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Empathy-Driven Innovation: Human-Centered Design Thinking for Transforming Healthcare Delivery
Empathy-Driven Innovation: Human-Centered Design Thinking for Transforming Healthcare Delivery
Sulaiman M¹, Amran H², Tarar K3, Pervaiz S³, Lalani D³, Shonibare A⁴, Khan I⁵, Mian A 1,5
¹Innovly, ²Rashid Latif Medical College, ³Evercare Hospital Lahore, ⁴Evercare Hospital Lekki, ⁵Evercare Group,
Background/Rationale/Purpose
Healthcare systems in LMICs face unique systemic challenges, particularly in high-stakes areas like Emergency Medicine (EM) and Intensive Care Units (ICUs). Resource limitations, fragmented workflows, and communication gaps exacerbate inefficiencies, compromising patient care and operational outcomes. These challenges necessitate innovative approaches tailored to address the specific needs of critical care environments.
Human-Centered Design Thinking (HCDT) offers a transformative methodology to tackle such issues by prioritizing empathy, collaboration, and iterative problem-solving. By aligning systemic improvements with the needs of patients, families, and care teams, HCDT can enhance both clinical outcomes and operational efficiency.
In this context, HCDT workshops were conducted in 2024 at Evercare hospitals in Lekki, Lagos, Nigeria, and Lahore, Pakistan, focusing on identifying and resolving critical issues in emergency and intensive care management.
Objectives
The workshops aimed to:
1. Identify critical pain points within emergency and intensive care operations, including specific units such as the Emergency Department, PICU, NICU, MICU, SICU, CCU, and Special Care Units.
2. Co-create actionable solutions through multidisciplinary collaboration among participants from diverse professional backgrounds.
3. Foster a culture of empathy-driven innovation to enhance patient care, team dynamics, and operational efficiency.
4. Empower participants to integrate design thinking principles into their daily workflows, encouraging sustainable and innovative practices.
Methodology
The workshops employed Stanford d.school’s five-step HCDT framework: Empathy, Problem Definition, Ideation, Prototyping, and Testing (see Fig. 1). Each step was implemented in a structured manner, as listed below briefly.
• During the Empathy phase, participants reflected on patient and staff interactions to create detailed empathy maps.
• Problem Definition sessions used the PICO framework to dissect identified challenges, encouraging participants to craft "how might we" questions. PICO is a structured problem-dissection tool designed to guide teams in identifying and analyzing challenges by breaking them into four key components: Problem/Population (P) to define the issue and those affected, Ideation (I) to explore why the problem exists and its underlying causes, Context (C) to understand its relevance to local or global settings, and Outcome (O) to define the desired impact, feasibility, and sustainability of potential solutions.
• The Ideation phase involved brainstorming sessions using divergent and convergent thinking techniques to generate and refine solutions.
• Prototyping activities encouraged participants to create tangible models, such as digital tools or workflow processes.
• The Testing phase involved conceptualizing success metrics and feedback loops for real-world application.
Figure 1. Evercare Group 2.0 workshops on HCDT as a 5-step process (see text for details).
Workshop Structure (Operations and format shown in Table 1 below as an example)
• The workshops, conducted at Lekki and Lahore in January and April of 2024, respectively, were between two to two and a half days long.
• They were designed to be contextually relevant for LMIC settings, emphasizing low-cost, scalable, and inclusive approaches to foster innovative problem-solving.
• Activities included empathy mapping, assumption-storming, PICO-guided problem dissection, and collaborative brainstorming.
• Facilitators used a mix of lectures, role-playing, and hands-on problem-solving exercises.
• All sessions were led by Evercare-based co-facilitators under the supervision and support of Prof. Dr. Asad Mian (senior author) as team lead.
Date Module Details/Activities Facilitator(s)
01/25/24 Introduction Introduction to HCDT: discuss need for complex problem solving; hack process AM
01/25/24 Five steps of design thinking Pre-thinking exercise: Break the ice; Recap HCDT in small groups; choose a specific topic within the theme to be hacked; E.g.: I would like to work on XYZ Assumption-storm: Pen down assumptions on a paper regarding the selected topic AM/team
Step I: Empathy Looking through the lens of empathy: Participants will:
• Observe: what the learner is doing
• Engage: talk to them
• Watch: look at them, observe the pattern
• Listen: what are they saying
• Unpack: Create an empathy map at the end AM/team
Step II: Problem Identification and Dissection State the problem: Ask participants to write a problem statement, followed by a brief intro to PICO guidelines for problem dissection.
