Is the Present State of Health Care Even Worth Saving?

Editor's note: H&HN Staff Writer Marty Stempniak is blogging this week from the Mayo Clinic's Transform 2012 symposium.

ROCHESTER, MINN. — Is this country's health care delivery system a Ferrari in need of a quick tune up, or a worn old Pinto ready to be scrapped?

Listening to Marc Matthews, M.D., talk on Sunday, you might start to be convinced it's the latter. Attendees piled into the Mayo Clinic, in Rochester, Minn., this weekend for the provider's fifth annual transform symposium, highlighting outside-of-the-box ways to retool the industry.

"You can't continue to tweak a broken system and expect different results. That's the definition of futility," said Matthews, a consultant in the Mayo Clinic's department of family medicine and member of the clinic's Center for Innovation. "What we're trying to do here is ask more fundamental, holistic questions of why the system is broken, and start addressing those root causes."

During the session, Mayo staffers advocated for the use of "design thinking" to solve health care's peskiest of problems. Now, I'm still brushing up on my health care lingo, so when I hear "designer," I think of those folks from my newspaper days who would make the pile of words I just dumped on them look pretty on the page.

But the way Matthews describes its, Mayo's designers serve as sort of a physician's fairy godmother. He related a story about trying to better the patient experience in the primary care physician's office by designing a "shiny," more welcoming exam rooms. But afterward, satisfaction remained low and patients continued to complain that their doctors weren't talking to them.

Matthews had designers return to the physician office, and gave them permission to observe the patient interactions to look for the root causes of the problem.

"It got really uncomfortable really fast," he said. "The questions were always respectful and sympathetic, but they started asking some really fundamental questions about how we practice medicine." For example, he recalled, why was the doctor just glossing over the patient's lack of transportation to get to appointments, or money to buy groceries?

Mayo staffers laid out steps along the design process, from scanning and framing the issue, to researching and experimenting, synthesizing, prototyping, and then implementing a possible solution. Attendees were asked to huddle up, agree on a problem, and walk through the steps of design thinking to try and solve it.

The issues that crystallized in attendees' minds were common ones. While touring the Center for Innovation, I met a pediatrician from a critical access hospital in Washington, concerned that the "writing is on the wall" and his place of work would need to find ways to stop relying on just reimbursements. During the design session, a woman from Singapore said her hospital has had issues with getting elder patients to use new technology, such as telemonitoring.

Our little group powwowed on the issue of way finding, a problem that Melissa Schoenherr said is an ongoing headache at her hospital in St. Louis Park, Minn. We brainstormed a list of ideas, which a designer scribbled on a poster board. Matthews encouraged attendees to take a sense of wonderment into the design-thinking process, and that mindset was palpable throughout the Center for Innovation. Little colored post-it notes riddled the walls, covered with ideas. Others were scribbled on dry-erase boards and even windows around the office looking out over Rochester from the 16th floor.

Back at the session, Matthews emphasized that doctors need to be able to put themselves in an uncomfortable situation and work collaboratively with others. Otherwise they'll end up trying to put a Band-Aid to treat a gaping wound.

"It's hard but this is worth it," he said. "For me I was burnt out. The system was constraining me, I could not fix it; I was banging my head against the wall. I'm sure many of you have probably felt the same way. But the design process gives you the tools to start addressing the system differently."