Friends,

From time to time, David Durling and I have proposed that design
research contribute to design practice by generating an approach we have
labeled "evidence-based design." When asked for examples, we've offered
some suggestions. As a field, neither design research or design practice
have accumulated the rich corpus of evidence that would permit a 
comprehensive approach. As a goal, however, the exemplars exist,
particularly in such fields as medicine and nursing. (Incidentally, both
of these fields qualify as design sciences in Herbert Simon's
definition.)

To give an idea of how one might seek the evidence for evidence-based
medicine, I'd like to pass on an article from the New York Times that
Gunnar Swanson sent my way. In this article, the general manager of a
successful baseball team, a former conservative Speaker of the House of
Representatives and a current United States Senator show how winning
baseball teams are using evidence-based management. They also show how
evidence-based medicine could provide superior health care while
reducing costs.

Several iteresting examples of how evidence can serve design appear in
the book Supercrunchers by econometrician and law professor Ian Ayres

http://www.randomhouse.com/bantamdell/supercrunchers/

In past threads, such suggestions have brought interesting responses.
Some people want to know more. Others question the very idea of
evidence. Indeed, I was once asked, "what's the evidence for evidence."

Rather than go further, I'll pass on the article that Gunnar sent me.
For those who want to know more, I'd suggest Googling "evidence-based
practice." You can also learn a great deal from the on-line tutorials at
University of Minnesota.

http://www.biomed.lib.umn.edu/learn/ebp/

University of Sheffield also offers a condensed, valuable set of
definitions and ideas.

http://www.shef.ac.uk/scharr/ir/def.html

It may only be my view, but I'd suggest it's time we give this kind of
thinking some consideration in design research and in design practice.

Yours

Ken

Ken Friedman
Professor, PhD, DrSci (hc), FDRS

Dean, Swinburne Design
Swinburne University of Technology
Melbourne, Australia

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New York Times

October 24, 2008

Op-Ed Contributors

How to Take American Health Care From Worst to First

By BILLY BEANE, NEWT GINGRICH and JOHN KERRY

IN the past decade, baseball has experienced a data-driven information
revolution. Numbers-crunchers now routinely use statistics to put better
teams on the field for less money. Our overpriced, underperforming
health care system needs a similar revolution.

Data-driven baseball has produced surprising results. Michael Lewis
writes in “Moneyball” that the Oakland A’s have won games and division
titles at one-sixth the cost of the most profligate teams. This season,
the New York Yankees, Detroit Tigers and New York Mets — the three teams
with the highest payrolls, a combined $486 million — are watching the
playoffs on television, while the Tampa Bay Rays, a franchise that uses
a data-driven approach and has the second-lowest payroll in baseball at
$44 million, are in the World Series (a sad reality for one of us).

Remarkably, a doctor today can get more data on the starting third
baseman on his fantasy baseball team than on the effectiveness of
life-and-death medical procedures. Studies have shown that most health
care is not based on clinical studies of what works best and what does
not — be it a test, treatment, drug or technology. Instead, most care is
based on informed opinion, personal observation or tradition.

It is no surprise then that the United States spends more than twice as
much per capita on health care compared to almost every other country in
the world — and with worse health quality than most industrialized
nations. Health premiums for a family of four have nearly doubled since
2001. Starbucks pays more for health care than it does for coffee.
Nearly 100,000 Americans are killed every year by preventable medevidence-based medical information.

Look at what’s happened in baseball. For decades, executives, managers
and scouts built their teams and managed games based on their personal
experiences and a handful of dubious statistics. This romantic approach
has been replaced with a statistics-based creed called sabermetrics.

These are not the stats we studied as children on the backs of baseball
cards. Sabermetrics relies on obscure statistics like WHIP (walks and
hits per inning pitched), VORP (value over replacement player) or runs
created — a number derived from the formula [(hits + walks) x total
bases]/(at bats + walks). Franchises have used this data to answer some
of the key questions in baseball: When is an attempted steal worth the
risk? Whom should we draft, and in what order? Should we re-sign an
aging star player and run the risk of paying for past performance rather
than future results?

Similarly, a health care system that is driven by robust comparative
clinical evidence will save lives and money. One success story is
Cochrane Collaboration, a nonprofit group that evaluates medical
research. Cochrane performs systematic, evidence-based reviews of
medical literature. In 1992, a Cochrane review found that many women at
risk of premature delivery were not getting corticosteroids, which
improve the lung function of premature babies.

Based on this evidence, the use of corticosteroids tripled. The result?
A nearly 10 percentage point drop in the deaths of low-birth-weight
babies and millions of dollars in savings by avoiding the costs of
treating complications.

Another example is Intermountain Healthcare, a nonprofit health-care
system in Utah, where 80 percent of the care is based on evidence.
Treatment data is collected by electronic medical records. The data is
analyzed by researchers, and the best practices are then incorporated
into the clinical process, resulting in far better quality care at a
cost that is one-third less than the national average. (Disclosure:
Intermountain Healthcare is a member of Mr. Gingrich’s organization.)

Evidence-based health care would not strip doctors of their
decision-making authority nor replace their expertise. Instead, data and
evidence should complement a lifetime of experience, so that doctors can
deliver the best quality care at the lowest possible cost.

Working closely with doctors, the federal government and the private
sector should create a new institute for evidence-based medicine. This
institute would conduct new studies and systematically review the
existing medical literature to help inform our nation’s over-stretched
medical providers. The government should also increase Medicare
reimbursements and some liability protections for doctors who follow the
recommended clinical best practices.

America’s health care system behaves like a hidebound, tradition-based
ball club that chases after aging sluggers and plays by the old rules:
we pay too much and get too little in return. To deliver better health
care, we should learn from the successful teams that have adopted
baseball’s new evidence-based methods. The best way to start improving
quality and lowering costs is to study the stats.

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Swinburne University of Technology
CRICOS Provider Code: 00111D

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