• Create multiple “how might we” questions
• Choose one problem and dissect it using the PICO guidelines AM/team
01/26/24 Step III: Ideation Low hanging fruit ideas to moonshots: Process of divergent and convergent thinking; ask participants to:
• Through divergent thinking, pen down 15-20 ideas, using “anything goes” approach
• through convergent thinking, shortlist the three innovative, yet doable ideas AM/team
time permitting Step IV: Prototyping Embrace experimentation Ask participants to:
• Think of a prototype and create something too (for their identified solution)
• Common examples: Sketch, meeting, tool, activity, google form, plan
• Doodle it
• Have a hypothesis, the questions they’re trying to answer, pass/fail conditions AM/team
time permitting Step V: Testing Testing: Reflect on testing ; think of a testing paradigm for their favorite solution identified AM/team
Table 1. Schedule breakdown for the HCDT workshop at Lekki, Lagos, Nigeria. Total time ~ 5 hours over 2 days.
• Participants represented diverse professional roles, including clinicians, paramedics, nurses, and administrators, ensuring multidisciplinary collaboration throughout the workshops.
• Evaluations were collected from the participants at the end of each workshop.
• True to the low-cost and low fidelity nature of HCDT, other than PowerPoint/projection, laptops, Wi-Fi, the requirement was to be non-judgmental and non-hierarchical.
• This structured methodology empowered participants to generate actionable, context-specific solutions for critical care challenges.
The outcomes of these workshops, including the innovative prototypes and their potential impact, are detailed in the following sections.
Results
Participant Demographics: A total of 41 participants attended the sessions in Lekki, and 45 in Lahore, with completed evaluations from 23 participants at each site. The majority of respondents were aged 31-40 years (52.2% in Lekki and 56.5% in Lahore), with a slightly higher proportion of males at both locations.
Key Findings
1. Lekki (Emergency and Acute Care):
o Pain Points: Inefficient referrals, delayed emergency responses, and fragmented communication.
o Solutions: Referral coordinators, standardized checklists, and digital tools for communication.
o Metrics: Potential to reduce delays and improve patient satisfaction.
2. Lahore (ICU Management):
o Pain Points: Delayed triage protocols and lack of empathy in patient care.
o Solutions: Empathy training leading to the establishment of Empatheon and revised triage protocols.
o Metrics: Improved staff confidence, triage accuracy, and patient satisfaction.
Satisfaction Levels
Lekki
The HCDT workshop in Lekki demonstrated high participant satisfaction, as illustrated in the Educational Value and Logistical Factors graphs in Fig. 2A & B. Most participants rated inspiration (65% giving a score of 5) and knowledge enhancement (57% rating 5) very positively. The practicality of solutions also stood out, with 65% rating it 5. Team diversity and plans for further development were similarly well-rated, with the majority assigning scores of 4 or 5. For logistical factors, the workshop's relaxed and fun atmosphere received overwhelmingly positive ratings (74% scoring 5). However, adequacy of time received slightly more mixed feedback, with 43% rating it 5 and 35% rating it 4.
Fig. 2A. Likert score distributions for Education Value for the HCDT workshop at Lekki, Jan 2024.
Fig. 2B. Likert score distributions for Logistical Factors for the HCDT workshop at Lekki, Jan 2024.
Lahore
The HCDT workshop in Lahore also received strong feedback, as seen in the Educational Value and Logistical Factors graphs in Fig. 3A & B. Inspiration and knowledge enhancement were highly rated, with 70% of participants giving a score of 5 for each. Confidence in the practicality of solutions and team diversity were also notable, with the majority assigning ratings of 4 or 5. For logistical factors, while time adequacy received mixed ratings (43% rating 5, 39% rating 4), the relaxed and enjoyable workshop atmosphere was a highlight, with 57% scoring it 5.
Fig. 3A. Likert score distributions for Education Value for the HCDT workshop at Lahore, April 2024.
Fig. 3B. Likert score distributions for Logistical Factors for the HCDT workshop at Lahore, April 2024.
