Some of our experiences so far....
This is the first of a series of articles I will be writing called "REFRAME" where I will be exploring the intersections of design and health, and how reframing the challenges we see in healthcare today could be the spark that ignites a true evolution in care.
One of my goals for this summer was to rediscover my enthusiasm for medicine. I knew that I wanted to be at the intersection of medicine and technology. I love new toys and I wanted to be a part of development of these tools. When I heard about the Summer Design Program at Jeff, I was intrigued by the philosophy that formed the foundation of its curriculum. It was an environment built to foster self-directed projects and team-based problem solving—two ideas that I have not even thought about since I graduated college. Most importantly, failure was seen as a part of the problem-solving process and not a result. I saw the design lab as an opportunity to learn how to marry innovation and design to clinical medicine.
This summer has been unexpected in every way possible. For starters, I had never been to Philly and was shocked when I arrived and saw the size of the city. Everything was super foreign to me, like the concept of having street after street named after trees, and having a grid system that actually worked and made sense. My first day I was thrown the curveball of having to take an excursion to the Navy Yard to get blood drawn.
Hello, our names are Ashley and Brooke Barlow and we are 3rd year pharmacy students at Thomas Jefferson College of Pharmacy. On Tuesday August 8th, we were honored to join the JEFFDESIGN team to impact underserved communities in Philadelphia as a part of the Health Insights 215 initiative. Our role as student pharmacy volunteers was to perform blood pressure screenings, and to educate patients on the importance of a healthy lifestyle. Community members who stopped at our booth expressed immense gratitude for all they have learned, but what we realized was that we truly have them to thank for what they taught us in turn. As we packed up our tents and parted our way, we sat back and had to REFLECT on the impact this had on our role as a health care providers that day.
When I came down to Philadelphia for the first time in my life at the beginning of the summer, I wasn’t sure what to expect. All I knew was that when I had interviewed for an internship at TJU, Bon asked me to help out with a bit of troubleshooting for some Bluetooth sensors. As an engineer at Princeton, I had taken a couple of computer science courses, so I decided to give it a shot. When I first stepped into the vault, I was amazed. It was a treasure trove of cool tech - outfitted with six 3D printers, a whole deck of circuitry, a special STL printer, and even an Oculus Rift, I knew I was in for a fun ride. However, work came first, and after an initial session of design thinking training we started our work on the smarterPlay project.
Reports show that Philadelphia is one of the unhealthiest large cities in the United States. They also show how zip codes determine life expectancy within Philly: those in Center City are predicted 88 years while those in Kennsington are only given 68. What reports don’t show is what challenges those in the zip codes with lower life spans face when trying to lead healthier and longer lives. We are provided with statistics displaying the effects of neglect by the healthcare system on lower income areas; yet, we are not given the causes: the reasons behind the percentages.
In the Health Design Lab, there are always several projects going on at once. Whether that’s the smarterPLAY project looking at how community members use playgrounds and public space, or rehearsal of design thinking workshops, there’s constantly something interesting happening. One project that’s currently moving at a lightning fast pace, is our Ear, Nose, and Throat (ENT) 3D Printing Project. This project focuses on a surgery called mandibular reconstruction during which a part of the mandible is removed, leaving a gap in the bone that has to be supported by a metal plate. This plate must be manually bent and re-bent so it fits into the patients jaw just right; this process can take up to 45 minutes and is common practice in most operating rooms.
It’s insane how fast this summer has gone by, considering we’re now at the end of week 8. As a neuroscience major at Swarthmore College, I never expected to work side by side with medical students and physicians, interact with community members in Philadelphia, and conduct research on four different projects all at once. This summer has been more than I ever could have imagined it to be. One of our ongoing projects, Health Insights 215, has probably been the most grounding experience for me in a while. This project involved going out into underserved communities in North Philly and talking to individuals who live in that area about what they need to be healthier and what being healthy means to them. The responses from some of the people we met were astounding, and described realities I never would have thought of.
At only week 7 it really is amazing how far we have come. Having finished my first year of medical school, this summer has been a whirlwind learning experience and I feel well on track to accomplish the goals I set for myself. One of our first projects, working with the ENT department, started out as a specific task requested by an ENT resident, but it seemed interesting so Denis and I put our names down. We thought we were going to whip up a few jaws as models for the ENT department. We couldn’t have expected that the initial impression our models had on the ENT resident and attendings would uncork a volley of ideas.
As summer begins in our new Vault, we greet a new crop of interns and a new set of projects. One of these projects is smarterPlay, a study that aims at analyzing the use of children's playgrounds in order to help design playgrounds that promote health and physical activity. With Philadelphia being one of the country’s most unhealthy cities, and with a childhood obesity rate of 50%, promoting children’s health through play will be very important down the line. For the doctors in the ER and the rest of the hospital as well, having a generally healthier population overall would mean fewer complications when people do get sick. We partnered with Studio Ludo, an non-profit organization that studies children’s play in America, in order to assess some of the playgrounds in the city. With Philly’s Rebuild project, in which over half a billion dollars has been allocated to renovate playgrounds across the city, we had plenty of choices as to how and where we could do our research.
