health care: a strategy for supporting change - dmgt 748 - spreads
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M.A. Final Project
Health Care: A Strategy for Supporting Change
M.A. Final Project | Process Book | SCAD DMGT 784
Synthesize
Communicate
Clarify
Eval
Con
Translate
Play
Draw
Balance
Structure
Foster
Determine
Implement
Figure 1. Cover image. Exploring the relationship between design,management, and transformational change. Author’s image.
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M.A. Final Project
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Health Care: A Strategy for Supporting Change
Enrique L. Von Rohr
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Introduction
Thisproject employed principlesand methodsof design
management,the effective use of design strategy,operaconstraints,and businessobjectivesto generate astrateapproach thatsupportsinstitutional health care manag
and designers.
HealthCare: A Strategyfor Supporting Changeshowcasethe developmentof MergeCare,an approach for facilitat
the adoption of design-led methodsinto existingprocesimprovementsystemswith the goal of supportingchangduringnew initiatives.Research,prototype developmen
testingwere conducted overa ten-week period.The prodemonstrateseach step of thisprocess aswell asthe fin
prototype.Interview subjectsincluded managersand de
within two health care companiesthatprovided rich insthe culture of theirorganizations,how they currently mchange,and whatthey believe mightsupportfuture initCommon strengthswere identified in both targetaudien
asthe ability to translate,communicate,iterate,and synThese organizationsalso have astrongculture of inquiry
subjectsdemonstrated the desire to adoptnew methodswould improve theirwork and supportclients. The heter
systemsand human factorswithin health care contributneed forintegratingnew approachesand methodsintoexistingprocesses.
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Dedication Acknowledgment
I dedicate thiswork to my friend,companion,advisor,and
amazinglife partner,MelissaVon Rohr.Thank youforyourconstantlove,support, encouragement,and forgivingme thespace to take thislong journey.Thank youalso forthe many
reviewsyou have done to make thisprojectcomplete. And to mychildren,thank youfor yourpatience and giftof time thatI hope
to return tenfold.
Itis with greatpleasure thatI acknowledge and thank th
have helped me complete thisproject.
Tomy professors, particularlyRegina Rowland, PhD:Tha
foryour dedication,perseverance,and leadership in guidgrowth and instillingconfidence in me to build anew fut
have changed my mind forthe betterand opened the doexpansive chapterin my life.
Tomy classmates: Thank youfor yourconstantsupport aencouragement,for stretching the boundary of my com
and pushingme to explore the richnessof thisemergingspecial thanksto my lastquartercohorts, Johan Verstra
Kangjun Seo foryourconstructive reviewsof my final pr
And to my otherclassmatesJashuaPlotkin,Erika S.Rose,Shannon D.Simon, and Yirun Xu:it hasbeen alearningexwatchingyourprojects develop and discussourcollectivchallengestogether.To pastcollaboratorsJason Spinksa
Benson:thank youfor yourthoughtful teamwork!And thto Jason Millsforbeing my St.Louisclassmate on the gro
Thank youall formakingthe experience well worth the j
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Table of Contents
Project Framing. . . . . . . . . . . . . . . . . . . . . . . . . 11–13Subject ofStudy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Problem Statement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Target AudienceDescription . . . . . . . . . . . . . . . . . . . . . . . . . .12
PurposeofProject . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Scopeof Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
S ig ni fic an ce o f t he S t ud y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 3
Project Positioning . . . . . . . . . . . . . . . . . . . . . . 15–33O pportu nity Statemen t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16
Positioning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17–29
Z AG St ep s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1
ValueProposition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32
OnlinessStatement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Research Activities and Synthesis . . . . . . . . . . . . 35–60Research Space. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
R es ea rc h M et ho do lo gy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 7
Research QuestionsMatrix . . . . . . . . . . . . . . . . . . . . . . . . . . .38
Consent Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
R es ea rc h P ro to co ls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0 – 41
Research Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Data, Analysis& Synthesis. . . . . . . . . . . . . . . . . . . . . . . . . 43–58
R es ea rc h I ns ig ht s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 9
Research Fin din gs at aGlan ce . . . . . . . . . . . . . . . . . . . . . . . . .60
Design Opportunities and Criteria, Reframing. . OpportunitiesforDesign Matrix. . . . . . . . . . . . . . . . . .
OpportunitiesforDesign Map . . . . . . . . . . . . . . . . . . .
