At UVA's Medical Design Program, we train tomorrow's physicians in design thinking to address the challenges of our changing health system


Modern healthcare is changing rapidly. Complex challenges like epidemics of obesity and diabetes, inequalities of healthcare access and quality, rising costs, and dramatic policy shifts demand new solutions. At the same time, groundbreaking research discoveries, innovative technologies, and new therapies present unprecedented opportunities to improve human health.

These challenges call out for a new kind of doctor – creative physician-leaders with clinical mastery and the ability to design and deliver patient-centered solutions to seemingly intractable problems. Skilled at systems-level thinking, innovation, and patient advocacy, these doctors will be ready to work with and lead interdisciplinary teams reimagining our healthcare system.

At UVA's Medical Design Program, we’re training doctors like this with design thinking, also referred to as human-centered design.

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What is design thinking?

Design thinking, or human-centered design, is a core problem-solving method employed in many disciplines. It provides a structured approach for tackling complex problems that require systems-based solutions. Specific emphases are given to:

  1. Developing empathetic understanding of groups of people – for example, patients – and the challenges they face
  2. Rapid prototyping of products and services to help meet unaddressed needs
  3. An interdisciplinary approach to creating systems-based solutions

Design thinking has been successful at driving innovation in healthcare, the technology sector, and other fields. We are applying it to one of the most important issues in medicine: preparing future doctors to improve healthcare at the patient and system level around the world.

It’s more than just a design course. You learn how to truly listen and learn from a patient interview, and learn what it means to really empathize with a patient.
— Dhruv Desai, SMD'19
 

A Year-Long Design Thinking Elective for First Year Students

The Medical Design Program offers a year-long elective teaching essential design thinking skills for future physicians to first-year medical students. Over the course of an intensive training program in the fall semester, our students learn the basic tenets of design thinking, as well as clinically-relevant skills like design-based interviewing techniques, how to translate empathy into action helping patients, and rapid prototyping to develop solutions to a range of healthcare problems. Students learn by doing in experiential, hands-on workshops, learning from world-class educators and practitioners in UVA's Health System, graduate schools, and nearby professional firms. In the spring semester, students participate in a variety of workshops that help them learn how design thinking has been applied at micro and macro scales, in and outside of healthcare.

 

2015-2016

In the Medical Design Program's first year, our students partnered with members of UVA's Be Safe quality improvement initiative to learn design thinking by applying it to two important issues in the health system.

Reducing Inpatient Readmissions

At first glance, a hospital’s 30-day readmission rate is a simple metric: how many patients are readmitted to the hospital in the month following a prior admission? But when a patient is in this situation, it is often the result of a complex interplay of pathophysiologic, socioeconomic, cultural, and other factors. Our students delved deeply into the patient perspective, working with patients and health system leaders to identify how we might empower patients to stay well and avoid repeated hospital admissions. The team realized that confusing discharge instructions caused patients to have a hard time following their treatment and follow-up regimens after going home, leading to readmissions. Students proposed improvements to the “After Visit Summary” that each patient receives at the end of a hospital stay so that each patient would have a clear understanding of what to expect after discharge and how to maintain their health at home.

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Preventing Inpatient Falls

Falling in the hospital can be extremely debilitating for patients. Preventing patient falls has become a quality-improvement priority at hospitals throughout the United States. But despite these efforts, falls remain difficult to prevent across the health system. Our students worked on potential solutions to this issue using a variety of design research methods, including role-playing sessions that simulated navigating a hospital with various disabilities, to understand the challenges that patients face and the factors that cause patient falls. The team’s research led them to reconsider two important factors: (1) bathrooms are the site of most falls. The design of bathroom thresholds and spaces is highly variable, so the team proposed standardization to accommodate patients with limited mobility. (2) Trying to walk with poor balance and vision, some patients lean heavily on rolling IV poles, turning them into dangerous "canes-on-wheels.” This insight led the team to explore how they might redesign common hospital equipment and develop new walking aids to reduce the frequency and severity of inpatient falls. 

