Lately, in the Hub, we've been saying "the process of design is easy to understand quickly, but you'll spend the rest of career practicing it." One of our favorite ways to practice are sprints. We look for challenges for which we can apply design and we set a tight time limit. This week, our employee wellness team released some figures on hospital needle sticks by employees. While our numbers are consistent with the industry, we saw an opportunity for some design thinking.
We asked ourselves: how might we reduce needle sticks by employees at Sibley? We set a time limit of 24 hours. We cleared our calendars, cranked some Spotify tunes and stuffed our pockets with post-it notes.
One of our other axioms is to never start with the end in mind, but rather with the end-user. Starting the challenge, we knew only one thing —we knew nothing about how needle sticks happen. Our employee wellness team suggested we start in the operating room. So, with a stash of sharpie markers, bagels and coffee we headed to the OR nurses' lounge.
What we learned
Sibley's OR nurses were incredibly welcoming. We asked them to teach us everything they could about how needle sticks happen. One nurse ran out of the room and came back with a suture kit and some clean supplies from the OR. As a group, they showed us how doctors and nurses pass needles back and forth during a procedure. They showed us how, particularly when things get rushed, it's easy to get stuck by something sharp.
We learned that Sibley's nurses had already done some of their own innovation work around reducing sticks. In a team-lead project, they had created what they call the neutral zone —an orange mat where nurses and doctors can pass sharp objects using the no touch method. One person sets the sharp in the neutral zone and then the other picks it up. Pretty clever!
Several nurses spoke about doctors throwing needles when things have to happen quickly. Almost universally there was a sense that sticks happen when someone lets their guard down. "If I get stuck, it's because I wasn't paying attention." (As it turns out, there's a lot of self-blame associated with a stick.) Nurses also told us they are trained on how to avoid sticks, but sometimes things get in the way of that training. "If we're working with a new team or different doctor, then we might not all be on the same page."
Thinking caps on
After nearly 2 hours of interviews, stories and demos in the OR lounge, we went back to our home base in the Hub. We put quotes and stick figure drawings on post-its. After some discussion and reframing there was a pattern emerging. It seems sticks, in the OR, happen when people are fatigued or something causes them to lose their technique.
A few questions came to mind: * how can we help ensure people stay focused? * how might we ensure technique is consistently applied?
Who else has this challenge?
Hospitals aren't unique in having teams who have to do important things, in a hurry, around dangerous objects. For instance, passing a needle between two people is a lot like passing a loaded gun at a shooting range. It's like how boy scouts are trained to pass a knife. Speaking of knives, how do restaurant chefs keep from being cut?
Clearly we needed to research that last question. It turns out Chipotle has workers wear a metal chainmail glove when they are cutting food. It also turns out they make a mean burrito. Ok, we might have just wanted burritos.
A suture needle looks a lot like the curved fang of a venomous snake. And, since Chipotle is right next to the National Zoo, we though well, we should at least go ask...right? Two us, in our business slacks, with Johns Hopkins ID badges around our necks, wove our way though the throngs of school kids and tourists at the zoo. At the reptile house, we stalked a herpetologist on his way out of the building.
"This is probably going to be the strangest question you get today... we work for a hospital and we're studying how people get stuck by sharp things. So....how do you keep from getting bitten by a snake or crocodile?"
For nearly 15 minutes Matt, a Smithsonian herpetologist, told us all about their techniques. To get access to a reptile's mouth, they use small tubes or pipes to keep the jaws open and still allow access. They also have a very clear, very well defined protocol. The person at the head of the animal is in charge. They have a series of calls to verbally communicate everything. "Ok, I'm going to turn [the croc] to the right in 3...2..1..go!"
the idea lab
Fueled by burritos, we were brimming with ideas. Back in the Hub, we stood at a white board and set a timer. For fifteen minutes we came up with as many wacky ideas as we could.
What if we made the needles self-destruct after each use? What if we had one of those big magnets like at a junk yard and it'd stuck the needles up to the ceiling? Ohh...ohhh I got it! What if each of the surgical trays had one of those stickers of a fly like in urinals to help people aim? What if it was like rock climbing and every time there was a transfer there was also a call...like on belay, belay on?
The fun part about a no-holds-bared brainstorm is how a totally off-the-wall idea can lead you to an exciting breakthrough.
make to think
We had two hours left in our sprint. The best way to test an idea is make a prototype. We narrowed our list of brainstorming ideas to three things:
- a magnetic alignment device
- a special putty to keep needle tips protected
- a standard call and response protocol *
Hub designer Joe Sigrin took inspiration from Apple's magnet iPad Smart Cover. He glued an array of magnets, paying particular attention to polarization, to a piece of plastic. We also glued magnets to a suture needle to imitate how a polarized needle might behave on the mat. The result is a system where you can drop a needle onto the platform and it will always land tip side down, with the curve up. This has the added benefit of orientating the needle in a way that it can be picked up by forceps without having to pick it up with fingers. We call it Joe's Magnetic Needle Orientating Device, or the J-MNOD for short.
We spread a thin layer of play-doh on a plate. Since we were out of our small magnets, I scavenged the two circular magnets I use to keep my collar stays stuck to my shirt. We pressed the magnets into the play-doh until they were just below the surface. We used orange play-doh to evoke the nurses' neutral zone mats. When a needle is set on the play-doh, it's very slightly pulled into putty, protecting the sharp tip from inadvertent sticks.
the Sibley Protocol
Our last idea was directly from Matt at the zoo. We proposed a standard call and response protocol (which, we learned, already exists with some OR teams at Sibley).
Needle back! — doctor passing a needle or sharp object back to a scrub nurse hands up! — a nurse's acknowledgement that a sharp object is incoming sharp in hand — a nurse's call that she or he has picked up the sharp back to you - a nurse's notice to a doctor that he or she is ready to pass the sharp back to the physician.
How'd we do?
With minutes to spare, we throw our prototypes on top of a box of sub sandwiches and ran back to the OR lounge. "Those funny guys fro the Hub are back," someone chuckled warmly. We started unpacking sandwiches and told the story of our 24 hour sprint. We shared back what we thought we'd heard when we were first in the lounge. "That sounds right," one nurse told us. We told them about burritos and snakes. And we showed them our post-its from brainstorming. "So what's this thing?"
"Oh that? That's the J-MNOD!"
We showed them how our specially magnetized needle would always land point down on the mat we'd constructed. We showed them how one of their orange neutral zone matts could lay over our plastic prototype and suggested they use their imagination to envision a new magnetized neutral zone and special needles.
"Do you have a patent lawyer? Because you're going to need one."
We also showed off the putty. "That could work... that just might work..."
When we discussed the Sibley Protocol everyone agreed how a consistent verbal communication tool is the easiest and most effective solution. Together, we spent a great deal of time discussing barriers to implementing a verbal protocol; we even brainstormed some ideas around those barriers.
There's a thing about sprints. You probably aren't going to solve the problem or invent a new product in 24 hours. Super fast sprints are great for recharging designers' batteries. They are even better at inspiring creative thinking in teams. We know most people in the hospital don't have 24 hours to dedicate to a sprint. But we also know it's nearly impossible to understand a complex problem during a one hour meeting. Getting creative about solving a problem requires enough time and space —even if only 24 hours. That's the beauty of design. And besides, when else can burritos and the zoo be a legitimate work outing?