D esign Criteriaf orP rototype . . . . . . . . . . . . . . . . . . . .
Reframing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Prototype Development and Testing . . . . . . . . PrototypeIdeas . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Concept Development Process. . . . . . . . . . . . . . . . . . .
Concept Testingwith Target Audience . . . . . . . . . . . . .
Concept TestingFindings. . . . . . . . . . . . . . . . . . . . . . .
Validation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Final Design to Market . . . . . . . . . . . . . . . . . .Final Prototype. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bu sin es s Model Can vas . . . . . . . . . . . . . . . . . . . . . . . .
Business/Implementation Plan . . . . . . . . . . . . . . . . . .
Conclusions and Recommendations. . . . . . . . .Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . .
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Project Framing
Design
Health Care
Manage
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Project Framing
Scope of Project
ContextThe contextforthis projectwas the challengesfaced by the
institutional health care sector.These challengesinclude theprocessimprovementmethodsand strategiesthatmanagersanddesignersuse to supportcare in hospital settings.
Content
The contentof the project included design process,designmanagement,businessmanagement,processimprovement
methods,and transformational change strategies.
SubjectsThe subjectswere designersthatwork for institutional healthcare systemsand institutional health care professionals,such as
decision makersand managersof operations.
Subject of Study
The research investigated how individuals in two institutionalhealth care systems use design and management methodsto support transformational change.
Problem Statement
JohnHalamka,MD,ChiefInformationOfficeof BethIsrael
DeaconessMedicalCenterinBoston statesthathealthcare intheUnitedStatesisof poorvalue,significantcostandless thanoptimal
outcomes(Jones,2013).Halamkasuggeststhatinnovationandreconsiderationof modelsofservice andinstitutionalpracticeare
neededinorder tocreate continuouscareandsupport.
The PatientProtection andAffordableCare Act (PPACA)signed
into law by PresidentBarack Obamaon March 23,2010,is an
effortto improve how health care is managed atmultiple levels.The PPACA reflectsthe challengesthat have existed in the UnitedStateshealth care systemforsome time.Reformingthe system
through transformational changesin termsof patientcoverage,coststructure, and patientcare will continue to be along-termchallenge.Strategiesto supportthe institutional health care
systemsthatcare for and manage patientsare needed by thedesign industry (Jones,2013).
Target Audience Description
Two subjectgroupswere identified forthis study.Group one
wascomposed of institutional health care managerswho focuson processimprovementmethodsto support transformational
change.The second subjectgroup wascomprised of designerswho seek opportunitiesfor greaterengagementin the
institutional health care sectorand wish to develop tools they canuse to supportchange.
Purpose of Project
The purpose of thisprojectwas to uncoverorganizational barriersto operational culture in orderto develop methodsthatsupportmanagersand designerswho intend to lead transformational
change in health care institutions.
LocationThelocationof theprojectwas inthe St.Louis,Missourire
morethen20 milesfromthe citycenter.Subjectswere intattheiroffices atvarioushealthcare systemsfacilities.
TimelineThe projectbegan on July 1, 2014 with secondary researc
lasted through January 4,2015.The primary research anddevelopmentbegan of January 5,2015 and lasted throug
March 11,2015.
DelimitationsThe study did notinclude cliniciansin health care practicconsumerhealth care productsor theiragents, norothe
disciplinesthatmake up the institutional health care secalso did notinclude small health care practicessuch as d
officesor largerinsurance payersand pharmaceutical cothatfocus on health care.
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Project Positioning
Build Evaluate
Connect Foster
D et er mi ne M ob il iz e
Encourage
R ec og ni ze T ra ns la te
Weave
DesignProcess
Discover
Define
Develop
Explore
Iterate
Play
Visualize
Synthesize
Draw
ImplementTransform-
ationalChange
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Project Positioning
Opportunity Statement
The research contributed to the field of designmanagement by:
1. Demonstratinghow adesign-led method can be used tofostereffective collaboration and sustain change.
2. Helpinghealth care managersand designersintegrate design-led strategicapproachesinto day-to-day activities.
3. Clarifyinghow health care professionalscan supportchange
by embeddingdesign-led expertise into their processes.
An opportunity existed to conduct research in the institutional health caresector of St. Louis. The study investigated what strategies were being usedby design and management to support transformational change.
The health care sector hasmany specialized components.Designersoften bringa variety of backgroundsand approachesto
supportspecificproducts orservices. In orderto effectsystemicchange,design managersneed to develop modelsand toolsthatsupporthealth care innovation fromwithin the systemitself.
