Written by Christiana von Hippel, ScD, MPH
Nov 20, 2024
After a decade of implementing human-centered design (HCD) in healthcare settings, we at The Better Lab have witnessed firsthand how this approach can transform care delivery for vulnerable populations. But here's the reality: while healthcare innovation continues at a breakneck pace, the gap between what's possible and what's actually accessible to underserved communities continues to widen.
Why Traditional Healthcare Innovation Falls Short
Traditional healthcare innovation often starts with technology or efficiency metrics rather than human experience. We see this repeatedly in safety-net hospitals: sophisticated EMR systems that don't account for limited English proficiency, patient portals that assume consistent internet access, and appointment systems that don't consider the complex lives of working families.
Our research has shown that this disconnect isn't just an inconvenience—it's a significant barrier to health equity.
Human-Centered Design: More Than Just Another Methodology
HCD is a methodology that studies problems from patients’ or users’ perspectives through ethnographic research (observing their experiences) and collaborative design practices (working on solutions with them) to make healthcare work better for everyone who uses and provides it. It is a fundamental shift in how we approach healthcare innovation, placing the lived experiences, fears, hopes, and constraints of patients and providers at the center of the design process. Through rapid prototyping and iterative testing of potential solutions in real-world contexts, HCD allows teams to refine interventions quickly while minimizing risk and resource investment.
Here's what this looks like in practice:
1. Redefining Efficiency in Surgical Care
In our work at a major safety-net hospital, we discovered that traditional metrics of surgical rounds efficiency weren't capturing the full picture. By shadowing surgical teams and interviewing patients, we identified that what looked “efficient” on paper often created downstream bottlenecks and patient anxiety. Through HCD, we redesigned the rounding process to better align with both staff workflows and patient needs, resulting in more focused patient interactions without increasing round duration.1 For example, we found that simply moving patient presentations from noisy hospital corridors to a dedicated conference room reduced clarification interruptions by nearly 5% and eliminated redundant discussions. This shift allowed the team to identify missed diagnostics earlier in the day and focus more intently on each case. The redesigned workflow also led to concrete improvements in hospital operations: discharge orders were submitted nearly an hour earlier, on-time starts for first surgical cases increased from 40% to 63%, and resident physicians could complete their work 97 minutes sooner—reducing residents’ work hour violations while maintaining quality of care. Most importantly, the time spent in direct discussion with patients and families increased from 3.5% to 5.2% of rounds, showing that efficiency gains didn't come at the cost of patient interaction. Through an iterative process of testing and refining solutions, we transformed what was once a chaotic morning routine into a streamlined system that better served both care teams and patients.
2. Transforming the Waiting Experience
Our recent study of surgical waiting rooms revealed how the waiting experience disproportionately affects vulnerable populations.2 Through careful observation and interviews, we found that uncertainty and lack of communication—not just wait times—were the primary sources of stress. This led to simple but powerful changes in communication protocols and waiting room design that significantly improved patient experience without requiring major resource investment.3 For example, in the waiting room we suggested that chairs be reoriented so patients face the clinic door to make it easier for them to see who is coming and going and gauge how long it will be until their name is called.
3. Building Trust Through Technology
When working with violently injured patients admitted to a safety-net hospital who are part of a Hospital-Based Violence Intervention Program (HVIP), we learned that traditional healthcare communication tools and SMS texting are falling short in connecting patients with case managers who can help them navigate their recovery journey and prevent future reinjury. Through an HCD-based approach, we discovered that these technologies fail to fully account for the balance of privacy and accessibility concerns (e.g. losing the connection between patient and case manager when the patient’s phone number changes) and the complex social support needs patients have that require robust resource libraries patients can search through, visibility of motivating milestone achievements in their care plans, and service referral tracking. We are in the process of co-designing and testing a mobile app that prioritizes both security and accessibility, enabling case managers to maintain consistent contact with patients who have experienced violent injury, while also respecting their need for discretion and integrating new tools to enhance their engagement with HVIP social and medical support services after they leave the hospital.4
The Path Forward: From Research to Real Change
Our work has shown that HCD's true power lies in its ability to bridge the gap between research and implementation.5 But to create lasting change, we need to:
Expand Beyond Clinical Spaces: Many core issues affecting patient care lie outside traditional healthcare settings. HCD helps us identify and address these broader social and environmental factors.
