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The Alliance’s Collaboration Strategy Addresses ‘Wicked Problems’ in Organ Donation and Transplantation


Complex issues currently facing organ donation and transplantation include regulatory shifts, economic challenges, staffing pressures, and the need to incorporate novel technical innovations into existing practices. The Organ Donation and Transplantation Alliance (The Alliance), with its existing foundation of collaborative practices, is exploring the addition of design thinking principles that in concert with ‘radical collaboration’ practices can improve the exchange of collective expertise across the healthcare continuum to address these and other issues.

The Alliance was created to convene all three areas of the transplantation continuum to find solutions and to drive continuous change. This unique position brings together important perspectives from donation to transplantation to better understand barriers and opportunities that are not easily identified within one domain. “In an age with tremendous disruption, collaboration will be the key to find solutions to the challenges that face us collectively,” says Alliance Executive Director Karri Hobson-Pape.

Collaboration is so key, in fact, that a situational analysis conducted as part of The Alliance’s 2021 Strategic Planning process resulted in Community Collaboration becoming one The Alliance’s three strategic pillars with a related strategic plan goal to “Enhance collaborative leadership opportunities to improve donation and transplantation practices.”

The Alliance continuously examines practices in other fields – in healthcare and outside of healthcare – to evaluate and improve current approaches to collaboration. Applying the model of design thinking to the field of transplantation provides an opportunity to enhance innovation and effectiveness through an increased focus on patient and provider needs.

Design Thinking is Human Centered

Developed over the last several decades, design thinking is a tool for innovation that can be used when organizations and industries face a great need for fresh approaches. This approach is focused on a human-centered problem-solving method that promotes ethnography, empathy and iterative solutions influenced by testing new concepts and effective practices – a powerful tool for teams to uncover hidden, ambiguous, and unknown truths about the experiences of those they are trying to solve for.

Also called Human-Centered Design (HCD), Design Thinking has become a popular creative problem solving approach. As they say, everything old is new again. Design Thinking is a 50-year old process used to create worlds and solve problems.

Design Thinking was codified and socialized by IDEO founders Tom Brown and Tim Kelley – who simplified the engineering and product design process and added the “thinking” and behavioral aspects. Tom Brown and Tim Kelley helped start the Stanford, or design school at Stanford.

The Stanford, founded in 2005, is recognized as a thought leader in human-centered design and a leading teaching institute for design and experiential learning. The builds on methods from across the design field to create learning experiences that help people unlock their creative potential and apply it to the world.

Building upon psychological studies in the 1940s, design thinking began to flourish in management in the 1990s. Led by several academics at Stanford University, the model was applied widely in technology and social innovation fields, continuing with the shift from creative engineering to innovation management in the 2000s.

According to a 2018 CDC report, there is much enthusiasm for the use of design thinking in health care, from intervention development to large-scale organizational and system changes.

Earlier this year, The Alliance invited Amy Zehfuss, founder of Springboard Strategy, to give a presentation on design thinking to The Alliance staff. “Design thinking fits in well with The Alliance given our focus on collaboration to drive innovation,” says Hobson-Pape.

The Alliance’s existing focus on collaboration provides a jumping-off point for adopting valuable aspects of the design thinking process, including the emphasize/insight gathering, the define/find a problem worth solving, and the ideate/brainstorm solutions steps.

“The design thinking step of empathy—of being human and patient centered­––to discover and understand the real needs of patients and their families, of staff members, of physicians and of regulators could be key as our Councils and workgroups develop best practices,” says Deanna Fenton, Alliance Senior Director of Educational Program Development and Operations.

The 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report, “Realizing the Promise of Equity in the Organ Transplantation System,” also emphasizes the value of human-centered approaches as a way to continue to improve upon inequities in transplantation.

Wicked Problems

The term “wicked problem” was first coined by Horst Rittel, who wrote extensively about problem-solving in design, to describe problems which are multidimensional and extremely complex. Wicked problems are problems with many interdependent factors making them seem impossible to solve. Because the factors are often incomplete, in flux, and difficult to define, solving wicked problems requires a deep understanding of the stakeholders involved, effective collaboration, and an innovative approach provided by design thinking.

Wicked problems are complex, open-ended, and ambiguous. They don’t lend themselves to traditional or linear approaches. Design thinking provides an approach that celebrates ambiguity, exploration, and learning. 

