“Mummy, can we come back again tomorrow?”

As an industrial engineer Doug Dietz had spent two years designing an MRI scanner, working on the enclosures, controls and display, patient transfer.

He was more than proud of his achievement and chose to go see it in situ in the hospital…as he viewed his finished product, a technician tells him that a patient is coming in to be scanned. She asked Doug whether he wanted to see his product in operation – what an opportunity!

Doug steps outside the scanning room to see a young girl of about seven coming down with the corridor…slowly, head bent, weeping. Her parents are supporting her and as he watched her father bent down to his daughter saying “you know we talked about this, you can be brave’…

At this point Doug bends down and looked at the room from the angle of a child – he saw:

• The large triangular sign with an exclamation mark
• The yellow and black tape marking the floor – as he tells this story he likens it to crime scene tape
• The dark room with ominously flickering fluorescent lights
• Beige…and more beige….
• And then the machine that looks like a brick with a hole in it

He knows at this point that there will be worse to come – the loud and terrible noise that the MRI scanner will make….

In his TED talk he describes the huge failure that he now felt. That the result of all his work and creativity had been to design this machine which scared children witless. He later finds out that 80% of children undergoing a scan need to be anaesthetised.

He knows that his MRI scanner, his product, works but now he knows it gives the customer a terrifying experience. An experience he had not thought about from the child or parents’ perspective.

As he begins to think about customer/patient experience he speculates that things that will be of concern to the parents may be:

• What will they find out through the MRI?
• How will we find the money to pay for this?
• How will we get the time off work for to attend appointments

However, once he starts talking to those involved he finds that the over-riding concern is:

• How will I get my child through this experience [the MRI scan]?

The point is driven home –  there is more to a successful product design than ‘does the product work?’

In this case, when thinking about the user experience he knows there is anxiety but he still needs to know what causes this anxiety?

So Doug tells us how he goes back to the ‘drawing board’ and starts work with stake holders and people who may understand the problem, in this case high levels of anxiety and the causes of this anxiety – looking at cause and effect. He works with:

• Children
• Parents
• Local children’s groups
• Staff from radiology
• Paediatricians
• Nurses
• Hospital Play Specialists

Not only is he looking at what causes anxiety for the children but what causes the anxiety for the parents as they support their child through an MRI scan – he had begun to understand that if “you get the parent – you get the child, if you get the child – you get the parent.”

It was these stakeholders who not only provided the understanding but also who came up with the solutions. In effect Doug begins to run the Root Cause Analysis Process to help him solve this complex problem. This looks something like this:

Step One – Gather and Manage Data

Doug has visual evidence that there are issues, he also talks to service users, children, parents and staff related to children’s issues and the delivery of the service.

Step Two – Define the Problem

Doug is now is the defining the focal point as an ‘MRI scan for children which creates low anxiety’ – he knows failure to do this has impacts:

Actual Impact

Anaesthetising children

Costs of anaesthetising children

The effect that the anaesthetising of children has on patient volume ie the numbers that can use the service

Patient satisfaction

Staff satisfaction

Potential Impact

The risks associated with anaesthetising children

Patient complaints

Staff turnover

Step Three – Cause and Effect

As good practice would determine he gathers his team comprising of stakeholders to examine what would cause this anxiety – he creates a cause and effect chart

Step Four – Solutions

With a sound understanding of the problem and issues he can now work with this team to identify, evaluate and select solutions.

So what was the outcome from using this approach and process?

Doug tells us proudly that in hospitals where this has been installed:

• Sedation has been reduced to 0.5%
• Patient satisfaction is up to 92%
• Patient volume has increased substantially – more patients are able to access the service
• But maybe as importantly he discovered that those delivering the service now felt engaged and proud to be doing so.

So what does this tell us about Root Cause Analysis, product design and the customer experience?

I think the things that shine through for me are that:

• The customer experience is a vital ingredient for successful product design
• This applies whether the ‘product’ is in banking or in health care….
• The assumptions that we make about what will concern the customer maybe very far from the actual customer concerns
• In order to understand the causes of these concerns we have to ask what causes them
• We need a structure that enables stakeholders to work together to ‘mine’ and to capture the concerns – cause and effect charting
• When we have full understanding (through cause and effect charting) we need to utilise stakeholders to help us identify, evaluate and select solutions

Doug finishes his narration with the last part of his moving story:

“As I was standing talking to the staff and parent in the MRI room, a little girl tugs at her mothers arm. Her mother bends down and listens as the young girl says:

‘Mummy, can we come back tomorrow and do it again?’ “