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May 18-19, 2005, Chicago
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INTERVIEW: innovation rigor
Alan K. Duncan

Alan K. Duncan, MD, shares with us how The Mayo Clinic's SPARC Innovation Program improves healthcare by blending the practices of design and medicine.


Imagine the complexities of introducing continuous innovation into the risk-averse world of healthcare. It may sound next to impossible, yet Mayo Clinic's SPARC program and its Medical Director Alan K. Duncan, MD, have managed to blend the rigor of medical trials with design practices to improve the patient-provider relationship.


Brandon Schauer: Why have you devoted so much of your career to the patient-provider relationship?

Alan K. Duncan, MD: Well I think the patient-provider relationship is where outcomes happen. When we look at the application of evidence-based medicine, everything that occurs happens in the context of the patient-provider relationship. It's the critical piece. It's where I say the rubber hits the road.

The patient-provider relationship is the one context in which all care is ultimately delivered. The medical community has a body of evidence that informs best practices and treatment, but ultimately it's the interface between the provider and the patient where that can be brought to bear. This relationship is a key predictor in the ability to affect positive health outcomes.

The quality of the relationship between the patient and the provider helps determine what some call compliance, but it's probably better termed adherence. So once a treatment plan is agreed upon, this issue becomes whether that patient will continue to work with that treatment or whether they will abandon it. The better the quality of the patient-provider relationship — as measured by shared communication and shared decision-making — the more likely it is that the patient is going to stay with the treatment.

Brandon Schauer: Tell us a little about SPARC. What is it?

Alan K. Duncan: SPARC (See, Plan, Act, Refine, Communicate) is a program consisting of physical space, of people dedicated to the program, and of a methodology for innovation in health service delivery.

Let me give you a little background. SPARC began about three years ago in one of the clinical departments, the Department of Internal Medicine at Mayo Clinic in Rochester. The idea was to be able to do real time experimentation with new practice models. That was the initial idea. However we very quickly realized that we needed to go beyond the idea of experimentation and apply design principles to be able to fully understand what the unmet needs were in the delivery of health services. SPARC began with an idea of how we would simply have a physical space where we could play around with new models of healthcare delivery in the outpatient setting, but we rapidly realized that in order to identify those new models we would have to apply entirely new principles, at least new to us in healthcare.

So to apply these new design principles we learned a lot about how to go out into the field and do user research. We learned a lot about video tools and contextual interviews and other modes of observation in order to gain empathic insight into what our users were experiencing. And we learned about how to translate these insights into prototypes that we could bring back to users to gain feedback from those insights.

Brandon Schauer: How does SPARC address the inherent risk associated with innovation and change within a medical environment, where procedure and rigor are requisite?

Alan K. Duncan: Well I think that gets to some of the unique features of bringing design methodology into a healthcare practice. The one thing we don't want to sacrifice is quality and safety, particularly safety. So the way we've gone about this is to say, "we need to isolate this to a learning environment, first of all, and we need to bring a marriage between design principles and experimental rigor."

I think this is what's unique about the methodology in SPARC. The process involves bringing design principles and experimental rigor closer together. When we find something that works in prototype form we always wrap around it the rigor of the experimental design to understand what impact it's going to have on the patient and on the organization — in terms of effectiveness, in terms of quality, and in terms of patient safety.

Brandon Schauer: Can you share with us any examples of new ideas or new exciting output from SPARC?

Alan K. Duncan: First of all, our work for the first few months was just to get the program up and going and to prove that we have the capability of delivering innovation. So I think the things that we have done early on are not necessarily of tremendous impact to either the organization or healthcare in general but instead are to demonstrate the capability of the program.

But I'll tell you about one of the things we've been able to take through one entire cycle of this process, starting with observations, then building prototypes, and then delivering a finished product. It's a self check-in service. It's analogous to what you would find in the airline industry now, whereby patients are able to interact with a kiosk to check in. It was based on an observation that's very common in service industries, which is dissatisfaction at the point of check-in, primarily with long lines at the point of initial service.

We decided to try to draw a parallel between another service industry, the airlines, and what we do. The insight came from the fact that most of the patients are standing in line simply to say, "Hello, I'm here, and I'm ready to be served," which really doesn't require a human-human interaction. With the long line, check-in is a big dissatisfier. So we took that insight and we constructed a mockup of what a self check-in kiosk might look like, collected initial feedback from potential users, and then began to iteratively refine that prototype to ultimately build a functioning kiosk that patients can use to check in on their own without having to stand in line.

We then created an IRB-approved, randomized control trial, recruiting a hundred patients. The trial patients were randomized either to use the routine check-in or to self check-in using the kiosk. What we found was a high rate of acceptance, and statistically significant reduction in the number of interactions required to have the patient wait for service. We also found a marked reduction in waiting time. So we're now in the process of looking at how to drive this innovation forward through the organization.

Overall, I think the story we feel most passionate about telling is the need to bring design principles in alignment with experimental rigor to really see improvement in health service delivery. We think we've had some early successes in doing that.

Brandon Schauer: How difficult was it to convince Mayo Clinic that SPARC needed to exist?

Alan K. Duncan: Innovation in everything that we do is a strategic priority of the Board, it's a strategic priority of the Department of Medicine, where SPARC began, and I don't think it’s a difficult leap to then support SPARC. I think where we're still working is to try to show the power of design in changing health service delivery.

Fundamentally Mayo is a physician-led organization and physicians come from a background in the sciences. So what we've tried to do is show that the left-brain and the right-brain activities that are part of SPARC's combination of design and experimental methodology are complimentary and not in opposition to one another. I think that's a work in progress.

Brandon Schauer: How are you measuring the success of SPARC?

Alan K. Duncan: I think that's a challenge that we have. I think that once we see it we'll know it, but it's a very difficult thing to measure. So far what we've measured is our throughput of ideas. We've looked at the number of ideas that we've been able to generate around particular design challenges. While we can currently measure our throughput it's difficult to directly measure at this early stage of the program the impact on the organization as a whole. We can understand the impact of some of the things we are testing, but it's tough at this early stage to measure SPARC's impact on the organization as a whole. I think that will come.

Ultimately our aim is to positively impact the health of our patients. And I think we do that in a lot of different ways. I think one way is by improving the patient-provider relationship. One way is to deliver better value in patient care. Another way is to improve the efficiency of the system so that we're able to deliver on that value better. Our impact is on all of those demands.

Dr. Duncan serves as medical director of the SPARC Innovation Program at Mayo Clinic, identifying opportunities for innovation in health care and helping multidisciplinary teams understand the clinical relevance of service design. He also is responsible for the application and integration of new technologies in the health service delivery.

In addition, Dr. Duncan serves as an Assistant Professor of Medicine at the Mayo Medical School and co-director of the Men's Health Center. He graduated from Louisiana State University Medical Center and performed his internship and residency at The Johns Hopkins Hospital.

 

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current newsletter: ISSUE 3

INTERVIEW: Succeeding with complex systems
james hackett

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INTERVIEW: innovation rigor
alan k. duncan, Md

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