MHA 505 Week 4 Design Thinking for a Health Care Solution Example

Designing the Trip Home With the People Who Make It: Using Design Thinking to Rebuild Heart Failure Discharge Around Patients, Families and Facility Nurses

[Student Name]

University of Phoenix

MHA/505: Systems Thinking in Health Care Environments

Week 4 Assignment

[Instructor Name]

[Date]

The hospital, its patients, prototypes and results are composites written for a model paper; research findings come from the sources listed.

Midway through the heart failure transitions project at the community hospital, a patient's adult daughter told the care transitions director something that changed the project. Her father's discharge folder had forty pages of printed instructions, medication lists and education sheets, and at 2 a.m. on his first night home, when he was short of breath and she was frightened, none of it told her what to do. The team had been planning a better folder. The director proposed instead to use design thinking, a method that starts with the people who experience a problem. This paper describes the process and its results.

What Design Thinking Is

Design thinking is a human-centered approach to solving problems that moves through understanding users, defining the problem from their perspective, generating many ideas, building quick prototypes and testing them with users, cycling back as needed. A framework for its use in health care management describes stages of inspiration, ideation and implementation, emphasizing observation of users in real settings and rapid, low-cost prototyping before investment (Roberts et al., 2016).

How It Differs From the Usual Approach

The hospital's usual approach was a committee that reviewed complaints and wrote a new form. Design thinking differs in three ways: users shape the problem definition, many ideas are generated before any is chosen and solutions are tested cheaply with users before they are built at scale.

Empathy: Following Patients Home

Over two weeks, team members shadowed six patients from the day of discharge through their first days at home or in the partner nursing facility, with consent, and interviewed eight family caregivers, four home health nurses and three facility nurses. They noticed that discharge teaching happened in the hour before transport, when patients were tired and families distracted; that patients kept the folder but used only the medication list; and that facility nurses received discharge summaries hours after the patient arrived.

Defining the Problem

The team's original problem statement was that patients do not follow discharge instructions. After the empathy work, they rewrote it: families caring for someone with heart failure do not know what to watch for or whom to call during the first nights at home, when symptoms are most frightening and the hospital feels far away. The problem was never a lack of information; it was information that did not work at 2 a.m.

Ideation

In two sessions with patients, family members, nurses, a pharmacist and a cardiologist, the group produced 47 ideas, from video instructions to a refrigerator magnet with a phone number. They grouped the ideas and chose three to prototype based on likely impact and ease of testing.

Prototype One: A One-Page Going-Home Plan

A single page with three sections: what to watch for, written as a traffic light with green for normal, yellow for call the clinic and red for call 911; medications with times, printed large; and the names and numbers of who to call day and night.

Prototype Two: A Color-Coded Weight Chart

A chart for the refrigerator with space to record daily weight, with a highlighted band showing when a gain means calling the nurse.

Prototype Three: A First-Night Call

A nurse calls every heart failure patient the evening of discharge to ask how they are, review the one-page plan and answer questions.

Testing and Revising

The team tested each prototype with 10 patients and families. The first version of the one-page plan used medical terms that families did not understand; it was rewritten at a sixth-grade reading level and translated into Spanish. The weight chart was confusing for patients who used kilograms; a pound-only version with a large number line fixed it. The first-night call worked best after 6 p.m., when families were home and the patient had settled; calls earlier in the afternoon often reached no one.

What the Evidence Says About the Method

Design thinking has promising but limited evidence in health care. A review of 24 studies using design thinking found that 12 interventions improved all outcomes, 11 improved at least one and 1 improved none, and the 4 studies comparing design thinking with traditional interventions found greater satisfaction, usability and effectiveness, although methods and quality varied (Altman et al., 2018).

What the Evidence Says About Discharge

The clinical evidence supports redesigned discharge. In a randomized trial, a reengineered discharge program that included patient-centered instructions, scheduled follow-up, medication reconciliation and a follow-up phone call reduced hospital utilization within 30 days, with an incidence rate ratio of 0.695 compared with usual care (Jack et al., 2009). The team's prototypes share several of these components but were shaped by local users.

Early Results

In a two-month pilot on one unit with 64 heart failure discharges, 91% of families said they knew whom to call, compared with 52% before; 30-day readmissions were 17%, compared with 24% on other units, a difference too small in numbers to be conclusive.

What Staff Learned About Themselves

The empathy work surprised the nurses on the team. Several had taught discharge instructions hundreds of times and believed families understood them. Watching families at home, trying to find the right page while a patient struggled to breathe, changed how they saw their own teaching. One nurse said she had been teaching to the folder, not to the family. That shift in perspective, as much as any prototype, may prove the project's most lasting result.

Ideas That Were Set Aside

Some popular ideas did not survive testing. A video of discharge instructions, favored by the team, was rarely watched at home; families said they wanted a person, not a screen, when they were frightened. A smartphone app for weight tracking worked well for younger caregivers but not for most patients, who were in their seventies and eighties. The team kept the app as an option but built the core solution on paper and phone calls, the tools users actually reached for.

Involving the Partner Facility

Facility nurses tested a version of the one-page plan adapted for skilled nursing care, with the hospital nurse calling the facility nurse at transfer. They asked for the patient's baseline weight and diuretic plan at the top, which became the facility version's first line.

Scaling and Measuring

The team will extend the prototypes to all units, embed the one-page plan in the electronic record, staff the first-night calls from the care transitions team and track family confidence, readmissions and calls to the clinic.

Conclusion

Design thinking changed the problem before it changed the solution. By following patients home, the team learned that families needed simple, usable guidance for the first nights rather than more information. Three quick prototypes, tested and revised with users, produced a one-page plan, a weight chart and a first-night call. Evidence on the method and on redesigned discharge supports scaling what worked.

References

Altman, M., Huang, T. T. K., & Breland, J. Y. (2018). Design thinking in health care. Preventing Chronic Disease, 15, E117. https://doi.org/10.5888/pcd15.180128

Jack, B. W., Chetty, V. K., Anthony, D., Greenwald, J. L., Sanchez, G. M., Johnson, A. E., Forsythe, S. R., O'Donnell, J. K., Paasche-Orlow, M. K., Manasseh, C., Martin, S., & Culpepper, L. (2009). A reengineered hospital discharge program to decrease rehospitalization: A randomized trial. Annals of Internal Medicine, 150(3), 178-187. https://doi.org/10.7326/0003-4819-150-3-200902030-00007

Roberts, J. P., Fisher, T. R., Trowbridge, M. J., & Bent, C. (2016). A design thinking framework for healthcare management and innovation. Healthcare, 4(1), 11-14. https://doi.org/10.1016/j.hjdsi.2015.12.002