The many complex issues faced in transplantation – from organ transport logistics to opportunities with marginal organs – can be framed as “wicked problems” in the landscape of design thinking.  “We have some wicked problems,” says Hobson-Pape.  “Adding some elements of the design thinking process to our existing use of radical collaboration could accelerate the innovations that our Councils and workgroups develop.

Another example of a wicked problem in transplantation is increasing Donation after Circulatory Death (DCD) opportunities.

DMindsets As Presented By The Stanford Dschool Dschool 2011 P 3

The Alliance’s National Donation Leadership Council determined that a guide was needed to increase the number of DCD organs available for transplantation and to highlight best practices around the country. A number of organizations provided volunteer professionals to contribute to the guide including the American Society of Transplantation (AST)Association of Organ Procurement Organizations (AOPO)American Society of Anesthesiologists (ASA), Association for Surgery of Trauma (AAST)Donate Life AmericaNeurocritical Care Society, and several organ procurement organizations. The Alliance coordinated the work of this interdisciplinary group of volunteer health-care experts to create the first-of-its-kind comprehensive guide to Donation after Circulatory Death, The Alliance DCD Educational Resource Guide for hospital patient care teams.

“Design thinking is essentially a learning journey – one that teams must experience together. The Alliance learning portfolio can incorporate intentional exercises to imbed the Design Thinking practices throughout our work together,” says Corey Bryant, Senior Director, Communications and Strategic Initiatives.

The Radical Collaboration Approach

The Alliance’s vision “To be the catalyst that ignites bold advancements in organ donation, transplantation and overall patient survival through collaboration and engaged learning” begins with the premise of community collaboration.

“We have learned that underpinning the design thinking process is a series of mindsets, which are essential for collaboration and successful creative problem solving. The process falls flat without the right mindsets,” say Fenton.

One of these key mindsets is Radical Collaboration, which is inspired by the desire to learn from, offer and embrace diverse perspectives within the processes of problem-scoping, idea generation, solutions finding, and innovation.

By structuring groups around the principle of linking diverse disciplines, viewpoints, and levels – with patient outcome at the center, broad areas of expertise rather than a hierarchical ranking, radically collaborative organizations favor networks of dynamic, self-managing teams. These are grounded in partnership and equality and feature a fluid approach to leadership granted by trust. Taken together, these facets of radical collaboration paint a striking alternative to the traditional corporate hospital model.

“The Alliance lends itself well to radical collaboration as we bring together people from different domains, different roles in their organizations, and different parts of the country to address problems,” says Fenton.  We offer a neutral platform for multiple stakeholders to have critical conversations,”

As best practices are identified through collaborative sessions, they are then cascaded throughout The Alliance’s portfolio of learning programs. This facilitates the testing of new opportunities quickly across the nation. Please see more information about the learning portfolio here.  “Once new opportunities and solutions are identified through workgroup discussions, we determine how to cascade the information through our educational resources so that professionals in the community can apply and test these areas of innovation in their everyday practices,” says Fenton.

The Alliance’s Councils, Events & Workgroups

Fortunately, the Alliance is structured with governance and input from all members of the healthcare continuum as it relates to organ donation and transplantation and great attention is paid to ensure the groups have professionals that can contribute with a unique perspective. The Alliance offers numerous collaborative opportunities, which can be viewed here.

Next Steps

In May 2022, Zehfuss’s concepts were incorporated in a workshop for leaders who serve on The Alliance’s three national leadership councils. The sense of the group was that design thinking could be a powerful tool for teams to uncover hidden ambiguities and unknown truths about the experiences of those they are trying to solve for and there was interest in the further exploration of the use of design thinking principles.

“The Alliance is well positioned to explore the application of design thinking principles to drive innovation and solve wicked problems in donation and transplantation,” says Hobson-Pape, “so we plan to explore adding certain design thinking principles to workgroup processes and to continue to be intentional in the composition of our Councils and workgroups. The Alliance is committed to providing a platform that celebrates ambiguity, radical collaboration and the learning that can emerge from it.

Resources to Learn More

Driving Community Collaboration is an Alliance Strategic Goal

The Alliance is structured with governance and input from all members of the healthcare continuum as it relates to organ donation and transplantation and efforts to enhance that collaboration were informed by a situational analysis that was conducted as part of The Alliance’s 2021 Strategic Planning process. The analysis resulted in a strategic plan goal: “Enhance collaborative leadership opportunities to improve donation and transplantation practices.”

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