Design Thinking Aims for Right Solution to Improve Behavioral Health Transfers

By Melissa Goodwin

Innovation emerges in countless different ways. Sometimes you walk straight into a problem and an effective solution appears right in front of you. Sometimes, however, you find yourself struggling with a problem so complicated and ambiguous that you don’t know exactly what you need to (and can) solve.

Enter design thinking.

The Innovation Lab uses this methodology tool to peel back layers on gnarly challenges and address specific problems. As we research and analyze an issue, we often uncover the key insights that lead us to a human-centered solution. Our tailored approach is known as Concept to Commercialization, as we look for meaningful solutions with market applicability, so we’re not just addressing a local challenge but making systemic gains.


Informational graphic showing the innovation lab design thinking guide, from Planning and Research, Empathy, Definition, IDeation, Prototype and Test, and Commercialization; Concept to Commercialization


Right now, we’re leveraging design thinking to find a better way to connect patients in a behavioral health crisis with the next step in their care. The number of Emergency Department (ED) visits related to mental health and substance abuse issues represents a growing opportunity for improvement. On a national level, in the eight years leading up to 2014, these kinds of ED patient visits increased more than 44%.

With so many challenges packed into how we treat ED patients in crisis, what is an actual problem we can solve? As we initially analyzed potential ideas and problem statements, we sharpened our focus – which always includes an aim to improve healthcare delivery – on opportunities to improve the transfer process, as patients are transitioned to facilities designed to provide behavioral health therapy. With great passion for helping patients and families navigate this universal challenge of lost time in getting to needed facility treatment, our team recognized we could develop a meaningful, human-centered approach that puts patients first, with broader benefits for everyone involved in this process.

Drilling down to find the right question

Even before COVID-19, about 19% of Americans struggled with mental illness. In the first nine months of 2020, the number of individuals who sought screenings for anxiety or depression jumped exponentially.

When they hit a crisis moment from substance abuse, depression or perhaps even suicidal ideation, these patients often come to the ED, especially for afterhours care. Most emergency providers are best trained to triage and stabilize critically ill or injured patients and transition them to a specialty area – from surgery to an ICU unit – for the treatment they need. To provide some context, our country operates 4,000 general EDs, but less than 150 specifically for mental health emergencies.

At the same time, many hospitals don’t offer behavioral health wards, and patients can remain at risk as providers try to determine the next step or find the best place for them to receive care. National research shows patients might sit for hours in the ED; in some cases, they might have to return home to wait for a phone call. One hospital reported its ED staff called an average of 19 facilities before the pandemic to find a bed. Social distancing means even fewer spaces in a healthcare segment where patient needs have long outnumbered beds, another complicating factor in the transfer process.

By interviewing across every touchpoint in this patient experience, our team can begin identifying patterns of how people interact or paths they take that don’t align. We’ve asked patients and families to describe how they felt while in the ED and what brought them there. We’ve asked transfer center professionals how the process works with admitting facilities and what information they need to match a patient with an available bed. We’ve asked providers, including behavioral health experts, on the treatment experience.

How we do this

Those stories now serve as our data, which we are mining for clues or patterns that help us define a clear problem we can solve. We must first take all our interview and observation data and then turn it into a format that allows us to analyze it. This is where we are in the process.

In this impactful moment, as we move into what I call a “sense-making session,” we’ll begin to figure out what those stories are telling us. We’ll cover the walls with Post-It notes that capture individual responses, quotes or observations we’ve collected from clinicians, patients and transfer center staff. Over a couple of immersive sessions, we’ll change our perspectives and fit the puzzle pieces in different ways, resulting in clusters of common themes and challenges. Only then can we truly understand what they mean and what might be driving current behaviors or fueling people’s motivations across the transfer experience.

Ultimately, we arrive at the big problem that we plan to tackle. Design thinking also helps us determine where we aren’t positioned to drive change right now, such as when a facility can’t make an open bed available because it has a nursing staff shortage. That’s part of this bigger puzzle.

What comes next

At this stage, we don’t know what the solution might be. That’s OK, because the design thinking process helps us uncover what it is and how it should function. Once we have the defined the problem to solve for, the Lab will bring in our product development team. Most likely, we’re looking at a technology that can ease the transfer experience

Design thinking differs from traditional research because it accounts for the messiness of being human, such as when what we say is different than what we do. For example, I might say to my kids that I exercise regularly, but if you trailed me, you might see different patterns.

Each story associated with an ED visit adds up to the universal need for improving this transfer experience for patients nationwide. We’re looking for solutions that help people help themselves, particularly as COVID-19 has enhanced awareness and acceptance of the growing need for effective mental illness treatment.

Different ideas push us to the answer

Design thinking allows us to harness the common elements across many different stories and stakeholders so that we are creating innovative solutions to the right problems. As part of the interview process, we encouraged people to submit their innovation ideas for a human-centered solution that will ease concerns in the transfer process for behavioral health patients who arrive at the ED. This is a long journey, and we welcome your ideas on how we can solve a problem that could create a better experience and outcome for patients and families at a moment that matters. 

Melissa Goodwin is national director of the Innovation Lab.