Originally presented at the 2017 Duke University Innovation by Design Symposium
Hello! My name is Brett Bishop and I’m here to talk with you about your roles in the future of healthcare. But first, let’s quickly level-set on the state of healthcare in the U.S.
$10,345 per capita. That’s $10,345 for every man, woman, and child in the U.S. (Doesn’t matter if you used it or not, that’s the breakdown.) That amounts to 3.2 trillion dollars every year. And it’s going up. I spent way too much time looking into ways to bring that number into some kind of perspective, but A) all I could find were comparisons for 1 trillion dollars and multiplying it by 3 immediately diminishes the comparison and B) even the 1 trillion dollar comparisons seemed to lack the punch of exactly how much money that is. Every. Single. Year.
The poor outcomes.
Any guesses on where the U.S. sits in a comparison of global health outcomes? Top 10? 20? 30? Nope. The United States comes in at number 37, just behind Costa Rica. And that’s with spending 3.2 trillion dollars.
Medical errors are estimated to be the 3rd most common cause of death in U.S. medicine. The reason I say estimated is that we don't actually count medical errors in official records. A professor at Johns Hopkins (who I'm sure is very popular in health circles these days) conducted a meta-analysis just last year and came to the conclusion that if we were able to count medical errors, that's where they'd sit. At the number 3 cause of death in U.S. cases.
And before you immediately put the image of a clumsy doctor slipping with a scalpel or a nurse not reading her instructional manual, this more often the kind of "medical error" that abounds. This is an EMR that's supposed to tie things together. This is considered an improvement.
In reality, those medical errors are more often caused by a confusing, disconnected web of information that leads to different clinicians seeing different things at different times and making disjointed decisions...all of which land at the feet of the person receiving care.
And do you know where conversations about solving these problems start?
Right here. Over a spreadsheet. Rows, columns, red and black, year-over-year trends. You can talk about it all day long. Look at it just about every different way.
And we find ourselves asking these questions atop those spreadsheets. These are great questions. The people asking these questions want to help. Yet these questions lack specificity. They lack the humanity that underlies improving an outcome, reducing a cost without impacting care, or reducing an error. What does it actually mean to accomplish any of these things? What's on the other end of a percentage drop or a bump up in any of these areas? We instead should be asking the question, "...how are we improving a person's life?"
And yet - these questions are often posted atop an excel spreadsheet. In a meeting room. Closed doors, good luck with some windows providing some semblance of a connection to the outside world.
All of this to say, "You cannot solve problems with the same thinking that created them." And of course, Einstein boiled this thought to a much better point. This is essentially what I want to share with you today - that we cannot solve the healthcare problems we are currently facing with the same thinking that's led us here. We will not build a better healthcare system in the generations to come by blindly following the procedures you'll likely run into as you join the healthcare industry. How important it is for each of you to solve problems differently and push for that different way of problem-solving in your future work. And how important it is for me, personally, to see this happen.
As I said previously - I'm with Philips Health - working as a Design Lead for the Connected Sensing Venture. Our vision is to improve peoples' lives by erasing the lines between the various silos in today's healthcare landscape and plugging the holes where people fall through the cracks as they move through their healthcare journey. We aim to accomplish this through a combination of software and hardware that allows both patients and clinicians to move seamlessly through the touch points in their care.
Like I said, this isn't just a job for me. I came here to share my perspective and why it's personally important for me to see us do things differently. These are my grandparents - seen with their favorite grandson here. Betty and Hank Zelias. Native New Yorkers who moved to Florida during the rapid growth of the 1960s to provide a better life for their 4 kids. I still marvel at the gall of my grandparents to pick up a family of 6 and move them from upstate New York, leaving everything and everyone they knew, and settling in southern Florida based on some conversations with members of their church.
And I lost them both in 2016.
My grandmother to COPD. or Chronic Obstructive Pulmonary Disease. A lung disease that essentially renders you perpetually short of breath. And, with each year, shorter breath. Doctors estimated her lungs were operating at roughly 20% capacity when she passed away. After living with the disease for roughly 15 years, she passed peacefully in her sleep, surrounded by family.
My grandfather to complications from sepsis. Essentially, a blood infection. It likely languished for months while he was at home - slowly worsening yet not enough to raise concern. He took a fall at home ("he must've tripped, old people are clumsy, right?"), was admitted to the hospital, stabilized, and went to a skilled nursing facility for rehabilitation, and went into septic shock over night. The nurses didn't find him until the following morning.
It's not they died that bothers me, though that's never pleasant. There's always going to be a period at the end of the proverbial sentence. It's how we're sort of trained to expect things to go. Our grandparents, our parents, that's the natural order.
It's how their lives were lived in the decades preceding their deaths that get to me. The confusing doctor's appointments, the referral from one specialist to the next, the constantly changing medications, the confusion and stress on their- and their family's - shoulders. And that's only mentioning the times they were being "cared for".
No amount of poring over a spreadsheet is going to improve those years of life.
And the thing is, their situations are not unique. As painful as it is to me, and my family, my grandparents' experiences are an epidemic in the U.S.
An estimated 258,000 people die every year from sepsis. In the span of this talk, 15 people will have died.
There are currently 16.8 million people in the U.S. living with COPD. And there is no cure for COPD - that's the whole "chronic" aspect. These are 16.8 million people who have been told it's a matter of time before the disease catches up with them.
But we lose the gravity of the situation when we flip it to faceless numbers. And we lose the level of detail necessary to truly understand what an individual's life is like and develop solutions that fit into their lives in order to improve their care, their quality of life, and ultimately - impact the massive systemic inadequacies we're facing within the U.S. healthcare landscape. (As an aside, has anyone seen a Stalin quote used in a positive manner before?)
We, and I use "we" in this instance to corral the multitude of skills we have here - tech, engineering, business, design, etc. - must considering it our own responsibility to remember the individual tragedies, not only the statistics, as we set out to solve these problems. It's what keeps us grounded, digging it out, and continually orients us in the right direction.
Too often I see the responsibility for "understanding your end users" fall to designers. As if designers will single-handedly force that perspective into the brains of every team member that's critical to brining something new to the market. Additionally, simply "understanding" what happens isn't enough. My ability to recount, factually, what occurs in a given environment is table stakes. We have to passionately feel what it's like in the situations we're tackling. It keeps us hungry and allows us to see the solutions that may not seem obvious or "logical".
In fact, there's no guarantee that a designer will even be there to shoulder that load - particularly in medtech companies just getting off the ground.
It is every single person's responsibility to demand that perspective, be guided by that perspective, seek it out and work with others to ensure it's driving the decisions you're making.
And it's not just everyone having that impassioned perspective for those at the center of care. It's those delivering care. They systems they're using. And how all of these pieces interacting with each other to ultimately deliver better care and a new lease on life for those we love.
So why am I telling you this? Because I'm at Duke University. I've grown with a favorable impression of Duke. But I did some digging into exactly the kind of pedigree Duke can claim. I found a laundry list of c-suite executives, politicians, board members, founders, and more.
(This animation was 3x longer but I think you get the point.)
I'm standing in front of a group of people that have pretty good odds at making some big decisions in the future. This isn't ass-kissing. It's a simple fact. You'll start something, decide something, change something that has some significant weight in the grand scheme of things. And I ask of you - when you find yourself in those situations...
Don't just think of this.
Think of this.
Or more accurately, your own grandparents, parents, and loved ones. Remember their individual, personal journeys.