Imagine a space where Doctors and Designers alike can come together and solve some of the toughest challenges in healthcare in one of the most evocative spaces in Philadelphia. The Health Design Lab @JeffInnovation exists to bring people together, including patients, who in the past may never have interacted with the goal of accelerating change and translating technological innovation to real innovations at the bedside. Fueled by traditional and modern prototyping technology and a foundation of user-centered design principles, the Health Design Lab is more than just a maker space, but a space that will change the way we all think about the future of healthcare.
As I reflect back on the semester for JeffDESIGN, I am proud of what we accomplished in such a short time. What started as a crazy idea, turned into a truly meaningful experience for everyone involved. Personally, I learned a great many lessons from coordinating the class (probably more than my students did :-P). For me, the goal was always to create a unique co-creative learning experience, routed in reality, with design thinking at the core, and delivering content was was meaningful to both doctors and designers. Easy, right! One such lesson I learned developing this course, that I would like to explore with this post, is that the contributions of others were essential to its success. One such contributor, was Lariq Byrd, a bright 16 year old Philadelphian who loves sports and writing spoken word.
As common as 3D printing has become in popular culture, it still elicits a sense of wonderment and curiosity in most people who are exposed to it. After the initial “WOW SO COOL” moment, the next reaction is generally a dichotomy. Either they can’t wait to learn how to use it or feel like there is no way they can figure out such a seemingly complex technology. Once these individuals learn about 3D printing and experience it, next comes a wonderful example of human behavior...the person who couldn’t wait to dive in realizes that there is far more detail and complexity to using the technology successfully than is readily apparent as you joyfully watch the extrusion of a perfectly formed object.
When going through my list of potential elective rotation options, the emergency department (ED) stood out above the rest. I had some exposure to an ED rotation in the past and enjoyed the fast-paced environment that this type of practice offers. The list of assigned rotations came back and to my excitement, I ended up securing an ED rotation at Thomas Jefferson University Hospital (TJUH). I reached out to my preceptor as I have done for all other rotations inquiring about what to bring with me on my first day. His response was different than any other response I have received in the past – the first thing he said was “come ready to learn with an open mind”. I didn’t realize at the time what he meant by “open mind” but I quickly found out as the rotation unfolded.
This semester we are focusing our JeffDESIGN coursework on additive manufacturing (aka 3D printing) and its implications for health care. I find myself regularly explaining why we teach 3D printing to our medical students and I always start off with how 3D printing is not a simply a curiosity or flashy toy, but a powerful tool. I also stress that it is not some kind of magical creation-engine that can single handedly solve all of The World’s problems. Like any other tool, it is only powerful when wielded intelligently and with purpose. For this course, our purpose will be designing accessibility solutions for people with a disability.
When I first heard from my preceptor that my Emergency Medicine rotation would include a component of design, I was excited but also curious as to what that meant exactly. When I was initially introduced to design thinking as it pertains to healthcare, it didn’t click. What does design have to do with healthcare? As I soon learnt, design thinking is about allowing for creativity to establish the different ideas that can result either in a solution to an issue or a re-imagining of a system in which the issue is circumvented. Scientific thinking is about understanding constraints and prerequisites in which a solution must sit and then progressing to develop one. Much of healthcare utilizes a scientific approach to solutions, and while an efficient means, it does not give way to the creativity allowed with design thinking. By wielding design thinking as a tool of innovation, healthcare may find relief from the constraints that hold back progress.
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.
The US healthcare system is broken. This is a phrase that has been used for so long that it practically defines the word cliche. When I made the decision to pursue a career in healthcare, I did so with the grandiose idea that I would somehow be able to change at least a small part of the broken system for the better. Since that time, there have been some amazing achievements in the delivery of healthcare on a grand scale, but from the view on the front lines, the main thing that has changed is my optimism that the status quo will ever be broken. Then I discovered design, it changed the way I think, and my optimism returned.
Like many of the incredible connections I have made in recent years, the relationship with Northfield Community Middle School (NCMS) in Northfield, New Jersey, started on Twitter. Dr. Pamela Moran (@pammoran), Superintendent of Albemarle County Public Schools and a leader in innovation in education, saw that we were both doing some pretty cool stuff involving design and education and made the connection. Soon after, we were invited to visit NCMS by Principal Glenn Robins (@glennr1809), and Digital Shop STEAM teacher, Kevin Jarrett (@kjarrett). We at JeffDESIGN knew they had something special going on, but once we saw it in action, we realized that they were truly remarkable.
In my opinion, Emergency Medicine (EM) is one of the most dynamic and exciting practice environments for a pharmacist. Emergency medicine is also a very rapidly growing specialty in pharmacy as shown in the 2014 AJHP Pharmacy Practice Survey where 16.4% of hospitals responded to have pharmacists staffed in the Emergency Department (ED) up from 6.8% in 2008. This growth is creating many job opportunities for new and experienced clinicians alike, and it is also driving many students to seek out learning experiences in the ED as well.
Written by Robert S. Pugliese, PharmD, BCPS - About the author