Cutting Health Care Costs Through Design

The need to cut the cost of health care in the U.S. has become obvious to almost everyone, as Ezekiel Emanuel discussed the "Billions Wasted on Billing" in the New York Times last weekend. But we may never achieve the necessary savings if we leave it up to the politicians. Most of the political discussion around this issue has focused on how to pay for health care, through the establishment of health benefit exchanges and tax credits in the Obama plan, for example, or through the reduction of government regulation and medical liability in the Boehner plan. The greatest savings, however, lie elsewhere: in redesigning the delivery of health care itself.

Health care systems have begun to realize this. Leaders in the field such as the Mayo Clinic have established in-house innovation centers largely staffed with designers adept at identifying inefficient and ineffective processes and procedures and developing much lower-cost ways of accomplishing the desired ends. Over the last few years, the Mayo Clinic has sponsored an annual "Transform" symposium that brings together health care designers and medical personnel from all over the world to share their innovations and experiences, and the results are extraordinary. While politicians have largely argued around the periphery, health care providers and designers have begun to act.

At the University of Minnesota's Center for Design in Health, its director, Dr. Kathleen Harder, has, for example, worked with several health care systems on reducing the incidence of unintentionally retained foreign objects -- sponges and the like -- in patients after surgery, which leads to costly additional procedures to remove the objects as well as possible litigation as a result of the errors. By redesigning the count process in operating rooms, Harder and her team virtually eliminated the problem. For one client alone a $20,000 redesign effort was leveraged into approximately $3 million of savings over a five-year period -- a return on investment of $150 for every $1 spent.

The U.S. health system is full of such opportunities. Harder's center has reduced errors in the handling of specimens, medications, blood, and the administration of patient care and surgical procedures -- all very costly to correct -- by doing what designers and cognitive psychologists working in this area do best: observing human behavior, analyzing the nature of a problem, and developing and testing alternative processes and new protocols, products, and procedures that address the need in the simplest and least costly way possible.

In the above example, for badly designed electronic medical records systems that hinder workflows, the center recommended changes that utilize basic graphic- and interactive-design principles to ease communication and information sharing. And for errors related to surgical procedures, the center developed the Safe Surgery Process, with each step designed to cognitively engage the surgical team at critical points, to ensure that patients receive the correct surgical procedure -- a very low-cost way of reducing the extremely costly errors that can result from wrong-site surgery.

Harder's work and that of the growing number of designers working in hospital and clinic settings represent one of the most promising ways of reducing the cost and improving the quality of health care delivery in the U.S. With their work has come a new appreciation of the value that designers bring to the solving of problems, and a new understanding of the possible applications of design thinking within the design community itself. The health care industry stands at the leading edge of this transformation because of the enormous savings that better design has delivered, but such thinking can bring improvements in effectiveness and efficiency and reductions in errors and waste in almost every aspect of our lives.

Design is no longer a nice-to-have luxury. As the exorbitant cost of our health care system shows, we can no longer afford bad design. In fact, the real luxury in this country has been our tolerance of so much bad design -- sloppy procedures, careless processes, and wasteful products -- that costs us way more than we can possibly sustain. Indeed, if the U.S. really embraced good design and its ethic of doing more with less, we would see that one of the areas most in need of redesign is our political system, evident in the endless bickering among politicians about a health care system that, to its credit, has begun to redesign itself.