matthew geary
joint replacement surgical kit workflow
background
Orthopedic surgery is not unlike general construction. For joint replacement procedures, the typical operating room is packed with countless trays that are filled with hundreds of tools and parts to account for various patient sizes. Besides the sheer effort required to set up, this increases the chance for error. From a business perspective, there is also a complexity and sourcing issue as these kits are managed by local companies and shared across hospitals.
methods
ethnography
contextual inquiry
in depth interviews
task analysis
design strategy
role
researcher on team of two at InsightPD
challenge
Our client is one of the largest medical device companies in the world. As they prepared to update one of their surgical kits, they wanted to better understand the existing workflow, key challenges and work arounds, and identify opportunities to improve surgical outcomes and operating room experiences.
process
Immersion and Stakeholder Interviews
At the start of the project, our research and design team traveled to the client offices to get a better understanding of the problem. Using the existing surgical kit, each team member performed the procedure using artificial bones and getting a hands on perspective of what surgeons were facing — at least as close as legally allowed. While in the client office, we conducted several interviews with key stakeholders to review their priorities and understand the key questions they hoped to answer in the effort.
Ethnography
My colleague and I conducted research at multiple sites around the US and in the UK, in large part to observe the impact of public versus private health care systems. We observed 12 surgeons completing the joint replacement procedure, both with the client’s product as well as key competitors. Each visit started with an operating room tour, and observing the transport, sterilization, and storage of the kits. Surrounding the procedure, we interviewed the surgeons, residents, nurses, and scrub techs at the facility.
Task and Tool Analysis
From the observation and video taping, we analyzed each step of the surgical process. We collected different techniques from surgeon to surgeon, calculated error rates, flagged the largest variations from surgeon to surgeon, and identifying the underlying cause of each delay and outlier. We paired this with an analysis of each tool used throughout the process, how frequently it was used, and just as important, tools that were widely unused by our surgeons.
Innovation Workshop
After the research, we presented the findings to client stakeholders and executives as part of a two day innovation workshop. Using each of the pain points and themes as inspiration, I led a series of brainstorming and prototyping exercises to explore different design directions and opportunities.
results
The research effort led to design recommendations at the individual tool level all the way to the business model for storing and using tool sets. We noticed several design inconsistencies that led to repeat surgical errors, such as conflicting mental models about how tools should be used. We also suggested a different layout to better reflect the observed workflows and proposed modular half kits to reduce setup time, taking advantage of better predictive pre-op technologies.