The Design Institute for Health's 2020 cohort of doctor designers, the "Three Medsketeers," graduate from Dell Medical School this month. While the world shut down, these students dove in to keep momentum on design that makes a difference in people’s lives. The team reflected on their experience as med students working on design teams in the conversation below.
Third-year medical students at Dell Med choose from many different tracks — including what was formerly our distinction in healthcare design and innovation track, which evolved in 2020 into a full M.A. in Design focused on Design in Health. Last spring these students worked with various local and global partners listed below to offer design-based solutions that improve health while also navigating the impact of a global pandemic.
How might we address access in and out of ASH facilities to meet the safety perceptions of providers while also retaining autonomy and restoring choice for patients?
Austin State Hospital redesign: We initially started with the framework of exploring technology in the context of the ongoing redesign efforts for the Austin State Hospital and undertook a project to study the intersection of technology, security, and safety from both provider and patient levels.
How might we design a drive-thru testing site and workflow that meets the needs of both health care providers and people who come for testing?
UT Health Austin and CommUnity Care COVID-19 Drive Thru Testing design: This project unfolded alongside COVID-19 response efforts in our community. Due to the nature of crisis response work, we were embedded on the team—versus tackling a portion of the project on our own—and thus offered unique perspective on how health care providers might experience our service and workflow designs.
How might we transform a global health strategy of campaign-based vaccine delivery to operate primarily in-country as opposed to dependent on inconsistent influxes of external resources.
Bill & Melinda Gates Foundation funded project on alternative vaccine delivery strategies: This work was a subset of the broader team engagement on systems design for global health.
Q: How did your training in medicine uniquely situate you to participate in the design project?
Laura: Having seen first-hand the day-to-day interactions of the various members of the health care system from doctors and nurses to the pharmacists to the kitchen and maintenance staff provided insight to both the individual contributions of these teams and their impact on the patients. I also witnessed a disjointed health care system and the widespread consequence on a patient’s everyday life. Living in this world allowed me to bring that perspective to a design team trying to generate solutions for a more streamlined care system.
Josh: I had a foundation in the ‘how will the person use this’ and ‘how will this work on the ground’. Coming into design, I was surround by people who were much more experienced with creating and being creative than I was (especially after two years of medical school!) It felt like a good balance as I think we rubbed off on each other as I grew in my creativity, and the work lended itself more to the capability of people to be impacted.
Jacob: I was very new to design but it was clear early on that having a diverse background is an asset to designers. Design excels at bringing diverse perspectives together and is often informed by the backgrounds of the team. For me, that was not only medicine but global health, economics, and policy.
Medical training gives you a unique perspective on health care and where the problems are but not necessarily the tools you need to change anything. I've worked in global health for over ten years now, so I also think of health and health care more broadly than the US system. The Gates project was so exciting because even though the focus was on reaching children who had never been vaccinated in developing countries, the lessons learned can easily apply to underserved areas in the US, particularly with the pandemic causing lower routine vaccination rates and challenges now with the COVID-19 vaccination rollout. I see design as a tool in my ‘doctor toolkit’ for solving challenges that have health repercussions but are not strictly confined to medicine.
Q: What was one thing that surprised you about your work in design?
Laura: The problem you start with is often not the core issue that is ultimately addressed as the work progresses.
Josh: How quickly I could grow my creativity! Once I stopped resisting the inner dialogue attempting to make everything conform to what is expected, practical, effective, efficient - throw your favorite buzzword in there - and simply gave myself permission to play and break constraints (slowly learning I could bring constraints back in whenever I pleased) I was able to be more artistic, creative, and productive.
Jacob: I initially struggled to see the differences between the scientific method and design thinking. But it became clear that differences start at the very beginning. Where science observes, design empathizes. In approaching the problem of increasing childhood vaccination, we could have just looked at objective data - what areas have lower rates, what are the medical resources in those areas, what are the demographics of the people living there, etc. But that approach neglects the wealth of information that families not receiving vaccinations have experienced and observed themselves, what insights they have to inform the process. I think the difference is also in the end goals. While the motivations of the people conducting the scientific method are likely to help people, another goal is simply to learn. There is an additional process to implement whatever it is that you learned. Design, however, starts and ends with the end-user, often patients. There is a continuity from defining the problem to creating a solution with design.
Q: What from your design toolkit do you carry with you as you advance your careers in medicine?
