Design Thinking in Chronic Care Models in Nursing. Free Essay

The nursing profession continues to approach the care of chronic conditions through a research-backed chronic care model (CCM). In this model, a practice team in the healthcare institution is allowed to proactively and supportively interact with an activated and informed patient. For chronic conditions, the patients are often required to experience some form of long-term behavior change to manage chronic illness. As such, their behavior change influence requires a model that is responsive to their needs and individual motivation trends. While the current frameworks of the CCM in most healthcare sectors have proven successful in addressing patient-healthcare worker interactions, they are seen as highly doctor-centric. The present forms of CCM-based projects are thus primarily centered on the doctor's expertise. The nurses and the patients are thereby bombarded with decisions and prescriptions from top management and medical technocrats (Altman et al., 2018).

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Such a rigid approach to CCMs fails to address one of the essential dynamics in chronic conditions care: the human behavior aspect. While the doctors may be more competent in medication and diagnostics, the nurses play a significant role in the managing of patients' recurrent conditions. As such, the nurses are better placed to understand the patient-behavior aspects of chronic care models. Research is thereby continuously advocating for nurses to be better involved in the governance processes in the institutions (Eines & Vatne, 2017). In fact, in most countries globally, nurses continue to take leadership roles in CCM environments and entire health institutions.

Furthermore, CCM requires patients to be sufficiently informed and activated. Current practice shows that up to 50% of patients leave the doctor's offices without understanding what the doctor talked to them about (Näslund et al., 2019). Additionally, over 90% of patients are not involved in the treatment decisions made during their consultation and prescription meetings at the healthcare center.

The poor communication and collaborative focus of the doctors in health institutions may be solved by a proactive approach to patient needs and healthcare demands. Time constraint is often blamed for the inability of doctors to share information with the victims. To remedy this time factor concern, studies continue to position nurses as central to improving the efficiency of CCM and chronic care visits. Furthermore, proper handling of patient care in chronic care settings requires a close focus on the behavior of the concerned participants in the care model. As such, the patients, nurses, administrators, and doctors must work closely together to create and implement long-lasting behavioral solutions. Through the years, shared governance, design thinking, and collaboration have been introduced into healthcare research and practice to address such behavioral concerns (Eines & Vatne, 2017). In the present project, the author shall propose and prototype a design thinking approach as a methodology for improving patient and healthcare sector collaboration and an intimate understanding and solution to specific chronic care behavioral concerns.

Design Thinking in Chronic Care Models in Nursing

Design Thinking in Nursing

In the nursing and healthcare practice, design thinking continues to find rooting in creating intuitive and easy-to-learn solutions among nurses and patients (Roberts et al., 2016). It has continued to improve the effectiveness of nursing and healthcare provision by creating contextualized solutions for patients. In practice, design thinking begins with a focus on patient interests, motivations, and value-systems (Eines & Vatne, 2017). This initial process in the design thinking journey in nursing requires the innovators and leaders to proactively engage the patients in creating potential solutions to the healthcare problems by understanding the patient's perspectives and actual issues.

As stated earlier in the introduction, patients mostly feel like complete outsiders of their conditions during their visits to the healthcare centers. They are often bombarded with expert information that they do not understand. After the diagnostics, the doctors then hand them medication and treatment prescriptions without knowing if they comprehend what the doctor reported in their diagnosis and testing. From such visits, the patients and nurses often end up in the dark regarding the details of the epidemiology of the conditions. Such limited awareness of the disease incidences and potential control is usually determined to be causative factors for erratic and non-collaborative behavior by nurses and patients. Top-down leadership models in healthcare are thereby the leading causes of low patients' and nurses' interaction with the healthcare practice. To create such communication-rich and intuitive solutions systems in nursing, most researchers continue to endorse the use of the principles of design thinking in the healthcare sector (Roberts et al., 2016).

As a report by the National Institutes of Health pointed out in 2016;

"The business community has learned the value of design thinking as a way to innovate in addressing people's needs -- and health systems could benefit enormously from doing the same" (Roberts et al., 2016, p. 11).

