How Design Thinking Turned One Hospital into a Bright and Comforting Place

Long dreary corridors, impersonal waiting rooms, the smell of disinfectant — hospitals tend to be anonymous and depressing places. Even if you’re just there as a visitor, you’re bound to wonder, “How can my friend recover in such an awful place? Will I get out of here without catching an infection?”
But the transformation of the Rotterdam Eye Hospital suggests that it doesn’t have to be this way. Over the past 10 years, the hospital’s managers have transformed their institution from the usual, grim, human-repair shop into a bright and comforting place. By incorporating design thinking and design principles into their planning process, the hospital’s executives, supported by external designers, have turned the hospital into a showplace that has won a number of safety, quality, and design awards — including a nomination for the prestigious Dutch Design Award. Even more important to the not-for-profit organization: patient intake rose 47%.
They started with patient-first thinking. The first step in any design-thinking process is to understand the end-user’s experience. In this case, a team of the Rotterdam Eye Hospital’s CEO, CFO, managers, staff, and doctors wanted to understand how their patients felt when they entered the hospital and what could be done to improve their experience. The hospital board directors realized that most of their patients felt afraid of going blind. Thus their primary goal should be to reduce patients’ fears.
To do that, the team next looked inside and outside the health care for ideas about how to improve the hospital’s service. For example, they learned about scheduling from the just-in-time practices of the upscale Dutch supermarket chain Albert Heijn and KLM, the Netherlands’ flagship airline. They also gained important insights about operational excellence from two eye hospital organizations founded by Rotterdam Eye Hospital: the World Association of Eye Hospitals and the European Association of Eye Hospitals.
At this point, teams of caregivers at the hospital began designing experiments based on the most promising concepts the Rotterdam Eye Hospital innovation hunters had brought back with them. Such experiments were crucial to the program’s success: proponents of the methodology insist that because it’s impossible to know in advance what impact an idea will actually have, making small-scale experiments is a crucial part of refining the concepts and winning the support of senior managers.

These small experiments were somewhat informal. They were not run like a clinical trial with a formal reckoning at their conclusion. Instead, the transition to formal adoption tended to be more gradual. If an idea worked, sooner or later other groups would ask if they could try it too, and the best ideas spread organically.
One reason the hospital could be so flexible was that most of the ideas eventually adopted were fairly inexpensive. From the start, planners kept a tight rein on costs, in part because the hospital worked with no outside consultants or high-priced designers. When designers were needed, the planners usually found up-and-coming external designers who saw a commission from the hospital as a way to gain experience and exposure.
A good example of a small but powerful change to improve the institution’s information and communication structure involved the children’s hospital. The hospital sends beautiful T-shirts with a specific animal print to children in advance of their stay. The consulting ophthalmologists wear a button with the same animal during the appointment, which gives them a way to immediately connect with the children and to create a feeling of community.
An example of a more complex change to the hospital’s operations is the newly created culture and training program called “Eye Care Air.” Inspired by the safety and training programs of airlines, Eye Care Air trains all caregivers in fear reduction, teamwork, and safety. The program addresses such topics such as: How openly should I talk to patients, doctors, and other colleagues? How do I speak frankly to a patient without triggering panic?
Clever architectural and interior ideas also contributed to reducing patients’ fears. For instance, the children’s department got a face-lift to make it less frightening and more fun, with such imaginative new features as stepping stones at service counters that allow kids to communicate eye to eye with the hospital staff.
Not every idea worked. One concept, to pick patients up directly from their homes in a taxi, didn’t reduce their fears at all. When a pilot didn’t catch on, the hospital planners would analyze the experiment and try to understand why. In the case of the taxi service, patients’ fears weren’t reduced because the taxi ended up in the same traffic jams as patients would have encountered if they had used their own cars.

Other ideas, such as the EyePad, an iPad app that made it possible for an individual patient to track his or her progress through a procedure, took more time to sell to the staff than to the patients. In that case, planners had to persuade employees that the idea behind an electronic checklist was to reduce patient anxiety and improve service quality, not “blame and shame.”
Making the Rotterdam Eye Hospital a more pleasant environment has had a number of positive effects. Patients heal faster now and have a more positive experience overall. The hospital staff can now conduct 95% of all procedures without an overnight stay and the hospital itself scores 8.6 (out of 10) on its customer satisfaction surveys. Employees are also happier. One staff members says, “Because the Rotterdam Eye Hospital is so small, lines are short and I can deeply focus on my profession. There is room for new ideas.”
Design thinking has also earned the hospital a reputation as an innovator. Even people outside health care are talking about the hospital now, largely because of its creative approach. (The hospital’s art collection is even included in the city’s annual museum night.)
Over time, as many of these experiments succeeded, internal skepticism about the value of design declined. Employees can see that better design had a positive effect not only on the patients but also on themselves.

