At a time when "medical innovation" often is associated with dramatic pharmaceutical advances, complex imaging equipment, and other high-tech wonders, students at Stanford are also looking for innovation at the other end of the spectrum: relatively simple, low-cost modifications to existing health care processes that would reduce costs while improving outcomes.
One example is the Design for Service Innovation lab (also known as the D-Lab), which for the last two academic years has been jointly offered by Stanford's business, medical, and design schools. The lab emphasizes a "bottom-up" approach to innovation, with students working closely with patients, caregivers, and others, understanding their needs and, in some cases, getting ideas for their innovations directly from the interested parties.
"We are strong believers in human-centric design," said James M. Patell, the Herbert Hoover Professor of Public and Private Management at Stanford GSB, who co-led the most recent lab, along with Stefanos Zenios, the Charles A. Holloway Professor of Operations, Information and Technology. "It's crucial for our students to gain empathy for the real patients, doctors, nurses, and families."
"The course doesn't start by trying to think up some cool new technology. It starts by trying to understand a real need — a weakness in the system, or an instance in which the system is failing its constituents. Then, we do whatever it takes to fix it," noted Patell.
The 30 students enrolled in the class during the 2012 winter semester were placed in 4- or 5-person teams. Each team was assigned a real-world health care problem at a clinic in the Bay Area, many of which were associated with a medically underserved population.
The students were from a wide sampling of the Stanford population: the business, medical, design, and law schools, along with graduate students in electrical engineering, materials science, and other fields. Here are three representative projects from the most recent lab:
Senior citizens, mainly native Chinese and Russian speakers, being served at the Ocean Park Health Center, run by the San Francisco Department of Public Health in the city's Sunset District.
Getting them to show up, fully prepared, for a colonoscopy.
Patients at the clinic who are 55 or older have annual stool screenings. In a very small percentage of the patients — less than 1% — the results of the test trigger the need for a follow-up colonoscopy. But notifying patients, and then preparing them for the procedure, is a lengthy, complicated process. Patients drop out at each stage, especially when they learn about some of the unpleasant pre-screening preparation requirements.
The problem is compounded when language difficulties are added to the mix. The staff at the Ocean Park Health Center faced challenges in its colonoscopy-related education efforts, even when aided by "patient navigators" fluent in the patients' native language. Explanations, delivered either in person or on the phone, often were quickly forgotten. Professionally prepared educational materials, especially brochures, often were set aside, unread.
Personalized letters from the health center team provided to patients at key points in the screening process. In talking with patients and staff, the Stanford students realized that patients considered a personalized letter written on professional stationary and delivered via first-class mail to be a serious matter that required their utmost attention. The proposal calls for every patient requiring the procedure to receive such letters, hand-signed by a caregiver at the clinic. The letters would be in their native language, and would carefully explain everything they needed to know to prepare for the procedure. While the letters would duplicate most of what would be contained in a brochure, the quasi-legal, personalized nature of the communications resulted in patients taking them more seriously. Tests suggested that patients would keep the letters in a safe place, and share them with their children or other family members, as befitting an important communication.
Jia Chang, Hayley Chan, Anya Greenberg, and Elena Kaye.
Transition Into Adult Care
Adolescent patients at hospitals with strong pediatric programs, such as the Lucile Packard Children's Hospital.
There is a large population of pediatric patients who have been receiving intensive medical care for most of their lives. Babies born prematurely or with clear health challenges often develop close personal relationships with their care providers as they grow older, due to the frequency with which they need to seek care. This sort of pediatric medicine usually is extremely personal, because of the deep emotional bonds that develop over the years between care providers, patients, and their families.
As pediatric patients reach adulthood, however, they are required to enter the traditional adult healthcare system. This transition often is a shock, as young people suddenly must fend for themselves after a lifetime of being at the center of a nurturing and supportive network.
A transition specialist assigned to patients, while still in their mid-teens, to help them prepare.
The specialist, working with each individual, would be responsible for developing and then implementing a master plan to help young people take this crucial step. He or she might, for example, engage in role-playing activities with the young patients, teaching them the assertiveness they will need to communicate their medical needs when their parents no longer are accompanying them through the process. The specialist also might help patients prepare a one-page "resume," which would serve to introduce themselves to new caregivers, bringing them up to speed on current medical conditions, without patients having to answer the same sets of questions they've answered dozens of times in the past. And special attention would be paid to explaining some of the most opaque aspects of the adult health care system, notably insurance.
Jacqueline Jacobs, Brian Kidd, Cammie Lee, and Alisa Mueller.
Fire Station Health Portal
Residents of Oakland, with the potential to expand across Alameda County.
What are the best locations for drop-in health clinics, designed for medically underserved residents? Are fire stations reasonable candidates? Fire stations are dispersed throughout the community, and their staffs already have considerable experience in matters of emergency care. Because the buildings are county-owned, adding space to them to accommodate a clinic would be easier than starting from scratch with a new structure.
The students came to appreciate early on that it would not be practical to expect a busy urban fire station to also function as a drop-in health clinic, although a clinic conceivably might be built next to a fire station. But in the process, the students realized that just as important as deciding where to place a clinic is figuring out exactly what services the clinic ought to provide. Because different communities have differentiated needs, no single scope of services would be appropriate for everyone. The team designed a decision-making tool that could help communities determine the scope of services they ought to offer in each local clinic. The Java-based program helps rank the community's needs, while also systematically taking into account the severity of the diseases treated, cost of treatment, legal risk, number of emergency department visits that potentially could be averted, and other important factors.
Spring Sun, Ian Connolly, Maura Aranguren, Mira Wijayanti, and Curtis Chow.