Appropriate Testing : Ordering the Right Test at the Right Time for the Right Patients

Updated: Feb 13, 2019


INTRODUCTION

Inappropriate testing is problematic as it can result in a burden to patients, may cause unnecessary harm and increases costs for health systems. Examples of inappropriate testing include unnecessary or too frequent testing, tests whose results will not affect care management or diagnosis, and low probability of positive results. In collaboration with Michigan Medicine Department of Pathology Division of Quality and Health Improvement (DQHI) and the DQHI Laboratory Stewardship Committee, the design team sought to investigate the problem space of test utilization and appropriateness in the hope to support ongoing efforts within DQHI to reduce inappropriate testing.


DESIGN PROCESS







  • Their workflow and when/ where tests are place.

  • What factors they consider when determining the appropriateness of a test.

  • What has influence on their team’s motivation and behavior when it comes to test ordering.

  • If they monitor order patterns and provide feedback.

  • Their perceptions about patients’ needs and expectations.

  • The level of communication they have with patients around test ordering.

  • What they consider to be the challenges of inappropriate testing.

  • How they would increase appropriateness of testing.













REFELCTION / LESSON LEARNED

  • At the beginning of the project, the partner had requested that the team make improvements to the design of the dashboard, which was intended to prevent inappropriate testing behavior among health professionals and which was still being developed. However, as we engaged in exploratory research, we discovered that the hospital culture was a more important and fundamental problem. Rather than focusing on the problem as the partner had suggested, we took it upon ourselves to reframe the problem and to persuade the partner to view it in this way as well. Through this, I gained firsthand understanding of how design is a process of negotiation: A designer must negotiate a shared understanding and meaning among participants.

  • This project taught me many new things about hospital culture, hierarchy, physicians’ perceptions, and more. The most valuable lesson was in understanding the complex system and differing perspectives of stakeholders and learning how to locate potential points for intervention and change.

  • This project also engaged me in extensive reflection and questioning about how we can meaningfully encourage stakeholders to change their behavior and how we can counter their natural bias, which can lead to negative outcomes.