What is the first step you take when you want to tackle a complex problem for a patient? Perhaps you start brainstorming solutions, or maybe you think about the resources you can put toward the problem. Have you ever slowed down to think first about the user’s needs, experiences, and goals? Welcome to design thinking!
Design thinking is a team-based problem-solving process that can be applied to a wide variety of fields and complex situations. Design thinking incorporates well-defined stages to produce insights that lead to solutions that address problems the team has identified as user pain points. One key defining factor of design thinking is that the user’s needs and experiences are kept at the forefront of the problem-solving process from the initial stages.
I’m sure that many of us have worked with O&P products and services that make little sense for the users they were supposedly designed for. Think about the last product that you used in your clinic: Was it designed with the user’s needs and experiences in mind, or was it designed based on assumptions the product team had about the user? Design thinking can be a way to make sure that the problems we are working on are actual problems for our users and that the solutions we craft address those problems in a meaningful way.
Models of Design Thinking
In the Design Council’s Double Diamond process, the stages of design thinking involve identifying a challenge and then moving through four stages: discover, define, develop, and deliver (see Figure 1).2 The stages combine convergent thinking (narrowing down options and enhancing focus) and divergent thinking (considering more solutions, options, and thinking about a situation more broadly).
In the discover stage, it is time to put aside our assumptions about the problem and the people the problem affects. During discovery, a divergent phase, we should try to understand and empathize with users. This process can include observing the user encountering the problem in daily life or interviews with users about their experiences. In the define phase, a convergent phase, we examine the data gathered from user interactions and observations to better define the problem. In the develop phase, another divergent phase, the team seeks to brainstorm and ideate solutions to the problem. In this stage, it is important to suspend judgment: let’s hear the crazy ideas! Shutting down others’ ideas (or even hesitating to propose your own for fear they are too outlandish) will stifle the team’s ability to think broadly and openly about the problem. The deliver stage, another convergent phase, is when a few of the ideas are tested at a small, manageable scale. Now the team can construct prototypes and test them with users to get feedback. Prototypes should not be fully fleshed out but should instead be developed just enough to see if the idea or concept can be a potential solution.
Another way to think about design thinking is considering the Stanford Design Thinking Bootleg, which illustrates design thinking in five phases: empathize, define, ideate, prototype, and test.3 There are many parallels between this process and the Double Diamond process. Both methods begin with empathy and an effort to understand the user and the core problem. From empathy comes a better understanding of the problem and user experience. The ideation phase is the time to create as many ideas as possible, and the prototyping phase is when the user should interact with the prototypes to see if the problem is being addressed.
One other element that is important in both methodologies is iteration. Iteration is the process of continually refining and tuning a product or service. Consider the process of continually testing a hypothesis, receiving feedback and results, and then refining the hypothesis as well as the experiment. In iteration, particularly at the prototype stage and early in the process before there is a more permanent solution, it is encouraged and acceptable to make many changes to better meet the needs of the user. Failure should occur early and often. Iteration also does not need to be a completely new version of the concept; it can be simple adjustments and refinements that are prompted by user feedback. The earlier this type of testing is done in the process, the more efficient and focused the resulting solution.
During these stages there are other lenses to consider which can help direct your thinking and problem-solving, including desirability, feasibility, and viability. Desirability is assessing if the user wants the solution. Viability involves considering if you should pursue a solution based on financial considerations and business needs. Feasibility involves whether the solution is possible.
Consider these lenses as applied to designing a patient’s prosthesis: a patient might want a torsion adapter on their prosthesis (desirability), and there is the available build height and foot compatibility (feasibility), however there is no insurance coverage, and the patient is unable to pay out of pocket (no viability). These lenses can help clarify ideas for consideration during the convergent phases.
One last concept to touch on before thinking about these ideas as applied to O&P is creating personas to help with the empathy-building experience. A persona is a user profile that helps to better define your user population by defining various user types or categories. Personas can be created from user research and observation.1 Think of the patients that you see every day at your clinic. Are there groups of patients that might have similar needs and experiences across various diagnoses, or could they possibly be grouped by diagnosis as a starting point? Creating personas helps you step outside of your own perspective and attempt to become immersed in someone else’s point of view. Give your user persona a name, find a photo that represents this person, and think about what that person does, says, feels, and thinks. This activity is best done with a group to help create a well-rounded persona that includes various perspectives. It can also be helpful to interview patients that match the persona for quotes to help keep you grounded in their perspective. It is here, during persona creation, that you can carefully examine your own assumptions about the users you have in mind. What are your assumptions regarding your patients, particular patient populations, or even allied healthcare professionals that you work with? What are the assumed pain points of these individuals, and what might be the real pain points?
Applications in O&P
Design thinking as applied to O&P was of particular interest to me when I realized that as clinicians we already implicitly do some of these steps in our quest for quality patient care. Consider a classic O&P anecdote about a prosthesis or orthosis that sits in the patient’s closet even after countless appointments to get things “just right.” This might happen when we may not be able to discern a patient’s needs for a variety of reasons or miscommunication occurs. We are rarely successful when we ignore the users’ needs. One of my guiding principles as a clinician was constantly considering two questions: What is best for this patient, and what will help the patient achieve his or her goals? When things went wrong, I would ask myself if the current stage was still on track with those questions. If I felt the process was not aligned, I would check in to gather the patient’s perspective about the process.
