Educating the next generation to solve complex health problems through design thinking
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Pharmacists: The Original Designers in Healthcare

Design thinking, at its core, is a person centric method for solving problems while also leaving room for innovation. This focus on the person/customer/patient is also the core of what drives the modern pharmacist. The first line of the pharmacists oath states "I will consider the welfare of humanity and relief of suffering my primary concerns". Just as in design, the person comes first and the process/solution always keeps the person/patient at the center. Also as in design, in pharmacy, there is no room for stagnation. Pharmacists must constantly have their eyes towards the next innovation in care, must always remain vigilant and understand the benefits and risks of any new treatment. I personally believe that pharmacists historically and today, are true designers of healthcare.

When people find out that I’m an Emergency Medicine (EM) pharmacist, their first response is usually to wonder what I do if not standing behind a counter counting pills. This is a question many pharmacists have to answer as few outside of healthcare really know how varied a field pharmacy has become. These days, everywhere medications are being used, there is a pharmacist there to make sure they're being used right. At this point in my career, I’ve gotten used to explaining my unique job in the Emergency Department (ED). EM pharmacists are the essential medication experts in the ED and are consulted on the most complicated and acute cases. With the incredible abundance of medications in the caregivers arsenal today, pharmacists focus on understanding the intimate details of therapy, providing a second opinion and assuring safety. Along with our diverse knowledge of pharmacology, we are also knowledgeable in all the operational aspects of medication use and focus on optimization of the logistics of pharmaceutical care.  Speaking in the context of design, pharmacist's have to consider more stakeholders than pretty much any other employee in a health system when making a decision. Patients, nurses, doctors, managers, technicians, and pretty much every other health system employee are all connected to medication use in some way. Therefor pharmacists must be practical, innovative, thoughtful, and organized and assure that all of these individuals are considered. Even with no formal design training at all, pharmacists must master many of the core principles of design thinking just to do their job.

 Pennsylvania Hospital Apothecary - 1752

Pennsylvania Hospital Apothecary - 1752

Now that I have began to also focus more of my talents in design and education, I get even more weird looks. It was strange enough telling people that I work in the Emergency Department, but now that I'm talking about 3D printing, Arduino, and Design Thinking, people really think I'm crazy. The way I see it, Pharmacists are the original designers and innovators in healthcare. Historically, for as long as there have been medicinal compounds, apothecaries/pharmacists have been manipulating them and preparing them in a manner that makes them more functional and appealing to patients. Everyone knows Coca-Cola, invented by pharmacist John Pemberton as a pain remedy and substitute for his morphine addiction (albeit by addicting him to coca instead). Benjamin Franklin, one of America’s great inventors, was a pharmacist in early life and was essential to creating the first hospital pharmacy in the US colonies at Pennsylvania Hospital in Philadelphia. Hubert Humphrey, Pharmacist and 38th Vice President of the United States, introduced a bill as a senator to insure the elderly that eventually led to Medicare, and along with another pharmacist created the act that led to the separation of prescription and OTC medications. 

It wasn’t long ago that pharmacy students took “window dressing” class in school to learn how to design their pharmacy windows to be more appealing to customers. Have you ever heard of the term “pharmaceutical elegance”? For pharmacists, it wasn’t enough that medications worked, it was mandated that they also have an appealing and consistent look and feel, a brand of quality. Pharmacists must be inherent designers, we are expected to understand both the clinical and operational aspects of healthcare across the spectrum. On top of that, pharmacy is very much a person/patient centric profession with customer service and education being at the core. From factory to store, shelf to patient, pharmacists truly are intertwined with every step of the healthcare continuum.

Personally I have always considered myself a professional problem solver, a skill that translates very well from medicine right over to design. To use a term I heard for the first time very recently, pharmacists must be "noticers". To keep care safe and systems running smoothly, pharmacist have to see both the big picture and the tiny details. With each medication or problem we encounter we have to use the same "funnel" that is critical to the design process. When making a decision, we take all of the possible outcomes (think of the endless list of side effects you hear in drug commercials), apply what we know about the patient/stakeholder(s), then make a judgement based on our experiences and knowledge weighed in with the previously aforementioned information. The "product" we end up with is a treatment decision that is never completely perfect, but is very carefully designed to be the best possible product given all of the available information. While we rarely get to start this design loop over again and hone our product with the same patient, we do continually improve the quality of our output, learning with each iteration of a similar problem.

For me, Design Thinking simply adds a name to a process that I and every other pharmacist does every day. That's not to say however that every pharmacist is a designer, because as a member of the healthcare family we are all complicit in the poor state of affairs in American healthcare today, and I don't think a Design Professional would ever allow such a poorly designed product into the world. 

Wanna learn more about the long and storied history of Pharmacy? Check out this really cool "Great Moments in Pharmacy" document from the American Pharmacists Association!

Also, for more on cocaine and Coca-Cola, check out this enlightening article on the Toxic History of Soda Pop

Robert PuglieseComment