There isagrowingneed fordesigners and,more broadly,design
managementto understand the complexemotional and culturalconditionsof the health care field in orderto supportthe sector
effectively (Jones,2013).Equally,health care practitionersarelookingto design managementfornew strategiesto develop and
sustain many activities(Jones,2013).The institutional health caresector,which isthe strategic managementside of health care,needsnew modelsand approachesfor implementing
change initiatives.
Competitor/Collaborator Analysis
The marketanalysisreviewed a range of institutional health care
structuresat the national level.These structures,of varyingsize,incorporated eithertransformation change orinnovation into
theircurrent systems.Additional not-for-profitorganizationswereevaluated thatfocused on health care,includingone company
thatfocused on transformational change strategies.A review ofthe institutions’websites,includingthe t erminology used andthe typesof projects initiated,wasused to evaluate the degree
to which innovation orprocessimprovementmethodologies
were incorporated into toolkitsand methodspresented fortransformational change.
Positioning:Overview
Regional Health Care Systems
Eighthealth care systemsof varyingscales were analyze
St.Louis region.Websiteswere reviewed forthe words“transformation” and “innovation” to evaluate if they ha
centers,or initiativesthataddress these areasand whatthey mightbe usingto effectchange.
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Project Positioning
> Integrated consultingbusiness
> Clearmethodology and steps
> Toolsto supportchange
> BusinessConsultancy
> Engineering
> Financial Services
> Government
> Pharmaceuticals
> A model with added consultingservicesand software can createholistictoolsets
> A clearmethod thatis shared withall providesconfidence
> Variouschannelscan be used forthe model
Objectives:What is theirnetwork’s value?
Members:What categories dotheyfall into?
Channel:What is theentrypoint totheir network?
Lessons:What canthey teachus forournetwork?
Collaboration Opportunities:Wheredoweoverlap?
Approach:How dothey createvalue?
> Online portal
> On-ground site visits
> Coaching
> E-learning
> Theirmethod servesothersectorsaswell ashealth care
> Clearprocessin place
> Global officesoffer internationalperspectivesand knowledge base
> Toolsexistfor visualizingprocesses
Changefirst
Changefirstisa consultingcompany thatsupportsall typesof businesseswith change initiatives.They have sixstepsthat
are guided by whatthey call a learn , apply ,and embed process.They also provide trainingworkshops,e-learningmodules,andcoaching(http://www.changefirst.com).
Positioning:Competitor/Collaborator Analysis
> University-level organization thatprovidesresearch and knowledgeon bestpractices
> Consindu
Objectives:What is theirnetwork’s value?
MemWhat
ChanWhat i
Approach:How dothey createvalue?
> Onli
> Publ
> Rese
> Knowledge to leaders
> Patient-centered approach
Cornell University: HealthcareTransformation Project
The Healthcare Transformation Projectat Cornell University
providesconsultingservices to health care leadersin theareasof needsassessment,delivery of bestpractices,strategicpartnerships,and organizational change approaches.Most of
theirpractices appearto be in areasof processimprovementmethods(https://www.ilr.cornell.edu/healthcare).
Table1. Changefirst competitor/collaboratoranalysis.
Adapted from “ Workshops,”“Ourchangemanagement methodology,” “Key featuresofe-change,” “Ourclients,”and “Really embeddingPCI®in yourorganization,”2015, Changefirst.
Adapted from “Who weare,” “What wedo for you,” “Work we’vedone,” “NewHealthcareTransformation Project.
Table2. Cornell University: HealthcareTransformation Project competitor/c
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Project Positioning
> Affiliated with auniversity
> Leadershave track record ofsuccess
> Actasacatalyst
> Health care systems
> Health care teams
> Strategists
> Translation of science to practice
> Bestpractices
> Example model
> How we mightprovide consulting
Objectives:What is theirnetwork’s value?
Members:What categories dotheyfall into?
Channel:What is theentrypoint totheir network?
Lessons:What canthey teachus forournetwork?
Collaboration Opportunities:Wheredoweoverlap?
Approach:How dothey createvalue?
