By Oloruntobi Dare
Across many industries, the question of how to design tools and products people will want and use is critical. While a product might sound helpful in theory, if it’s too difficult to use, too expensive, or requires too much time and effort to start using, it’s unlikely to be widely adopted.
Solutions in public health and health care are no exception. While things like follow-up appointments after concerning test results or open communication among care teams during labor and delivery may seem simple, putting systems in place to ensure those things happen is more complicated.
To solve this problem, involving end-users of the tool or product from the beginning of the design process is critical. Through a process known as human-centered design, product designers can put the needs, wants, and behaviors of people at the center of the design process. This process is further strengthened when the tool or product’s intended end-users can co-design the solution, whether by giving guidance as subject matter experts, through interviews and focus groups, or as patient advisors.
So, what does co-design look like? At Ariadne Labs, a joint center for health system innovation at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health, we apply human-centered design to our work to design, test, and spread solutions to some of health care’s most pressing issues. Since 2012, Ariadne Labs has been able to to develop and disseminate hundreds of tools and solutions, touching more than 97 million lives around the world in 2022 alone. We’ll look at a few examples of how co-design has played a role across Ariadne Labs’ work.
Convening an Expert Advisory Board to Support Conversations about Racism in Health Care
According to a survey study by the Pew Research Center, when asked about their own health care experiences, 56% of Black Americans said they’ve had at least one of several negative experiences, including having to speak up to get the proper care and being treated with less respect than other patients.
Ariadne Labs’ Serious Illness Care Program launched the Race Dialogues project to explore an evidence-informed approach to talking about racism in health care settings, particularly for people affected by serious illness. Their goal is to develop and pilot a novel tool to promote authentic healing relationships and address inequities in health care experiences that result from poor clinician-patient communication with people affected by both racism and serious illness.
Co-design plays a critical role in this project by sourcing perspectives from a broad range of stakeholders at an early stage. Thus far, the project team has conducted individual interviews with white clinicians, completed five focus groups of patients and clinicians, and convened an interdisciplinary advisory board with varied backgrounds in social work, religious leadership, psychology, geriatric medicine, and more. The ethnic identities represented on the boards include Native Americans, Asian, and Latino Americans, and there are plans to keep them engaged and involved as the project progresses. Though the project is in its early stages, assembling these participants is informing the creation of specific tools and language for clinicians to have conversations about race and promote understanding. The diverse perspectives represented provide the team with context of how to design race dialogue tools such as conversation guides and trainings.
Partnering with Patient and Family Advisors to Improve Cancer Screening
Currently in its 18-month pilot phase, the Ambulatory Safety Net Collaborative project team continues to partner with patients and families through their engagement. Ambulatory Safety Nets are person-centered programs that provide a backup system for following up on abnormal test results when the standard follow-up process fails. When successful, safety nets offer a reliable and effective approach to connecting patients to the right care at the right time. Before launching this pilot, the team at Ariadne Labs took the time to understand why medical errors happen, and they found that communication failures were a big part of the problem. That’s why it was only fitting that the team co-created with key stakeholders, including patients, families, and hospital leadership.
The team authored a Patient Safety Adoption Framework, with contributions from a diverse group of patient and family advisors to make the program with vulnerable populations in mind and account for differences in cultural context and potential barriers in the development and implementation phase. For example, patients face barriers in health literacy, access to services, and mistrust in the health care system. In the context of the Safety Net, the participating clinical sites are encouraged to document health equity metrics to see if a population is overrepresented, which may signal issues with contacting, scheduling, and completion. Patient level barriers such as insurance plans and personal scheduling issues are other factors that trained patient navigators take note of during outreach.
When these equity metrics are reviewed monthly, sites can use the data to make steps forward to determine where in the process the breakdown is occurring and work to ensure patients receive the appropriate follow-up care within an acceptable timeframe. Patient and Family Advisors continue to stay involved in the initiative through in-person learning sessions and facilitate discussions on how to handle challenging patient conversations and closure criteria. The Framework informed the Ambulatory Safety Net Implementation Guide, which is being used by seven health systems in the Boston area since 2022. Programs at these health systems have identified patients who are currently receiving follow-ups for colorectal cancer and behavioral health.
Conducting Interviews and Focus Groups to Improve Communication and Teamwork in Childbirth
TeamBirth is a process innovation to improve communication and teamwork in childbirth pioneered by Ariadne Labs’ Delivery Decision Initiative (DDI). TeamBirth ensures people giving birth and the clinicians who are caring for them have shared input and understanding into decisions during and after labor and delivery. TeamBirth has been adopted in close to 90 hospitals across the U.S.
The success of TeamBirth stems from its thoughtful design and testing process, which incorporated numerous stakeholders. To understand the acceptability and feasibility of TeamBirth, the team conducted in-depth, semi-structured interviews of 103 (58 nurses, 37 obstetricians, and 8 midwives) clinicians and 16 focus group discussions with 52 implementers between June 2018 and October 2019. The clinicians also came from diverse facilities like midwifery care, hospitalist care, and private practice, which brought in a unique perspective for the design for scalability early in the development of our solution. Prototypes representing the “minimum viable product” of TeamBirth materials were developed and refined based on the feedback from the aforementioned diverse clinician group, to show that the initiative could work across multiple contexts and clinical care environments.
Why is it crucial to include patients, family advisors, and other stakeholders in the design process of public health interventions? It’s because when we work together, we can create interventions that are tailored to meet the needs and preferences of the people who will actually use them. When patients and health care providers collaborate, it builds trust and engagement, which leads to better health outcomes and overall satisfaction with care. The result? Uptake is increased, new knowledge is discovered, approaches are refined, disparities are addressed, and more innovative solutions and well-informed products ultimately improve patient safety and the overall patient experience.
Oloruntobi Dare, MPH, is a public health technical professional who previously served as an Implementation Specialist at Ariadne Labs. Currently, she holds the role of Consultant for the Veterans Health Administration (VHA), contributing her M&E expertise to enhance healthcare initiatives.