Laura: When in doubt draw/write it out! Sticky notes and idea grouping have become a central part of my problem identification and problem-solving approach.
Josh: Moving into the next phase of my professional training, the tools front of mind are asking "what if", breaking constraints, and having lots of ideas and the sillier the better!
Jacob: "No idea is precious" is such a great lesson. Early in medical training, we learn to be aware of anchoring bias - where one weights too heavily an early idea or piece of information learned about a patient that causes them to miss the true diagnosis or evaluate all subsequent data based on that first piece of information. Design calls out this cognitive bias explicitly through the idea of not holding any single design too dearly. I find it to be a clever technique to remain actively flexible to new data.
Hand in hand with preciousness is rapid iteration and prototyping. Medicine as a profession is made up of a group of highly educated people and with that comes confidence (rightfully so) in our decision-making ability. There are plenty of examples of programs or initiatives in medicine that we thought would solve all problems, only for some unforeseen issue or externality to arise when it was instituted. Iteration and prototyping help refine ideas and ultimately find better solutions. It also helps to refine goals for the design, which is increasingly important for keeping patients at the center. Because medicine moves slowly, iteration offers a way to continually improve to better serve patients.
Q: What else about the work do you want to share?
Laura: Design has taught me to not be precious with my hold on a situation, to be constantly willing to set an idea/project/solution aside and discuss a new approach. Great ideas come from being willing to let go.
Josh: The importance of thinking big before narrowing down. It was so difficult for me to hold two different conflicting ideas in my head at once—one being how grand can we go, the other being what is practical enough to be built and get used—and yet the real magic happened as I let these two differing perspectives be intertwined and dance in my head.
Jacob: It was such a privilege to be able to pursue broader issues within health and health care through the lens of design as a medical student. I think that learning design and medicine together informed both studies in appreciable ways. By learning design research methods, I became a better interviewer of patients. I learned to always ask ‘why?’ to get to a deeper understanding, for example. I think working in medicine made me better prepared to work as a team and gave me a role within the design as a content expert, sharing nuances that wouldn't otherwise be apparent. Working on the Gates project also confirmed for me a larger role within medicine where I could combine my various interests into work/projects that have very real consequences for patients and families, both in the US and globally. Ultimately, I think, design in health is another way to practice medicine. While I may never be a full-time designer, I will certainly carry the tools from design forward into tackling problems within health care.
It's an asset in medicine to be able to think in terms of systems. Not just of bodily systems when considering differential diagnoses, but social systems as well. Perhaps a patient with diabetes isn't meeting their goals because they don't have ready access to healthy food, perhaps they cannot afford it, or they do not have transportation to their appointments or a grocery store. Similarly, a child who hasn't been vaccinated perhaps didn't have a family member to take them to an appointment or their parents didn't have reliable information regarding the safety and efficacy of immunizations, or perhaps a pandemic has made it even scarier to go to a doctors office. In an under-resourced area, there may not be a supply of vaccines, human resources to give the injections, refrigeration, or steady electricity for storage; or they live in too remote an area to access these services. Illness is so often multifactorial and if all those factors aren't addressed, a full return to health might not be achievable. Health is entwined with so much of our daily lives.
Q: What is design’s superpower in health?
Laura: Bringing together a true interdisciplinary team – people from both within and outside of health care to look at a problem from a person-centered perspective.
Josh: Recognizing that everything is built, and by asking "what if...", teams are able to get to a place where something—a system, a clinic, a product—can be reinvented and reformed so it best serves the people who it is meant to serve. Another would be design's ability to build, iterate, and ship work. For so long, I was stuck at the beginning because I expected the first attempt at something to be perfection. Design works for progress, not perfection through experimentation and iteration.
Jacob: Incorporating design into healthcare is happening at a time when so many other sectors have already embraced it. Medicine is very slow to change, in large part due to its complexity and interconnectedness. The US healthcare system is really a patchwork of multiple systems that have been forced to work together and not particularly well. When one system changes, you get repercussions in all the others. The idea of design being able to tackle "wicked" problems really stands out to me. Design thinking helps to cut through that complexity, embraces it, and make sense of both the parts and the whole.
When looking at the Gates project, you have all these contributing factors that make it difficult to get vaccinations to kids. The overall problem is low vaccination rates but contained within that are the problems of staff, resources, infrastructure, geography, politics, trust, etc. There are multiple organizations working in the space with competing priorities that don't always work together. I think design finds a path through that complexity.