The first kiosk looked like a grade-school project or a prank. It didn’t have a screen. Didn’t even plug in. Patients stared at a piece of paper and tried to imagine the real thing, a terminal that would allow self-service check-in for a doctor’s appointment. The next iteration was less primitive, a laptop with an apparent touch screen, except that it didn’t work; someone sitting beside it, using a separate keyboard, typed in the system’s response like a high-tech ventriloquist. The model after that had a responsive touch screen, but the functionality was sparse. No matter. The kiosk was getting there.
And that was the idea: Put the earliest version, the rough sketch, in front of patients to see what they thought. Then use the feedback to tweak and retest. Then do the whole thing over again.
The Mayo Clinic in Rochester, Minnesota, is no stranger to innovation. W.W. Mayo and his sons–still known here as Dr. Charlie and Dr. Will–founded their rural group practice in the late 1800s around a new concept at the time: integrated medical care, which involved various specialists working together in the same building, performing comprehensive evaluations, and administering coordinated treatment. Ever since, innovation has been a vital part of the clinic’s DNA, traditionally in the research lab.
But the approach with the kiosk–rolling out unfinished ideas to patients–is something new. Last summer, Mayo opened SPARC, a clinical innovation lab that operates like a design shop and that specializes in the “patient experience.” Doctors, nurses, and other staffers do what designers do: They interview, shadow, and observe customers (in this case, patients) to uncover their needs, brainstorm with abandon, and engage in rapid prototyping–hence, the paper kiosk.
Despite its status as one of the best known and most respected medical facilities in the world, Mayo is wrestling with the same issues that designers routinely tackle: In an increasingly competitive field, how do you differentiate yourself? How do you generate fresh ideas and implement them in a timely fashion? And how do you make sure those ideas actually benefit customers?
Mayo’s program is “definitely unique, and it has enormous implications,” says Dr. Samantha Collier, vice president of medical affairs at HealthGrades, which rates the quality of the nation’s hospitals. “Medicine has long been embedded in tradition. But just because this is what we’ve done since the days of Marcus Welby doesn’t mean it’s still the best way. [Mayo] could find disruptive ways of practicing medicine better. This isn’t just about customer service but about quality.”
SPARC is not simply a research lab or a medical clinic. It’s both. Real patients see real doctors and, in doing so, participate in experiments (they’re briefed and asked for permission). Instead of being shunted off-site, the program is based in the Mayo Building like any other clinic; it occupies a corridor that used to house urology. The acronym, which stands for “see, plan, act, refine, and communicate,” is meant to remind participants of the design-oriented methodology so they’ll continue to employ it when they return to their departments.
The idea grew out of the realization that outpatient care is overdue for fresh ideas. “Medicine has changed, people have changed, technology has changed, but the exam room isn’t so different than it was in the 1800s,” says Dr. Michael Brennan, an associate chair in the department of medicine, where the program originated. Mayo wants its doctors to apply the same experimental approach to clinical innovation that they apply to scientific innovation.
Ryan Armbruster, SPARC’s director of operations and design, researched how other organizations, such as Procter & Gamble and Hewlett-Packard, foster innovation, and was struck by the prominent role of design. Dr. Alan Duncan, SPARC’s medical director, had always thought of design as merely about aesthetics, but he quickly recognized the parallels to health care. “Look at how physicians generate a diagnosis,” he says. “You do a history, listen, and think about all possibilities. It’s purposefully broad to avoid locking into an early diagnosis, just as a designer wants to avoid locking into an early solution.”
The inclusion of actual patients is critical. Understanding user needs, after all, is a tenet of smart design, says Armbruster. There are three types of needs: those that are explicit and tacit and can be identified by surveying and interviewing people; those that can’t be articulated but become apparent through observation; and latent needs, the hardest to root out. “The only way to identify them is to make something and have people experience it,” Armbruster says.
“Just because this is what we’ve done since the days of Marcus Welby doesn’t mean it’s still the best way. Mayo could find disruptive ways of practicing medicine better.”
