Nursing and design have much in common, including how they improve human lives by understanding their needs, says the DesignSingapore Scholar. This is why he is pursuing doctoral studies in healthcare design to explore how the professions can support one another to create better health outcomes for an ageing Singapore.
In secondary school, he failed his art and design class. Today, Nat Liew not only has a master’s degree in design but is pursuing a doctorate in the subject too. The nurse is also a design advocate in Tan Tock Seng Hospital (TTSH), where he has worked over the last decade. In fact, Liew nowadays introduces himself as a “nurse-designer”.
He discovered his love for design in 2015 when tasked by the hospital to lead a study on the problem of nurse fatigue. In searching for research methods, he encountered design thinking, which was unlike the drawing exercises he had done back in design class. The process relies on an iterative method of identifying user needs and prototyping solutions to solve problems, which helped Liew better understand his subjects and got him curious about how else design could be used at work. He later learnt that Apple employed a similar approach in developing its products. As a fan of the technology giant, this discovery made him more curious about design.
“Before I encountered design, I couldn’t appreciate why people loved them… I realised it is because Apple has a very strong human-centred process and its outputs address users’ needs,” he says. “It connected the dots on why I love their stuff, and I started thinking how design can be used for healthcare too.”
Liew began reading up about design, and even attended design thinking workshops organised by the DesignSingapore Council. Despite his enthusiasm, many of his colleagues did not understand how design could be used in healthcare when the hospital asked him to share what he learnt with them.
Design was not a familiar term to them, like a foreign discipline coming into healthcare. To some people, it was like you talk so much about design thinking, do you still want to be a nurse?
— Nat Liew
Nursing his love for design
These doubts did not deter him. It just so happened that the hospital’s Centre for Healthcare Innovation was exploring using design thinking methods to improve its healthcare operations. Liew accepted a secondment to its department known as the Kaizen Office to learn design on the job. One of his first projects was participating in a makeathon to design a multi-functional hospital chair that patients could use for rehabilitation and visitors could sit and even sleep on when they stayed overnight. Liew was part of the team that created the winning concept chair, which could be reclined and converted into a bench and even a bed.
“That was when I got my hands dirty learning what prototyping means. It deepened my understanding of design in terms of applied experience,” he says of the experience building prototypes entirely out of cardboard. The design, which Liew and his team called the FuSA (Function and Safety meets Aesthetic) chair, has since been deployed across TTSH, and attracted interest from other hospitals too.
During his two years at the Kaizen Office, Liew was part of various projects that used service design to improve processes at the hospital. The experience convinced him that the same could be done for nursing, which he returned to when his secondment ended in 2019. He also enrolled part-time in the Master of Science in Healthcare and Design programme run by Imperial College London.
“There was always this question of how qualified I was to do healthcare design. I was also very curious what was taught at a design school. I didn’t dream or expect myself to be accepted into a top-ranked university,” says Liew. He had struggled in secondary school and ended up studying nursing by chance after the polytechnic recommended it to him.
The two-year postgraduate programme – which he received the SkillsFuture Study Award for Design to pursue – deepened his appreciation for healthcare design. He even did well enough to pursue a doctorate. While such a qualification was not required for his work as a nurse manager, Liew saw an opportunity to advance the adoption of design methodologies in healthcare.
If I were to use service design in the hospital, people will ask ‘Is this a standard in healthcare? What if it leads to complications? Do you have evidence this works?’ Design talks about possibilities and user experiences versus healthcare which is science-based and asks if you can prove your solution is better. Pursuing a doctorate allows me to investigate how to better articulate and measure the impact of design and also carry out practice-based research using design principles to spark transformation.
— Nat Liew
Bringing nursing and design together
To support his studies at The Hong Kong Polytechnic University, Liew applied for the DesignSingapore Scholarship. He first learnt about the programme through his Kaizen Office colleague, Chua Jia Xiang, who received the scholarship in 2015. However, Liew was unsure if he was what the programme was looking for as most of the previous scholars work in the design industry.
I wasn’t confident because I’m not a designer by training. I went in with the idea that I would just show how I applied design in nursing, and I was quite surprised that the DesignSingapore Council celebrated such diversity.
— Nat Liew
The endorsement affirmed Liew’s belief that nursing and design have much in common. Both are user-centred and require empathy. The founder of modern nursing, Florence Nightingale, was also known for developing solutions through observations and speaking to patients – not unlike design thinking methods. This is why Liew believes design methodologies can complement the work of nursing.
He is particularly interested in using design to help nurses craft better solutions to the challenges they face on the ground. One example is feeding tubes that disconnect over time due to a build-up in pressure, causing spills and a loss of nutrients for patients. TTSH nurses initially resolved this by taping the tubes to the patients until Liew and a team transformed the makeshift design into a 3D-printed connector to hold it in place. This solution is not only more hygienic but supports a variety of different tube designs.
It is not the kind of big design where you spend thousands of dollars to solve a problem. But these are examples of ‘frugal innovation’, and I’m interested in how they can become a systemic design that have an impact on our health services,” he says. “Nurses are a very creative bunch, so the question is how can we harness this creativity and put in a structured design thinking process to help them solve their day-to-day problems.
— Nat Liew
A healthier Singapore by design
Such healthcare innovation will only become more important in the coming years, adds Liew. As Singapore’s population ages, the demand for health services has grown but there is also a limited supply of healthcare workers. He believes design can help address these challenges in a variety of scales. It can ensure digital services are inclusive so both the young and old can manage their health independently. It can also be used to develop everyday environments that support healthy lifestyles and active ageing. Such designs will support the government’s ongoing efforts to transform the healthcare system in Singapore from a reactive treatment of diseases to a more preventive one.
Design can also support the profession of nursing as nurses evolve to stay relevant with the times too, says Liew.
I see design as integral to each and every individual to help them towards improvement while always placing users at the heart of what they want to achieve. Design is a mindset and attitude towards all situations in life.
— Nat Liew
Liew is a living example of this. He embraced design to redefine his career as a nurse. Now he is helping to improve the everyday lives of his fellow nurses and bringing about a healthier Singapore by design.