> Online portal
> Location within partnerschools
> Production of toolkits
> May wantto testourapproach fortheirhealth care clients
> Resourcesto theirstakeholders
> Brokerrelationshipswithinnovation implementationstrategies
Healthcare Transformation Institute
The Healthcare Transformation Institute isa not-for-profitaffiliated with the University of Arizonaand ArizonaState
University.The institute providesknowledge aboutbestpracticesat the intersection of scientificdiscovery,healthcare delivery,and reimbursementservices.They have a
structure,method,and criteriafor workingwith health caresystemsin orderto effectchange on ahigh-level path (http://
healthcaretransformationinstitute.org).
> Internally supportchangesthathelp to adoptexternal innovationbestpractices
> In-ho
> Healsyste
Objectives:What is theirnetwork’s value?
MemWhat
ChanWhat i
Approach:How dothey createvalue?
> Onli
> Wortheir
> Knowledge to theirleaders
> Trainingfunctional groups
Independence Blue Cross:Center for Health Care Innovation
The Centerprimarily facilitatesinnovation-based activitiesforemployeesof Independence Blue Cross.They are lookingfor
outside opportunitiesto importinto theirstructuresto supportchange and innovation activities(http://www.ibx.com/company_
info/innovation).
Table3. HealthcareTransformation Institutecompetitor/collaboratoranalysis. Table4. IndependenceBlueCross: CenterforHealth CareInnovation compet
Adapted from “Healthcaretransformation institute,” “Strategy and Focus,” “Engineeringto createa health caresystem,”“Vision and Mission,”2015, HealthcareTransformation Institute.
Adapted from “TheCenterfor Health CareInnovation at IndependenceBluecarewith innovation,” “Innovation at work,” 2015, IndependenceBlueCross:C
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Project Positioning
> Large database of research
> Expertadvice
> Longhistory of expertwork
> Global reach
> Strategist
> Think tank
> Educators
> Facilitators
> We may need more depth
> Value of information
> Total businessmodel
Objectives:What is theirnetwork’s value?
Members:What categories dotheyfall into?
Channel:What is theentrypoint totheir network?
Lessons:What canthey teachus forournetwork?
Collaboration Opportunities:Wheredoweoverlap?
Approach:How dothey createvalue?
> Online portal
> Officesin Cambridge,MA
> Online teachingtools
> Printmaterials
> Mightadopttheir method/toolkit
> Could be apartner
> May validate ourwork
> Resourcesto theirstakeholders
> Brokerrelationships
> Think tank approach
> Hostconferences
> Conveners
Institute for Healthcare Improvement
The Institute for Healthcare Improvement (IHI) is anindependent not-for-profit organization providing resources
to the health care community. IHI serves as a clearinghouseof innovation science in various areas. Along with linking tomany articles, they also produced “A Guide to Idealized Design,”
which combines transformational and design approaches in astep-by-step guide. In addition, IHI has developed the “Triple
Aim” model, which addresses the health of a population,experience of care, and per capita cost. The Institute alsoprovides coursework at various levels for transformational
change leadership (http://www.ihi.org).
> Partof alarge network of healthcare providers
> Ability to gatherknowledge fromall participants
> Impactsthe whole industry due tobeinga network resource
> Strat
> Educ
> Conn
Objectives:What is theirnetwork’s value?
MemWhat
ChanWhatis
Approach:How dothey createvalue?
> Onlin > Provide aregistered process
> Offerclear toolsall can use atthe same time
> Help understand existingtools
Joint Commission Center forTransforming Healthcare
Thisnot-for-profit organization issupported by leadingnational health care systemswith the mission of transforming
health care through aset of processimprovementtoolssuch asRobustProcessImprovement, which includes
Lean SixSigmaand Targeted SolutionsTool (http://www.centerfortransforminghealthcare.org).
Table5. InstituteforHealthcareImprovement competitor/collaboratoranalysis.
Adapted from “Vision, Mission, and Values,” “Innovations,”“Education,” “Scienceof Improvement: How toImprove,” and “Open School,” 2015, Institutefor HealthcareImprovement.
Adapted from “About theCenter,” “Projects,” “FAQs,” “Targeted SolutionsToo JointCommission Center for TransformingHealthcare.
Table6. Joint Commission CenterforTransformingHealthcarecompetitor/c
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Project Positioning
> A large-scale facility allowingforrapid prototypes
> Value to the KaiserPermanentesystemand national model
> Only one of itskind in the USA
> A livinglaboratory
> In-house innovation team
> Prototype development
> How aphysical demonstration sitecan garnerenterprise adoption
> Can testmultiple modelsat once
> Role play allowsfora human-centered opportunity to testideas
Objectives:What is theirnetwork’s value?