Fig 4. Participant brainstorming sessions, role-playing activities, and empathy-mapping exercises demonstrate the high level of engagement and collaboration throughout the workshops (shown here for Lekki, Nigeria).
Post HCDT Incubation: Lekki, Lagos, Nigeria
Four teams—DEC-I, ERA, TalkLine, and Communications Hub—developed targeted prototypes addressing key challenges in emergency medicine, including referral inefficiencies, emergency response delays, and communication gaps among interdisciplinary teams (see Table 2). Prototypes ranged from referral pathways and pre-ED care improvements to communication training programs tailored to acute care and paramedic operations. While the teams advanced to the prototyping phase, no real-world testing has been conducted yet.
Team/Startup Name Team Composition Empathy/Pain Point/Problem Statement Ideation (Convergent Thinking) Prototyping Stage
DEC-I (Referral System Improvement) 11 members (paramedic, nurses, admin, orthopedic technician, etc.) Poor referral system causing delays, miscommunication, staff burnout, and increased morbidity/mortality. Policies/protocols, referral coordinator role, and centralized referral platform. Focus on ED policies; paper-based solutions; metrics like reduced wait times and improved satisfaction.
ERA (Emergency Response Enhancement) 9 members (paramedics, intensivist, medical administrator, nurse, etc.) Emergency response delays affecting patients, staff, Evercare reputation, and economic productivity. Training/retraining emergency response team on communication and empathy. Focus on paramedics and pre-ED care; develop training; measure reduced response times and patient feedback.
TalkLine (Communication Improvement) 11 members (ED staff, ICU staff, OBGYN, dialysis, business development, etc.) Communication gaps among caregivers and with patients, leading to poor satisfaction and patient experience. Workshops on communication, feedback template use, and conflict resolution. Training on communication practices; conflict resolution; feedback mechanisms integrated into processes.
Communications Hub (Communication Improvement) 10 members (physiotherapists, medical officers, admin, interns, radiographers, etc.) Poor interdisciplinary staff communication impacting operations and patient experience. Training on communication ethics, respect, and task documentation. Merge with TalkLine; focus on communication ethics; use feedback mechanisms and reflective practices.
Table 2. Lekki, Nigeria: Summary of each team's composition, problem focus, and proposed solutions.
Post-HCDT Incubation: Lahore, Pakistan
The HCDT workshop in Lahore resulted in the formation of five teams focused on addressing challenges in ICUs and Critical Care Medicine, including staff turnover, communication gaps, and humanizing care. While there were five teams in total, detailed information could only be curated for three teams (see Table 3): Health Heroes, SHAFAA, and Empathy Listeners. These teams developed innovative solutions addressing critical issues such as improving staff well-being, enhancing communication in high-stakes ICU environments, and creating compassionate care models. Their prototypes reflect a commitment to improving outcomes in critical care settings, aligning with Evercare’s mission of patient-centered excellence.
Team/Startup Name Team Composition Empathy/Pain Point/Problem Statement Ideation (Convergent Thinking) Prototyping Stage
Health Heroes (ICU Staff Turnover Reduction) 5 members (nurses, ICU physicians, admin, patient experience staff) High nurse turnover in a 30-bed ICU, leading to reduced care quality, staff burnout, and recruitment costs. Flexible scheduling, wellness programs, recognition and rewards, and professional development. Tested shift options, wellness events, recognition initiatives, and training programs; feedback loops to refine prototypes.
SHAFAA (ICU Communication Improvement) 4 members (ICU nurses, admin, communication specialists) Ineffective communication in ICU impacting treatment timelines, trust, and financial and emotional costs. Setup of counseling rooms, interactive patient education, and communication training for ICU teams. Created counseling rooms, modules for patient/family education, and introduced communication training; focused on measurable patient feedback.
Empathy Listeners (Humanization of ICU Care) 6 members (nurses, occupational therapist, ICU admin, patient care team) Dehumanization of ICU environments affecting emotional and psychological well-being of patients, families, and staff. Training on humanization protocols, empowerment of stakeholders, and open communication policies. Implemented competency evaluations, family engagement strategies, and humanization-focused communication; used patient feedback tools to refine.
Table 3. Lahore, Pakistan: Summary of three teams’ composition, problem focus, and proposed solutions.
