Designing the 'Care' into Health Care
In the current political debate over America's health-care crisis, candidates' solutions appear to be divided along party lines. Democrats want to offer universal health care (but to varying degrees and in slightly different ways) while Republicans, if they have commented on the issue yet, promote a free-market approach. The debate boils down to varying levels of commitment to universal coverage and ideas about who's going to pay for it.
To a designer's eye, efficiently providing for a basic need is indeed the fundamental issue. But it should be possible to go beyond rudimentary solutions to achieve the overall objective of a healthy population by also addressing an essential question: What does the individual want and need from the experience of health care?
The fact is, even among those covered by insurance, no one is happy with the American health-care experience today. It is an expensive, complex system to which people resort only when a problem has grown threatening. Focusing on improving the user experience could inspire people to tap into the system more regularly to support healthful choices that could help stave off more serious illnesses. Innovations are called for that are relevant to people's needs and encourage compliance, improve communication between doctor and patient, and help people help themselves be healthy. The candidates today have an opportunity to put the "care" back into health care.
Consumers Want to Be Empowered
Of course, while wellness is a desirable goal, a health-care redesign isn't only about getting everyone to take care of themselves before and as they get sick. It is also about the bottom line. Workers are expensive. And as journalist Richard Seven noted in The Seattle Times in 2006, "Unhealthy workers are the most expensive of all. In any given year, 10% of them account for 70% of the health-care costs. Many of the expensive chronic diseases such as some types of diabetes and cancer are lifestyle-related, meaning somewhat preventable." Seven reported that Caterpillar (CAT) projected its wellness program may save about $700 million on health costs by 2015 and that Motorola (MOT) reported in 2003 that it was saving $4 in health-care costs for every $1 it spent on wellness.
Ziba Design's research, conducted for a number of medical and pharmaceutical companies, indicates that consumers want to be empowered to make choices that enable them to live a long, healthy, happy life. The health-care system has evolved from an "Age of Entitlement" (from the 1930s to the 1970s, when employee benefits proliferated and group health care gained popularity), through a have and have-not "Age of Privilege" that existed from the 1970s to 2000, when health costs rose, forcing many to go without health insurance, and cheaper, managed-care plans replaced employer-sponsored group plans.
Today, we live in an "Age of Responsibility," when consumer-directed health plans are gaining momentum to counteract rising health costs. Consumers have the opportunity to exert more control over spending their health-care dollars, and to judge their health-care outcomes. Girding this trend is Web 2.0, which promises to empower consumers with healthy lifestyle information and better communication with health-care providers.
What the Future Looks Like
What lies ahead is an opportunity to design a health-care experience that reflects our nation's desire to help itself be healthy. Let's call it the "Age of Empowerment," when we innovate to create healthful experiences that can save money, support better clinical outcomes, and improve patient quality of life.
Design thinking can lead us there. Institutions like the IIT Institute of Design in Chicago have begun researching design-based solutions to the health-care problem. Their Rethinking Health initiative aimed at creating human-centered, systemic solutions was recently awarded a generous grant by Robert C. Pew, chairman of the boards of both Steelcase (SCS) and the Institute of Design, that will allow large-scale systems design, economics and design, and user-centered design research.
Here are some examples of what health-care experience innovation looks like:
Empowerment through self-care: Home-based dialysis is an example of self-care that provides a win-win solution for everyone. A recent report published in the medical journal Peritoneal Dialysis International recommends home-based services as the treatment of choice. The report, written by Fresenius Medical Care, the largest provider of in-center dialysis care in the country, states that "patient independence, lower mortality, reduced hospitalizations, higher overall satisfaction by patients, and lower costs are clear benefits to the [home] dialysis provider. Providing patients with the option to choose is clearly the right path, and exactly what we would want as patients."
Glucose monitoring for diabetics is a good example of self-care, with Roche (ROG), Lifescan, and Abbott (ABT) leading the way selling blood test strips for personal use. Experience innovation in the design of easy-to-use glucose monitors and supporting online services have replaced the days of cumbersome, multistep test kits that provided limited information. Today, smart monitors provide the patient with information related to diet, medications, and other factors that enable them to better manage their glucose levels and are connected to caregivers who can support a patient's care.
Empowerment through service innovation: Company health programs can support employee wellness. Pitney Bowes (PBI) set up health clinics at its largest sites, with appointment hours available before 8 a.m. and after 5 p.m., made healthy changes in the cafeteria, encouraged workers to take the stairs rather than elevators, and to wash their hands regularly. They have also given employees pedometers to reach a goal of 30 minutes of exercise per day. Joseph Straw at The New Haven Register explained the additional boost to the bottom line: "The return comes in increased productivity, fewer sick days, and reduced costs in worker's compensation and retiree health care, all of which they said should be viewed as part of health-care costs."
Retail health clinics like MinuteClinic offer patients quicker, more affordable, and more convenient diagnosis and treatment of common illnesses. This provides a simple, cheaper solution for many patients who tend to avoid the doctor's office until they are really sick because it costs too much and takes too much time. Clinics are popping up everywhere, with over 200 clinics in more than 20 states.
Empowerment through Internet technologies: Online tools allow people to manage their own health records and maintain a comprehensive history. For example, Microsoft's (MSFT) HealthVault will offer free, secure personal health records that, once given permission by a patient, will be made accessible to doctors, clinics, and hospitals. Reliefinsite.com allows doctors, clinics, and patients to work collaboratively to map, monitor, and analyze pain.
Social networking and online community-building tools have the potential to create healthy communities. Imagine a help desk that would extend health care beyond limited office hours; the use of e-mail, chat, or Twitter for drug regimen updates; RFID for monitoring and medical device identification; visualization tools for patients to chart sources and severity of pains, symptoms, and drug intake, to show doctors during later visits. The sky's the limit.
User-centric experience innovations need not be relegated to businesses using design to establish a loyal bond with their customers. Applying time-tested design methods to a national institution like health care can help ensure that our citizens not only have affordable care, but that the quality of the care actually empowers them to live the lives they desire. Nothing much: just a long, happy, healthy life.
Ziba Creative Directors Eric Park and Jeremy Kaye contributed to this article.