Build Multidisciplinary Partnerships: Healthcare challenges require solutions that span clinical care, social services, technology, and policy. HCD provides a common language and framework for these diverse stakeholders to collaborate effectively.
Prioritize Equity from the Start: Rather than treating equity as an afterthought, HCD allows us to center the needs of underserved populations throughout the innovation process.6
A Call to Action
For healthcare innovators and designers reading this: we challenge you to move beyond surface-level applications of HCD. Dig deeper. Spend time in waiting rooms. Shadow providers. Listen to the stories of patients who have fallen through the cracks.
For healthcare administrators and policymakers: consider how HCD might help you better understand and address the challenges facing your most vulnerable patients. The initial investment in this approach pays dividends in more effective, equitable care delivery.
At The Better Lab, we're committed to advancing this work and sharing our learnings. This is just the beginning of our conversation about how human-centered design can transform healthcare for those who need it most.
Note: The Better Lab is a healthcare innovation research lab based at University of California San Francisco’s Department of Surgery and the Zuckerberg San Francisco General Hospital dedicated to improving care delivery through human-centered design. Our team combines expertise in clinical care, design thinking, and implementation science to create practical solutions for complex healthcare challenges.
The author, Christiana von Hippel, ScD, MPH, is Research Director at The Better Lab, with expertise in digital health, human-centered design, and women’s health. A Harvard-trained social epidemiologist, she has led research at Meta and OMGYES.com, focusing on user-driven innovation and health communication. Outside work, she enjoys baking, gardening, and the arts!
Footnotes
Sammann, A., Chehab, L. Z., Patel, D., Liao, J., Callcut, R., & Knudson, M. M. (2020). Improving Efficiency and Meeting Expectations Without Compromising Care on Trauma Surgical Rounds. Journal of Surgical Research, 247, 163-171. https://doi.org/10.1016/j.jss.2019.10.026 ↩
Liao, E. N., Chehab, L. Z., Neville, K., Liao, J., Patel, D., & Sammann, A. (2022). Using a human-centered, mixed methods approach to understand the patient waiting experience and its impact on medically underserved Populations. BMC Health Services Research, 22(1), 1388. https://doi.org/10.1186/s12913-022-08792-8 ↩
Liao, E. N., Chehab, L. Z., Ossmann, M., Alpers, B., Patel, D., & Sammann, A. (2022). Using Architectural Mapping to Understand Behavior and Space Utilization in a Surgical Waiting Room of a Safety Net Hospital. International Journal of Environmental Research and Public Health, 19(21), 13870. https://doi.org/10.3390/ijerph192113870 ↩
Patel D., Sarlati S., Martin-Tuite P., et al. (2020). Designing an Information and Communications Technology Tool With and for Victims of Violence and Their Case Managers in San Francisco: Human-Centered Design Study. JMIR Mhealth Uhealth, 8(8):e15866. https://doi.org/10.2196/15866 ↩
Matheson, G. O., Pacione, C., Shultz, R. K., & Klügl, M. (2015). Leveraging Human-Centered Design in Chronic Disease Prevention. American Journal of Preventive Medicine, 48(4), 472-479. https://doi.org/10.1016/j.amepre.2014.10.014 ↩
Nijagal, M., Wissig, S., Stowell, C., et al. (2021). Using Human-Centered Design to Identify Opportunities for Reducing Inequities in Perinatal Care: Protocol for a Mixed-Methods Study. JMIR Research Protocols, 10(4), e25407. https://doi.org/10.2196/25407 ↩