Richard L. Griffith, DEngSci in EE, MD wandered about in his career not unlike John James. Physics, graduate work in electrical engineering, military service, medical school, head trauma research, residency in anesthesiology, private practice, academic practice, a decade in medical device development at Becton Dickinson, then back to medical practice/teaching, and now retired. At Becton Dickinson he first met industrial designers and recognized with genuine envy the power of their unique approach to problems. He tried to teach that perspective to residents in anesthesiology at the Albany Medical College, with very limited success. Richard and his wife created videos on the topic of patient safety, a couple of these are still showing on YouTube [search “battle of hospital medical errors”]. He eventually concluded that the institutions of medicine need expert help from actual industrial designers.
His nomination said: “Dr Richard Griffith is both an Engineer and an accomplished Anesthesiologist who applies engineering safety principles to minimize medical errors and uses multiple engineering-based initiatives to improve medical practice.”
Griffith and Hagen Patient Safety Initiatives
When we contacted Richard Griffith about his patient safety nomination, he linked us to Episode #1 of a new Patient Safety video they placed on YouTube. The video talks about an approach to making health care delivery safer. We invite you to view this video.
Health care professionals cannot effectively utilize the perspectives of industrial design (ID) on their own because they have been too firmly cemented into a very different paradigm of responses. When Richard counts his blessings now, he counts Sean Hagen and all the members of this Task Force thrice.
When asked how this partnership with Sean Hagen came about. He responded: Often new perspectives come from people who go to school for one thing and end up working in a different field. I suppose I fit that mold. I studied physics in college, then went to graduate school in electrical engineering, and finally decided I would see if someone might let me into medical school. I eventually emerged as an anesthesiologist and then mid-career went to work for Becton Dickinson and Company, (BD) the huge manufacturer of the “nuts and bolts” of healthcare. People in healthcare rarely notice BD products (syringes, needles, blood collection tubes, and such) because they use them so naturally every day assuming they will always be in a hospital drawer ready as needed. A great deal of work goes into keeping such products up to the constantly expanding requirements of healthcare delivery.
At BD I found myself interacting constantly with industrial designers, a new kind of professional I had never before encountered. I knew about engineers of all sorts, and about health care professionals, but not designers. We joked about the fact that when given a new assignment the industrial designers would run get their lawn chairs. Lawn chairs? Yes, they would get lawn chairs and go sit in them for hours to watch people doing whatever job the designers had been asked to tackle. Then the designers would create a wall of images showing each step of the task, some photos, plus lots of drawings, lists, and diagrams, usually in a spectrum of color coding’s. Why do they do all this? Well, the majority of neurons in the human brain’s cortex process images. Humans are good at images. Some argue that all human creativity comes about visually. Einstein said that. Many composers say they see their music before they hear it. Industrial designers work visually.
Industrial designers are architects for products, processes, and experiences (everything not a building). They define excellence in a design when users need no training or instructions to properly use that product, process, or experience. They build the design to contain the “cues” or “affordances” necessary to make proper use happen. That aspect of industrial design makes them the experts in our society on “avoiding mistakes.” Obviously, we need them at the table when we set about to reduce errors in health care delivery. We all actually know that training does not eliminate mistakes, but design can. In the field of anesthesiology, training does not keep me from turning the patient’s oxygen too low, the design of the machine does that.
After a decade at Becton Dickinson, I returned to medicine as a faculty member in a teaching program in anesthesiology. The residents all had various research projects and I would try to give them an industrial design perspective on their project. They would listen attentively to me but when I followed up weeks later, they would appear to have totally ignored everything I said. I assumed it was my teaching limitations, but eventually I came to understand that reading a book on the piano does not make one a pianist, just as hearing about design perspectives does not make one an industrial designer. The Agency for Healthcare Research and Quality created a wonderful book in 2007, entitled Mistake-Proofing The Design Of Health Care Processes. But that book does not turn health care professionals into designers. We actually need to get designers physically into the hospital and involved in the process of delivering medical care.
When I retired four years ago, I started trying to find an industrial designer who would help me involve designers in Patient Safety. I eventually found my way to Sean Hagen, founder of BlackHagen Design located near Tampa, Florida. Sean at that time was the Head of the Medical Device Section of the Industrial Designers Society of America (IDSA). In 2016, Sean asked the Board of Directors of IDSA to get designers involved in Patient Safety. They agreed but asked Sean to put together a Task Force on Patient Safety to figure out exactly how to make that happen. We are still working on that.
Sean sees Patient Safety as an eco-system with lots of interdependent players and he wants to get his lawn chair out and figure out how all the pieces fit together. I want to go straight to saving lives. The video represents my focus. Episode #2, still in the works, will talk about ideas stolen from Drs. Larry Weed and Peter Pronovost for making medical practice less prescriptive and more informative.
We know Peter Pronovost mostly for his work in central line infections but he did many other things that proved ground breaking. He required physicians with patients in his ICU to define goals in writing for each patient each day with the nursing staff. That simple step changed everything. Suddenly the entire team could use their expertise to get the patient to the goal rather than simple carry out orders. That is the topic of Episode 2.
Larry Weed recognized over 50 years ago that patients in Burlington, Vermont, commonly died on the wrong service in the hospital. For example, they died of a heart attack on orthopedics. He tried to create “road maps” for care to combat this. Those road maps were not unlike the protocols Brent James created in Utah. I think Brent James made InterMountain the safest hospital system in America.
Finally, we plan an Episode #3 that borrows from the amazing work of Dr. Brent James. Dr. James created protocols that encouraged both modification and evolution while reducing complications by making errors of omission almost impossible. Dr. James has retired but has left us a talk on YouTube in which he says he tried to make InterMountain Healthcare into a hospital system that will deliver community standard care even if the patient’s physician enjoys a very lazy day. When not having a lazy day, the system helps make a patient’s healthcare extraordinary!
I want to recruit industrial designers to create tools that allow every hospital to deploy these strategies. Sean Hagen’s eco-system model will help make that happen, but we will also need the skills of industrial designers to get us to the place in Patient Safety we want to go.
Originally published in Issue 1, 2019 of MTM Magazine.