Empatheon: Transforming ICU Care
A standout result from Lahore was the evolution of the Empathy Listeners initiative into Empatheon, a program dedicated to redefining ICU care through a human-centered and iterative approach (see Table 4). Leveraging PDSA (Plan-Do-Study-Act) cycles, Empatheon systematically tests and refines interventions to address key challenges and ensure sustainable improvements.
Area of Focus Key Actions/Initiatives Outcomes/Updates Next Steps
Psychological Support -Initiated psychology consults with four sessions conducted. - Addressing burnout and mental health gaps. - Expand access to psychological support services.
- Incorporate structured mental health training for staff.
Focused Group Sessions - Held three sessions with ICU SMOs, nursing, housekeeping, and pharmacy staff.
- Identified issues and co-developed solutions, including: Formalized consultant rounds in HDU; Reinforced security and attendant policies; Enhanced pharmacy-nursing collaboration.
- Adjusted timing of educational sessions to better suit nursing staff schedules. - Key systemic issues resolved.
- Greater staff engagement and collaboration. - Continue focused group sessions to identify new challenges.
- Establish routine follow-ups on implemented solutions.
Mid-Intervention Analysis - Assessed communication and employee well-being challenges:
- 47% reported handover challenges.
- 57% highlighted gaps in burnout support.
- 60% indicated a lack of psychological support. - Data-driven insights guiding targeted actions for improvement. - Use insights to prioritize staff training and system-level interventions.
- Leverage trends for sustained progress.
Communication Training - Introduced training to improve interactions across teams and with patients and families. - Enhanced collaboration and patient-family engagement. - Conduct periodic training refreshers.
- Develop scenario-based workshops to strengthen practical skills.
Feedback Mechanisms - Established tools to track progress and monitor outcomes. - Focus on reducing complaints and improving satisfaction scores. - Use PDSA cycles to refine feedback tools.
- Request a dedicated budget for scaling the initiative.
Table 4. Summary of Empatheon’s recent progress and next steps.
Empatheon’s impact on the double bottom line
Empatheon is redefining ICU care by addressing systemic challenges such as communication gaps, staff well-being, and patient-family dynamics. The program emphasizes the double bottom line, creating both social value through improved care quality, staff morale, and patient-family engagement, and financial impact by reducing inefficiencies, minimizing staff turnover, and fostering operational excellence. Through its iterative approach and focus on continuous improvement, Empatheon serves as a model for human-centered, scalable critical care innovation in resource-constrained environments.
Discussion
The workshops demonstrated the transformative potential of Human-Centered Design Thinking (HCDT) in addressing systemic challenges in healthcare delivery, particularly in resource-constrained settings. By leveraging empathy-driven insights and practical, low-cost solutions, participants co-created innovative approaches to complex problems in emergency medicine and intensive care.
Key Insights
1. Empathy as the Foundation: Empathy mapping uncovered critical systemic challenges, fostering a deeper understanding of the needs of patients, families, and healthcare teams.
2. Collaborative Problem-Solving: The inclusion of diverse, multidisciplinary participants bridged clinical and administrative workflows, enriching the problem-solving process.
3. Scalable Innovation: Solutions such as referral coordinators, communication protocols, and empathy-driven ICU improvements laid the groundwork for broader implementation and system-wide transformation.
By emphasizing empathy, collaboration, and resourcefulness, the workshops showcased how practical, adaptive innovation—rooted in Jugaar innovation principles—can be tailored to the unique realities of low- and middle-income countries (LMICs).
Conclusion and Next Steps
The success of these workshops highlights the potential of HCDT to foster a culture of empathetic and innovative healthcare delivery. By addressing critical pain points with resourceful and scalable solutions, HCDT provides a replicable framework for sustainable transformation in healthcare systems.
Strategic Outcomes
• Enhanced Quality of Care: Strengthened patient and employee experiences through empathy-driven design.
• Innovation and Diversification: Solutions developed during the workshops demonstrate the potential for broader application and adaptation across varying healthcare settings.
• Scalability and Adaptability: The methodologies emphasize feasibility in resource-constrained environments while remaining adaptable to diverse healthcare contexts.
• Skill Development and Sustainability: Training initiatives and iterative processes create a foundation for continuous improvement and measurable impact.
Future Directions
1. Prototype validation: Testing solutions in real-world settings with a focus on measurable outcomes such as patient satisfaction and operational efficiency.
