To err is human — so let’s design for it together

How can we use co-creative design to improve the culture of patient safety?

By Mubnii Morshed

In 2013, I attended a talk by Deb Matthews, who was the Ontario Minister of Health and Long Term Care at the time. She began her talk by summarizing the trajectory of healthcare over the last few centuries: “Healthcare began as something done to patients. Then, it was something done for patients. Now, we’re finally realizing that healthcare has to be done with patients.”

This idea of working with patients has gained traction in many facets of healthcare. Now more than ever, healthcare experts are looking beyond static data collection and are employing a wide range of methods to better understand the patient’s perspective. Reporting tools such as on-site feedback, patient advisory boards, and in-field observation are only a few examples. These methods provide us with deeper insight into how stakeholders are actually experiencing and interacting with the healthcare system, helping us to better understand what their needs and key areas of concern are. Such insight can support a variety of quality care and patient experience initiatives, patient safety included.

With our ability to collect more data than ever before, one has to wonder how all this information is being leveraged and applied to the design of new solutions. Currently, the onus still falls on healthcare experts to extrapolate from this data and look for solutions. Unfortunately, the solutions devised are often layered interventions, applied on top of the legacy systems and processes that are causing medical errors in the first place.

Let’s use hand hygiene as an example; in Canada, infections associated with healthcare visits kill approximately 8,000 to 12,000 people every year. In an effort to reduce this number, hospitals provided education to their staff on best hand washing practices, including posting visual reminders on all hospital sinks. Despite their efforts, the practice of hand washing wasn’t being adopted into the hospital culture. Shortly after, it was discovered that the visibility and location of sinks in the hospital environment had a sizable impact on hand washing compliance. For every meter a healthcare worker had to walk, the chances of them washing their hands was reduced by an astounding 10%.

This type of fragmented problem solving begs the question: why are we divorcing the design of patient safety solutions from the people they’re designed for? If the hospital staff were engaged prior to implementing this intervention, the roadblock of sink location and visibility would have surely come up.

In healthcare, we need to shift our thinking of what it means to “work with” others

It’s increasingly evident that patient safety doesn’t revolve around the patient alone. Nor does it focus solely on physicians and other front-line staff. It’s the complex relationships between these stakeholders, and the systems and environments they interact with that influence the culture of safety. In order to understand barriers and work towards realistic and sustainable solutions, we need to involve all stakeholders in designing what the future of patient safety looks like.

At Bridgeable, we use an approach called co-creation to help solve design challenges. You may have heard of co-creation by one of its many other names such as co-design, cooperative design, or participatory design. Co-creation is not a new concept. In fact, it’s been around since the 1970s and is widely used in the fields of architecture, product design, and urban planning. More recently, the value of co-creating is becoming apparent in designing (or re-designing) complex healthcare services.

Co-creation brings together internal and external stakeholders who may never have been in the same room otherwise. In the healthcare space, this can include patients, caregivers, nurses, physicians, hospital administrators, researchers, academics, experts, or anyone else who interacts with the health system in a meaningful way. The goal of a co-creation workshop is to engage all of these voices through generative design activities that elaborate our understanding of unmet needs, and incorporate diverse perspectives into the solutions we build together as a team.

Co-creating allows participants to get a look into how somebody else interacts with the same system they do, and for many, it’s the first time they’ve done so. This simple idea can expose subtle nuances that static data alone cannot provide. At a recent co-creation session with healthcare professionals, we mapped out what the typical lines of communication look like between physicians and their patients.