Members:What categories dotheyfall into?
Channel:What is theentrypoint totheir network?
Lessons:What canthey teachus forournetwork?
Collaboration Opportunities:Wheredoweoverlap?
Approach:How dothey createvalue?
> Primarily theirphysical site
> Online website with videoexamplesof spacesand projects
> Potential partnerfortesting the
product > Potential adopterof the product
> Showshow an environmentcan
be designed to supportoperationsand lowerthe long-termcost ofinvestment
> Testspotential ROI beforeinvestmentismade
Kaiser Permanente: Garfield Innovation Center
KaiserPermanente isone of the largesthealth systemsinthe country.The Garfield Innovation Centerleadsthe way in
testingnew ideasand implementingthemthrough large-scaleprototypingin modeled hospital environments.Anyone within thenational systemcan visitthe site in orderto prototype within the
physical conditionsand see how operationsmightbe impacted.The physical environmentallows fora human-centered design
approach to exploringproblem-solvingmethods.In addition itprovidesthe opportunity forstakeholderbuy-in fromall teammembers(https://xnet.kp.org/innovationcenter/index.html).
> Innovation teamintegrated into ahealth care system
> Clinician-initiated formationencouragesinstitutionalleadership trust
> In-ho
Objectives:What is theirnetwork’s value?
MemWhat
ChanWhat i
Approach:How dothey createvalue?
> Faci
> Onli
> Available to theirimmediate
stakeholderson adaily basis > Build transdisciplinary teamsfromprojectonset
> Demonstrate by participatingateach step of process
Mayo Clinic: Center for Innovation
The Centerfor Innovation atMayo Clinicbegan in 2008 andbridgesmedical practice with human-centered design.They
have been the leaderin usingdesign thinking to facilitatethe transformation of health care delivery atall levelsof theorganization.They use a“Connect,Design, Enable” approach to
initiate and delivertheir projects(http://www.mayo.edu/center-for-innovation).
Table7. KaiserPermanente: Garfield Innovation Centercompetitor/collaboratoranalysis.
Adapted from “Who weare,”“What wedo,” and “Howto start,” 2015,Kaiser Permanente: GarfieldInnovation Center.
Adapted from “What WeDo,” “Projects,” and “Transform,” 2015, MayoClinic: C
Table8. Mayo Clinic: Center forInnovation competitor/collaboratoranalysi
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Project Positioning
> A clearinghouse forideas
> Sourcingand evaluatingbestpractices
> In-house innovation teamfor amajorhealth care system
> Criteriaforevaluatinganinnovation
> How to identify and match leadproblemswith an innovation
> Robust“Deep Dive” processforprojects
Objectives:What is theirnetwork’s value?
Members:What categories dotheyfall into?
Channel:What is theentrypoint totheir network?
Lessons:What canthey teachus forournetwork?
Collaboration Opportunities:Wheredoweoverlap?
Approach:How dothey createvalue?
> Online website
> Theirtoolkit/process
> Toolkitmay have many similar
stepsthatsupporttransformation > May supportnew methodsandposton theirsite
> Knowledge to theirsystem
> Knowledge to broaderhealth careindustry on bestpractices
UCLA Health: Institute for Innovation in Health
The Institute ischarged with identifyingnew opportunitiesanddeliveringtransformational change in health care.They have a
seven-step processforevaluatingan innovation.The Institutealso usesaspectsof design thinkingand processimprovementto evaluate and initiate projects.In addition,they provide a 60-
page toolkitthatwalksreaders through astep-by-step processofinnovation (http://uclainnovates.org).
> SupportSutterHealth system
> Facilitate innovation activities
> In-homajo
Objectives:What is theirnetwork’s value?
MemWhat
ChanWhat i
Approach:How dothey createvalue?
> Onli
> Even
> Disseminate knowledge to their
system > Facilitate workshopsfor systemleadersand staff
Sutter Health: The David Druker Centerfor Health Systems Innovation
The Centerbegan in 2010 to advance exploring,creating,anddeployingnew health care in the region.It usesa
human-centered design approach to facilitate developingnewideas.The Centerfocuses on new innovations,as opposed to
improvingexistingstructureswithin the SutterHealth system(http://innovation.pamf.org).
Table9. UCLA Health: Institutefor Innovation in Health competitor/collaboratoranalysis.
