Innovation by Design in Patient Experience

Not by Accident, but by Design

How to Innovate in the Patient Experience

2014-‐07-‐02 David Dunne, Ph.D.

2014-‐07-‐02 David Dunne 2

My credentials: my grandfather was a designer.

L


Summary

•  Patient experience is all about getting the right outcomes – not “patient satisfaction”

•  Design of patient experience is an act of conscious creation

•  There are massive opportunities to solve healthcare problems through design …

•  … for example … •  How the process works •  Case study: Mayo Clinic Center For Innovation •  Challenges and how to deal with them


PATIENT SATISFACTION IS NOT PATIENT EXPERIENCE


Patient satisfaction is not patient experience

•  To think of patient experience is to see the experience from the patient’s perspective

•  Patient satisfaction is typically a short-term quantitative score that misspecifies the experience and obscures the story

•  Well-designed patient experiences achieve desirable goals for all: satisfaction vs. outcome is a false dichotomy



The era of paternalis/c medicine, where the doctor knew best and the pa/ent felt lucky to have him, has ended. We don’t worship authority figures anymore. Our health-‐care system has become impersonal, mechanized, and hollow, and it has failed millions of people, many of whom want to find a way to regain control of their own medical decisions. Michael Specter “The Operator” The New Yorker Feb 4 2013 Read more: hJp://www.newyorker.com/reporMng/2013/02/04/130204fa_fact_specter?printable=true&currentPage=2#ixzz2KjLIuKHd


Patient experience = patient satisfaction surveys



Can we reframe this?

•  Instead of thinking of patient satisfaction and health outcome as either-or, can we see them as linked?

•  Patient satisfaction measures are influenced by: –  Outcomes –  Expectations

–  Human interaction

–  Process … etc.

•  A good experience is a good process that leads to a good outcome


Says who?



If we put a fraction of the effort into understanding the patient experience that we invest in understanding diseases, we could immeasurably improve healthcare

DESIGN IS AN ACT OF CONSCIOUS CREATION


Design is an act of conscious creation

•  The needs of the individual user/patient are paramount*

•  Design thinking does not come naturally: it requires training, method and attitude. Most of all, attitude

•  Its purpose and methods are different from science. It proceeds by learning from low-resolution/low-risk field trials.


*(P.S. Frustrated staff do not deliver good paMent experiences)

Nobody experiences the system; they experience their own pathway through it


What is the “lived experience” of healthcare from the patient’s perspective?



This (well-intended) finger wagging is often ineffective …


We are different from patients We do not understand their experience, because: •  We don’t see everything they see •  We don’t live their lives •  All patients are not the same •  We are biased observers

There is a better way


Understand

Frame

Create

Patient-Centred Design

Develop a deep, empathetic, intimate understanding of the

context patients live in

Define the problem to be solved as the patient

would define it

Explore – i.e. make – solutions to learn more

Medicine, Science and Design are different ways of thinking


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Symbolic)

Real)

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Design&Medicine&

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Owen 2007

Design proceeds by thoroughly understanding patients’ lives, by making connections, by experimenting to explore the problem.

Medicine proceeds by testing hypotheses one at a time, by understanding before acting and by doing no harm.

THERE ARE MASSIVE OPPORTUNITIES TO SOLVE HEALTHCARE PROBLEMS THROUGH DESIGN


There are massive opportunities to solve healthcare problems through design

•  Many studies support the link between experience and outcome

•  Increased importance of chronic conditions, where the patient is main actor

•  Patients make choices … and not always choices you’d like

•  Well-designed experiences reduce cost and make patients happier and healthier

2014-‐07-‐02

BUT every paMent is different … and experiences the same processes differently

David Dunne, Ph.D.

The elephant in the room: adherence

14% to 21% never fill their original prescriptions. 60% cannot identify their own medications 30% to 50% ignore or compromise medication instructions 25% admissions related to poor self-administration. 12% to 20% take other people's medicines.

… AND BTW …

For a chronic disease like diabetes, 95% of treatment is self-administered


Patient choice and health outcomes


SOME OTHER CHOICES


Memorial’s rehab center prepares patients for home

The sweet spot: making patients happy and saving money

2014-‐07-‐02

hJp://www.youtube.com/watch?v=16p9YRF0l-‐g

David Dunne, Ph.D.

How a Dutch fly keeps costs in line


HOW THE PROCESS WORKS


To understand design thinking, you need to understand three things

2014-‐07-‐02 David Dunne 31

ObservaMon

Quant & qual interviews

Storytelling

Understanding the user and context

Rapid prototyping

Bodystorming

Walk throughs

Making as a way of thinking

Root causes PerspecMve flips

Systems thinking

User experience

Reframing the problem

PCD emphasizes ‘lived experience’

•  Focus on groups of individuals, not ‘general public’

•  Empathy – attempting to see the experience from the patient’s perspective

•  Understand what drives behaviour so we can achieve better outcomes

•  NOT the same as ‘pampering’ patients


Diabetes: the old way

"The needles were enormous, and they came with liJle pumice stones so that you could sharpen them. They oken became dull and developed barbs on the end. And in order to sterilize them they had to be boiled for twenty minutes."


A problem well-framed is a problem solved

•  We do not accept the problem ‘as given’ but look to reframe it based on –  Patient perspective –  Underlying issues

–  Analogies

•  Reframing is more important than brainstorming


CHANGING FOCUS AT SINAI EMERG

INITIAL FRAME: “WHY CAN’T I GET ANY PRIVACY?”

