By Karen Brooks
In 2018, a New York Times story highlighting the nation’s opioid epidemic famously dubbed Kensington, a neighborhood in North Philadelphia, “the Walmart of Heroin.” The area is, in fact, the largest open-air drug market on the East Coast and the epicenter of the region’s overdose crisis. But where most onlookers see hopelessness, Bon Ku, MD, sees hope.
An emergency medicine physician and the Marta and Robert Adelson Professor of Medicine and Design, Ku is chronically discouraged by the stigma associated with Kensington as a whole. Rather than demeaning its residents, he wants to extend better care to their community—so he and his Jefferson Health Design Lab colleagues partnered with various organizations to develop CoLabPHL, a 1964 Airstream trailer reimagined as a mobile healthcare platform that brings resources directly to the places that need them most.
“Kensington is only associated with poverty and drugs, but there are beautiful people there who are trying to live their best lives, and the opioid crisis does not define them,” says Ku, Health Design Lab director and assistant dean for health and design. “Unless we change the narrative, we will not have a successful intervention in the crisis. You can draw parallels between opioids today and AIDS in the 1980s. Until we reduced the stigma, we couldn’t make a dent.”
Funded by the generous support of the TD Charitable Foundation, the Wawa Foundation, and the Community Design Collaborative, CoLabPHL offers services like health screenings and nutrition education, but Ku cites an art installation as its most impactful initiative. The interactive exhibit invites residents to take selfies that are incorporated into a digital mural, then answer a series of questions about their dreams and goals. Their responses print out on strips of receipt paper that are hung like party streamers.
“Rather than coming in with premeditated solutions, we really listen to these people,” Ku says. “By engaging with them, we elicit hope and demonstrate that they are much more than just opioids and poverty.”
The most important ingredient in developing meaningful interventions like CoLabPHL—which received the 2019 Impact Award from DesignPhiladelphia, an annual celebration of design innovation—is empathy, according to Ku. “User-centered research” drives every initiative born in the Health Design Lab, a collaborative makerspace where students and professionals across widely varying disciplines confront healthcare challenges using design thinking.
“We think of ourselves as a test kitchen for the hospital. We explore new technologies and apply our imaginations to find ways to make experiences more efficient for both patients and providers,” he says.
His favorite definition of the term “design thinking” comes from Ellen Lupton, curator of contemporary design at Cooper Hewitt, Smithsonian Design Museum (and co-author of Ku’s book, Health Design Thinking: Creating Products and Services for Better Health, to be published this spring). She describes the method as employing a set of creative tools to generate ideas and solutions that meet human needs; using physical prototypes and storytelling to help teams build empathy and actively engage with a situation; and keeping an open mindset that invites people to rewrite the rules of business as usual.
“When people hear the word ‘design,’ they typically think of an object, like a piece of furniture or an artifact in a museum,” Ku says. “To us, design is a verb that means approaching the world with creativity to create a path to a better future, starting with understanding the needs of others.”
The Health Design Lab is home base for students in Jefferson’s Scholarly Inquiry Design track, launched by Ku six years ago as the nation’s first four-year design program for medical students. Enrolling in the program—which pushes students to revamp healthcare facilities, services, and devices—“is like majoring in medicine and minoring in design,” he explains. “Our students learn to apply human-centered design to real problems in healthcare.”
Those problems are rampant, from the most complex, like the dearth of resources in poor neighborhoods such as Kensington, to the most basic, like skimpy hospital gowns that leave patients feeling overexposed.
“There are exam rooms set up so a provider is physically unable to look at the patient, who stares at their doctor’s back as they type into a computer,” Ku says. “This is not OK, and we can use design to come up with solutions.”
Ku’s determination to infuse creativity into medical education stems from his own unsatisfactory medical school experience. Uninspired by traditional science courses, he pursued an undergraduate degree in classical studies at the University of Pennsylvania. Exploring the humanities stoked his imagination in ways the hard sciences could not while cultivating the writing, speaking, and critical thinking skills he considers fundamental to connecting with patients. Once he entered medical school at Penn State, he felt stifled.
“It was mainly rote memorization, a complete creativity killer. Making people healthier is a creative pursuit, but we had no opportunity to apply our imaginations to problems,” he says. “You don’t learn how to be a better doctor from traditional pre-med classes. Many future doctors are sitting in a lecture hall right now. Is that what we want?”
The key to design thinking is learning by doing. Design track students prototype their ideas using simple tools such as paper, glue, Legos, and Play-Doh. If they were conceptualizing a new check-in kiosk for a medical practice, for example, they might build a cardboard model and do a role-playing skit to identify potential shortcomings with its design.
They also collaborate with experts from other fields, like industrial and graphic design. A recent research project involved Philadelphia’s KieranTimberlake architecture firm, whose team helped students evaluate how the layout of Jefferson’s emergency department influences behavior. They tracked physicians, nurses, and other providers and identified ways physical spaces could be modified to foster better interpersonal interactions.
To us, design is a verb that means approaching the world with creativity to create a path to a better future, starting with understanding the needs of others.
“The problems in healthcare are so complex, the solution does not always lie within a biomedical framework. It benefits us to co-create with people who think differently than we do, especially those who look at things more visually,” Ku notes. He also draws insight from some unlikely sources—like professional chefs, who have more in common with physicians than it might appear. Both work grueling hours in service industries, and both experience high rates of burnout. The biggest difference, as he sees it, is that chefs use their imaginations in ways most physicians don’t.
“They need technical skills but also use their creativity with recipes and restaurant design to ensure a great experience for their patrons. Why don’t we value that creativity in healthcare?” he wonders. He pays close attention to cooking-related podcasts, particularly “The Dave Chang Show,” in which the head of the acclaimed Momofuku conglomerate of restaurants dissects his and his guests’ creative processes.
Ku challenges his students to tackle issues across the healthcare spectrum, but the timeless problem of caring for underserved populations resonates with him the most. His parents, South Korean immigrants who worked at a flea market, did not have health insurance when he was a child—so when Ku had a knee injury, his father had to pay an orthopedic surgeon out of pocket.
“He literally pulled out his wallet and paid cash, probably most of my family’s weekly income. I felt very guilty, even though no kid should feel guilty about getting medical care,” Ku remembers. “That experience helped form what type of doctor I became—the kind who will provide care irrespective of a patient’s ability to pay. Living and working in poor immigrant communities is 100 percent the reason I went into my field.”
Three years after joining Jefferson and nearly a decade before devising its design curriculum, Ku felt he was burning out in trying to fix a system that seemed irrevocably broken. He took a leave from practice to pursue a master’s degree in public policy at Princeton, where he learned about healthcare economics and policy—more lessons that had been absent from his medical education and that bolstered his commitment to social justice. He hopes that by imparting both this knowledge and design thinking skills onto students today, he is preparing a new generation of physicians to change the future of healthcare.
“I’m seeing inklings of change already, but the incubation phase of a physician is so long—our first cohort is still in residency now. But those who go through our design track consistently report that it was their best experience in medical school and that it made them think differently about healthcare,” he says. “Design matters to all of us every day, from the design of our most comfortable shoes to our favorite café. It’s time we realize it matters in our healthcare, too.”