Design as a quality improvement strategy

Why it matters

Bad design in safety-critical environments like healthcare can exclude, frustrate, hurt or even kill people. In contrast, good design can make it easier for people to navigate healthcare services, leading to positive impacts on the safety and efficiency of their delivery, and a more positive experience for patients and staff.

Design is an interdisciplinary field of academic inquiry, with its own ideas, ways of thinking, tools, and methods. Although most industrial sectors use design skills to create safe, engaging, efficient products and processes, design expertise seems to be lacking in many healthcare improvement projects. There is much evidence about the positive impact expert designers can have in healthcare, but design is rarely discussed in the medical literature, and there appear to be a lack of understanding of its value among clinicians and academics involved in improvement.

In this article, we define the field of design, explain why poor design can be so disastrous, and show the benefits that good design can bring. We also make the case for the distinctive contribution design expertise can make in health services, including disciplines like architecture, industrial design, engineering, and human factors.

What we found

Good design doesn’t happen by accident: it is a specialist skill (or range of skills), which draws on an understanding of theory as well as practical experience. Evidence proves that the mundane issues designers know are important to safety recur and risk harm when designers are absent from projects, because designers have developed their own ways of thinking about problems using concepts, processes and techniques to account for complexity and practical implementation.

Poor design has been explicitly linked to impaired patient safety by the UK’s Department of Health and Social Care, and the Health Services Safety Investigation Body. Thoughtless design can potentially exclude whole categories of users. For example, respiratory protective equipment is often designed to best fit a Caucasian male body shape while trauma care products are frequently built around the characteristics of adults without considering those of children. At its worst, bad design has the potential to injure or kill. For example, a confusing interface in prescribing software can lead to wrong – even deadly doses being administered.

Good design on the other hand can make life easier and safer – and an inclusive design approach promotes understanding about how some users might be excluded by the demands of a particular design. An example of this is emergency departments that accommodate the needs of patients with dementia through noise reduction, altered lighting, orientation aids and fixed seating.

Sometimes, a good design makes it physically impossible to misuse a product: there is only one way to plug a three-pin electric socket. Good design also incorporates creativity and devising new ways to solve old problems, while avoiding fixation on the ‘normal’ way of doing things. For instance, the inspiration for the ODON device, a low cost, easy to use inflatable device to facilitate operative vaginal delivery, came from a trick to open corked bottles.

Design is not a ‘nice to have’ skill – in other safety critical industries, it is seen as a ‘must have’ and is integrated into processes aimed at improving safety, quality, performance and reliability. With its focus on creativity and user-centredness, design can help to improve, transform and reinvent our healthcare systems. We propose that achieving this will require better engagement between designers, health service users and improvement researchers; better study of how design happens in improvement projects; and better knowledge of what good healthcare design entails, beyond methods and frameworks and into practice.