems, 88% of the time they used language that described working collaboratively, and 53% of the time they used language that described taking an empathetic approach. Conversely, language that described navigating uncertainty, imagining possibilities, and engaging optimistically was rarely used to describe their organization’s problem-solving process. However, when asked to rate their own problem-solving capabilities on a scale of 1 (low) to 10 (high), participants rated their own capabilities between 6 and 8. This suggests that individuals believe they have skills that are not fully utilized in their work. A comment from one participant further illustrates that, although individuals may have these capabilities, organizations are set up in a way that does not enable them to thrive:

Sometimes it is just hard to maintain that optimism when there are so many forces around me that won’t support ideas. So, there is a constant tension between what I know to be an effective way to address issues and the real world around me. I know you are asking about me yet I am, we all are, constrained by the organization in which we work.

The good news is that some design thinker capabilities already exist in organizations, and it is likely that others exist but are lying dormant waiting to be realized. The challenge for leaders is awakening these dormant capabilities so that their full potential can be realized. Design thinker capabilities exist to some degree in all of us, but to be effective they need to be developed. Think of these skills as muscles: the more we use them, the stronger they get. Leaders who tap into these capabilities can unleash the mindset needed to overcome barriers to change and become strong players in today’s healthcare organizations.

How Design Thinkers Overcome Barriers to Change

Failing to establish a compelling reason for the change, lack of buy-in, and fear of uncertainty are often cited as key barriers to change.(11-13) Untapping the hidden design thinker potential in organizations can be a catalyst for overcoming these barriers.

Establishing the Why

Design thinkers take an empathic and human-centered approach. They engage with customers and teams from across the organization to gain a deep understanding of a problem. For example, they engage with key stakeholders, including patients, external service providers, and staff, not only to understand how they use the company’s products and services but also to learn about the customer as a whole person. Specifically, in healthcare, design thinkers would look to understand a patient’s entire journey, not just how the patient interacts with the healthcare organization. This holistic view of patients helps design thinkers uncover unmet needs and pain points and develops empathy for the problems that people experience.(14,15) Empathy helps design thinkers put themselves in the shoes of others, which enables them to create solutions that are actually meaningful to those that use them. Being able to empathize helps create the mindset for change, because it allows teams to understand why things have to change. When teams feel connected to the pain points, they start to see why things cannot remain the same.

Lack of Buy-In

Another key reason that organizational change fails is lack of buy-in across the organization. Organizations have a tendency to work in silos where departments don’t engage with each other or understand the functions of each area. This means that a change that seems like a good idea from the point of view of one department might not be viewed the same way by another department. Working in silos also makes it easy for those who aren’t involved in creating the change to dismiss it. Design thinkers understand that good solutions are not created in a vacuum, so they bring together stakeholders from all areas of the business. They openly share the issues and engage others in discussing potential solutions. This way of working brings the entire organization on the change journey by engaging representatives from all areas. For decades, change scholar-practitioners have been calling for collaboration, open channels of communications, and early engagement as necessities for successful change implementation.(11,16)

Clearing the Fog of Uncertainty

Another key reason why organizational change fails is a desire to hold on to what is for fear of not knowing what might be (Table 1). Design thinkers address this head on by engaging others in conversations about what could be, to generate ideas. They capture ideas visually to help further the conversation about what could be created. These types of discussions help people to move beyond what they know and start exploring the unknowns and visualizing possibilities. Imagining possibilities gets us a step closer to moving toward change, but questions of “how will it work” or “will it make a difference” linger. Design thinkers address these types of questions by testing out ideas early on, before too much is invested in them. They might take ideas to people who were not involved in coming up with them or, they might put ideas in front of customers, or test them out with friends and family. Design thinkers find ways to make sure that what they plan to do will actually work and make a difference. Imagining possibilities and testing them out provides some certainties about what the future state might be like. With a clearer picture of what could be, change doesn’t seem as scary as it once did.

Design thinkers help shift mindsets about change, first by focusing on why change is needed—to address pain points and create a better experience for stakeholders—and second, by working collaboratively, which organically creates buy-in for new ways forward. Third, by easing fears of uncertainty through ideation, visualization, and testing. Even more encouraging is that design thinker capabilities are not mystical gifts that some people have and others don’t. These capabilities can be developed.

Three Strategies for awakening Dormant Capabilities in Healthcare

Here are three strategies we have found successful leaders use to awaken the dormant capabilities within their teams to overcome resistance to change.

