Pulse
What Patients Want
Physicians and designers from Mayo Clinic are using a creative process borrowed from industry to improve the patient experience.
Step off the elevator onto the 17th floor of the Mayo Building in Rochester and you might think you’re in a design firm in the heart of the Minneapolis warehouse district. Light fixtures that look like flying saucers hang from a ceiling supported by steel beams, hovering over open workspaces. Colorful, overstuffed chairs form a circle in the center of the room next to a wall of note-filled whiteboards. Glass walls offer passersby a glimpse into the work that goes on inside—here at the SPARC Innovation Laboratory in the heart of Mayo Clinic’s internal medicine department. Across the hall is a row of exam rooms that serve as Petri dishes for ideas that are dreamed up behind the lab’s glass walls.
Alan Duncan, M.D., medical director of the lab, enthusiastically points out some of the concepts physicians and designers are testing. Duncan walks quickly, stopping to show off a biometric reader on the door frame of an exam room and explain that physicians can place their index finger on the reader to log on to the EMR system.
He says they came up with the idea after watching how physicians would enter an exam room, greet the patient, then log on … and wait. “We knew that if you started the log-in process earlier, you could improve patient satisfaction,” he explains. “So why not reverse the order so you log on using biometrics, and by the time you’re done greeting the patient, the computer is ready to go? It’s one way design works—by reframing an issue.”
And that’s the whole point of the SPARC Innovation Program, Duncan explains: To find ways to use design to improve the patient experience. “Everything we do is from the patient’s perspective,” he says.
On the Fast Track
Duncan hopes that the biometric reader, along with other ideas to improve patient comfort and understanding incubated in the lab, one day will become the standard at Mayo. A general internal medicine physician who spends half his time working with the SPARC program and the rest caring for patients with difficult-to-diagnose problems, Duncan is a champion of the patient. “As a general internist, the relationship between the physician and patient is absolutely critical,” he says, explaining that physician-patient communication has long been his research interest. “I think it’s critical for any physician, but it’s really critical for the general internist, who often has a longitudinal relationship with patients.”
Five years ago, Duncan helped create a curriculum for new physicians at Mayo on how to talk to and establish good relationships with patients. He noticed one of the physicians’ challenges was having adequate time to listen to patients and make sure they understand their conditions and course of care. He began wondering what Mayo could do to make patients feel more valued and involved in their own care. Could they change the way doctors presented information to patients? Could they reconfigure the physical space to make it less impersonal?
About the same time, companies such as Motorola, Procter & Gamble, Boeing, and Mattel were looking for better, faster, and cheaper ways to develop products. They were feeling stifled by the traditional R&D process, where scientists and engineers come up with and patent an idea, then turn it over to developers who then pass it along to designers and marketers. It could take years to get a product on the shelves. To short-circuit this process, they began turning to (or in some cases building their own) innovation labs. Described in a November 2005 Business Week article as “mosh pits of creativity,” innovation labs are designed to bring employees from different departments together to generate ideas that can quickly be tested on customers and hustled to market.
Innovation was just entering the business lexicon when Mayo started talking about creating a lab, says Duncan. With the blessing of Mayo’s administration, Duncan and some internal medicine colleagues worked with IDEO, a Palo Alto, California, design firm, to turn an unused corridor that once belonged to the urology department into the first innovation lab to be housed in a medical facility.
Turning Problems into Challenges
When the SPARC (which is short for See, Plan, Act, Refine, Communicate) lab opened in 2004, Duncan and his team took on a problem common to service industries of all kinds: the waiting experience.
Duncan and the designers and project managers settled into lobbies and watched patients. Did they seem confused by the check-in process? Did they roll their eyes and shift their weight from foot to foot as if they’d been standing in line too long? What did they do after they checked in with the receptionist?
The team came up with the idea of having a check-in kiosk similar to those used by airlines. They built a cardboard prototype with a drawing of a touch screen and keyboard and asked patients whether they would use such a kiosk. After refining the design and building a crude computerized version, they did the same kind of randomized controlled trial they would use to test a new therapeutic agent: Half the people coming into the clinic were sent to the registration desk, the other half were directed to the kiosk. “We compared the patient’s waiting experience, check-in experience, the efficiency, the time in line and found improvements in all the variables we tested,” Duncan says. “We asked them if they would use the kiosk again if they came back to Mayo Clinic, and the answer overwhelmingly was ‘yes.’” Mayo has since worked with a vendor to build five kiosks, two of which are located in the internal medicine waiting area.
Victor Montori, M.D., an endocrinologist at Mayo, got involved with the SPARC program in 2004 and is now its director of research and education. He recently created and tested a decision aid designed to help diabetic patients decide whether they should take statins to reduce their risk of coronary disease.
“We thought it would be very cool to do it online,” he says. He and his colleagues asked members of a patient advisory group, which serves as a sounding board for the 10-member SPARC staff, to evaluate a rough online version of the tool. Montori was surprised to see them show up carrying printouts. “That gave us insight that the Web may be portable for people who jump from computer to computer but not for folks who need to be sharing this at the kitchen table or sharing this with different parties in different locations,” he says. “As a result, we abandoned the Web and went with paper.” Montori randomly assigned 98 patients to see physicians who did and did not use a paper version of the decision guide. Members of the control group listened to their doctor talk about the risk of developing cardiovascular disease and the benefit of taking statins, then, as needed, were given a prescription for a statin. Those who used the decision aid worked with their doctor to estimate their risk for cardiovascular disease over 10 years and learn how their risk would change if they started taking statins. They were then asked whether they wanted to try a statin. “The process took three or four minutes, and we found that at the end of three months, three times more people from the test group who decided to take statins were taking them compared with the control group,” Montori says.
Montori, who has presented the findings to the American Diabetes Association and the Society for Medical Decision Making, is now testing a similar guide that will help patients decide which type of anti-diabetes drugs to take. In addition to gaining notice at medical meetings, the SPARC lab has drawn visitors from Baylor Health Care System in Dallas; Capital Health in Edmonton, Alberta; Renaissance Health in Boston; and the Cleveland Clinic. It has also inspired California-based Kaiser Permanente and Massachusetts General Hospital in Boston to set up innovation labs.
At Mayo, members of the department of pulmonary and critical care medicine are incorporating ideas from the SPARC lab into the design of their new quarters in the Gonda Building. Department chair Andrew Limper, M.D., says they worked with the SPARC team to study the way physicians interact in order to build efficient workspaces. “Surgeons don’t sit down. So in those areas where we’re going to be talking to surgeons, we need space that is open so the whole surgical team can come in with a pulmonary specialist and oncologist and be able to stand around large video monitors to look at X-rays together and exchange clinical information.”
They also realized that not all patient rooms need exam tables and are designing some with circular or semicircular tables and moveable electronic monitors, so physicians, patients, and family members will be able to huddle around the screen to view and discuss X-rays and other information during consultations.
Montori, who considers himself “the luckiest guy” for being able to take part in the SPARC program, says he would like to see innovative design become as much a part of delivering good health care as clinical trials and quality initiatives. “Other folks are working on how to make health care less expensive, on how to make health care more accessible, on how to make health care more effective and safer. But there are not a lot of folks working on making the experience of health care one that meets the needs of patients,” he says. “There’s so much opportunity. We don’t know how good this can be.”—Kim Kiser