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Comfort in the ED Waiting Room

The Emergency Department waiting room is often an unfamiliar, uncomfortable, and even frightening place for patients. At the same time, it is also many patients’ first encounter with the health system. Our students tackled the issue of how we might improve the waiting room experience, and ultimately, patients’ overall experience at the hospital. After interviewing patients and families in the ED waiting room and other waiting areas around the hospital, students synthesized their findings into several patient- and family-centered solutions. One example: the "Comfort Cabinet,” a collection of supportive items - like water and warm blankets - that front desk staff can provide for patients to make them as comfortable as possible as they enter the ED.

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2016-2017

With a major renovation of the UVA Emergency Department (ED) underway, students did extensive research in the ED to surface insights about how UVA might improve and transform important aspects of the ED experience for patients, their families and caretakers, and clinicians. At the end of the spring semester, they presented the results of their research and made recommendations to ED leadership. 

Transparency in Patient Admissions

After it is determined that a patient should be admitted to the hospital, a patient can spend hours in the ED waiting to be admitted. This contributes to the limited number of beds available for seeing new patients, thus increasing wait times for new patients entering the ED. Furthermore, being admitted to the hospital is a long, multi-step process that involves multiple departments. Frequently, patients and families are frustrated by how long the admission process takes. Our students examined how best to communicate this complicated (and often uncertain) process to patients and their families. As a result, they imagined a digital dashboard that would pool information from the patient's electronic medical records and the hospital's bed management system to provide real-time updates to patients, keeping them informed about the admission process and alleviating much of the anxiety of waiting.

Reimagining the Waiting Room

Patients and their loved ones want to feel valued and cared for as soon as they enter the hospital, but the crowded and unpredictable nature of the ED often leads to long, uncomfortable waits, especially for patients with low-acuity issues. Students re-imagined the waiting room and explored ideas from outside the healthcare sector for how UVA might provide a comfortable, reassuring, and even enjoyable waiting room experience. For example, students looked at ways to allow patients to move freely about the hospital, such as by using a restaurant-style buzzer system for queueing and notifying patients when a space is ready for them in the ED. Students explored ways to make waiting enjoyable and entertaining, such as "in-flight movies" and amusing features of lines for theme park rides. They also developed ideas for more spaces where patients could wait, such as a café near the waiting room, a children's play area, and grouped seating for families, and how to apply principles of biophilic design to make sure that the waiting room helps keep patients calm and relaxed while waiting for care. 

Comfort and Privacy for Hallway Bed Patients

In crowded EDs, patients don’t always get a room to themselves. Some end up being treated in beds lining the halls due to space constraints. Some patients like the hallway (“It’s like a front row seat!”) but others find it uncomfortable and unpleasant. Our students examined how to improve the hallway bed experience for patients in light of patients' differing treatment needs, desire for privacy, preferences and expectations about the ED experience. Students explored ways that comfort and privacy might still be provided in this care setting via modular walls, shielding space dividers, and re-imagined fast-track areas that boost ED throughput and reduce or eliminate the need for hallway beds.

Empowering Patients with Information

Patients want to know what’s going on when they're in the Emergency Department, keeping up with information about wait times, medications, procedures, admissions, discharges, and more, but this information is not always clearly provided to patients and their caretakers. Furthermore, patients enter the ED with a number of questions and worries already on their minds from the moment they enter the door. In order to inform patients about their ongoing ED experience, students considered implementation of tablet-based resources to improve patient education and increase patient satisfaction with their ED visits.

 

2017-2018

In the Medical Design Program's third year, our students developed their design skills through workshops conducted with a range of partners in and outside UVA. These included internists and surgeons from the health system, entrepreneurs, investors, and strategy experts from UVA's Darden School of Business and Licensing & Ventures Group, and design professionals from mobile application development company WillowTree and architecture firm VMDO. For more information about how the Medical Design Program teamed up with VMDO, see this article.  

I think our biggest goal is to teach others that it’s okay to look up from the science to find patient-inspired solutions. There is strength in understanding that evidence-based medicine and human-centered medicine aren’t mutually exclusive.
— Emily Schutzenhofer, SMD '19
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