Good Health by Design

By Marcia Faye
Kim Irwin
Photo: Michael Goss

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isitors to Illinois Tech’s Mies Campus in the late 1960s may have noticed a young girl enthusiastically collecting rectangular pieces of stiff paper that were oftentimes strewn across the sidewalks and grassy areas. The paper was computer punch cards and the girl was Kim Erwin (M.Des. ’94), whose father, Joseph, was on the biology faculty.

“I was absorbed by the patterns and textures created by the numbers and holes. Each card was different, and I used them as materials to build things or design art,” says Erwin. One student, the late Barbara Herrington (DSGN ’75), noticed her interest in the cards and invited Erwin to her room in Cunningham Hall to view models she had constructed for an Institute of Design course. “I asked what design was and she described it as ‘problem solving.’ I was hooked,” recalls Erwin. “Barbara died young and suddenly, after a car accident, but not before convincing me that bold communication work can change how others experience new ideas.”

Erwin would go on to serve as a consumer innovation consultant for more than a decade, earn a degree from ID, and then join the ID faculty as a visiting professor in 2006 before being named assistant professor three years later. In 2016 she founded ID’s Center for Collaborative Healthcare Design (CFCHD), where she directs the efforts of various multidisciplinary teams in conceptualizing and testing novel concepts in health care delivery and disease management. The CFCHD works on multi-institution grant-funded projects, including a six-year, $4.5 million National Institutes of Health-funded endeavor to improve outcomes for adolescents and adults with sickle cell disease.

Would you attribute your passion for solving problems and eventually going into health care design, at least in part, to your father's influence as a researcher and educator?
As a man of science, my father approached everything (including what was on our dinner plate) through systematic, analytic, and creative discussion. There’s no doubt this influenced my interest and approach to ideas and problems. However, I also learned this is not always a successful approach to people.

Much of what’s driven my work is how to merge systems thinking around complex ideas with people-centered thinking about how to fit those ideas to our everyday lives. Health care is a great domain in which to engage this kind of thinking. In health care, there is exponentially more medical knowledge about effective treatments than is currently being delivered in clinical settings. People, not powerful ideas, are the X factor here. Applying design to health care, then, is about bridging great science to the people who need it by carefully examining and designing for the human behaviors into which any new idea must fit.

From where did your "communication conviction" arise?
I spent years in innovation consulting watching great work go unimplemented. This was work that was asked for, paid for, even enthusiastically received. And yet, too often nothing happened. And it turns out that this dynamic—the great idea that can’t seem to make it out of the room—was an industry condition. We can all agree that not all ideas deserve to be implemented. Some fail because they should, because the timing is wrong or the organizational fit is weak. But that did not explain what I was seeing.

What did explain this was realizing that we were unclear on the communication challenge of our work. Conventional practice relies on the power of the idea to drive action. I call this the Understanding Gap—the belief that selling the ideas in all their richness, strategic potential, and connection to customers will naturally move an idea through to implementation. But It turns out that knowledge/exposure doesn’t necessarily lead to action.

What I learned is that the more common communication challenge is the Conviction Gap. The Conviction Gap is about believing that anything different needs to happen at all. Paychecks are getting cashed; the lights are still on—so why rock the boat? The Conviction Gap is a different challenge. It requires selling the problem, not the solution. It is about building faith in the people who are telling the story, and building belief that the problem needs to be solved. From this conviction, you develop intuition about how to proceed — which way to approach each of the tens or hundreds of decisions along the way toward implementing a new idea. Conviction is also necessary because along the way some of the leaps are going to require the kind of courage that you can only have when you truly believe.

What are some of the challenges facing health care today that the Center for Collaborative Healthcare Design can work to overcome?
Widely accepted studies show that more than 80 percent of the factors that influence a patient’s health outcomes are outside the reach of clinical practice. People live, die, thrive, or suffer based on what happens in their homes, schools, workplaces, and neighborhoods, and depending on the choices they make as individuals. The current health care system, however, is almost entirely centered on that 20 percent of factors that happen within its four walls. And even in the clinical sphere, the vast majority of proven innovation in medicine does not make it into widespread practice. This is often because it’s too hard for doctors, nurses, and insurers to adapt their behaviors and systems. Genetics and computation are driving ever smarter, more precise medicine. The challenge is how to get proven, effective solutions into clinical practice and into everyday contexts.

Please describe one of the CFCHD’s projects.
The CFCHD’s first health care project, the CHICAGO Plan, is a three-year, multi-institution comparative effectiveness trial aimed at reducing emergency department visits for kids with uncontrolled asthma. It has just now concluded, and we should have definitive data by June. Our role in that work was to perform user interviews both to inform the study design and to develop discharge instructions that people can actually read and use. Working with the CHICAGO Plan research team, we designed a new discharge tool that promotes best practice asthma guidelines in a form that helps ED staff deliver consistent and accurate instruction using language that average people can understand. This new tool won a national design award and was tested at six hospitals on Chicago’s south and west sides.

Are students involved in any of the CFCHD’s projects? If so, please provide an example.
ID’s graduate students are heavily involved in moving our health care work forward. They already seek opportunities that make a difference, so the work is well aligned with many students’ personal missions. What’s great about having these grants in-house is that I can also use them to teach both the theories and methods behind design fieldwork and analysis. And because there are real people being impacted, not imaginary “personas,” we are inculcating the highest standards of ethics and rigor. So it’s a win-win.

One example is an NIH-funded grant to help people living with sickle-cell anemia get the care that they need. Students will be doing observational studies in emergency rooms, primary care settings and patient’s homes to understand current practice. Students get to work on a project with substance and meaning, while receiving mentorship and guidance from me and other faculty. People with sickle cell, who are often living in difficult conditions, are more likely to be candid with our students and share things with them that they would not share with doctors, nurses, or more conventional medical researchers. Similarly, clinical staff are more likely to open up to us than to their medical colleagues. We are (and are viewed as) neutral listeners.

Editor's Note: This web article is an expanded transcript of the version that appears in the print edition of IIT Magazine (spring 2017).