Through an application of the design thinking approach in healthcare, participation in decision making is expanded to include all the crucial players. As opposed to the traditional methods that centered the entire testing, prescription, and care decisions on the doctors and administrators, the proposed new model proposes a human-centered system that begins with the direct participants in patient care – including the patients themselves. In the next section, this review of the literature explores the role that design thinking may play in changing the behavior of nurses and patients in the chronic care model.

Design Thinking in CCM

According to the Stanford University School of Medicine, design thinking is the way forward in disentangling the complications in patient care within CCM (Moltrup, 2017). This care model – as introduced at Stanford Medicine X workshop by Dennis Boyle of IDEO – proposes an application of design thinking principles in improving patient engagement in CCM. In the CCM, thus, the solution systems should begin by understanding the foundational behaviors and motivational elements for the patients. While conducting such proactive needs analyses, the involved innovators should originate from multiple departments and possess diverse professional competencies within the healthcare institution.

The design thinking journey in CCM begins by developing an empathetic interest in the patients and their behavioral proclivities. During this essential beginning stage of design thinking, the engaged nurses and medical experts keenly talk with the patients about their present experiences with the chronic care system. While acting as designers, the healthcare experts approach these conversations with the patients openly and with no preconceptions. The outcomes of these interviews thereby open the healthcare experts to deeper causes of specific patient behavior. Researchers and innovators in design thinking reemphasize the importance of empathy in the entire problem and solution framing and prototyping journey (Altman et al., 2018).

Once the problem has properly been empathized with and framed, it is restated in the ideation stage. In this ideation phase, the innovators participate in extensive and actively engaging brainstorming sessions. The brainstorming sessions focus on generating solutions that are directly connected to the problems stated by the patients. During these sessions, the organizational actors must work together, collaboratively, and gather as many probable solutions as possible. The solutions generated must, however, stay sensitive to the problems stated by the patients. The leadership methodology required for this process must be accommodating to diverse viewpoints. While design thinking processes are often blamed for their excessive time consumption, the products or services that result from the processes are highly contextualized and shared among the participants.

A significant characteristic of the design thinking process is the focus on rapid and early prototyping of the proposed solution. After diverging and converging ideas in the brainstorming stage, the resultant idea or blend of ideas are prototyped with the patient population to identify the probable flaws earlier in the process. Such flaws are then corrected or upgraded in the subsequent implementation stages. The iteration and prototyping phases in design thinking for CCM involve introducing the new healthy behavior to the population based on the issues they presented regarding the present care model. As such, the design process for the modern chronic care and healthy behavior system is not built on assumptions. Instead, the solution comes from a real problem that the patient relates to (Altman et al., 2018).

Setting a Design Thinking Workshop

As already implied above, the design thinking process requires an extensive collaborative process of empathetic problem definition, idea creation, brainstorming, and aggressive prototyping. According to the concept founders at IDEO, design thinking is best actualized through diversely set workshops at the workplace (Altman et al., 2018). While aiming to respect the wishes of human-centered decision systems, the workshops must be comprised of nurses and fellow practitioners in CCM.

According to several studies, nurses play a fundamental role in educating chronic care patients and instilling healthy behavioral practices (Altman et al., 2018). As analysts and practitioners posit, chronic conditions do not have any quick solutions. Instead, they must be approached as lifetime educational and care routines. As such, the doctors will not consistently be involved in these care practices. While the doctors may be interested in the diagnosis, prescription, and occasional checks, the nurses are engaged with educating and monitoring the patients through most of their chronic disease management journey. Thereby, the nurses must take central positions in the workshops for designing a human-centered care process and system for the patients (Altman et al., 2018).

Shared Governance – Nurses' leadership in CCM

In the shared governance construct, nurses are empowered to stay involved in their practice (Porter-O'Grady, 2017). They must, as such, take central roles in contributing to decisions that directly impact their positions. As already alluded to in this review, nurses are critical players in CCM. As such, they must play leadership roles in encouraging patient health behavior. Shared governance continues to increase in importance in nurses' practice. Such co-leadership encourages accountability, shared vision, partnership, and ownership of innovations. In the CCM domain that is subject to this analysis, nurses must be trusted by top management to make collaborative decisions in the design teams (Porter-O'Grady, 2017). The tokenistic approach used by most top management must be avoided at all costs in the proposed design workshops. This proposed (design thinking) system introduces a constantly shifting change culture in the healthcare sector.