Here is the theoretical, ideal patient situation when design thinking is integrated. Your patient comes in for an AFO evaluation appointment following a stroke. The challenge or problem to address appears to be clear. Now you enter the discovery phase: You seek to understand the patient’s medical history, background, physical condition (i.e., manual muscle testing, range of motion measurements, and gait assessment), expectations, and goals for a new orthosis. You gather a great deal of information from your patient at this stage and can perhaps distill it as “I would like to walk confidently in my home without an assistive device” (define phase). Now with the problem clearly in mind, you start to ideate along with the patient about the options—perhaps going back to physical therapy to improve range of motion before providing an ambulatory orthotic intervention, or a variety of custom-fitted carbon fiber AFOs (develop phase). Together with the patient you can pick a path. In this case, suppose you pursue the custom-fitted carbon fiber AFO option. The iterating phase may be trying on various devices in the office and working with the patient to converge on a solution (deliver phase).
The full cycle of design thinking can occur even in the span of one appointment. Consider also that this process occurs at a larger scale across the patient’s rehabilitation. In the grand scheme of rehabilitation, this one device may be part of the iteration phase in the care plan. As the patient’s needs change, the carbon fiber AFO provided initially may no longer meet the patient’s goals, and a new solution may be in order.
Design thinking in O&P can also be applied outside the scope of patient visits and clinical work. Suppose your front office staff realizes that patient intake forms are not being fully filled out by new patients. The clinical staff agrees that not having comprehensive patient information up front is lengthening appointments and making it challenging to acquire a full medical history. What should be the first step to address this problem with the design thinking framework? Instead of assuming what the problem is, observe patients in the waiting room filling out the intake forms or analyze the forms to see if there are any trends in the fields that are not being completed (empathize phase). You could also interview patients informally about their experience with these forms to understand where the problem lies.
Next, in the define phase, you find there are a variety of challenges that patients encounter when filling out these intake forms. Perhaps patients don’t show up early enough to their appointments to complete a long form, or maybe the form is formatted such that patients become frustrated. It could be that patients feel there is not enough privacy in the waiting room to fill out the forms, or maybe patients assume that you already have their medical records. You analyze the trends in the data you have gathered and realize that most patients need more time to complete the form and the fields are too small. Ideally, you can move to the ideate phase with a group of patients, front office staff, and clinicians to understand how this process can be improved for all stakeholders. Some of the proposed ideas might include asking new patients to come in 15 minutes early for appointments, making the forms digital and/or shorter, collaborating with the referring physician to gather data ahead of time so less information is needed from patients, having patients fill the forms out at home, etc.
With many ideas to choose from, you can now converge and pick a few to prototype (prototype phase). Prototyping does not require fully building out an idea, but there should be enough of a representation such that users can confirm if this is a possible solution to the problem they are encountering. For example, you can print out some forms and send them to a small group of new patients to see if their forms are filled out more completely at their appointments. The key is to not get locked in with one idea and to gather feedback early in the process (test phase). If the printed forms do not address the problem, you can swiftly move to another idea after gathering feedback on why that was not successful. For each idea that is considered, you can apply the feasibility, viability, and desirability lenses to any idea as you start to converge with your team. Continue to iterate until you have gathered data to demonstrate that the problem of the incomplete patient intake forms has been addressed, and that you have not created new frustrations for your users and stakeholders.
Design thinking can be a new way to approach problems that you would like to tackle at your clinics by keeping the user in mind from the early stages and to build empathy and an understanding of what the underlying problem truly is. One of our strengths as clinicians is getting to the root of a fit problem (the socket fits well; it was actually a complaint about the cosmesis) and applying that strength to other challenges in the office can yield great results. Next time you are tackling a complex problem, consider using design thinking as a new perspective on the process and a way to help your users and stakeholders be more successful.
Nina Bondre, CPO, FAAOP, is an education specialist for Ottobock, headquartered in Austin, Texas. She can be contacted at [email protected] and welcomes your thoughts on this topic.
References
- Dam, R. and T. Siang. 2022. Personas-A Simple Introduction. https://www.interaction-design.org/literature/article/personas-why-and-how-you-should-use-them
- Design Council. 2019. What is the framework for innovation? Design Council’s evolved Double Diamond. https://www.designcouncil.org.uk/news-opinion/what-framework-innovation-design-councils-evolved-double-diamond
- Doorley, S., S. Holcomb, P. Klebahn, K. Segovia, and J. Utley. 2018. Design Thinking Bootleg. https://dschool.stanford.edu/resources/design-thinking-bootleg
- Linke, R. 2014. Design thinking, explained. https://mitsloan.mit.edu/ideas-made-to-matter/design-thinking-explained
Image and photographs: Anne Marie Martinez; WavebreakMediaMicro/stock.adobe.com;ThisIs/stock.adobe.com.