2. Scaling training programs: Expanding HCDT workshops to other regions, tailoring modules to address unique challenges and opportunities.
3. Integrating HCDT into broader frameworks: HCDT’s methodology aligns with broader innovation management frameworks, such as those exemplified by Innovly, which emphasize scalable, context-driven solutions for sustainable transformation in healthcare.
HCDT’s structured approach not only fosters empathetic and innovative solutions but also addresses inefficiencies that directly impact hospital operations. By optimizing workflows, reducing communication gaps, and improving staff engagement, HCDT has the potential to enhance operational efficiency, indirectly supporting financial sustainability in healthcare systems.
By embedding human-centered design principles into healthcare systems, organizations can create solutions that are empathetic, sustainable, and impactful—setting new benchmarks for innovation and resilience in addressing complex challenges.
References
1. Mian, A. I. (2021). #C2i-Create-2-Innovate: Expansion From The Merely Technical To The Metaphorical. In A. I. Mian (Ed.), MEDJACK: The Extraordinary Journey of an Ordinary Hack (Kindle Edition). SEED Pvt Ltd.
2. Dam, R. F. (2023). The 5 Stages in the Design Thinking Process. Interaction Design Foundation. Retrieved from https://www.interaction-design.org
3. Saeed, N., Sulaiman, M., & Mian, A. I. (2023). Human-Centered Design Thinking in the Emergency Department: Channeling the Chaos Together. ACEP Newsroom.
4. Salim, Y. (2024). Healthcare Innovation Powered by AI. The Express Tribune.
5. World Health Organization. (2022). Trauma Care Manual. Geneva: World Health Organization.
6. Kelley, T. (2016). The Art of Innovation: Lessons in Creativity from IDEO. Profile Books.
7. Thiel, P. (2014). From Zero to One: Notes on Startups, or How to Build the Future. Crown Currency.
From Boarding to Breakthrough: Tailored Interventions for Vulnerable Patients
Emergency Department (ED) boarding–prolonged stays in the ED while awaiting inpatient placement–is a crisis exacerbating crowding, increasing costs, and negatively impacting health outcomes. Vulnerable populations, including individuals with low socioeconomic status (SES), medically-complex older adults, and psychiatric patients are disproportionately affected. Yet, solutions tailored to their needs remain underexplored. This discussion examines root causes of boarding and proposes innovative, scalable interventions to mitigate its harms, specifically for marginalized groups. We highlight three strategies: (1) Patient Navigators, who assist low-SES patients navigating healthcare systems, (2) Community Paramedicine, which delivers in-home care to complex patients, and (3) Emergency Psychiatric Assessment, Treatment and Healing (EmPATH) Units, which provide targeted care for psychiatric patients. All three are associated with reduced ED visits. Traditional approaches to boarding have fallen short, particularly for vulnerable populations. Patient navigation, Community Paramedicine, and EmPATH units represent feasible, evidence-based solutions that health systems can implement. Broader adoption of these models can alleviate crowding, enhance care quality, and promote health equity. Future efforts must align these innovations with policy and funding mechanisms to ensure sustainable, system-wide improvements.Innovation Skills Assessment in Healthcare: Benchmarking Capacities in Low-Resource Settings
ABSTRACT
Background: Innovation is a key driver of healthcare transformation, particularly in low-resource settings where systemic constraints often hinder service delivery. Assessing innovation capacities among healthcare employees can inform workforce development strategies. This study applies the previously validated Innovation Skills Assessment (ISA) tool to examine workforce innovation potential at a tertiary care hospital in Pakistan, offering insights for targeted capacity-building interventions.
Methods: A cross-sectional survey was conducted at Mukhtar A. Sheikh Hospital in Multan, Pakistan, using the ISA tool adapted from the General Innovation Skills Aptitude Test. The survey captured demographic data and assessed innovation skills across four pillars: idea generation, risk-taking, interpersonal relationships, and idea implementation. A total of 250 electronic surveys were distributed via hospital communication channels, with 161 responses (64% response rate). Responses were rated on a 5-point Likert scale, and mean scores with standard deviations were calculated for each pillar. Descriptive statistics were used to explore observable trends across age, gender, education level, and job designation, without formal hypothesis testing.
