What is the future of surgery? Advances in technology and materials science, rising patient expectations and concerns by healthcare providers to reduce costs, improve accuracy and eradicate errors are all factors that are driving change in the way surgeons operate.
Against this background, DePuy Johnson and Johnson, a market leader in the design and manufacture of orthopaedic instruments, asked the RCA Helen Hamlyn Centre to set up a research unit dedicated to advancing surgical instrumentation and practice. Over a three year period, this unit has been tasked with looking at how a people-centred design approach can give insight into the future of surgery by looking at surgeon aspiration, patient need and drawing on expert advice.
‘Shaping ideas that will improve practice'
There are different facets to this relationship: developing design concepts that can feed into new products; bringing together experts from various fields to debate and discuss surgery as part of a Forum on the Future of Surgery; understanding the voice of the patient; and creating a body of clinical knowledge that can stimulate new thinking. Research associate Karina Torlei joined the research unit in 2008/09 to work on all areas of activity.
A key part of the work has been to develop new design concepts for knee replacement surgery based on a patient-centred approach. A number of key areas, including the surgical instruments themselves, their packaging and delivery trays for storage and sterilisation, have been successfully addressed using a process of research and development that the Helen Hamlyn Centre has piloted for DePuy.
While the unit has addressed the surgical process from different angles, research methodologies have been common throughout. Interviews have been conducted with all the relevant stakeholders in order to gain a better perspective on surgical procedures and understand current frustrations with instrumentation where both surgeons and the surgical support teams feel that additional improvements are needed.
The methodology has also entailed first-hand observation of surgery by the designers, who go on a journey of critical examination of procedures in the operating theatre as well as other locations within the hospital. Analysis of video footage taken during these observations has yielded further insights into the shortfalls of current instruments. Criteria for design projects have included requirements for device accuracy, intuitiveness, robustness, simplification, pleasure in use, ease of manufacture and assembly - and these projects have been realised through design synthesis, sketching and physical mock-ups.
Alongside specific design projects, the Forum on the Future of Surgery has met twice in 2009 - in February and June. This high-level think-tank - supported by DePuy, convened by the RCA and facilitated by Phillip Joe of Microsoft, who is on secondment to the NHS - has members from the worlds of medicine, science, design, engineering, management, marketing and research.
The inaugural meeting of the Forum mapped out the broad landscape, exploring different aspects of surgical practice including location for surgery, barriers to change, new materials and technologies, and the patient experience. The second Forum focused in-depth on the patient journey, leading participants through an interactive workshop. In tandem, the design project work and the Forum on the Future of Surgery are helping DePuy to shape ideas that will improve clinical practice in the longer term.
