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Redesigning Healthcare: A Q&A About Duke Design Health
The Design Health program bridges the expertise in disciplines across Duke to create real-world solutions to pressing needs in health care
This story originally appeared on the Duke MEDx website.
The Duke Design Health program gives interdisciplinary student teams a new opportunity to create medical solutions. Formed by Eric Richardson, Paul Fearis, and Joseph A. Knight, the program brings together students from the schools of engineering, business, and medicine and other disciplines across Duke to create real-world solutions to pressing needs in healthcare. Instead of giving students and trainees pre-defined problems, they actively identify, validate and prioritize problems to solve that impact human health during their nine-month intensive experience.
Two of the 2019-2020 Design Health fellows, surgery fellow Konstantinos Economopoulos, M.D., Ph.D., and pulmonology fellow Alejandro Pino, M.D., spoke about their experience in the Duke Design Health program and the impact it made on their career.
HOW DID YOU HEAR ABOUT THE DUKE DESIGN HEALTH PROGRAM?
Konstantinos: I was introduced to Eric Richardson by one of my co-residents, Dr. Muath Bishawi, clinical associate director of Design Health. They, along with Paul Fearis, talked to me about the goals of the program and I quickly realized it was exactly what I envisioned embarking during the academic years of my general surgery residency at Duke.
Alejandro: I was first introduced to the program during my fellowship interview for pulmonary and critical care medicine, during which the program director and Design Health mentor, Dr. Scott Shofer, mentioned it as a possible area of interest. I made my decision to join about a year later when Dr. Shofer reintroduced the program to me and encouraged me to apply.
WHAT MOTIVATED YOU TO JOIN THE DESIGN HEALTH PROGRAM?
Konstantinos: Two reasons: First was the ultimate goal of the program, which is to bridge the communication gap between engineers and healthcare professions. Second was a realization I had from my cumulative clinical experience as a surgery resident in the operating room and the hospital wards. On a daily basis, we deal with challenges in the healthcare setting that have an easy, but not always obvious, fix. It takes a multi-disciplinary approach to identify these challenges and implement the right solution to them. The Design Health Program proves that that this can be done and can lead to substantial improvement of our clinical practices.
Alejandro: I grew up in a household of engineers and have always had an interest in designing and improvising. As a child, I helped my father build and repair electrical equipment in Cuba. Tools and equipment were very limited, and we often had to be creative to solve problems. For instance, we built a water heater out of a stove wire ring, and a washing machine using a lawn mower engine. This upbringing, marked by imagination and discovery, shaped many of my interests, particularly my interest in solving health-related problems by researching and developing new biomedical technologies. For my undergraduate thesis, I built a low-cost EKG machine designed to be used in developing countries that lack medical equipment. Designing an inexpensive device that would provide physicians with diagnostic equipment when their patients needed it most was my priority. The Design Health program is an incredible opportunity to combine my engineering background with my medical training.
DO YOU HAVE AN ENGINEERING BACKGROUND? IF SO, DO YOU THINK SOMEONE WITHOUT AN ENGINEERING BACKGROUND WOULD BE SUCCESSFUL IN THE PROGRAM?
Konstantinos: I didn’t have an engineering background prior to entering the program. I believe that entering the program without an engineering background was a plus because it kept me unbiased from an “engineering-way-of-thinking” during the bootcamp period of ethnographic observations and needs-screening process. Currently I’m pursuing a master’s degree in biomedical engineering and I hope to be able to use these skills in the future to further facilitate innovative solutions in surgery.
Alejandro: Yes – I received my bachelor’s degree in electrical engineering and then worked for Medtronic as a research and design engineer prior to medical school. That was when I really developed a passion for product development. However, many of the skills that the Design Health Program requires were not related to medicine or engineering. Many backgrounds could be successful in the program. As an example, one of my team members, Mariel Lambrukos, an MBA student, could have led our team without a problem. Her skills, despite not having an engineering background, were indispensable for the team. She presented a different point of view, kept the team organized and created a bond among team members. She also understood how to communicate effectively with each team member in a way that motivated them.
YOU JOINED DESIGN HEALTH AS PRACTICING PHYSICIANS. WHAT EFFECT HAS THE COURSE HAD ON HOW YOU LOOK AT THE DAY-TO-DAY OF PRACTICING MEDICINE?
