Nosocomial infections are infections that patients contract inside of a hospital, due to contamination or germs present there. A patient undergoing treatment at a hospital is almost always has a weak immune system, which is more susceptible to infection. And the odds of contracting an infection are higher in operation theatres and ICUs. Most likely because those needing to be in the ICU or get operated are in a far more immunocompromised state.
Now ordinarily hospitals are brilliant at spotting and solving hospital related risks and challenges. Having been an examiner for a prestigious award that company, hospital and educational institute teams compete for in areas of innovation and improvement, I have seen the top projects being showcased, and they are impressive. The meticulous tracking and calculating of various data points, identifying causes, finding and implementing solutions, and tracking effectiveness, and then setting up a cycle for continuous improvement.
So it is concerning when nosocomial infections account for 5-10% of all patients in an acute care hospital in the US [+]. And the numbers are even more concerning in India, where our hospitals are far more crowded, with little concern or respect for regulation. Here in India, nosocomial infections are as high as 11-60% in ICUs [+].
While this one is quite obvious, assuming ICU cleanliness follows the highest of standards and procedure, I think a bulk of these infections occur in elevators. Elevators are known to be extremely contaminated, the buttons in particular.
While I unfortunately don’t have a broad solution idea to offer for this challenge, I do have some almost obvious suggestions:
If a new private hospital is being constructed, try and create an isolated elevator between ICUs and operation theatres. Often, patients are carried for surgery in common elevators, exposing them to every visitor who might have visited someone with another infection, which they are likely to catch
Again, for new hospitals yet to be constructed, ideally have the wards frequently visited by visitors on the lower floors, and have sloped ramps for people to walk up and down to those floors (say up to second floor). That way, a bulk of the visitors who would ordinarily use the elevators could be saved, thus perhaps making it economical to dedicate at least one elevator purely for shuttling only patients between ICU and/or operation theatres.
A shield-type enclosure (might look like the mosquito nets for beds) over the patient’s trolley while being moved might help contain their infections and reduce spread while in the elevator
Limited options for public hospitals or those with limited budgets, seem to include:
stricter laws for visitors,
encouraging the use of staircases by visitors,
installing affordable disinfection tunnels, and making masks compulsory for visitors
This concern was part of an initiative called RattL ’em. What is RattL ’em?: We are constantly fascinated by companies, products and services.
So, every few days, we send out an email to, or share an idea online about a random company anywhere in the world that caught our fancy. What we share is either an idea for a new product or service, a concern area to focus on, or a new feature or improvement to their portfolio.
We do it for free. And for fun. And the company that receives it is free to use the idea, with no financial or other obligation toward us. We think of it as our way to be the best at what we do in the field of innovation and design strategy consulting.
Design Thinking is a relatively new concept in many countries including India. It is, however, already some decades old now. And having been practicing it for a few years now, I often get asked what it is about. And for examples of its applications.
For starters, design thinking is a mindset. One that uses empathy and a set of tools to innovate and pursue complex opportunities or solve complex problems. It aims at better understanding the needs of the end-user, or identifying the root cause of a problem, before beginning to innovate. And that always requires empathy, without which, we often settle for one of the first few logical seeming solutions that come to mind.
Like many management and quality initiatives of yester-years, design thinking too is currently receiving its share of a superficial hype. With time however, I believe the hype will pass; leaving people with a better understanding and more sincere appreciation for the power of design thinking.
Ordinarily, in a traditional problem-solving process, more constraints would almost lead to a dead-end or teams giving up. Such complex projects are where design thinking works best.
“Recognizing the need is the primary condition for design.” –Charles Eames
About a year ago, I had undertaken a design thinking exercise for the paediatric oncology department of one of Asia’s leading cancer hospitals. Sharing an overview of the same here, in case some of you are wondering what design thinking is all about. For me, design thinking is simply a humble means to achieve a goal.
Client: Paediatric Oncology Ward of one of Asia’s leading cancer hospitals
Objective: Improving the overall paediatric patient experience
I was at the hospital with two of my associates, to meet the expert medical oncologist regarding a project the associates and I were collaborating on. During interactions, the doctor expressed that patient feedback regarding the treatment has been positive. He and his colleagues, however, were always keen on knowing how they could further improve the patient experience. And given that the hospital offered free/heavily subsidized treatment to the poor, this was a humbling gesture. I offered to work on it.
The task involved interacting with patient families, doctors, administrative and support staff. It was necessary to get a good understanding of each stakeholder group and interactions between groups, in this bustling ecosystem.
Over the next 2 months, I spent several hours a day or entire days, speaking with paediatric patient families. I broad-based the sample to include new admissions, patients currently undergoing treatment, and those there for checkups 1-3 years after successful treatments. The wonderful administrative staff helped identify patients in different segments, as well as introduce me to some of them, to make for a more comfortable interaction.
