Stroke Pathways


Time is brain – this is the current paradigm in stroke care and implies that there is a limited time in which one has a higher chance at success in treating stroke victims. Under current protocals the general consensus is that the best outcomes for stroke are achieved by getting a victim to any designated hospital as quickly as possible.

The Stroke Pathways project, led by Prof. Marco Steinberg of the Harvard Graduate School of Design in conjunction with the MIT Collaborative Initiatives, made a comprehensive study of the system of stroke care – from “birth to death” – and made two important findings based on a new model: Time is brain but all brains are different. So whereas one patient might have 12 hours to work with another might have 3 and yet another might have 1.

Patients brains are different and the scale of the ischemic stroke can be different, yet, in the earliest phase of triage, there is a standard range of care which does not allow for differentiation of treatment. In addition, while individual care providers may go through great efforts to respond to a patient’s individual needs there is a highly fragmented delivery system that varies by region, city, hospital and physician.

The project findings indicated a new paradigm, “Time is variable and the Right Care is Brain” therefore early segmentation, providing the right care for individual needs and assuring continuity of the right care are key to improving outcomes and decreasing costs.  Average approaches do not work.

The project produced a Strategic Roadmap for Stroke; a top ten list of recommendations for next steps; and a proven methodology for looking at complex societal issues through a design lens.  This methodology has since been applied by MIT Collaborative Inititiatives to the issues of Childhood Obesity and PTSD in the military.


Stroke is the third leading cause of death and the leading cause of severe disability in the United States, with projected yearly lifetime costs of over $30B. These impacts are anticipated to increase as the US population ages, despite the existence of sophisticated clinical approaches. Given the uncoordinated care-delivery system, access to effective stroke treatment is often impeded by competing external factors.


NM5, November 29, 2011 | Opening Remarks/Stroke Update

While multidisciplinary research of such complex problems is becoming more prevalent, our approach is unique because it is driven by Design. The Design process is based on an approach to problem solving that requires:

  • Synthesis of various needs
  • Integration of various perspectives
  • Visualization (3-D and 4-D) of complex problems as well as potential solutions

While Design is typically viewed as being limited to buildings and products, these skill sets can be applied to other kinds of complex problems. Historically, as a flexible, holistic, "horizontal" discipline, Design has been the core of resolving many complex issues ranging from products to buildings to strategic industry models.

Research and Results:
In phase 1 our work studied physical environments, processes, costs, outcomes, and futures, starting with field research in three major areas:

  • Review selected stroke treatment centers, their standards, operating models, and keys to success.
  • Examine the clinical process, its science, and its approach to patient care and technology.
  • Document the treatment process, analyzing all factors affecting patients, from the onset of a stroke up through treatment and beyond.

Design methodology and tools enabled the team to visualize and analyze the nature of diagnosis,
transport, and treatment bottlenecks, framing them towards productive solutions. Thus far our research has produced two distinct bodies of knowledge:

  • A methodology for looking at complex systems at the intersection of services, products, and physical environments.
  • A comprehensive stroke treatment strategy that also defines the top areas of research and business opportunity for lowering costs and improving outcomes.

We see this approach as a groundbreaking contribution to improving stroke treatment process and outcomes. We also see it as a venue for exploring better approaches to other major diseases, as well as larger healthcare delivery questions. The methodology developed can also serve as a model for looking at other complex industries.

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