Book Excerpt September 24, 2009, 5:00PM EST

Change By Design

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My design consultancy, IDEO, proposed that rather than hire a slew of internal designers, the existing staff should learn the principles of design thinking and apply them themselves. Over the course of several months we conducted a series of workshops with nurses, doctors, and administrators that led to a portfolio of innovations. One of them—a project to reengineer nursing staff shift changes—involved a strategist with a nursing background, a specialist in organizational development, a technology expert, a process designer, and a union representative.

Working with frontline caregivers at each of four Kaiser hospitals, the core team identified the problems that occur when shifts change. Departing nurses routinely spent 45 minutes briefing the arriving shift about the status of their patients. The procedures were unsystematic and differed from hospital to hospital, and methods used for compiling information varied from Post-it notes to numbers scrawled on hospital scrubs. Knowledge was often lost, and many patients felt the shift change created a hole in their care. What followed from these observations were the now-familiar elements of a robust design process—videotaping, brainstorming, role playing, prototyping—carried out not by professional designers from IDEO but by Kaiser's own staff.

The result was a complete change in approach. The first prototype, built in only a week, included new procedures and simple software that enabled nurses to call up previous shift-change notes and add new ones throughout their shifts. More important, patients were now part of the process and could bring up additional details important to them. Kaiser measured the impact of this change and found that the mean time between a nurse's arriving on shift and first interacting with a patient was more than halved. The innovation also had an impact on how nurses felt about their job. In a survey, one commented: "I'm an hour ahead, and I've only been here 45 minutes." Another admitted: "This was the first time I've ever made it out of here at the end of my shift."

The new procedure had an impact on patients and nurses but on its own was a long way from achieving the desired goal of a systematic improvement in the overall quality of health care at Kaiser. To achieve that, the core team of nurses, development experts, and technologists went from carrying out their own projects to acting as consultants to the rest of the organization. Through the Kaiser Permanente Innovation Consultancy, the team now pursues the mission of enhancing the patient experience, envisioning Kaiser's "hospital of the future," and introducing innovation and design thinking across the Kaiser system.

The design thinkers I have described here are not minimalist, esoteric members of an elite priesthood, and they do not wear black turtlenecks. They are creative innovators who can bridge the chasm between thinking and doing because they are passionately committed to the goal of a better life and a better world around them. In the process they are helping to make our societies healthier, our businesses more profitable, and our own lives richer and more meaningful.