The efforts of Pioneer grantee North Carolina State University to redesign the current hospital gown are featured on the front page of today’s Wall Street Journal. Congratulations to Blan Godfrey, Traci May Lamar and the NCSU team – it’s great to see prototype designs emerging from their comprehensive research to determine the needs, constraints and priorities of players up and down the hospital gown supply and demand chains.
The article takes a light touch with the subject matter. True, most everyone hates the gown because it’s an unmitigated fashion disaster…ugly, flimsy, see-through, ill-fitting, inconvenient, hard to tie or fasten, and often thoroughly humiliating in its, er, exposure. I’ve searched for who is buzzing about this story so far, and it’s been highlighted on the (presumably official, but who knows) Twitter stream of French fashion house Givenchy – I’m thinking this is an RWJF first.
But this project was always designed to go deeper, and there’s a real vision and potential for change in health and health care that motivated Pioneer’s decision to support this work. Indeed, it’s interesting to think about it in the wake of Clay Christensen’s visit last week. The current patient garment is a classic, ubiquitous example of a job that is not getting done for patients or, as the NCSU research shows, care providers either.
Between the survey research and focus group findings at the heart of this project, we’ve learned some interesting things about the gown, how people feel about it, and its impact on care. The upshot is that it’s never been about just looks:
87% of caregivers felt the current gown sometimes interferes w/ administering IVs, catheters, feeding tubes or other devices.
88% responded that the gown sometimes or always affects the emotional wellbeing of patients. 66% thought it sometimes or always affected patients’ physical well-being.
74% of nurses are involved in the gowning process; patients are not comfortable with how to put the gown on when confronted with it, so that even if they’re not seriously ill or impaired, they typically ask nurses for help.
Some patients confessed that they may limit their mobility becaused they are concerned about being overly exposed in areas outside of their hospital rooms – people don’t just lie in bed anymore to get well.
Patients tend to use a second gown as a robe to cover them from the back, which effectively doubles the cost and time of collecting, laundering and stocking gowns.
There is the perception that nicer, more dignified gowns may help patients feel better emotionally and be more active, boosting their prospects for and pace of physical healing and recovery. Patients are struck by their loss of dignity and control in the hospital experience..."If I have this gown, I’m really sick.”
It seems that there are certain things in medicine that we do because they’ve always been done that way; such is the case with the patient gown. It’s become institutionalized as part of the status quo and has gone unchallenged for decades. It seems so simple and obvious to change the gown and bring it in line with 21st-century care requirements and patient needs and preferences – however, if it were that simple, it would have happened. As NCSU’s Traci May Lamar states in the article, "We thought that it would be a much easier problem to tackle."
A redesigned garment that is more dignified and respectful – while still meeting the needs of care providers, suppliers, laundry services and others in the health care supply chain – may have a transformative impact on patients’ care and their experiences in the hospital. If we can pull it off, an innovative redesign effort that better meets patients’ and providers’ needs may have day-in, day-out implications for improving efficiency, reducing waste and cost, enhancing patient engagement in their healing, and ultimately, boosting their satisfaction in health care environments.
More importantly, though, we think that possibilities to redesign the patient gown are a springboard to opportunities to design innovations throughout health care that make a big difference in the lives of patients. We see the disconnects between the garments patients want and the one they currently get as emblematic of the larger opportunity before us to provide care that is truly patient-centered, more consistently, and more comprehensively. And to engage market actors in the search for disruptive innovations that make patients feel like the system is working for them.
Ultimately, though, the patient gown may be the tip of the iceberg…we all know it’s not just the gown that needs to be more respectful of and responsive to patients’ preferences, needs and values. However, it represents a critical step toward improving the quality of health care for all patients and ensuring that every American receives the care and respect that they need and deserve.
There are some very real health care realities interwoven in to the dreaded patient gown, and these are points that we wish the Wall Street Journal article had touched on a bit more. What opportunities do you see for market players to disrupt the status quo and push change forward? If it’s truly time to be “Down with the Gown,” what should emerge in its place?