Talk at the Health Design Conference at Rice University April 2018

1. Integrating Design Using
the Native Language of
Healthcare
Joyce Lee, MD, MPH
Robert Kelch Professor of Pediatrics
http://www.doctorasdesigner.com/
Twitter: @joyclee
@joyclee

2. Unitio
Lenovo (Grant Funding)
DISCLOSURES
@joyclee

3. Pediatrician/Diabetes Specialist
Health Services/Clinical Research
Clinical Translational Research
Participatory Design/Maker Movement
BACKGROUND
@joyclee

4. @joyclee

5. This is not my reality
@joyclee

6. xxxxxxx-diabetes-fax@med.umich.edu
@joyclee

7. Don’t fix the problem, make the USER Do a
workaround
@joyclee

8. Don’t Change the Default, Send an email Reminder
Hide Admin Docs
Email:
“The EHR made ”Hide Admin Docs” the default which hides lots
of documents.
If you are unable to find something that was imaged, first look to
see if the “Hide Admin Docs” box is checked and uncheck the
box if it is””
@joyclee

9. ”Do not follow these instructions-it will create the most
work possible”
Give instructions that go against the user’s best
interest
@joyclee

10. MD=“Medical Designer” @joyclee

11. Engaged Learning for Students
from UMSI/Art & Design
Design Thinking Workshops for
Medical Students
@joyclee

12. Design/Maker Workshops
Apps Design by Teens
Participatory Design/
Maker Workshops
@joyclee

13. MakeResearch:
Mastering Adolescents’
Knowledge and
Engagement in Research
@joyclee

14. umsickapp.info Diabetemoji.com @joyclee

15. How Might We Achieve
GreaterAdoption of Design
in Healthcare?
@joyclee

16. Design in Tech 2015, John Maeda @joyclee

17. How Do We Measure ROI
in Healthcare?
@joyclee

18. @joyclee

19. “Patients, caregivers, clinicians and
researchers work together to choose care
based on best evidence; together they
drive discovery as natural outgrowth of
patient care; and ensure innovation,
quality, safety and value, all in real-time.”
-C3N Project
A Learning Health Care System
@joyclee

20. Design
Quality Improvement

21. Quality Improvement
Measure and improve the ROI
Science of Improvement

22. Push boundaries, surprise, and
delight
Design Thinking Quality Improvement
Measure and improve the ROI

23. Aim: To decrease
the % of the
population with
HbA1c ≥ 9% and
increase the %
of the population
with ≥ 0.5%
HbA1c interval
improvement
Preference driven
treatment and
effective self-
management
Enhanced registry population
management & Pre-visit planning
Peer/community support
Education/training to support
technology use and patient viewing
and problem solving with blood
glucose data between visits
Interventions/toolkits for
addressing barriers to adherence
Efficient use of
technology and data
to support care
Access to care and
regular follow-up
Screening for depression
Psychosocial Support
Shared decision making
Partnership between
engaged patients and
the care team
Effective use of EHR by diabetes
team for population management
Care Process Measures
• % of pts testing ≥4 times/day or
using CGM (6/7 days/week)
• % of pts giving 3 or more short-
acting boluses/day
• % of pts reviewing data
between visits
• % pts setting, documenting,
and reviewing goals
• % completed pre-visit planning
• % with ≥ 4 visits per year
• % of pts with annual
CDE/RD/SW visit
• % of pts on case mgmt pathway
• % pts screened for depression
Developing a Clear Measurable Aim and a
Theory of Change
@joyclee

24. Assembling a Team
QI Director
Associate Director
Visual Designer
Patient/Family Advisor
Data Analyst
Research Associate
Project Manager
Marketing Specialist
Physicians
Diabetes Educators
Social Work/Psychology
Admins/Office Manager
Patient Advisory Board
@joyclee

25. Implementing Interventions to Support
Evidence-based Care
Depression Screening
Patient Portal Enrollment
High-Risk Follow-up
Shared Decisionmaking for Blood Glucose Monitoring
@joyclee

26. Studying the Science of Patient Engagement
Website and Newsletter
Surveys
@joyclee

27. Creation and Maintenance of a Data Registry
@joyclee

28. Caldwell P, Mother Jones @joyclee

29. Unstructured Data
Missing Patient-reported Data
Underutilized Data
Design (Too many clicks!!)

30. @joyclee

31. Unstructured Data
Missing Patient-reported Data
Underutilized Data
Design (Too many clicks!!)
Flowsheets/Smartforms
Patient Portal Questionnaires
Reporting for Population Management
Clinical Interface Redesign
@joyclee

32. Improving the Patient Experience
@joyclee

35. @joyclee

36. “I’m reaching my last year at Stanford and I’ve run into an
issue: I can understand why physicians should have design
thinking as a tool. But when I think about the schooling and
training to be a doctor I can’t help but imagine my creativity
being crushed by endless memorizing and “this is exactly
how you do this” kind of thinking.
I gave up medicine for design, and I want to know if I even
needed to make that choice.”
@joyclee

37. I think in my institution since they don’t know what design is, I
am better off being a doctor who practices design as designers
wouldn’t even be able to set their foot in the door (they would
never know to hire one!), I can be a “peer” or “one of them”
that can hopefully help convince them of the ROI. But that’s
inside a healthcare delivery system.”
@joyclee

38. “I do think that there is a lot about medical school that is a
pain; but it does gain you credentials, a deeper
understanding of the “mindset” of medicine, and
continuous exposure to users. Being immersed in that is
very instructive from an ethnographic point of view. I only
have clinic a few times a month. I savor those times
because I always learn new things.”
@joyclee

39. “One last thing, I do think systems design is important for
design and in particular learning health systems. When you
are trying to move outcomes and move multiple levers like
policies, recalcitrant medical professionals, patients, it does
sometimes help to have the clinical perspective and authority
to guide the design and development of clinical medicine as
well as patient experience.”
@joyclee

40. DESIGN IS A MINDSET
Don’t accept the status quo
DESIGN IS A MULTILAYER PROCESS
DESIGN WITH PATIENTS AND
CAREGIVERS
@joyclee

41. www.doctorasdesigner.com
Medium: https://medium.com/@joyclee
Twitter: @joyclee
joyclee@med.umich.edu
Ashley Garrity, Emily Hirschfeld, Valeria Gavrila, Michelle Wichorek, Lilia
Verchichina, Dorene Markel, Amy Ohmer, Jacob Dwyer, Ram Menon,
Pediatric Diabetes Team
ACKNOWLEDGMENTS
@joyclee