For hospital it's all a matter of design

By MICHAEL SMYTHE*

Hooray. Wayne Brown has backed down. The people have been heard. We will have a Starship Children's Department of the Auckland City Hospital. A compromise has been reached. Is everybody happy? I don't think so.

Mr Brown's district health board is bruised by the unexpected uprising, and the issues it was trying to address remain. The fundraising foundation and Starship staff don't like their discrete entity being relegated to the status of a department. So what is the real problem?

Is it a fiscal problem? The Auckland District Health Board is faced with huge cost overruns. The big idea, inherited by Mr Brown's board, is to centralise facilities so that resources can be spread over a larger operation.

The demand side of the ledger has led Mr Brown to suggest that hospitals should not be prominent brands that seek to attract customers.

As I understand the argument, the Starship brand has been too successful. So parents, being dragged along by enthusiastically sick children, are presenting at the Starship instead of attending their community-based primary care facility (that is, their local doctor). The cost of non-referred treatments and admissions far exceeds the funds raised by the foundation that capitalises on the Starship brand.

It seems the solution was to reduce costs by reducing demand. Mr Brown might have been on to something there. I have not been admitted to hospital since I had my tonsils out 52 years ago. The child-friendly diet of icecream and jelly was overshadowed by the experience of a crabby nurse who smacked me for dropping a comb on the floor. Maybe this aversion therapy scared me into a lifetime of robust health.

Is it a marketing problem? Maybe. Successful marketing, resulting from the application of a business model to a social service, creates the problem described. In most commercial enterprises there is no such thing as too many customers. When taxpayers' money funds a service, better marketing delivers a bigger loss.

But successful marketing is about reaching target markets. It does not profit any business to attract everyone to its product or service.

Rather than abolishing or diminishing the Starship brand, it can be argued that the health board should work at positioning the service accurately within its spectrum of services. This would mean applying effective branding and marketing to each health board service, and to primary care services in the community, so that appropriate customers present themselves at appropriate places.

Is it a political problem? The perception is that this is about power bases, fiefdoms, backstabbing and winning by making the other side lose.

Allowing the development, management and delivery of such an essential social service to degenerate into a them-and-us zero-sum game would miss the point.

The point is that everyone is interested in delivering an efficient and effective health service to enhance the ability of each person to contribute to the community and live the best life possible.

Viewing the issues through a design management lens allows all factors to be addressed within a commitment to resolution rather than compromise. Design thinking is intention-driven, holistic, integrative and dedicated to delivering results that work in practice for users at the right price. It operates in a state of creation rather than a state of reaction.

It might be a cliche, but intentions must be seen as challenges rather than problems. They present an opportunity to create something better than has ever been offered. The process begins with the identification of all those with a stake in the enterprise.

This requires early consultation and ongoing lines of communication.

The first task is to agree on intentions and to arrive at a checklist of performance criteria that aligns the creative process and helps the evaluation of ideas.

Well-briefed stakeholders will participate in the process of conceptualising ideas without putting self-interest ahead of co-operative synergy. Personal agendas, rather than hidden agendas, would be welcome.

Ideas can emerge in many ways from many sources. The difficulties usually arise in the assessment and selection of concepts. Egos collide.

The shock of the new, resistance to change, attraction to novelty and the need to be heard by being agreed with take over.

This is where the checklists deliver a return on the time and effort invested in their development. Ideas are evaluated against the agreed criteria.

Fundamental flaws and room for improvement show up. A sound critique generates more ideas. Design is a process, not an act. Any stakeholder-based, consultative, participatory process seems conspicuous by its absence at the Auckland District Health Board.

From the boardroom aggressive, top-down leadership might seem more cost-effective than some lovey-dovey, hand-holding approach. But when troops don't follow, there is no leadership. A design-driven organisation can integrate fiscal, functional and human factors to continuously create and improve products and services valued by all stakeholders.

* Michael Smythe is a partner in an Auckland design management and cultural strategy consultancy.