Be Your Own Customer

Build empathy and promote a human-centered approach by asking team members to be their own customer. Every employee of a company should know what it is like to be a customer of the organization for which they work. An effective way to do this is to have employees engage with the company as if they were customers. In healthcare this would mean members of the staff engage with the organization as patients. This does not have to be an elaborate exercise; it can be as simple as going through the check-in process or trying to book an appointment. Once staff members have experienced some part of the patient’s journey, we recommend leaders facilitate discussions to share their experiences. Two questions to ask are: (1) What did you find to be delightful? and (2) What did you find to be frustrating? By encouraging teams to be their own patients, you will help them build empathy while revealing pain points and establishing a compelling case for why change is needed. This type of exercise also serves as a source of inspiration for ideas on new way of doing things.

Day in the Life of . . .

To break down silos and foster collaboration, have one team invite another team to spend time with them to see what they do. For example, a few members from the accounting team might spend an hour with the nursing staff. These types of interactions, although at first they may seem forced, over time help foster relationships across departments and help individuals see what life in the organization is like from another perspective. It may seem impractical to do this type of exercise in a healthcare setting given heavy workloads, patient privacy, and other factors. However, even something as simple as having members of another team observing the nurses’ station for an hour or sitting in a waiting room for 15 minutes can provide valuable insights. Once again, we recommend leaders facilitate discussions about what the teams learned in observing each other’s work.

Host “How Might We” Sessions

As pain points and opportunities for improvements are identified, bring them out into the open where everyone across the organization can see them and ask team members to consider “how might we . . . make this better, solve this problem . . . move out of this situation” (Table 2). If collecting ideas live and in person isn’t practical, designate wall space where people can stick their thoughts on a Post-it note or create a virtual space where people can post their suggestions. This activity helps teams see beyond what is and start to engage in possibilities. This also helps set the stage for why change is needed and provides everyone a chance to participate in creating the change.

So What?

Design thinker capabilities present a way for organizations to overcome traditional barriers to change by creating a mindset shift in how individuals view change. The good news for healthcare organizations is that design thinker capabilities exist in their organizations today, but they go unrealized. By incorporating activities that help awaken these capabilities, healthcare leaders can help organizations improve their capacity for driving change. In using empathy to create a compelling reason why change is needed, by collaborating with stakeholders to imagine what is possible, and by demystifying the uncertainty of the future, design thinkers create a paradigm shift where change is no longer something that happens to people but rather something they help create. As research has found and our experience has confirmed—people support what they help create!

References

1. Buescher B, Viguerie P. Thriving under disruption: how to succeed in the years ahead. McKinsey Quarterly. 2014; (January):13-24.

2. Haughom J. Innovation in healthcare: why it’s needed and where it’s going. Health Catalyst. 2017.

3. Sheppard H, Spearman C, Carter K. Industrial Design: a Competitive Edge for US Manufacturing Success in the Global Economy. Washington, DC: National Endowment for the Arts; 2017.

4. Rae J. What is the real value of design? Design Management Review. 2013; 24(1):30-37.

5. Brown B. The Total Economic Impact of IBM’s Design Thinking Practice. 2018; www.ibm.com/design/thinking/static/media/Enterprise-Design-Thinking-Report.8ab1e9e1.pdf.

6. Body J. Design in the Australian Taxation Office. Design Issues. 2008; 24(1):55–67.

7. Bevan H, Robert G, Bate P, Maher L, Wells J. Using a design approach to assist large-scale organizational change: “10 high impact changes” to improve the National Health Service in England. J Appl Behav Sci. 2007;43(1):135-152.

8. McCreary L. Kaiser Permanente’s innovation on the front lines. Harvard Business Review. 2010; 88(9):92-94.

9. Boland RJ, Collopy F. Design Matters for Management. Stanford, CA: Stanford University Press; 2004.

10. Chesson D. Design Thinker Profile: Creating and Validating a Scale for Measuring Design Thinking Capabilities. Antioch University PhD dissertation. 2017.

11. Kotter JP. Leading Change. Boston: Harvard Business Press; 2011.

12. Kegan R, Lahey LL. Immunity to Change: How to Overcome it and Unlock Potential in Yourself and Your Organization. Boston: Harvard Business Press; 2009.

13. Pardo del Val M, Fuentes CM. Resistance to change: a literature review and empirical study. Management Decision. 2009;41:148-155.

14. Brown T. Design thinking. Harvard Business Review. 2008;86(6):84–94.

15. Liedtka J, Ogilvie T. Designing for Growth: A Design Thinking Tool Kit for Managers. West Sussex, NY: Columbia University Press; 2011.

16. Hiatt JM. ADKAR: A Model for Change in Business, Government and Our Community. Loveland. Colorado: Prosci Learning Center Publications; 2006.