Adapted from “Key Activities,” “Innovation at UCLA,” “Resources,”and “Econsult Deep Dive” 2015,UCLA Health: Institutefor Innovation in Health.
Adapted from “Home,” “linkAges,” and “Personalized Health CarePrograms,”Sutter Health: TheDavidDruker Center for HealthSystemsInnovation.
Table10. SutterHealth: TheDavid DrukerCenterfor Health SystemsInnovat
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Project Positioning
Small Large
In-house
Independent
Positioning:2x2 Axis of Organizations
Location vs. Size
The 2x2axisshown in Figure 4 plotsthe relative size of the healthcare organizationsand if transformational change was supported
within the entity.Larger organizationshad more robusttransformational and innovation-oriented teamleaders.They
also had clearmethodologiesto supportchange.Organizationsoutside health care systemsranged in the complexity of methods
and strategiesused to support transformational change.
An opportunity areawasidentified,indicatingthe need for
astrategic approach thatcould supportsmallerhealth careorganizationsin achievingtransformational change.
Organizationsincluded in Figure 4are:
1 . Ch an gefirs t2. Cornell University:Healthcare Transformation Project
3. Healthcare Transformation Institute4. Independence Blue Cross:Center forHealth Care Innovation
5. Institute forHealthcare Improvement6. JointCommission CenterforTransformingHealthcare
7. KaiserPermanente:Garfield Innovation Center8. Mayo Clinic:CenterforInnovation9. UCLA Health:Institute forInnovation in Health
10. SutterHealth:The David DrukerCenterforHealth SystemsInnovation
02
03
04
05 06
10
Figure4. 2x2axis oforganizationssupportingtransformation. Identifiesstructuressupportingtransformational changeacrosstheUnited States. Author’simage.
OpportunityArea
Low
Positioning:2x2 Axis of Approaches to Transformation
Design-led vs. Process Improvement
Many of the organizationsreviewed used avariety of methodsforcreating transformational change.Some took adesign-
led approach with afocuson human-centered innovation fortransformingpartof ora whole system.Others leaned toward
processimprovementunder aSix Sigmaapproach to makeincremental change within units.A few offered strategiesthat
reflected both methods,suggestingthere mightbe anopportunity fordevelopinga meta-method thatcombinesdesign-led and processimprovementstrategies.
Organizationsincluded in Figure 5are:
1 . Ch an gefirs t2. Cornell University:Healthcare Transformation Project
3. Healthcare Transformation Institute4. Independence Blue Cross:Center forHealth Care Innovation
5. Institute forHealthcare Improvement6. JointCommission CenterforTransformingHealthcare
7. KaiserPermanente:Garfield Innovation Center
8. Mayo Clinic:CenterforInnovation9. UCLA Health:Institute forInnovation in Health
10. SutterHealth:The David DrukerCenterforHealth SystemsInnovation
01
02
03
04
06
D e s i g n - l e d
Proce
Figure5. 2x2 axisof approachesto transformation. Identifiesinstitutionsthusedesign-led versusprocessimprovement practices. Author’simage.
Project Positioning
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j g
Positioning:Regional Health Care Systems
Figure 6 plotsthe relative size of the health care company
compared to the numberof transformation supportstaff andstrategiesevidentin the business.
1. AscensionHealthAscension Health isthe largestCatholic, not-for-profithealth
systemin the St.Louisregion.Based in St.Louis,Ascensionhasfacilitiesthroughout the country.A transformational
developmentteamis charged with initiatingclinical innovations(https://www.ascensionhealth.org).
2. BJCHealthCareBJC HealthCare isaregional health systemin the St.Louisarea
with 14hospitals.They have aCenterfor Clinical Excellence thatischarged with supportingtransformation atall levelsof the
organization.Theirmission is to improve clinical care throughinnovation sciences (http://www.bjc.org).
3. Blessing HealthSystemBlessingHealth Systemis afor-profit systemwith sixfacilities
in the Quincy,Illinoisregion. They do nothave transformationalorinnovation supportagentsor teamsaspart of theircorporate
structure (http://www.blessinghealthsystem.org).
4. CoxHealth
CoxHealth isa health care systembased in Springfield,Missouriwith five hospitalsunderitsmanagement.CoxHealth does
nothave an internal structure for supportingcompany-widetransformation or innovation (http://www.coxhealth.com).