Umpqua Bank: Innovation and Change in an Old-Fashioned Industry

The thrill of breakthrough creativity doesn’t just belong to upstart companies with the most radical technologies. It can be summoned in all sorts of industries and all walks of life, if leaders can reimagine what’s possible in their fields. In fact, the opportunity to reach for the extraordinary may be most pronounced in fields that have been far too ordinary for far too long.
One inspiring and instructive case in point is what Ray Davis and his colleagues at Umpqua Bank have achieved over the last two decades, in a field that is about as traditional as it gets. Davis took over as CEO in 1994, when Umpqua was a tiny community bank with five branches in Roseburg, Oregon. It had $140 million in assets, was privately held (worth $20 million), and had a plain-vanilla strategy no different from thousands of other community banks. Today, Umpqua, headquartered in Portland, has 300 locations in five states, $25 billion in assets, and a stock-market value of more than $4 billion. As American Banker, the bible of the industry, noted, “Few banks in the country have undergone as thorough a transformation” as Umpqua under Ray Davis, which is why the magazine bestowed upon him a Lifetime Achievement Award.
Most importantly, Umpqua has created a one-of-a-kind relationship with customers that distinguishes it from other community banks. Davis and his colleagues invented a retail experience that appeals to all five human senses: sight, sound, even taste. Umpqua locations host book clubs and yoga classes, serve Umpqua Blend coffee and specially made chocolates, invite merchants to open pop-up stores, become hubs for local businesses and civic groups. Today, Umpqua is a passion brand that stands for something colorful and hopeful in an industry that feels bland and broken.
Ray Davis will soon be stepping down as CEO of Umpqua Bank, so I asked him to reflect on his two-plus decades as a banking revolutionary. What could other CEOs learn from what he and his colleagues have built? What might leaders misunderstand about what it takes to do something this distinctive? What’s hard about sustaining innovation as a company gets bigger and its environment keeps changing? His reflections amount to a game plan for game-changers — lessons for achieving extraordinary things, even in ordinary fields.
There’s a difference between being creative and being reckless. Umpqua stands out in radical ways from the banking establishment. But that has not required big, audacious, risky financial moves. “The level of risk was small as far as I was concerned,” Davis told me. “First of all, if you don’t differentiate yourself you’re in a death spiral, so doing nothing is its own risk. But when it comes to financial performance, we have been consistent and steady, through the best of times and the toughest of times. Being distinctive does not mean you bet the company on any one decision.”
Big change sticks when it’s the result of lots of little changes.  There was no “aha moment” behind Umpqua’s dramatic transformation, no single bolt of insight that put the bank on a new course. “Banking had always been such a chore,” Davis told me. “In the mid-nineties, we asked, ‘Why can’t banking become something people enjoy?’ So we tried a few things. They felt good, so we tried a few other things, and it kept going.  I’m not sure there’s anything particularly brilliant about what we’ve done. But over time, there’s something brilliant about what this has become.”
The more you change, the more you have to keep changing. Over two decades, Umpqua has built the most distinctive physical retail experience in U.S. banking. Of course, customers now look to their phones, computers, and online apps to for much of their banking needs. So Davis, even after he steps down as CEO of Umpqua, will remain CEO of Pivotus, an Umpqua company based in Palo Alto that is translating the physical Umpqua experience into the virtual realm. “We are building a one-of-a-kind digital banking platform that does not exist anywhere today,” he told me. “We want to take this incredible customer experience and put it on a digital platform.”
There’s a difference between being admired and being copied. Ray Davis and his colleagues are genuine celebrities in community-banking circles, and in the financial-services field more generally. Umpqua is “so highly regarded by its peers,” American Banker wrote, “that bankers from all over the world regularly travel to Portland to study its approach.” Davis has spent time with executives from China, Russia, Australia, and across the United States. Yet as much as these visitors marvel at what Umpqua has built, few plan to build something similar. “I recently had a CEO visit and tell me, ‘This has been a terrific two days, I can’t believe what you’ve done.’ So I asked, ‘How will you apply this to your bank?’ And he said, ‘Oh, we won’t do any of this, it’s way too hard.’”  That’s a sobering reality check about the challenges of making change, and a powerful invitation for leaders prepared to rethink what’s possible in their fields. Remember, what your competitors won’t do will surprise you.
As you reflect about what you’ve achieved at your company and with your career, and as you think about what it will take in the years ahead to do something extraordinary in your field, no matter what field you work in, you may want to borrow a page from Ray Davis’s revolutionary playbook. And remember…There’s nothing standing in the way of breakthrough innovation other than your capacity to imagine it.