Results: Participants aged 36–45 years had the highest overall mean scores (4.48 ± 0.31), with notable strengths in idea generation (4.48 ± 0.31) and implementation (4.53 ± 0.33). Males showed higher average scores across all pillars, with interpersonal relationships as the strongest domain (4.49 ± 0.42). Participants with intermediate education reported higher mean scores in creativity and risk-taking (4.36 ± 0.45 and 4.20 ± 0.57, respectively). These patterns suggest potential demographic influences on innovation capacities.
Conclusion: The ISA tool can be feasibly applied to map innovation skills within healthcare workforces in low-resource contexts. The identified trends may help guide workforce development through tailored training and institutional policies that promote a culture of innovation.
Keywords: Innovation Skills Assessment, Healthcare Workforce, Low-Resource Settings, Human-Centered Design, Capacity-Building, Pakistan, Benchmarking, Workforce InnovationHuman Drugs & Veterinary Drugs - A Cost Comparison
Objective: The aim of this study was to provide an updated comparison of veterinary drug costs with human pharmacy equivalents.
Design: A cross-sectional study was conducted by identifying the 50 most common drugs from Medicare Part D spending data, and obtaining the costs of these drugs, in addition to select antidepressants and ophthalmic medications, from human retail (GoodRx, DiRx, and Cost Plus Drugs) and veterinary pharmacy websites (Chewy and Pet Meds).
Main outcome measures: Drug costs per tablet were calculated using 30-, 60-, and 90-count quantities. Drug cost data was normalized, and costs were compared via Student’s T-test.
Results: 41 drugs were analyzed between human and veterinary pharmacy alternatives. For 90-day supply costs, Cost Plus Drugs provided the cheapest price for 30/41 cases. The lowest normalized drug cost per unit 90-day supply was 0.4406 for Cost Plus Drugs, with DiRx second at 0.5789 (p < .05). For 30-day supply costs, Chewy provided the cheapest price for 30/41 cases. The lowest normalized drug cost per unit for a 30-day supply was 0.4665 for Chewy, with no significant difference to Cost Plus Drugs at 0.5270 (p > .05).
Conclusion: These results demonstrate that home-delivery pharmaceutical services offer more affordable options and address the high cost of human medications compared to equivalent veterinary medications. This represents a step forward in identifying solutions to reduce healthcare expenditures and pharmaceutical costs.
Leveraging Text-Based Outreach to Improve Enrollment in Federal Benefit Programs and Address Broadband Internet Access
Background: Federal benefit programs form the backbone of a social safety-net that provides access to essential services for millions of Americans. However, access to these programs is hampered by complex application processes and administrative barriers. Link Health is a Boston-based nonprofit organization that, through strategic community partnerships, has developed a framework to streamline benefit program enrollment, resulting in the disbursal of over $4 million in benefits. We evaluate the effectiveness of embedding benefits access within existing private messaging frameworks as a strategy for reducing systemic barriers to federal program utilization and improve broadband internet access.
Methods: In this prospective observational study of data from June 2024 through December 2024, Link Health conducted a targeted Massachusetts-based text-messaging campaign aimed at enrolling patients from partner community health centers in the Lifeline program, a broadband phone and internet access discount. DaisyChain, a web-based communication platform, enabled Link Health’s multilingual digital navigator team to collect patient responses and conduct follow-ups.
Results: The campaign reached 68,529 patients, with 2.15% (n=1,470) engaging with the initial message. Among those who engaged, 41.84% identified as Hispanic, 35.58% as White, 10.61% as Black or African American, and 2.79% as Asian. 62.59% of participants preferred English, 32.31% preferred Spanish, and 5.10% preferred another language. 68.91% of sign-ups were female. Applicants were predominantly working and middle-age adults, with 24.15% of applicants between the ages of 35-44 years and 24.15% between 45-54 years. Patients primarily qualified for Lifeline through SNAP (64.97%), Medicare (37.21%), or Medicaid (41.16%).
Conclusion: This study describes the effectiveness and feasibility of text-based initiatives in connecting patients from racially and linguistically diverse communities with the Lifeline benefit program. The campaign successfully and predominantly engaged Hispanic, publicly-insured groups, with an especially high enrollment rate among working and middle-age adults. By integrating digital technology with public health, Link Health’s text-messaging campaign provides a scalable and replicable framework to improve access to federal benefits.