"Every day in the operating room and in the wards has become an opportunity for me to come up with innovative ideas that help us improve the quality of care we provide to our patients."
-DR. KONSTANTINOS ECONOMOPOULOS
Konstantinos: After learning how to perform ethnographic observations, every day in the operating room and in the wards has become an opportunity for me to come up with innovative ideas that help us improve the quality of care we provide to our patients. Knowing the “design way of thinking” has equipped me with I need to transform every day in the hospital into a journey of innovative thinking and discovery.
Alejandro: The course not only reminded me of my love for engineering and the impact it can have on people but has inspired me to continue to combine engineering and medicine. Working with people from various training and education backgrounds on a common goal has shown me how invaluable such collaboration is. I now view things through a different lens in the hospital. I also have a deeper understanding of the innovation process and how to tackle it systematically. Paul, Eric and Joseph have been instrumental in furthering my understanding of product development and leadership skills; they constantly set an example of how to be teacher and leader to a team.
IN DESIGN HEALTH, YOU WORK IN MULTIDISCIPLINARY TEAMS. WHAT HAVE YOU LEARNED FROM YOUR TEAMMATES?
Konstantinos: I learned how to identify pressing needs in the medical environment and how to creatively think of solutions for them. I also learned how to not be attached to my ideas and keep an open mind when it comes to innovative solutions. “Killing” your ideas early in the process is what makes you start thinking outside of the box and come up with solutions that are both user-friendly and have a good value proposition.
Alejandro: I learned a great deal from my teammates. First, they provided me with different perspectives, ideas and viewpoints when approaching a problem and potential solutions. Second, I learned how to best motivate my team, keep them engaged and delegate tasks appropriate to their skill set. I also improved my communication skills and ability to effectively coordinate among different levels of expertise. Third, I developed a deeper understanding of leadership; I now know that true leaders work side-by-side with their teammates. The most important lessons I learned, though, were personal. I learned the value of different backgrounds to a team and how to listen, take time, and offer support both outside and inside the classroom.
WHY DO YOU THINK IT’S IMPORTANT FOR CLINICIANS TO TRAIN IN PRODUCT DEVELOPMENT OR ENTREPRENEURSHIP?
Konstantinos: Clinicians, specifically surgeons, are strategically positioned to the environment where most of the clinical needs emerge or currently exist. Our clinical experience helps us to know ahead of time which solutions have the potential to work and which do not. Being trained in design, product development, and entrepreneurship puts surgeons in a position to shape future medical devices in a way that makes them safer, more user-friendly, and more efficient in solving the need they are meant to solve in the first place.
Alejandro: Product development offers a unique perspective that goes beyond problem solving and creativity. It teaches you how to observe with purpose, how to truly understand a need and how to be a leader across various fields. Physicians are often leaders of a healthcare team, but rarely have any formal teaching on how to do so. The process of product development pushes fellows and teams to improve upon their skills and learn new management skills to meet deadlines, organize appropriate tasks, and prioritize deliverables, among other things.
HOW HAS YOUR VIEW OF THE INNOVATION PROCESS CHANGED OR DEVELOPED AS A RESULT OF THE COURSE?
Konstantinos: Before joining the Design Health course, I thought that the innovation process was the sole responsibility of the inventor and required a “lightbulb moment.” I now know that there is much more to it. The innovation process is structured and very sophisticated. If a multidisciplinary team follows the steps correctly, a positive outcome can be almost assured.
Before Design Health, I never would have imagined an engineering team springing into action like this during a health pandemic.
-DR. ALEJANDRO PINO
Alejandro: During my spring semester of Design Health the COVID-19 pandemic started to take hold in the United States and have a direct impact on the healthcare system. My experience working with Design Health opened doors for me to start collaborating with many faculty in the Pratt School of Engineering and allowed me to join the COVID-19 Engineering Response Team where I partake in projects that have a direct impact on both patient care and protection of healthcare staff. As an intensive care fellow with Design Health, I bridge a gap that is constantly present between the innovation process and clinical care of patients. I provide a deeper understanding of hospital needs, validate some of our solutions and lead projects within the team. One of our current projects, the PAPR Bridge Project, focuses on flexible use of the Powered Air-Purifying Respirator (PAPR). The goal of this project is to be able to effectively interchange various parts of each differently manufactured hood and pump. This will enable the use of all available hoods if and when certain PAPR pumps run out of battery, malfunction or are being used elsewhere. Before Design Health, I never would have imagined an engineering team springing into action like this during a health pandemic.
