Designing health


As the Irish election looms, our health sector is a major issue on the doorsteps. Leo Varadkar has stated that there is no quick fix to the system, and only incremental, strategic changes over time will improve the service. We spend enough (relative to other countries) on health to expect a better service and results. Recently launched was the Health Innovation Hub to encourage private companies to jointly develop products and research with the health services.

Last year, as I lugged my child’s bulky manilla folder of medical files from department to department in hospitals, and spent a half hour explaining her history to each of the multiple medical professionals I met, it definitely didn’t feel like the most efficient service. The waiting time for letters to be transcribed, signed, posted and delivered can seem like an age when we live in a world on whatsappslack and co. Realising the hospital pharmacy shuts at 5pm seemed a bit bizarre – don’t get sick out of office hours is the lesson. I also experienced the trolley crises. Next time you complain about a wobbly wheel on your supermarket trolly, go spend a night in A&E.

Things are moving though. Public consultation on Electronic Health Records (EHR) for all is ongoing with Richard Corbridge of eHealth Ireland (part of HSE) leading the initiative. However, is pushing for patients to maintain their own records, as opposed to a hospital or state owning them. eReferrals from GPs are being successfully piloted. Unfortunately, technology is generally regarded by the HSE/Government as a cost, not an investment. Public sector websites for instances are procured under IT rather than creative/marketing.

Glohealth recently launched their ‘Skype’ GP service, which allows you to video call a doctor 24/7. Surely when this goes mainstream it will reduce waiting times in primary and secondary care centres? There are apps now that give real time surgery updates – to reduce the stress of loved ones in the waiting room. I suppose that depends on the outcome of the surgery. Technology is years ahead of our public system. I recently saw an app demoed that enquired as to why the user hadn’t left their house in days and hadn’t answered any of their  close friends calls? Are they feeling down? Would they like their GP to call them? This is the future.

The goal of all health systems should be prevention not cure. However the obsession to optimise the existing diagnosis/post diagnosis system means we are starting the plan at the wrong place.

Interestingly, when I look through the list of job titles in the HSE and entire public sector, there is not one person with a job title of ‘designer’. I say let the designers at the health system. We are trained to think about the user (patient) and to design a system with them at the heart of it. Not an IT system, but a customer experience. Who can remember the last time they completed a satisfaction/feedback survey from a clinic or hospital? NPS for medical professionals?

Is there anywhere in Ireland I can go and look at a map that shows how we are going to improve (and monitor) the nations health and the medical system when they do need treatment? Does anyone have that plan? I could probably sketch it out on the back of a fag packet if anyone ever asked.

Finally, regarding the huge cost of our health system. How much would one free mandatory health check per person per year cost us? How much would one free mandatory health check per person per year save us? Health has always been, but is now fully recognized as real wealth. If we put as much effort into designing our health system as into complex financial products and spin doctoring, we could create something world class.

The election is over but without a government in place we have no health minister. The HSE however are still in town and for all intensive purposes are the health system. In March’s magazine, I looked at some of the issues in the health service in Ireland but also some of the amazing innovations going on globally. Smart design can sort our health system in Ireland and create an international template for best practice.

The idea of ‘user’ centricity or in this case ‘patient’ centricity is not new. It is however more of a written concept than a practised concept. Really understanding the entire patient journey can improve the interaction and outcome. However most Health Care Professional (HCP’s) have a small task to complete in the overall patient journey and are often unaware of what comes before and after them. Many private companies have intensive on boarding training that requires staff, no matter their level to work in all areas of the business for a period of time e.g McDonalds senior management work behind the restaurants counter. If the HSE / Dept. of health practiced this I am sure there would be a far more holistic view and better outcomes for all involved. Disney, Apple, Amazon, Zappos are some of the leaders in this area. As opposed to looking at healthcare in other countries look at how top brands do it.

To become more patient-centred, the Mayo Clinic in the U.S changed it’s design systems scheduling routines, staffing, and facilities to revolve around patients, rather than physicians or other care providers. It now schedules work based on what will provide the most effective and efficient experience for the patient, instead of what is convenient for the physician. Weekend consultant in Ireland anyone?

Patient centricity is currently a key focus for the pharmaceutical industry. Without the pharma industry of course the Irish economy would be a shambles. Traditionally a sales focussed industry the idea of really understanding a patients life and journey is now seen as key to being a trusted and helpful pharma brand. This of course in turn affects a companies culture and becomes a more attractive place to work. In a sector where talent acquisition is a huge factor this is a win win. Ultimately designing a better experience can improve the outcomes for all parties.

One of the key issues in health is adherence, literally taking your tablets, or administering an injection at home. Patients comply with their medicine schedule somewhere between 50-70%. So up to half of patient issues regarding non adherence could be solved. Companies like Health Beacon which monitors adherence by sending texts as reminders when medicines are not taken and AI Cure which uses artificial intelligence to confirm ingestion in clinical trials and high rick groups are just two applications of smart design to solve problems that were almost seen as impossible to fix.

Well designed technology has made it much easier for HCPs to access the data they require. Many GPs now spend more time looking at their screens than at their patients. Live consults with other HCPs online is an amazing way to speed up diagnosis though and is growing in specialist areas with the use of platforms like DefinitiveDx. HCPs use online resources to find drug information, prescribing guidelines and even view the highlights of a seminar that they couldn’t attend. These technologies need to be maximized in our system which is obsessed with a longer more staged based.

Burning books. Having experienced the health sector intimately in the last few years I have to address my personal pet hate. Paper based healthcare systems to me are something from another era. Without universal digital data the health system is hamstrung with administration and processes. Most tech companies have completely automated this part of their business. HCP’s should be delivering healthcare not health administration. This change needs dictatorial like leadership. I’m not sure who has the strength or vision to do this. Estonia have the world’s first digital led public sector. Flights to Estonia are commonly filled with Irish public sector fact finding missions. Stop finding, start doing. And get some design help while you are at it. Recognise this skill set does not exist in the HSE. The design industry is waiting to help.

This article was originally published in magazine in February and April 2016.