(This article was published in the November/December 2010 issue of interactions magazine.)
It seems likely that we find ourselves at an inflection point in the evolution of healthcare. While the situation has certainly been brought to a boil by recent American political events, the opportunities for change fit into a much larger context; they have the potential to truly transform the delivery of healthcare globally.
Unlike some, I don’t believe our current healthcare system is totally broken. I’ve conducted design research in quite a number of clinical settings and have consulted for businesses representing many different aspects of the healthcare industry, including provider networks, medical-device manufacturers, and even health insurance companies. I’ve seen magic worked on regular basis, and from a historical (and global) perspective, the standard of care in the developed world is astoundingly high. I am in awe of the abilities of doctors, nurses, techs, and other clinicians to consistently function at a very high level despite the fact they’re forced to work with archaic infrastructure in less than ideal environments. (As for the insurance companies, perhaps the best thing to say is that they function to make money but could be dramatically more successful as businesses if they changed their approach to things.)
It is at this level—the level of infrastructure—where these big opportunities for transformation exist. It isn’t that we don’t know what kinds of patient and clinician behaviors and medical interventions result in healthy outcomes; it’s that at a systemic level, we’re not doing a good job facilitating these behaviors and driving appropriate interventions. The right changes here will provide a conduit for evolutionary change to cascade throughout the system to achieve dramatic improvements in the quality and cost of healthcare. Which isn’t to say that it also isn’t incredibly important for medical knowledge to continue to evolve; it’s just that we already know enough to dramatically drive up quality and drive down costs.
Many of the opportunities to improve our healthcare system can fit into three big categories: proactively engaging individuals to take better care of themselves; providing better interventional care beyond the walls of the hospital; and improving care delivery inside hospitals through standardization and better collaboration between clinicians, patients, and families. All three of these strategies require new infrastructure and perhaps a shift in the definition, role, and activities that characterize the hospital.
The first two ideas are mostly about what happens outside the hospital. These are things that architects wouldn’t traditionally worry about when designing hospitals. But that kind of thinking has gotten us into our current predicament, where the current built “environment” for providing healthcare is sometimes an impediment to necessary change. If we step back and define a hospital as the nexus for healthcare in a community, we have a platform on which we can imagine the ideal infrastructure for keeping people healthy as possible in a cost-effective way.
In the May+June 2010 issue of interactions, Hugh Dubberly suggested designers ought to help reframe what healthcare is and how it is delivered, as well as to reframe what it means for design to help. I couldn’t agree more, and in this spirit, propose reconsidering what healthcare infrastructure is necessary to better care for people, how design should address this new notion of infrastructure, and what this all means for the institution of the hospital.