A project on reducing medication errors illustrates human-centred design thinking, says Jennifer Taylor
Innovation: an uninterrupted flow of ideas
Changing technologies or spaces can enhance patient experience, but healthcare is fundamentally about people treating people. That is why Kaiser Permanente uses human-centred design thinking to improve the delivery of care. Doctors, nurses, patients, families and managers at all levels are involved, with Kaiser’s design team acting as facilitators.
We don’t call it an innovation until it shows value in the system
“You need to understand the causes of some of those errors and the behaviours behind them,” she says.
That can be uncovered by observing staff and patients in the care environment (see methodology slide), which yields different results from those of surveys or focus groups where, Ms Zuber says, “people tend to say what they think you want them to say”.
Kaiser gathers stories, then presents them to the multidisciplinary group. In the next step - synthesis - they look for metathemes. Interruptions were a metatheme that came out during the observations about medication errors.
The group brainstorm solutions, then choose their favourites to mock up as prototypes. If the solution is a new technology, they build it out of cardboard or other materials and if it is a new workflow they act it out as the people involved.
After getting feedback on the ideas Kaiser takes them away for refining, then brings them back to the hospital for field testing. Refinements are made until a solution is found that works.
In the project on medication errors, they learned from airline pilots, who operate a sterile cockpit during the first 10,000 feet of landing and take-off, which means there are no extraneous conversations.
The outcome was a reflective sash that nurses wear when they are doing medicine administration. It is a visible reminder to others and themselves that they should not be interrupted. A step by step process for medication administration has also been implemented and together the changes have reduced medication errors.
Nurses are also trialling a handheld device with multiple timers to remind them to reassess patients after medication administration.
One project, called the nurse knowledge exchange, looked at handover of patients between shifts. Information had been exchanged by tape recorder, which was time consuming and impersonal. Now there is a verbal handover at the bedside, which involves patients and allows the takeover nurse to ask questions.
“When you’re working on innovations I think it’s important that you try to work with evidence-based design and show that it’s making an impact,” says Ms Zuber. “We don’t call it an innovation until it shows value in the system.”
South Devon’s enhanced recovery
South Devon Healthcare Foundation Trust adopted the enhanced recovery model of care with the aim of enabling patients to recover sooner after surgery. Every stage of the pathway - before, during and after surgery - is made as short as possible and focuses on the patient’s needs.
Patients are given information so that they understand the risks and can be active participants in their own care.
“Through far greater understanding and attention to detail along the whole pathway they will have a much clearer idea of their care,” says Kerri Houghton, consultant anaesthetist and clinical lead of the NHS Centre of Innovation and Training in Elective Care at South Devon.
The trust started in 2005 with colonic surgery. Hospital stays have dropped from around seven to 10 days to six days. The addition of robotic surgery is driving that down to less than four days.
The approach is applicable to all types of surgery. The Department of Health predicts that if the pathway was implemented nationally in colorectal, gynaecology, urology and musculoskeletal surgical specialties, between 140,000 and 200,000 bed days could be saved.
The connected home
The traditional crisis model where sick people are rushed to hospital is the most expensive way to deliver healthcare.
“That will not be sustainable within a decade,” says Yan Chow, director of Kaiser Permanente’s Innovation and Advanced Technology Group. The group evaluates technologies coming to healthcare in the next two to five years and makes recommendations to Kaiser’s leadership.
“The mobile phone is going to be the core of the healthcare future,” he predicts.
One example of where it will be used is in what Kaiser calls the connected home (pictured). Patients will have devices for measuring blood pressure, pulse, and so on, and the data will be sent to their care provider via their mobile phone. Frequent monitoring means intervention can be given earlier.