Design Urgent Healthcare Like Apple Design Phones - Adam Cairns


I’m writing this piece at home after a really weird day. It started first thing when I walked onto the Donald Gordon Theatre stage at the Millennium Centre, Cardiff with my good friend and colleague Professor Keith Harding. We were there to launch the joint Cardiff and Vale University Health Board and Cardiff University Clinical Innovation Strategy. As the opening speakers at the Bio Wales Conference 2016 we hoped to share the excitement we had felt over recent months as all the hard work we’d put into securing the commitments we needed to make this a reality, finally came to fruition.

After delivering our presentation, we were followed by a number of inspiring speakers, including the remarkable Lord Robert Winston who presented a passionate argument for science and with it a warning that not all knowledge is benign.

Bio Wales is a really big deal in Wales and the entire Millennium Centre was filled with scientists, clinicians, inventors, entrepreneurs, industry leaders and the odd health service manager like me.

Later in the morning, I was in touch with my office as our organisation wrestled with a 20% surge in patients arriving at our Emergency Unit – a phenomena we’ve seen consistently now over the last few weeks. We look forward to the current surge returning to more normal levels very soon.

The weird that I was referring to is the jarring juxtaposition I felt as I moved from a conference on innovation to the messy, difficult and pressurised every day world of the healthcare front line. It was as if fate had decided to give me a lesson, taking place in real-time, on the urgent and the important – and how utterly different these two states of mind actually are. And it made me think – what would an innovator do with our urgent care system? So here is what might happen if we were to design urgent healthcare like Apple design phones.

1. Develop a new format.

The first iPhone changed the game for mobile phones, just as the iPod changed the way we listened to music. Suddenly the mobile stopped being a brick and morphed into something elegant. Underneath its shiny exterior it integrated everything making the user experience pleasurable and at the same time powerful. The format for urgent care – with its primary and secondary care templates is worn out and urgently in need of re-imagining. We need to move past treatment and accelerate into health maintenance and prevention. Sir Michael Marmot has it right – all of medicine is failed prevention.

Apple urgent care therefore is:
  • Integrated around the end-user’s needs.
  • Delivers new service models that puts the user in control.
  • Offers the user access to information, solutions and communication with experts in an immediate, always on and responsive format.
  • Actively enables the early detection of symptoms.
  • Supports the immediate delivery of health maintaining interventions, de-escalating and restoring the user’s health status, avoiding unnecessary hospital visits.
  • In the Apple designed world of healthcare, unscheduled and urgent care vanishes. Now there is only emergency care and planned care, even when that planned care is urgent.

2. Change the interface.

Apple’s iPhone design removed physical keys on the keyboard and replaced them with a glass screen. Not only that, the glass screen came pre-packaged with the most sophisticated pointing device ever created – our finger. Suddenly the interface was transformed from a fixed physical format with little customisation capacity, to one with an infinite ability to change in response to the user’s requirements.

Apple urgent care is designed with a brand new interface:
  • It capitalises on wearable and other forms of digital technology.
  • Information is released from the captivity of wires and boxes to a cloud with a one to many interface.
  • The interface is customised around the needs of the end-user not around those of the healthcare provider.
  • Digital formats provide the keystone for dynamic service responsiveness.
Here’s an example. Instead of building offices to accommodate community staff – give every member of staff an iPhone (other phones are available). Say to them the deal is they must each switch on ‘Find ‘iPhone’ so that the co-ordinator can see where they are and deploy them efficiently in response to demand. Supervision takes place in FaceTime and staff create voice memos which are transcribed with voice recognition software and which form the record.

I could go on – you get the point – we don’t need purpose-built architecture to do this, it’s already there.

3. Make it easy and simple to use.

With the iPhone, Apple simplified the user interface. They used icons which clearly signalled to the user what they were for and how they could help. Users customise the way they appear to suit their own requirements. To get it ready you plug it into your computer and it sets itself up.

Apple urgent care:
  • Would immediately remove the blizzard of confusing symbols, titles and three and four letter abbreviations that festoon our urgent care systems and make it so difficult to navigate.
  • Would simplify and codify how the system looks and feels to the end-user, and enable the end-user to tailor how they interact with it.
After all a young single mum with a sick baby has a very different set of needs – and would be amenable to different solutions – than a confused, or frail older person or someone who is looking after someone dying at home.

4. Offer a new platform.

The app store opened the way for innovation at scale – by outsourcing solutions to anyone with a good idea and then incorporating those solutions into their system. By locking down the ‘rules’– something some people criticise Apple for – they have maintained system integrity and minimised risk. At the same time they created an exponential growth in flexibility and functionality.

Apple urgent care will:
  • Develop a stable platform on which solutions – both virtual and real world will exist.
  • These are the system rules that will protect and safeguard patients and their data.
  • It will not attempt to ‘know’ what all the solutions are – instead it will focus on encouraging citizens and solution providers to interact together to develop the service designs that are needed.

5. Never stop iterating.

We are now using the iPhone 6 – that’s six generations of the iPhone and each new generation has taken the format further into new realms of capability. Finger print recognition, Apple Pay, the Health App, accelerometers, GPS and a host of new technologies, leveraging everything into making the user experience better, faster and more powerful.

Apple urgent care:
  • Continually refines and develops its knowledge of what works and what doesn’t.
  • It cycles through multiple, rapid small tests of change and assesses how what they learn can be rolled up into the next version.
  • Their time horizon is two years – their expectation is that urgent care will evolve in these two-year cycles as it meets the huge demand for its elegant, easy to use, powerful and ever evolving services.
Modernising urgent care is not enough. We need nothing less than a revolution in our system design, format, intelligence and delivery systems that matches what Apple achieved with its iPhone.

What do you think? Who else do you think would do a good job of re-designing urgent care?

Author - Adam Cairns, CEO & Professor at Cardiff and Vale UHB. You can follow Adam on twitter @adamcairnsnhs


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