Louisville Medicine Volume 63, Issue 9 - Page 30

DOCTORS’ LOUNGE (continued from page 27) actually did the jobs were supposed to have a loud, clear, vital and authoritative voice in changing those processes (i.e. the opposite of the Kremlin dictatorial Five Year Plan). When carried out in manufacturing, quality-circle methods worked great (just look at the success of Japanese cars in America). In health care here, what survived after Mr. Petersdorf ’s untimely death in 1987 was the notion of managing a whole system at once. Since patients are not widgets, however, managing the variances and the outliers is a tremendous challenge. Office staff, nurses and doctors, and ancillary staff work with people, not with machines – and therefore they have to make a whole lot of independent decisions. Teaching, not blaming, still helps, but human beings have to be in a receptive mood to learn. Since then, the adoption of IT has made data management and time management even more difficult, especially in medicine where bad things happen to good people fast. The latest entry in “managing health care delivery systems” is called Design Thinking. David Kelley out of Stanford, in partnership with companies out of London and San Francisco, invented the phrase in 1991 and applied his concepts to business clients. His merged company, IDEO, is now the industry leader in “human-centered management,” and in the past few years more and more health care companies have adopted this approach. What’s different about it is that its inventors recognized that empathy comes first: talking to everyone involved about his or her experience of a process is the first commandment. “How did it feel?” is the question. The emotional IQ of the experience is what counts. Patients, staff and doctors have been exhaustively interviewed at the Mayo Clinic resulting in new exam room design and flow. After getting comprehensive “experiential” input, each specific problem is redefined; then people brainstorm ideas for solutions. Then – the other central feature of design thinking – prototypes are invented, to be tinkered with by all (for instance: flow charts, making actual gadgets, writing dialogue for encounters, role-modeling for the workers involved in the task, workspace changes, etc.). Initial failures are expected. Failing over and over until the right match is made between idea and prototype is part and parcel of the design (an “expected variance” as Deming would say). Failing is not grounds for reprimand or demotion or dismissal. People whose feelings are considered carefully are far more likely to learn how to do something differently for the good of all;