In this series, Healthcare Design asks leading healthcare design professionals, firms, and owners to tell us what’s got their attention and share some ideas on the subject. Dr.

Steven Merahn is managing director at Thinkwell Health, the Los Angeles-based healthcare practice of Thinkwell Group, a 15-year old global experience design and production company. Here, he shares his thoughts on rethinking the patient journey, planning for system failure, and what satisfaction really means in relation to the healthcare experience.

  1. 1. Design means more than what can be drawn or built

While it’s clear what “design” means to this industry, there’s still a lot of confusion among healthcare professionals as to the term’s definition. As a physician, as I come to understand its principles and practices, I see applications everywhere, including in the ”design” of clinical processes and operations. I’m especially interested in experience design, which is more of a sociotechnical process that focuses on goal-directed interactions of patients with systems of care. These interactions take place in both built and virtual environments, but also involve designing for activation, engagement, and connection between patients and professionals in order to orchestrate and optimize transformative health-related experiences. In healthcare, systems are often structured to meet technical requirements but fail because we don’t design around how people actually think and behave, especially when they’re under stress or duress.

  1. Patient Experience isn’t always satisfying

When most healthcare executives refer to “patient satisfaction” they’re referring to the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys that are increasingly used by the Centers for Medicare and Medicare Services to assess quality and can influence revenue streams. The linkage between these surveys and financial vitality has sometimes limited the view of experience design to concepts of customer service or hospitality, and the implementation of programs specifically designed to influence scores on survey questions. The bigger problem is that not all healthcare experiences are pleasant (a spinal tap is not necessarily satisfying, no matter how life-saving). Healthcare design can serve a broader role by considering how the interactions with the built environment can communicate concern and empathy to the patient (“oh, while I’m getting my MRI, there’s a way to secure my backpack that works like a hotel safe!”) in concert with the care delivery process (such as staging predictable sequences of events in order to manage expectations and allow patients to give feedback). This allows the patients to fully appreciate the value of the experience, “satisfying” or not, to their quality of care and quality of health.

  1. Departments and service lines can’t be silos

One of the greatest strengths of the American medical system is our commitment to subject-matter expertise as a dominant organizing principle. As such, departments and service lines are organized by discipline and professional identities generally prevail along specialty or disciplinary lines. However, it’s also a vulnerability because many patients require care across disciplines, and interdisciplinary is not the same as integrated. Patients expect a level of seamless continuity that is often not designed into their experience because patient journeys are often mapped as linear—pre-visit, arrival, treatment, discharge/exit, post-visit—which doesn’t reflect the genuine nature of care.  Without integrated experience design, patients can have discontinuous or discordant experiences for the same problem or condition (like being sent to a radiology department with a completely different registration strategy in the middle of an urgent care visit). Designers can help solve this by taking lessons from other industries who’ve dealt with similar obstacles. For example, in theme parks, food, retail, and rides are all different “departments” but, they work together seamlessly and have procedural consistency across sites, benefitting the consumer experience.

  1. Logic doesn’t always prevail when it comes to our health

Healthcare is pretty much left-brained—grounded in structured knowledge and informational learning, detail-oriented, and driven by reason. Even in the face of such knowledge, patients and families tend to be more “right-brained” about their health: Emotional, imaginative, intuitive, and theoretical. Sometimes the right-brain functions can overwhelm the left brain’s capacity to sense, receive, and respond to information, which can be disruptive to a patient’s ability to understand their situation and make good decisions. If we want improve health systems capacity to improve the quality of health of patients and communities, we need to design for the right-brain and account for the tactile (efficiency, consistency, reliability, responsiveness) and emotive (urgency, sincerity, integrity, authenticity) experiences that are associated with trust and connection and serve as incentives (or deterrents) for desired behavior.

  1. Plan for system failure

Healthcare providers may consider the risks of treatment decisions, but they rarely consider designing around the failure scenarios for the systems or locations of care in which they work (like when the special breast biopsy machine was in a different building than the women’s health pavilion where they were prepped). There are common and predictable patterns of system-level “failure” in every provider network, such as timeliness of delivery of abnormal lab results; seamless outpatient handoffs between departments or providers; or sustained communications with and between patients and providers. Anticipating these scenarios and planning alternatives when things go wrong requires thinking of healthcare as a “time-space” activity and tracking and mapping patterns of discontinuous movements through physical and virtual space that are required based on common diagnostic or treatment themes.