Part one in a series devoted to finding meaning at work.

Health-care providers are focused on delivery. Our daily routines of patient care are guided by concrete protocols based on reputable studies or on advice from mentors and by modeling our clinics after other providers. Yet, following this prudent path will eventually yield diminishing returns if we are just showing up for work to do the same thing as the day before. Lulled into inaction, our ability to grow, innovate and customize our goals becomes limited.

‘DESIGN’ TO THE RESCUE

“Design” is a discipline that offers structure, and that structure can facilitate the insights necessary to devise solutions. Now, please don’t dismiss this concept until you have read my explanation of Design thinking. Traditional design is related to a new product or space — for example, how to best design an innovative device or how to best lay out a waiting room so that it is aesthetically pleasing while remaining functional.

What happens when we borrow design approaches and apply the concept to humans rather than objects or spaces? In the book “Designing Your Life,” authors Bill Burnett and Dave Evans define Life Design as using the design principles traditionally applied to new products or services to your life to help you be creative, see new possibilities and prototype multiple paths before making a choice. This can allow providers or administrators to design practice life to better grow a clinic, engage staff and patients or define goals to provide daily motivation.

DOES THIS SOUND FAMILIAR?

You need to stay on this page and become familiar with Design principle if any of the following is happening in your practice.

You schedule 5 minutes for a postop visit or IOP check ... and wonder why your lunch break is down to 5 minutes rather than the 30 minutes allotted on the schedule. Or, you’re surprised that every Friday you work late because add-on emergencies pop up.

Now, let’s look at surgery days. Do you add time for cataract surgeries when you are planning to adjunct with a MIGS procedure or place a pupil-expanding device? If you are deep into your career, are you accomplishing what you expected?

Next, pivot to staff: Do they understand why you use different presbyopic IOLs, or do you get calls from referring doctors asking what MIGS you performed on the patient they sent you?

Now for personal goals. Do you make a yearly resolution to start de-stressing with exercise or better food choices but instead end up saying, “Thankfully, chocolate is healthy and romaine lettuce can be deadly”?

Once you answer these questions, you can draw on Design to plan a course of reflection then resolution.

FOUR PRINCIPLES

As Donald A. Norman explains in “The Design of Everyday Things,” the concept of Design focuses on a few inherent principles. The first principle is to create specific ways to optimize a function that brings value to both user and producer. Take the example of a provider hiring a scribe to document a patient encounter in a new EHR. This may bring values in many ways: A patient gains value with a doctor who is looking at them and not the computer, the scribe will not be rushed when explaining how to use drops — again — and the physician is happier because they no longer bear the burden of typing all day. The provider likely can see more patients in a day.

A second principle in Design is to create a process that focuses on quality and total experience in order to reduce frustration for all involved. Patients having a cataract consult are a good example of a process that demands such consideration. How often do you find a new cataract patient asking a lot of questions while you know the next two patients are waiting for what they were told would be a quick postop and IOP check? How could you reduce their frustration — and yours?

Another concern during a cataract consult is consistently having the patient testing and measurements performed prior to the physician meeting with the patient. Perhaps the refraction or IOL measurements or glare testing were not performed by the ophthalmic technician. This often requires the doctor to see the patient twice in one visit in order to obtain the tests necessary to determine treatment.

The stakes for all participants are higher if you are offering a premium IOL with premium out-of-pocket expenses for the patient. This is a clear opportunity to dedicate effort and time to “focus on quality and total experience.”

While the second principle examines the total experience to evaluate process and outcomes, the third principle emphasizes the experience of the user. Here, you are ensuring that the process works for the patient; focus all outcomes with the end user (in this case, patients) as the primary benefactor.

When you are working on this principle, keep in mind that Design entails dealing with how people behave rather than how you wish they would behave. Consider your glaucoma patients: You may prefer drops over laser as first-line therapy. However, if applying this Design principle, you should present both therapies as options to your patients so they can become educated to make a decision that is best suited for their life.

Finally, the fourth principle: Use your own positive experiences as examples to create meaningful change.

I recently took one of my kids to a new doctor; after this visit, I came back to my office and changed our entire check-in process as a result of experiencing this as a patient. Visiting other practices is a great opportunity to learn and improve your processes.

DESIGN AND THE THREE C’S

These four principles of Design can be overwhelming for a busy provider or administrator to digest. So much time each day, after all, is spent putting out fires or grinding through a clinic. For this reason, my next several columns will use Design principles to tackle some key areas most relevant to ophthalmology.

Our journey will explore the three C’s: communication, clinic and career. Communication with patients, staff and referring doctors often erodes over time, but impact satisfaction and growth for a practice. The clinic may seem efficient, but this metric depends on how it is measured and by whom. Regarding career, Design principles may give a provider the confidence to reflect on personal goals and consider what the physician’s career may resemble years later when they look back.

I will apply Design principle to one C per column to seek solutions to these common concerns. OM

Scott LaBorwit, MD, is a principal at Select Eye Care, with locations in Towson and Elkridge, Md., and is an assistant professor, part-time faculty, at Wilmer Eye Clinic of Johns Hopkins Hospital, Baltimore. His e-mail is Sel104@me.com.

Disclosures: Dr. LaBorwit is a consultant to and speaker for Alcon.