The Power and Beauty of Design Thinking: 5 stages of Health Care Product Development

By Rahul Nayak, MD, MTM and Prasanthi Govindarajan, MD, MAS

Innovation and scientific discovery are the future of health care and medicine. In medicine, we have unique cohorts of practitioners, including clinicians, clinician-educators, clinician-scientists, and clinician-innovators, who work daily to provide patient care and advance health care. Physician engineers who transform an innovative idea into a product that can be used in a clinical environment to improve patient care and clinical outcomes fall into the clinicianinnovators category.

The first step in improving patient care and outcomes is identifying the problem that challenges good patient care. Many design experts argue that identifying an obvious problem is more important than the solution; however, the need to develop a product to address a challenging problem can arise anytime, and the design process makes this easier. Take, for instance, January 2, 2023, when nationally televised NFL game, Buffalo Bills safety Damar Hamlin suffered a cardiac arrest. The medical staff was able to quickly rush to the field to begin resuscitation, including cardiopulmonary resuscitation (CPR) and defibrillation. This moment was witnessed by many who were physically present at the game, and by 23.8 million viewers worldwide. Cardiac resuscitation is arguably one of the most critical aspects of our job as emergency medicine physicians. Finding ways to improve the quality and outcomes of resuscitation, specifically in CPR, has been an important area of research in emergency medicine. Why not apply the design process to address this critical need?

In 2021, I led a team of senior bioengineering undergraduate students at the University of California, Berkeley, as part of the capstone engineering design course to help develop a tool to address decreasing "hands-off time" during CPR. My colleagues, Pranjal Gupta, MD, and Mohanad Alazzeh, MD, served as mentors for the undergraduate students as well. We worked with the engineering students, went through the various design phases, and tackled challenges as they arose.

Design Thinking

Empathizing

The five-step design phase for product development was pioneered and taught at the Hasso Plattner Institute of Design at Stanford University. The first step in product design is empathizing. Empathy is at the heart of all medicine and the care we deliver. In design, we must look at a problem from the perspective of others — what it feels like to them — and understand how an issue affects the patient, and the care team (e.g., physician, nurses, technician, respiratory therapist, pharmacist, medical center, family members, and so many more). Thus, gathering perspectives from a diverse group of individuals is salient to this stage of empathizing. Our students applied this concept to their capstone project, reviewed prehospital records, and gathered information from the health care team and clinicians.

Problem Identification

The second stage is problem identification. From the information gathered in step one, we started to see a variety of emerging themes that we could categorize into specific and succinct problems. From this, we were able to generate problem statements that considered the user needs, were specific in scope, and utilized action verbs. In our project, we identified minimizing "hands-off" during active CPR time as critical since prehospital providers are multitasking and may find it challenging to reduce the hands-off time.

Ideation

The third step is ideation, where imagination and creativity play a significant role. We devised as many solutions to the problem statement as we wanted. For example, the problem of adding numbers could be solved by hand, using spreadsheet, or using calculator. The ideation phase is similar to developing a broad differential diagnosis in the ED.

Design a Prototype

The next step is to use the solutions proposed in step three and design a prototype. Again, a prototype can be simple, inexpensive, and not necessarily functional since it will undergo many changes over time. In the case of the capstone project, one of the prototypes built by the engineering team was a hands-free pulse sensor that could detect and monitor pulse across a broad spectrum of pronounced bradycardia to tachycardia using a specially designed photoplethysmography sensor that provided feedback through a flashing light and sound.

Testing

The final phase is the testing phase, in which we test the prototype to assess if it meets the metrics. The design process, contrary to what sounds linear, is highly iterative. When the prototype doesn't meet the goals during the testing phase, it's time to return to one of the earlier stages of the design process. This process can continue for a long time until a final product is finally built. This iterative process is similar to our clinical environment, where we refine care and treatments as the patient is constantly reassessed. During the capstone project, we tested the prototyped hands-free

My Circuitous Journey to EM

sensor on an artificial test bed, (i.e., an engineered system of a pump with a pulse generator, special tubing to replicate the compliance of arteries, and a specially designed plastic polymer overlaying the tubing to replicate skin). Once the product is built and tested, it must go through the proper regulatory channels to be tested in the clinical setting.

In closing, innovation and scientific discovery can significantly improve the quality of care for many patients to impact our communities and the world. This is the power and beauty of design thinking.

About The Authors

Dr. Govindarajan is a physicianscientist in the Department of Emergency Medicine at Stanford University. Dr. Govindarajan’s independent health policy research program focuses on developing best practices in acute stroke care for U.S.based ambulance systems. She also serves on the SAEM nominating and research committees and spend her academic time supporting and mentoring trainees in their scholarly pursuits.

Dr. Nayak is a third-year resident physician at Stanford Emergency Medicine. He is an engineer by trade and his interests are in digital health, medical device development, and innovation.

@RahulNayakMD

“As a kid, on every birthday, I received a toy race car, an electric toothbrush, or some other electronic gadget. I would open the box with great excitement and immediately start dissecting the wires and motors. I recognize now that my interest in engineering started then. I went on to train as an engineer, worked as an innovator in multiple startup environments, was part of several success stories, and learned from many failures. Subsequently, I chose a career in medicine to have the opportunity to deliver health care to one patient at a time, discover the challenges in health care delivery along the way, and utilize engineering to address these challenges and help patients around the world. This journey led me to a path in medicine and, ultimately to specialize in emergency medicine. Today I am a member of a growing group of physician engineers in emergency medicine.”

— Rahul Nayak, MD, MTM, Stanford Emergency Medicine