Don Norman: Designing For People

Nielsen Norman Group

The UCSD Design Lab Philosophy on Health Care

One summary of the UC San Diego Design Lab's philosophy on healthcare is "Don't Drop the Patient."

What do we mean by "Dropping the patient"? The insight -- and the catchy phrase -- comes from Dr. Eliah Aronoff-Spencer, the physician who directs the Design Lab's Center for Health. Eli observed that many medical errors and difficulties in treatment result from lapses in the medical care: Basically, it means losing track of prior thoughts, analyses, and even testing results as the patient gets passed from clinician to clinician, clinic to clinic, and ward to ward. Multiple transitions and poor communication and limited oversight create a perfect setup for error, for dropping the patient. Miscommunication is at the heart of many poor handoffs in part due to the numerous transitions and distractions: e.g., shift changes and patient transfer between wards, clinics, specialists, laboratories, home, and hospital. The risks self-multiply leading to more tests, specialists, and transitions. In all cases, the chance for incomplete or erroneous communication between the various providers and the patient and family is high. Press, a primary care physician, documented the transitions during an 80 day period for one of his patients: 12 clinicians, 5 procedures, and 11 office visits. The primary care physician communicated with clinicians 40 times and with the patient and his wife 12 times. As patients and their records continually traverse the complex treatment chain, quality of treatment, the likelihood of a positive outcome can drop while costs rise. This system needs radical overhaul┬╣

What is the solution? We are writing a paper on this2, but the essence is that we need to think of the healthcare system as a system, with complex, dynamically changing parts. Simple fixes will not work. Moreover, the culture of every hospital and clinic is different, so although the high-level description of the solution will be the same all over, each clinic and hospital has to be treated independently.

┬╣. Press  MJ. Instant Replay -- A Quarterback's View of Care Coordination. New England Journal of Medicine 2014;371:489-91.

┬▓. Aronoff-Spencer, E., Ziedonis, D., and Norman, D. (Feb. 2018). Let's Stop Dropping the Patient: Designing a People-Centered Healthcare System. Unpublished manuscript.

It's a difficult problem.

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