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Stanford University School of Medicine

Flipping roles and using design-thinking principles to improve communication

""Providers are from Mars, Patients are from Venus continued a conversation that began at last year's Medicine X, when patients and physicians had the opportunity to switch roles.

After a few words from Larry Chu, MD, executive director of Medicine X, and quick introductions, attendees gathered around an improvised doctor's office in a corner of the conference room.

The simulations emulated a single mother's journey from the initial visit with her primary care physician, then a specialist, and finally, her enrollment in a clinical trial for "disease X."

The role-playing captured challenges facing both patients and professional caregivers. For example, how can providers best capture determinants of health, or the numerous factors that affect an individual's health?

Treating the whole person means accounting for social, economic, and environmental factors that influence health and well-being. While these variables should inform a care plan, what's the best approach, and how, when and who should ask these often sensitive questions?

Alexandra Buchanan, MD, 
director for simulation and education at Stanford's Center for Immersive & Simulation-based Learning, and Kyle Harrison, MD, a Stanford/VA Palo Alto Health Care System physician, related the scenarios and moderated the subsequent discussions. Abbe Don, a design-thinking specialist formerly with IDEO, also facilitated and led the debrief, which encouraged participants to "Get visual. Get tangible."

One of the hallmarks of design thinking is placing the user (a patient for our session) at the center of design and intention. The design process begins with empathy, appreciating and understanding the user's perspective.

Participants frequently frame challenges with a query: "How might we (verb) to (accomplish a goal)?" For example, "How might we find ways to better communicate the experience of chronic illness for patients?", a question posed in the workshop's description.

Placing a human at the center helps ensure you "design the right thing" and "design the thing right." Don urged participants to "take a step back and ask, 'What's your goal? What are we trying to help people accomplish?'"

Design thinking also changes the dynamic of how you work together with others. It often involves using sticky notes, a whiteboard, markers, visuals created on the fly, movement around the room and colloquial conversation to solve problems.

Animated participants smiled and chatted as they worked on Don's first request to use a sticky note to draw their neighbor at the table and the car they drove. The exercise also illustrated the often implicit bias in questions we ask (some people don't even own a car), and assumptions we make about others -- a root of miscommunication.

Don then asked participants to record observations, framed as a human need, from the first half of the session. These observations become opportunities for innovation.

Unfortunately, we ran out of time to create prototypes, but participants still had a lot to take away, including new perspectives.

Mary Gurney, PhD, RPh, from Midwestern University, described what she plans to take back to her students:

It's figuring out how to make sure we're on the same page, both with what's important to the patient and (for her students to understand) that patients may go home and do whatever they want. Their job is to try and educate patients with information that they may or may not have, explain why it's important, and ask 'what do you think?'.

Gurney also raised a point to explore further: A patient's health-care stakeholders -- doctors, nurses, pharmacists and others -- across physical and institutional boundaries. They need to be able to communicate, too.

We'll have to sketch that conversation out for the next Medicine X.

Previously: Design thinking is key to preparing doctors and improving health care, Medicine X speakers say, "Join me in reinventing health," Medicine X speaker Susannah Fox urges and "The patient will see you now": A summit on consumer-centered health-care innovation
Photos courtesy of Stanford Medicine X

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