Parakeets, problem analysis and the beauty of inconvenience

Parakeets, problem analysis and the beauty of inconvenience


In his 2014 book Being Mortal, Atul Gawande tells the story of how Dr. Bill Thomas, a medical director at a nursing home in upstate New York, improved the experience of residents by challenging conventional elder care practices. Thomas believed that no matter how good the standard of medical care, the nursing home was failing its residents in three key areas:

  1. Boredom
  2. Loneliness
  3. Helplessness

If they didn’t address these, the residents’ quality of life would suffer, with a knock-on effect on their physical health.

His solution started with 2 dogs, 4 cats and 100 parakeets.

Thomas, who maintained his own 400 acre farm alongside his medical director role, thought introducing the animals to the nursing home would help with all three of these problems. Of course, the programme was not without its challenges in a regulated environment where hygiene and safety were a priority, but Thomas persevered.

Residents were given the opportunity to adopt and name the parakeets. They could volunteer to walk the dogs and look after the cats. He followed up by encouraging staff to bring their children into the workplace and make noise. He replaced ‘safe’ and easy-to-maintain artificial plants with real ones that took more effort. He added vegetable gardens which needed tending.

Reading between the lines of Gawande’s account, it could be argued that Thomas wanted the introduction of these things to be difficult and disruptive. He did it in such a way that problems were inevitable, insisting that it happen all at once and with little warning. As a result, the staff and residents bonded together in solving the resulting challenges and a shared sense of humour over the temporary chaos.

Thomas told Gawande: “People who we had believed weren’t able to speak started speaking. People who had been completely withdrawn and nonambulatory started coming to the nurses’ station and saying ‘I’ll take the dog for a walk’…”

Gawande continues: “Researchers studied the effects of this programme for over two years, comparing a variety of measures for Chase’s [the nursing home] residents with those of residents at another nursing home nearby. Their study found that the number of prescriptions required per resident fell to half that of the control nursing home. Psychotropic drugs for agitation, like Haldol, decreased in particular. The total drug costs fell to just 38 percent of the comparison facility. Deaths fell 15 percent.”

By bringing a sense of life – with all its attendant challenges and inconveniences – back to the nursing home, Thomas started to alleviate the sense of boredom, loneliness and helplessness which comes with being in such a heavily managed, sterile environment.

The story inspired me to think about how breakthrough moments in product design often result from:

  • Outside perspectives. Dr. Bill Thomas was new to elder care, having worked previously in emergency rooms. He was also a farmer at heart, with a love and knowledge of the natural environment. He wasn’t attached to the established culture of nursing homes.
  • New metrics. The nursing home could have iteratively improved on measures of health, safety and cleanliness for years without ever achieving the leap forward which resulted from pursuing a new set of goals.
  • Shared purpose. By creating a situation in which staff and residents found themselves intertwined in solving a common problem, the staff improved their sense of empathy for the type of care they needed to deliver.

Being Mortal by Atul Gawande comes highly recommended as an addition to your reading list. You may also enjoy this 2009 interview with Dr Bill Thomas from the Guardian and the web-site of the Eden Alternative, the non-profit organisation he co-founded to improve elder care worldwide.

Part of MEX Inspirations, an ongoing series exploring tangents and their relationship to better experience design.