Flexible by Design, a Homage

I recently had the opportunity to attend the 2012 Healthcare Design Conference HxD in Boston organized and hosted by Mad*Pow and Claricode. I saw many excellent speakers and left feeling pleasantly overwhelmed by the new learnings and perspectives I was able to gain from attending. One talk, in particular, has stuck with me and is very relevant to the work I am doing at Mayo Clinic. Devorah Klein from Design Continuum gave a talk titled: Failure by Design. In her presentation she offered that "since we can't always prevent failure, especially when trying to help people make significant changes to their behavior and health, we must accept that failure is going to happen and design for it". She had many great examples of services that do design for failure and help people move past it, such as Weight Watchers and others that do not, causing people to ultimately abandon their goals.

Over the past few weeks this talk has stuck with me, not because my work centers around helping patients make lasting behavior changes, a worthwhile body of work others at the Center for Innovation (CFI) are deeply invested in, but because it is also applicable to the system design work I am currently engaged with. Over the past year I have been working with a multi-disciplinary team to understand how we can improve our outpatient practice. Through observational research and interviewing providers as well as patients, one of the key challenges we have found is our patient appointment scheduling system does not adequately account for failure. To help better illustrate this insight, consider the following scenarios:

Scenario 1: A person calls schedule to schedule an appointment with a cardiologist because of their heart condition. Our Patient Appointment Coordinators (PAC's) talk to the person and walk them through pre-defined decision trees to ensure that they see the right provider who treats their condition. When they arrive at Mayo Clinic they have a very successful appointment with this provider; however, the provider uncovers that in addition to their cardiac complaint, they have uncontrolled diabetes which is a contributing factor to their overall health and will impact how their cardiac problem is treated. At this stage, the cardiac specialist realizes they need to have their patient see an endocrinologist but one is not available until the following week as their schedules are fully booked.

Scenario 2: A person calls to schedule an appointment and talks with a PAC. They describe their symptoms and the PAC again uses decision trees to triage them and ensure the patient sees the right provider. The appointment is set and when the patient comes to see the provider, say a neurologist, the neurologist discovers that the symptoms the patient reported and the appointment was set-on are not accurate and do not fit into his area of expertise. At this point the provider realizes the patient would be best served needs to see one of his colleagues however, an appointment with this person is 1 month out and the patient is expecting answers from their encounter.

Both of these scenarios do not happen frequently at Mayo Clinic; however, they do happen and when they do, both providers and patients are frustrated with the system and feel disappointed with the interaction. Some may look at these situations and say "why is the scheduling system at Mayo not perfect" but his would be missing the point. The point is the scheduling system at Mayo is excellent for how it was designed but it has not been designed to anticipate and expect failure, or rare instances, which is necessary in a complex system.

With this insight, we are now looking at innovations that will change our current scheduling system. We are not looking to design the perfect system, rather a flexible system that can handle failure seamlessly and quickly realign resources to best meet the needs of the patient. As we are digging into this challenge we are aware that this type of systemic change is a very large undertaking that, if successful, will challenge many core business and operational principles in place at Mayo Clinic.

While I do not have the ultimate solution today, my take-away from the HxD conference and Devorah's talk is that so much of what people are talking about, if viewed from a slightly different perspective, offer us as designer's fundamental principles that apply to universal design problems.


Meredith DeZutter is a Senior Service Designer at Mayo Clinic's Center for Innovation. Her recent HxD entitled, "Aligning New Care Models for the Patient of the Future," highlighted her work towards Practice Redesign platform's goal: reducing outpatient costs for Mayo Clinic by 30 percent while improving the patient experience, maintaining & enhancing quality outcomes.