Design Thinking and Solutions in Medicine, Health & Care

 

Opinion | Joseph Ferenbok
Date: August 30, 2019


Over the last several years there has been a rise in the application of Design Thinking for creative problem-solving in healthcare. Having been an early adopter and proponent of Design Thinking it has pained me over the last several years to admit and realize the limitations and short-comings of Design Thinking in health and medicine.  I do not wish to be fatalistic, but I do not believe that the approach is completely without merit, and using a human-centric strategy is (in my opinion) significantly better in many cases especially in healthcare contexts than many other approaches (if your goal is to improve quality of life or patient experience).  However, there are a number of nuances to Design Thinking that
are incongruous with innovation in health and care because of the specialized ethical and regulatory constraints 

One significant point of contention is the focus on and use of language associated with finding “solutions”.  Although in many cases the identification of needs and framing of problems within Design Thinking positions the outcome to the process as a human-centric “solution” to the identified problem. This can be extremely problematic and borderline unethical in healthcare. For one, the nature of problems in health and care tend to be more on the side of complex “wicked” problems of design rather than absolute binary problems that have definitive solutions.  For example, the redesign of a process or practice in a hospital will not in all cases ‘solve’ the identified problem.  To reduce the spread of opportunistic infections the proposed solution seems simple—get people to wash their hands.  Hand washing as a “solution” as part of anti-microbial stewardship has been advocated for decades.  Even if handwashing was performed 100% of the time by everyone, it would not entirely “solve” the spread of opportunistic infections.  The reality is that many of the problems in health and care are complex and multi-factorial and no one “solution” is likely to the absolute magic bullet for prevention.   

Even highly effective solutions, like vaccines, are not in and of themselves ‘solutions’ to medical problems because they, like many other interventions, are deeply embedded in ideologies, practices, customs and beliefs that complicate how problems are solved.  The Anti-vaxxer movement, if nothing else, adequately makes this point.   

However, the variability of outcomes, implementations and contexts of healthcare-related solutions are not the main reasons why I find the use of Design Thinking as a preferred way of creative problem-solving in healthrelated domains problematic.  All of these can be pragmatically overlooked, in my opinion, when juxtaposed to the potential good that human-centric empathy-based innovation may contribute to improving healthcare delivery.  But there is the rub, if we are to claim a human-centric approach based on empathy in healthcare and its delivery, we cannot avoid or ignore the patient or the patient experience.  At some level, healthcare innovations that are human-centric must (directly or indirectly) improve the experience or quality of life of a patient.  To understand the lived experience of a patient to define needs-based problems is at best irresponsible and at worst unethical to throw around notions of absolute “solutions”.  To engage people, patients, physicians or family members in a design-based problem-solving exercise and even accidentally imply that the process will result in a “solution” can be seen as misleading or overpromising Added to the moral implications of these possible perceptions of promising someone in a vulnerable position a potential “solution” to their problem, in healthcare, there are ethical considerations around issues of voluntary participation and informed consent.  Working with potentially vulnerable populations looking for hope the language around finding solutions has implications around the nature of participation, informed consent and coercion.  Telling a patient, who may be facing significant emotional and physical strain that participation or inclusion in a project that employs the Design Thinking vocabulary may not be the most responsible protocol when there are issues of informed consent involved.   

More problematic, however, than then ethical debates about what constitutes voluntary “informed” consent is the moral issue of false hope.  The idea that Design Thinking involves testing a solution to a problem—especially when patients may be directly or indirectly involved.  Any possible implication (intended or unintended) that a concept, drug or intervention is a solution to patientneed without solid evidence can be misleading and morally irresponsible.  Even the promise of co-developing a “solution” with patients has the unfortunate consequence of reaffirming existing differences and power imbalances between the practitioners and the people they are trying to problem solve with/for—promising a fix, a cure or a solution in healthcare may evoke false hope in a vulnerable population beyond the scope of the design project.   

On the one hand, I realize this argument is extremely abstract and likely not even something that practitioners have confronted.  It is not intended to undermine the important innovations in health-related contexts that Design Thinking has facilitated but medical/healthcare solutions, have deep emotional implications for people who are living with the issues frameworks and practitioners are trying to address, stop, or alleviate, and this requires an additional level of understanding and ethical conduct that Design Thinking does not evoke.  So, alongside with the process-related issues I have with Design Thinking in these domains, suggesting, Design Thinking, a preferred framework for structuring an approach to innovation in health-related domains, is problematic from an ethical perspective.   

Surely, there are other frameworks we can use that promise more contextual integrity without overpromising their outcomes.