Doctors had already provided considerable information from their perspective. I then spoke with administrative and support staff across the hospital. From admissions, to inquiry and even 3rd party social service representatives.
Initial Observations & Findings:
Based on information gleaned, and using Design Thinking and other tools*, here were some findings:
Patients/ patient families:
90% of patients came from outside the city, 80% from outside the state
Nearly all patient families spoke one or more of 6-8 different languages
Wait-times to meet a doctor, were significant – between 2 – 6 hours or more
A slight delay in patient arrival could mean making another trip the following day
At least 2 family members accompanied each patient. It meant putting their normal lives on hold. It meant treatments that lasted between a few months to over a year or more
Was well-intentioned, but mildly stressed and curt in responses to patient families
The staff dealt with hundreds of patients and family members on a regular basis
Some staff, on average, answered a request for direction to a particular building/room once every 2-4 minutes. Same was the case with some others about when their turn to meet a doctor would come, etc.
Some staff members were aware of their curt disposition. However, they admitted that in the region a bulk of the patients came from, they were accustomed to speaking in a curt manner. I too realized the same based on my observations and interactions with some of them. It was an amusing dilemma, the innate intention to be more polite, but an audience that might complicate your work if you yielded. A solution I proposed, aimed at solving that problem from the staff point of view
The funding enabled treatment to be completely or partially subsidized for the poor
Doctors had requested that solutions be cost-effective, if they were to be considered for implementing
Initial Verdict from Patients/ Patient families:
The overall feedback regarding the existing patient experience at the hospital was stellar. This included quality of process, staff, doctors, etc. However, I soon realized that this view was biased. Biased by gratitude for a hospital that covers all or a large part of their medical expenses.
I was back to the beginning. How do you improve patient experience when their treatment is paid for?
Back to trying to identify the opportunity:
I split the problem areas into three:
Long wait times for paediatric patients to see a doctor
Duplicate room number problem
Multiple inquiries to staff for directions to a room/ward
Increased stress levels of staff
How can an already good patient experience be made better?
Without burdening the hospital resources?
Again, using Design Thinking tools, I came up with initially unidentified problem areas. I also stumbled upon a promising solution for improving the patient experience.
Cutting to the chase:
My recommendations were as follows:
Split patients into morning and afternoon batches to make for easier sequencing and much shorter waits
Unique naming and numbering of rooms/wards (using words that cut across at least the 6-8 languages)
Colour coding of important rooms across buildings, with colour-coded stripes on the wall, to help patients ‘follow the coloured line’ (ideally with the colour names being identifiable across languages)
Colour coding would significantly bring down the number of times staff got asked for directions. (Patient families would be able to direct others. Colour/line/name-for-room would help overcome language barriers). It would reduce staff stress levels and making them more productive and happy
And most importantly, Customer Experience:
Proposed Tie-ups with companies (nearby to start with) for low-to-medium skill jobs that were individual-independent. One that anyone could turn up to do it. That would ensure work continuity while not limiting patient treatment schedules
Thought behind it: What was clear, was a free/almost-free treatment, and capable and polite doctors and staff. What design thinking helped me identify, is how family members put their lives on hold as their child underwent treatment. Earning some money while they were in the city, would help them buy small joys. It would help reduce the horrors of the disease and side-effects of the treatment on their child. That’s the only thing doctors and staff could not give
This would not burden hospital finances
I also proposed an alternate strategy option: where patients would pay a very nominal fee for services (from their salaries/stipends). This could bring new-found respect for the institution. The institution could also perhaps extend treatment to a few more patients with the same funds
Please note that coloured stripes and naming of rooms isn’t part of design thinking. What is, is identifying underlying issues such as staff stress and its causative factors. So is identifying possible areas to delight a customer in an otherwise perfect seeming environment.
“The goal of a designer is to listen, observe, understand, sympathize, empathize, synthesize, and glean insights that enable him or her to ‘make the invisible visible.’ –Hillman Curtis
Key learnings from this assignment:
Customers might not always articulate what they want
Be aware of tendencies where the ecosystem might bias a customer’s viewpoint
Often, solving or even addressing one problem area could have benefits across multiple areas
Anyone can learn and practice design thinking. It does, however, need a lot of Empathy and Involvement from you. It also requires an unwavering commitment towards customers, employees and innovation. And it is especially for those who are comfortable grappling with lots of ambiguity, and can stay true to the larger objective.
Got questions on design thinking, or how it might help your company innovate and grow? Comment below, or get in touch with me via LinkedIn or Twitter (links below).
“Only those who attempt the absurd will achieve the impossible.” –M.C. Escher
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* tools including (but not limited to) observation, interviewing techniques, design briefs, contra-logic, changing perspectives, forced connections, etc.