Dr. Victor Montori, an endocrinologist, brought doctors and patients to SPARC to experiment with a new way of discussing statins, drugs that lower high cholesterol. Too often, he says, patients get overwhelmed with information and let the doctor choose the treatment. Because they didn’t decide for themselves, patients tend to abandon the therapy, which puts them back in the doctor’s office.
Montori tested a one-page guide that gives an individual’s risk of a heart attack, shows how statins affect those odds, and outlines possible side effects. He’s still reviewing the data, which suggests better adherence to medication, but he already knows that the personalized guide got patients’ attention. “After the fifth or sixth prototype, we started seeing an emotional and physical response,” Montori says. “They were moved.” He knows this because SPARC’s exam rooms are equipped with small cameras that provide rare glimpses into doctor-patient interactions. “We hear all the time about a clinician being empathetic,” Montori says. “Now we’re watching empathy at work. The eye contact. The listening. We see the whole dance.”
In fact, most everyone can see. With the help of office furniture maker Steelcase, Mayo created a highly transparent environment. The glass walls reveal SPARC’s inner offices and show support staff working at the front desk; researchers reviewing project videos; and the SPARC team leading workshops in a central space that functions as an informal lounge and meeting room. SPARC removes the mystery found in a typical closed-off clinic.
The space is also highly flexible. Much of the corridor, including the exam rooms, can be reconfigured to accommodate a variety of experiments. Walls, furniture, and computers can be moved like puzzle pieces. “People come expecting to see the finished product,” says Armbruster. “But they experience the opposite. They see prototypes in different stages of evolution.”
Mayo’s physicians both embrace design principles and integrate them with traditional medical research–in effect slipping the doctor’s white coat over all-black designer duds. Doctors or managers propose a problem or a question they want to explore, and the SPARC staff assembles a cross-functional team, which gets a crash course on design methodology. By “the second hour, we were out with cameras, notepads, and tape recorders,” says Becky Smith, a manager in patient education. Her team discovered that Mayo’s main education center was confusing. It was intended for patients and family members to learn more about diagnoses or treatments. But because the space was open–no walls or doors–patients weren’t sure if the computers were for them or the Mayo staff. When they did venture online, it was mainly to check email.
“We hear all the time about a clinician being empathetic. Now we’re watching empathy at work. The eye contact. The listening. We see the whole dance.”
After researching user needs on the Mayo campus, study groups typically reconvene in the SPARC lounge to share observations, ideally in the form of stories: how patients checked in, how they learned about treatment options, and so on. The goal is to explain how and why people behave the way that they do, to uncover the short cuts around a problem. Then the brainstorming begins. Whiteboard walls get papered with sticky notes and possible solutions. Finally, it’s on to prototypes.
Smith’s patient education group generated a host of ideas: an enticing name for the area–“The Discover Center”; an entrance modeled after an artery of the heart; more interactive computer programs; anatomical models that encourage hands-on learning; and a snack bar devoted to learning about and making healthy food. Management approved one of the upgrades right away, removing a pillar to improve visibility. In the next two months, visits increased 15% over the same period a year earlier.
The innovation program is still finding its feet, but Armbruster can tell it’s having an impact. In one sense, it’s subtle; he hears from workshop participants who are applying what they learned in SPARC in their day-to-day problem solving. But SPARC experiments are also beginning to have tangible effects on Mayo’s patient experience. Take the long lines at check-in. The last thing people want when they’re feeling sick or anxious is to stand around waiting. According to the SPARC team’s research, 87% of patients using a kiosk would use it again to speed things along. In fact, the latest kiosk prototype actually plugs in and has a fully functioning touch screen. Based on that work, a top-level committee is weighing the addition of kiosks across the Rochester campus.
Already, SPARC’s reach is expanding. What began a couple of years ago as an intriguing but modest concept was named one of the Mayo Clinic’s top priorities last year. SPARC’s full-time staff has grown from two to six. There are a half-dozen projects going on, and the number of workshop participants is 500 and counting. SPARC is catching on, winning traction–and, hopefully, sparking Mayo’s next whirl of innovation.