Viewpoint July 7, 2010, 3:01PM EST

Redesigning the Health-Care System

Health-care executives need to take a leaf from Apple's playbook and consider a patient's experience with the whole system

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In March, Time magazine publicized an Amnesty International report about pregnancy and childbirth in the U.S. In "Deadly Delivery," co-author Nan Strauss wrote that American women are at greater risk of dying from pregnancy-related causes than women in 40 other countries. She attributed this to several factors, but a single root cause was: a fragmented system.

A day spent on the phone with tech support or in line at the DMV is enough to illustrate the inefficiency and waste in fragmented systems. But when we're talking about health care, fragmentation is tragic. Recent legislation in the U.S. has attempted to bridge some of the system's most jarring gaps, but health-care companies still tend to focus on individual components of the patient journey, maximizing immediate efficiencies but losing sight of the total experience. Consequently, patients are shuttled from generalist to specialist to surgery to clinic to pharmacy, passing though dozens of different rooms and record systems along the way. Each of these transitions presents a pain point to the patient and an opportunity for error to the provider. It doesn't take a designer to see what a difficult journey this is, rife with redundancy, wasted effort, and potentially catastrophic mistakes.

But design can help. What design thinking can offer is a practiced eye for integration opportunities: connecting adjacent but unconnected pieces of the patient experience to create small, incremental improvements. The integration process begins with a question—"What's right for the patient?"—and proceeds to a deep examination of the patient journey, resulting in a holistically designed experience that benefits all.

A New Home Ventilator

Respiratory support, for example, has historically been divided into two quite different types. In the hospital and clinic, patients can be hooked up to a number of different mechanical ventilators—expensive, complicated pieces of machinery that allow clinicians to control breathing support precisely. At home, PAP ventilators are used, smaller, simpler, noninvasive devices that home caregivers can operate. Philips Home Healthcare, one of the world's largest manufacturers of these devices, recognized an opportunity to bridge the two categories. Working with them, we developed the Trilogy100, which combines much of the function of a hospital-grade ventilator with a dual-mode interface, meaning clinicians get the control and information they want, and home users get an unscary device with an intuitive control panel. This means fewer costly trips back to the clinic and less paperwork for administrators, while the unit's portability allows chronic patients to integrate therapy into their daily activities, affording them greater independence. It's a small step toward integration, but for patients with respiratory problems, a potentially life-saving and life-enhancing one. Philips estimates it'll have won 20 percent of the home ventilation market within the first 18 months of the product's release.

Kaiser Permanente's "Total Health" initiative emphasizes preventative over acute care. In December 2009, Allison Arieff wrote a story in The New York Times about the health-care giant's attempts to rethink and redesign every aspect of its operations, "from medical records to medication administration, color palettes to carpet," all in an effort to create more integrated patient experiences. Kaiser identified 22 key steps in a patient's journey, including check-in, visiting the pharmacy, even walking along a corridor. Changing the design of the patient bed's headboard saved Kaiser $2,369 per room. The real beauty of this initiative? Kaiser is a highly visible player in the industry, and other providers are watching them closely for signs of success.