HOW MUCH TIME DO YOU SPEND WITH DESIGN HEALTH AS A FELLOW WITH TEAM LEADERSHIP RESPONSIBILITIES?
Konstantinos: I invest approximately 15-20 hours per week. The bootcamp, though, was a full-time 3-week experience from which I learned a lot by observing procedures in the operating room that I used to be the one performing. Sitting in the corner of the room watching your daily routine gives a different perspective and you realize the pitfalls of our status-quo clinical practices. It was a life-changing experience for me.
Alejandro: It varies depending on the part of the product design process we are focusing on. It can take 15-20 hours a week doing various tasks – sometimes meeting and discussing ideas, sometimes going over general details from the group, and sometimes conducting interviews with shareholders whom the product would impact. During the design and prototype phase, my team and I met multiple times a week in various settings to test and validate our proof of principal and proof of prototype. During other phases, such a need analysis and prioritizing, we worked on our own and met twice a week to discuss our work.
NOW THAT THE PROGRAM IS OVER, HOW DO YOU PLAN TO USE THE TRAINING YOU RECEIVED? HOW DO YOU ENVISION THIS EXPERIENCE WILL HELP YOU ACCOMPLISH YOUR FUTURE CAREER GOALS?
Konstantinos: My experience as a Design Health fellow made me fall in love with the design and innovation process so much so that I decided to pursue a degree in biomedical engineering at Duke. I envision using my engineering and entrepreneurial skills to become a surgeon-innovator who will continue to help bridge the gap between engineers and surgeons.
Alejandro: The Design Health program has truly impacted my future career goals. It solidified my desire to continue to incorporate engineering in my work. I picture myself working as a physician-scientist helping my patients through my work in biomedical research and clinical care. As a researcher, I see myself helping patients through technological innovations that can be applied in a clinical setting. As a clinician, I picture myself helping patients make educated decisions as to what device or procedure may be best for their needs and motivating them to commit to making changes in their lives to improve their health.
WHICH PART OF YOUR JOURNEY WAS THE MOST DIFFICULT? MOST REWARDING?
Konstantinos: The most difficult part of my journey, but also the most rewarding, was that as a surgeon with a basic and clinical research background but no engineering background, I was in uncharted territory. When I first started the program, I wasn’t comfortable with anything I was doing. I quickly realized, though, that if you put in the required work, you quickly adapt to perform at the level needed to make a valuable contribution to the innovation process.
An example is our new device, COVIAGE, which is an isolation tent attached to the patient’s bed to minimize healthcare workers’ exposure to infectious droplets while minimizing use of personal protective equipment (PPE). It also increases our ability to safely perform non-invasive ventilation in patients who are COVID-19 positive. Engineers from the Design Health program - Benjamin Wesorick, Shikha Sharma, Kanishka Patel and Yaas Bigdeli - an engineering masters student, Theresa Thompson, and I performed need screening, designed, built and tested the device in two weeks, and will deploy it at Duke for clinical use. Going from an idea on a napkin to clinical implementation of a sophisticated device in such a short period of time was only possible because we all knew and had worked with each other prior in the Design Health program. This is a perfect example of several people working around the clock and succeeding to make a difference and have a real impact on patient’s lives in a short amount of time.
Alejandro: The most difficult part for me was learning how to efficiently manage my team, especially in regard to optimizing our time, and paying attention to important details. Working simultaneously on parallel goals, such as financial modeling and prototyping, within a team can be challenging. Also, working on a project for a year can get monotonous, and team creativity and drive can suffer. As a fellow and leader within the team, finding ways to motivate everyone and bring out the best in them throughout the project was a challenge, but also instrumental in my leadership development. The most rewarding part of my journey was the ability to learn from fellow students and faculty with different backgrounds. Our team had six different nationalities, six different undergraduate majors, and three different graduate degrees all in six members. It was truly a diverse team that I admire and am proud to have been a part of. All faculty had a direct impact on my career, either via grant application writing or innovations during the difficult times of the COVID-19 pandemic. Their dedication to their students and everyone in the Design Health family was admirable and greatly appreciated.
HOW WOULD YOU SUM UP YOUR EXPERIENCE IN DESIGN HEALTH IN A FEW WORDS?
Konstantinos: Life changing
Alejandro: Eye opening