JMIR Publications

ABSTRACT

Background:

Overtreatment and overtesting expose patients to unnecessary, wasteful, and potentially harmful care. Reducing overtreatment or overtesting that have become ingrained in current clinical practices and are being delivered on a routine basis will require solutions that incorporate a deep understanding of multiple perspectives, particularly those on the front-lines of clinical care: patients and their clinicians. Design Thinking, one model under the umbrella of user-centered design, is a promising and innovative approach that incorporates stakeholder needs, desires, and challenges throughout the process of developing solutions to complex problems.

Objective:

1. To engage patients in developing high-level “de-intensification strategies” for primary care (i.e., strategies for scaling back or stopping routine medical services that more recent evidence reveals are not beneficial) (Phase 1). 2. To engage both patients and primary care providers in further developing and refining the broad de-intensification strategies identified in Phase 1 (Phase 2).

Methods:

We used a flexible Design Thinking model to develop and engage stakeholders in “design charrettes” – intensive workshops in which key stakeholders are brought together to develop creative solutions to a specific problem – focused on de-intensification of routine overuse in primary care. We conducted the study in 2 phases: a 6.5-hour design charrette with two different groups of patients (Phase 1) and a subsequent 4-hour charrette with clinicians and a subgroup of Phase 1 patients (Phase 2). Both phases included surveys and educational presentations related to de-intensification. Phase 1 involved several design activities (mind mapping, business origami, empathy mapping) to help patients gain a deeper understanding of the individuals involved in de-intensification. Following that, we asked participants to review hypothetical scenarios where patients, clinicians, or the broader health system context posed a barrier to de-intensification and then to brainstorm solutions. The de-intensification themes identified in Phase 1 were used to guide Phase 2. This second phase primarily involved one design activity (WhoDo). In this activity, patients and clinicians worked together to develop concrete actions that specific stakeholders could take to support de-intensification efforts. This activity included identifying barriers to the actions and approaches to overcoming those barriers.

Results:

Thirty-five patients participated in Phase 1. Nine patients and seven primary care clinicians participated in Phase 2. The analysis of the de-intensification strategies and survey data are currently underway. The results are expected to be submitted for publication in late 2019.

Conclusions:

Healthcare interventions are frequently developed without input from the people who are most affected. The exclusion of these stakeholders in the design process often influences and limits the impact of the intervention. The current study employed design charrettes, guided by a Design Thinking model, to bring clinicians and patients with differing backgrounds and with different expectations together, to co-create real-world solutions to the complex issue of de-intensifying medical services.