REFRAMED: “WHY ARE THERE SO MANY PEOPLE AROUND?”


Get physical, early and often

•  Prototypes can be anything –  Rough models –  Role plays –  Sketches/collages

•  They force you to get your idea clear and explicit

•  They help others to see what you are talking about

•  They allow patients to respond, experience and comment


Supporting these is an extensive toolkit

2014-‐07-‐02 David Dunne 37

… and the right attitude

2014-‐07-‐02 David Dunne 38

Empathy … to appreciate the user’s problem even when they are very different from you

Curiosity … “mind of a child” who keeps asking “why?”

Openness … to different forms of knowledge and to new perspectives

Nonattachment … to one’s own ideas, or to those of the team

Mindfulness … to see the inherent possibilities

A nonlinear, iterative process

2014-07-02

UNDERSTAND CONTEXT REFRAME

CREATE

STATE AND RESTATE THE PROBLEM: WHO NEEDS WHAT BECAUSE WHY?

DEVELOP DESIGN PRINCIPLES EXPLORE SOLUTIONS

DRAW, MAKE, DO REFINE AND ITERATE

DEVELOP PATIENT INSIGHT UNDERSTAND THE SYSTEM

ITERATE: WHAT DO OUR FINDINGS

INDICATE ABOUT THE PROBLEM?

ITERATE: WHAT DO OUR

SOLUTIONS TELL US ABOUT THE PROBLEM?

ITERATE: WHAT INSIGHTS MAY LEAD TO SOLUTIONS?

WHAT DO OUR SOLUTIONS SUGGEST WE NEED TO KNOW?

UNDERSTAND REALITY

FRAME THE NEED

CREATE POSSIBILITY

David Dunne, Ph.D.

MAYO CLINIC CENTER FOR INNOVATION CASE STUDY



Igniting a SPARC

•  SPARC (see/plan/act/refine/communicate) was started in 2000

•  This became the Center for Innovation (CFI) in 2008

•  CFI uses design approaches: 1.  Topic framing

2.  Research 3.  Design

4.  Implementation


The intent: to understand and improve the delivery of care


Redesigning outpatient practice: Jack and Jill rooms


Based on the observaMon that physical exam takes up a small porMon of Mme

ConversaMon room Treatment room

CFI Mission, Goals and Approach


Mission The Center for Innovation's mission is to transform the experience and delivery of health care. Goals •  Focus on the human experience to identify needs and design services, products

and business models to meet them •  Innovate care delivery that's accessible, affordable and value-driven •  Collaborate openly — internally and externally •  Generate economic value by demonstrating financial return from sustainable

delivery models, services and products Approach The Center for Innovation works with a "Think big. Start small. Move fast.™"philosophy. •  Connect. Bring people together in new ways inside and outside of Mayo Clinic. •  Design. Identify opportunities and realize solutions that transform care delivery

and experience. •  Enable. Facilitate and accelerate innovation across Mayo Clinic.

The CFI’s process


The RED engineering project


Goal Pay for performance è enhanced need for better care at lower cost Method ‘Interview and Observation Key Insights

•  “Patients don’t get vacations”. •  Medical and non-medical considerations were interwoven in the

dialysis experience, but there were gaps between them. •  The patient care team was often patients’ sole source of

support – not just medical, but emotional too. Because of this, patients were often reluctant to leave the hospital.

•  Patients and healthcare providers spoke different languages, but had common goals and intentions.

What they learned


In the middle of a lot of stress and acute illness, we were asking them to make big decisions: do you want dialysis tonight? You don’t need to do it, but of course if you don’t use dialysis you’ll probably die by tomorrow morning … What kind of dialysis do you want? OK, now you’re on dialysis, goodbye; you can be dismissed from the hospital. Good luck with your new life. We realized that this did not set our patients up for success in the future.

Dr. Amy Williams, MD, Nephrologist

What they did


Exploration and Experimentation •  Mapped the experience •  Developed an integrated care team approach that took into account

medical and non-medical aspects. •  In-depth patient understanding à new educational materials

Outcomes

•  Hospital admissions fell by 40% •  Reductions in in-hospital dialysis. •  Patient satisfaction, provider and care team satisfaction all

increased. •  Quality standards were met and there were significant cost savings.

CHALLENGES AND HOW TO DEAL WITH THEM


The challenges

•  Lack of (or passive) on-the-ground cooperation

•  Mental models: –  It’s about pampering patients/customer service/

marketing … all stuff other people do –  It’s about low-priority issues –  It’s not scientific –  It leads to higher costs –  It’s too time-consuming

•  The lure of the incremental


The major risks

•  Isolation and lack of cooperation •  Getting overloaded with incremental

projects

•  Lack of departmental engagement •  Too few visible results


Fortunately, others have faced these challenges

Strong, public, vocal top-level support

Project work: Find early wins

Protect unallocated time for “banner” projects

Engage departmental teams

Internal relationship strategy:

Communication and engagement

Find allies and draw them in

Have someone who knows networks intimately Establish and support communities of practice


Summary

•  Patient experience is all about getting the right outcomes – not “patient satisfaction”

•  Design of patient experience is an act of conscious creation

•  There are massive opportunities to solve healthcare problems through design …

•  … for example … •  How the process works •  Case study: Mayo Clinic Center For Innovation •  Challenges and how to deal with them


Healthcare

Innovation by Design in Patient Experience