(Re)building Trust in the Healthcare System

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Earlier this month, it was reported that 22 patients in a renal ward of the Singapore General Hospital (SGH) have been infected with the deadly hepatitis C virus. 4 have since died. The current prognosis is that it was likely due to cross-contamination across medical equipment. I’m convinced that the hospital in question and the Ministry of Health will take steps in identifying the root cause and fixing the problem, however the real victim in this series of unfortunate events is trust.

If we took a user or customer centric point of view to these proceedings, we will soon realize that the basic reason for medical institutions to exist has not been held. All this said with no disrespect to the many professionals in the industry, many of whom are my good friends.

In design thinking, we often adopt a problem solving mindset we call: “Jobs to be done”, or “What’s in it for me?”. This helps us understand what is in the mind (or heart) of the consumer when he or she visits a medical institution. In most cases, our research tells us that this “job” is to get well. In this case of cross contamination due to poor infection control, not only did patients not get well, they just happen to pick up an incurable disease as well.

This aligns with some ethnographic research that we did some time back when people whispered to us that there are certain “hospitals” you don’t bring the sick or elderly to…if you do they never leave. When people’s deep-seated needs and motivations have not been satisfied, they lose trust in the system. Further reports telling us that such infections are rare is only going to create more cynicism. While this challenge of building trust is a wicked one to solve, some basic principles apply.

Say Sorry – To the credit of all the parties involved this was done. Admission of guilt shows that you are taking responsibility and ownership of the problem. Nothing diffuses hate and distrust quicker than saying sorry.

Transparency – This is one of the cornerstones of building trust, which unfortunately, takes guts to deliver authentically. People don’t like to see the responsible parties hiding behind bureaucracy or even things beyond their control. Try engaging your stakeholders (patients, caregivers etc.) by brining them into your organization to validate what you have done to solve the problem. Even better, work with them to co-create an even better solution. I believe the role of patient or community advocates in hospitals are here to stay.

Stop treating people like numbers – Many large organizations, not necessarily in healthcare, tend to look at their customers as a number on a spreadsheet. When this happens, it becomes too easy to treat problems like we do collateral damage. Numbers should be used to track improvements, not as a means to accept failure when your percentages are low enough.

Be Human – understand that people have deep seated needs and motivations (often not expressed or made visible) that need to be satisfied. Most importantly recognize that this is going to conflict with how you do your job, especially if you are in healthcare.

The key to all of this is about understanding and managing your stakeholder’s expectations. Many things that we do, especially when they are systemic, are now expected as a standard deliverable by our customers. Especially if we have good competitors that do their job well. This means we need to classify services, productivity, efficiency, infection control etc. as “hygiene” factors. Something that we need to get right from the start, if not we are just wasting our time doing what we do. Not an easy task, but at least we know that the design thinking mindset will help you manage this and even alert you when these expectations shift.

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12 Thoughts on Implementing Design Thinking in Your Organization

A few simple observations on how you can implement Design Thinking in your or any organization large or tiny. These observations have been validated time and time again during my continual involvement with this activity.

1) The acceptance of Design Thinking is a lot easier when there is a real problem to be solved. If there isn’t one, it helps to talk about Design Thinking in the context of one.

2) Biggest roadblock to Design Thinking: organizations seeing it as a nice to have rather than a must-have.

3) Many of the articles I’ve read about DT misses this point: It is not only about the “who” or the “how”, but also about the “why” and “so what?”

4) Design Thinking lives in the future; hence it is hard to convince the minds that live in the present.

5) Design Thinking is really about applying design strategically across many disciplines and functions. This perspective helps designers be more comfortable with the concept.

6) Not everyone can be a design thinker. The stories I could tell you about trying to convert the unconvinced. Therefore, it is a huge myth when someone tells you that anyone can be a Design Thinker. Well, let me qualify that, anyone can be a Design Thinker if they allowed themselves to, most people can’t move past that. So therefore not everyone can be a Design Thinker.

7) I’ve found that Design Thinking sometimes struggles with credibility when non-designers facilitate the activity. The reverse is also true, in that not all designers are Design Thinkers or able to facilitate Design Thinking activities.

8) Most organizations don’t get innovation. They think it is this shiny new thing that can be sold for a premium. The trick is that most people forget that it is really a positioning play. To be positioned so far ahead that the competition has a hard time catching up. Design and design strategy (or thinking) can help you here.

9) Implementing Design Thinking requires a change in mindset. Most businesses, especially those taller that the Pyramids of Gaza, struggle with change. That’s a fact. So when Design Thinking does not work take a look at the talent or the organization’s culture instead.

10) Design Thinking also needs to stop being fluffy and start being results-oriented. Wait, I think we can phrase it better. Design Thinking needs to stop focusing on the process but on the outcome. Yep, make sure there is always one.

11) There is never a 100% success guarantee with the solutions generated by Design or Design Thinking (don’t forget to learn and iterate quickly!). But that does not mean you do not identify your ideal outcomes or define your KPIs (the horror!). Just make sure it is not always about making more money.

12) Finally, Design Thinking is a very uncomfortable activity, process, approach, mindset etc. (pick one?) for many people. After working with a number of clients and also with participants from many Design Thinking workshops, we have found people lost, uncomfortable and sometimes even angry. We should spare a thought for how they feel when we are working with them. Wait; is that not Design Thinking as well?

So what do you guys think? I would love to hear your experiences and stories of how you have helped or led the implementation of Design Thinking in your or any organization. Please do leave your feedback and comments below, thank you!

If you have not already check out this other series of articles on Implementing Design Thinking. (I was experimenting if I should write many small articles or one longer one like this. In the end I just did both!)

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