HCD Conference Keynote: The Time Is Now For Change In Healthcare
Whether serving in his previous role of executive editor at Wired magazine, as a book author, or in his current position as entrepreneur-in-residence at the Robert Wood Johnson Foundation, Thomas Goetz has maintained a keen focus on the world of healthcare. In November, Goetz will take the stage to kick off the 11th annual Healthcare Design Conference. Here, he talks about healthcare’s past, present, and future, and why the industry’s new consumer-driven marketplace changes everything.
Healthcare Design: One of the questions that might be on the minds of a room full of healthcare designers in November is: “Why should we listen to you?" What’s your response?
Thomas Goetz: I’ve been thinking about the individual experience with healthcare for a decade and how we can engage ordinary people using the tools and resources that have transformed consumer experiences in every other industry—retail, consumer electronics, architecture. A lot of basic ideas have not made their way into healthcare. My approach is, healthcare doesn’t have an excuse anymore. We have to start applying the best practices that have been tested and integrated into other industries and bring those to healthcare.
Do you feel the industry is ready to accept that?
The healthcare industry has some unique obstacles that make it more complicated and that have traditionally served as enough of an excuse to impede—along with regulations—any kind of movement. I don’t think that washes anymore, especially when you’re getting the impetus coming from consumers as well as from people inside the industry. Care organizations realize that they are in a consumer marketplace. For years, it hasn’t been; but now, with things like the Affordable Care Act, this is becoming a consumer-driven industry.
And that changes everything?
I think it does. Consumers are closer to cost; they’re going to be making more choices based on what they’re getting for their money, for their deductibles, for their co-pays. Hospitals have basically been marketing to consumers based on location, but there are all sorts of other variables, most of which fall under the category of design. Consumer experience is becoming a priority, and that’s very exciting, because once you start integrating design thinking throughout the healthcare experience, you have the opportunity to not just make for a richer, more pleasant experience but also to improve outcomes and comprehension.
Your presentation in November, “Design From All Sides,” will talk about how new ideas and new technologies can mitigate failure and optimize innovation in our healthcare infrastructure. What innovation do you see that excites you and what still needs to happen?
One of the really exciting areas to watch is the idea of information design and physical design coming together. It’s a really potent area in the commercial/technology world. There’s a trend among technology companies to have information-rich facilities that are using and thinking about signage and messaging.
One of the problems people have when they go into a hospital environment is that there’s a big disconnect between people who work in those environments and the people visiting them for care. The people who go there every day see it as their office and they’re used to the hallways and know where to go. Everyone else who enters that environment is terrified, confused, and unhappy on some level. That physical experience is what’s driving a lot of those emotions.
I’m excited to have a conversation about how we can make that better. How can we bring some clarity to basic approaches with signage and language that make people understand where they are and where they’re going, to alleviate and address the fear, insecurity, and anxiety that they’re feeling?
What about healthcare has you most excited?
The recognition and imperative from both sides [consumers and the industry] to take patient experience into account. The [design] community has probably been preaching these lessons for years. It’s getting traction inside organizations now and I’m heartened by that.
What keeps you up at night?
I don’t want people to think about patient engagement or better design and say, ”We tried that and we couldn’t quantify how it saves money or improves patient outcomes, so we’re not going to bother anymore.” I don’t want this to be a trial bloom. Healthcare is hard, and changing things takes a long time. As hopeful as I am that all these things are coming to bear now, I just want to be sure that it isn’t perceived as a fad.
What’s one thing you want the audience to walk away with in November?
Every choice is a design choice. Everything that people decide to do inside a hospital environment—whether it’s signage, or lab test reports, or where to put the whiteboard—is a design decision. Therefore, all of those are an opportunity to make a better experience for patients but also for the people who work there.
A lot of your work centers on the idea that “When we engage in our health, we have better health.” How does design play a role in that engagement?
In essence, we’ve done an experiment for the last 50 years where we throw healthcare information at people without any consideration of design at all and people don’t really react to it. I’m talking graphic and information design, but in that context, the lowest common denominator design is the default. That’s because the people making those decisions are clinicians and researchers, and not designers. They’re only beginning to have designers in the room.
I’m working on a project for the Robert Wood Johnson Foundation on this very problem of data visualization, with a team from the University of Michigan. It’s hard to get doctors not to think about presenting information truly scientifically as if only to themselves. But [the process] starts by opening the door and having designers in the conversation about how are we designing experiences—whether it’s information, or facilities, or tools. How are we building design into the creative process and delivery of these environments for patients?
I should say most doctors are hungry for that. They know they’re not good at it and that there are better ways to do it. We have organizational and institutional issues where we are only beginning to think of hiring those people for healthcare. But we are: Mayo’s doing it, Kaiser’s doing it, Cleveland Clinic has designers. On the other hand, there are amazing designers who are starting to realize that healthcare is this area where they can make a real difference.
Your book, “The Decision Tree,” emerged out of two trends: From public health, that engaging people in their health and involving them as decision-makers can improve their behavior and their outcome. From technology, the emergence of cheaper, better tools that can offer people a way in, through everything from self-tracking gadgets to online disease communities. What about today’s confluence of ideas and technology makes it an auspicious time for healthcare?
There’s been an amazing ecosystem of new companies that have risen in the world of health technology—a whole sector that didn’t exist three to four years ago. I think that’s very encouraging, but I don’t think technology is the whole answer, though.
There’s a spectrum of tools out there that people are starting t
o wrestle with and figure out what works and what doesn’t work for people. In many ways, it’s a large experiment that we don’t know the answer to yet. But what we’re getting for physical design are some best practices. I’m thinking about Michael Graves—he’s thought about this in terms of designing furniture and hospital room equipment from the patient’s perspective and how the patient actually uses it. That kind of orientation is harder with architecture and hardware because you need to design it and manufacture it, but it’s out there. And it’s been encouraging to see all that stuff get off the ground.
I think right now we’re about to enter the next phase where we say, “OK, we’ve been doing this for three, four, five years; what are the best practices and how do we iterate on that?”
In our discussion with readers, the issue of technology and how to incorporate it into the built environment is tricky because technology is constantly changing. But at the same time, readers recognize that they have to figure it out.
Five years ago, when I would tour facilities, there were all these pieces of hardware that were built expressly for patients in specific circumstances, such as home monitoring. It’s expensive to create hardware products that are for a niche audience. What’s changed between now and then, among other things, are things like the iPad. All of a sudden you have the hardware, and the software becomes the actual thing that you’re building to customize. That becomes a much more flexible and agile way of integrating technology into these environments in a way that doesn’t get you locked into hardware products that are going to get old and involve million-dollar contracts. It’s changed the game for hospitals.
For more on the Healthcare Design Conference, Nov. 16- 19, at The Gaylord Palms Resort & Convention Center, in Orlando, Fla., visit www.hcdconference.com.