A Prescription for Disruptive Design

For Convening Leaders 2017 Stacey Chang, design goes beyond the creation of ‘beautiful things.’

StaceyChangHeadshotColorTwo years ago, Stacey Chang was working as the managing director of the health-care practice for the influential design firm IDEO when he received a call from a former client. “We have this opportunity,” began S. Claiborne “Clay” Johnston, M.D., Ph.D., who had become dean of the Dell Medical School at the University of Texas at Austin. “We’re trying to design a new health system, and we have no designers.”

The pitch: Would Chang help establish an institute that was a unique collaboration between the medical school and UT Austin’s College of Fine Arts? “That was a very hard thing to say no to, given my proclivities and aspirations for health and society as a whole,” Chang said. So in 2015, he became the executive director of UT Austin’s new Design Institute for Health (DIH), which he calls a “first-of-its-kind institution.”

For Chang — who holds a bachelor’s degree from MIT and a master’s from Stanford University, both in mechanical engineering — design is a discipline that transcends aesthetics to become “a uniquely different approach to problem solving, especially in complex systems that are human-centered, iterative of nature, and collaborative.” At DIH, innovative thinking is applied to an array of health-care settings and deliverables, from buildings to interfaces — and possibly in the future, medical meetings.

Chang will offer a Thought Leader session at PCMA Convening Leaders 2017 in January. Recently he gave Convene a preview.

Design can take many forms. When does it mean to you when it comes to health care?

Design is anchored in the public’s consciousness in ways that are familiar, like graphic design, or fashion design, or interior design. There’s this idea that it creates beautiful things to make people go ooh and aah. While that may be the end result, and a good one, as a designer you spend a lot of time understanding human motivation, human cognitive perceptions, all these uniquely difficult-to-reveal emotions about how people interact, and ultimately how effective they are at whatever they’re trying to do.

Design has a huge influence on how systems work. The design of spaces dictates how people interact with each other. The design of technology dictates how effective someone’s workflow might be. At the Design Institute, we’re doing everything from designing business incentives and business models, to organizational structures, to the interior layouts of buildings and clinics, to service blueprints, to interfaces. All of it. Design is a unique lens to approach a lot of these problems that have become hard to solve because our traditional tools don’t provide new insight.

You’ve said that the medical system doesn’t need incremental change — it needs disruption. What do you think is most dysfunctional about the U.S. health-care model, and most in need of revamping?

It’s actually pretty simple. Look at the incentive system we designed starting with Medicare, back in the ’60s. We pay doctors, or the health system, to do things to us as patients. The more complex our illness or our disease, the more difficult what they have to do to us, the more they get paid. If that’s the incentive, then the system naturally orients to get paid well as often as possible.

That’s sort of where we are in America’s health system now, where we wait for people to get sick. We don’t invest any time or energy or dollars in keeping them from getting sick. While that might have been appropriate three generations ago, when most of the stuff that killed us was infection or disease or accidents or injuries, most of the disease now that’s encumbering our nation is chronic disease that’s more social in nature — diabetes, obesity, hypertension, the function of lifestyles or eating decisions, of lack of exercise, of lack of access to green space.

Design has a huge influence on how systems work. The design of spaces dictates how people interact with each other. The design of technology dictates how effective someone’s workflow might be.

Our approach to solving those problems has to be really different. We have to change the incentive structure, and then we have to change the mechanisms to address them.

How does that extend to information design, the design of buildings, and some of the elements you mentioned before? Are they interrelated?

Absolutely. One of the biggest challenges is that, if we’re going to address chronic disease and the social-lifestyle issues that are causing us to be ill as a nation, we can’t do that only in a clinical environment. Ninety-nine percent of the time, we’re not in a doctor’s office. We live at home with our families, or are at work, at school, at play. We have to empower people to treat themselves so they can live not in spite of the disease, but live with it.

That means we actually have to turn what we traditionally call patients into consumers who have a motivated and empowered role in their own health. Technology is a huge enabler on that front. What’s the best way to access people, to engage them in their health, to give them feedback and encourage them when they need it, to allow them to take control? It’s going to be through technology and through interfaces — so the design of information and information technology are really critical to that.

I’m old enough now to have had enough experience in the health-care system to know that it’s an inhospitable place. It’s not designed for my experience. It amps up my anxiety, it adds to my confusion, it’s an unpleasant and ineffective experience. Compare this for a moment to a hospitality experience. You go into a hotel and people have pre-thought everything that you could possibly need, and given you control of your experience. It’s easy to master. No one has to explain it to you. There’s no reason that health care shouldn’t be the same, because actually we know when we empower somebody and give them mastery, lower their anxiety, give them control, they actually have a better outcome. We just choose not to do that, because that’s not how we’re paid right now.

Do you think that medical meetings have a role to play in changing the design and experience of health care?

Absolutely, amen, and hallelujah. Of course. I’m married to a physician, and she goes to traditional medical meetings. They are, by comparison to the kinds of sites that I go to for design meetings, rather staid and formal — that’s the polite way of putting it. The topics they’re discussing are very serious. The evidence is scientific in nature. There’s legitimacy and authority, and those are appropriate descriptors of the kind of tenor of those gatherings.

However, what they’ve lost in the midst of that is this connection to the human motivation for the work that’s being done. Not just the patients who are being served, but for the doctors who are serving. You ask doctors, “Why did you join this profession?” They’re like, “I wanted to care for people. I wanted to develop a skill set that allowed me to care for other human beings.” That’s a very emotional basis, and so as we consider the change in health care, it’s a reorientation back to humans and to care and to things that are more than just reimbursement of money.

Can you recall a medical meeting that left an impression on you?

I actually think we’re heavy on facts and authority, and short on inspiration. Human beings need to be convinced and shown evidence, but they also need to be inspired. I think maybe the most notable one that is consistent with that is TEDMED. The TED conference in general, but TEDMED in particular, combines both inspiration and motivation with a real concern for this commonly held, altruistic notion of caring for your fellow human being. The combination of purpose and inspiration is really strong in something like TEDMED, and it’s something that I think we could learn a lot from, even in the most professional settings.

Corin Hirsch

Corin Hirsch is associate editor of Convene.