5. MemorialHealth System
Memorial Health Systemisa Midwestnot-for-profithealth systembased in Springfield,Illinoiswith seven hospitals.The systemlacksa transformation supportstructure;however,a teamof
individualsare charged with transformational change within theleadership structure (https://www.choosememorial.org).
6. Saint Luke’s HealthSystem
SaintLuke’sHealth Systemisa not-for-profitorganization thatincludes10 hospitalsacrosst he KansasCity region.Itdoes nothave astructure fortransformation beyond afew employeeswho
supportthe practice internally and often hire external experts(http://www.saintlukeshealthsystem.org).
7. SouthernIllinois Healthcare
Southern IllinoisHealthcare isanonprofit,three-hospitalsystemin Southern Illinois.The organization doesnothave atransformational change supportteam, nordo any individuals
within the organization have atitle suggestingthis type ofactivity (http://www.sih.net).
8. SSMHealth
SSMHealthis aCatholic,not-for-profithealthcare systembasedinSt.Louiswith 18hospitalsandaffiliationswith40 ruralhospitals.Theorganizationsupportstransformationthroughsenior
leadershipandotheremployeeswhoare chargedwithclinicaltransformationandinnovation(http://www.ssmhealth.com).
O r g a n i z a t i o n S i z e
TransformationSupport
High
Low
Low High
01
02
03
04
05
06
07
08
Figure6. 2x2 axis ofregional healthcaresystems. Identifieshealth caresystemswith transformational support staffaspart oftheirorganization. Author’simage.
OpportunityArea
An opportunity areaexistsfor supportingtransformational
change forsmallerhealth care systems.A toolkit may provide asolution to supportteamsthat do nothave staff dedicated to thetransformation process.
Zag Steps
1:Who amI? MergeCare isa strategicmethod forsupportinginstitutional healthcare managersduringch ange initiatives.
2:Whatdo I do? The purpose of MergeCare isto supporthealth care managersand designersthrough a combination of design-led and processimprovementphases and stepsto plan,ini tiate,and sustain change.
3:Whatis my vision? The vision of MergeCare isto empowerhealth care professionalswhenfacilitatingoperational changes today and in the future through amixed-method approach.
4:Whatwave amI riding? Health care lookingto design forinnovation.Processimprovement strategieslack innovation.Processimprovement strategieslack ahuman-cen tered approach.Need to reduce health care costsand errors.Pressuresto improve health outcomes.
5.Who sharesthe brandscape? Large health care systemsthat incorporate design-thinkingstrategiesinto theirmanagement structures,change managementconsultingfirmswith established practices,and think tankswith methodsthatincorporate human-centered design to supportchange.
6.Whatmakes me the only me? MergeCare isthe only design-led and processimprovement strategythatwas created to supportchange for US-based institutional healthcare managersand designers who seek to collaboratively improveoverall operational and patientoutcomesin an era when both large and
small systemsneed new waysto lowercostsa nd manage resources.7.Whatshould I add orsubtract? MergeCare will continue to add the bestmethods thatstrengthen its
offeringsto institutional health care professionals.
8.Who lovesme? Health care managerswho need new strategiesto align teammembersand stakeholders,and designers who are seekingto facilitate betterrelationshipswithin complex institutional health care environments.
9.Who’sthe enemy
10.Whatdo they ca
11.How do I explain
12.How do I spread
13.How do people e
14.Whatdo they ex
15.How do I earn t
16.How do I extend
17.How do I protec
Table11. Zagsteps.
Project Positioning
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Placeholder
32
Value Proposition
MergeCare is for institutional health care managers and designerswho need to support change in complex functional and operationalenvironments. Our strategic approach integrates an intuitive and logicalprocess for evaluating, understanding, and implementing changeinitiatives. We do this by facilitating a set of design-led visual sessions thatclarify opportunities, imagine futures, and codify processes for participantsto implement. Unlike other change strategies that are primarily data-driven,
our approach is based on research that revealed an opportunity to combinea human-centered design and process improvement methods to delivergreater outcome and adoption success. As a result, health care professionalsare better equipped to facilitate innovative change programs becausepeople are at the core of our strategy.
Onliness Statement
MergeCare is the only design-led and process was created to support change for US-based inmanagers and designers who seek to collaboroperational and patient outcomes in an era wsystems need new ways to lower costs and m
Design-Led:Human-CenteredDesign
Figure7. Venn diagram ofnewprocessintdesign management and Lean SixSigmato suggest anewmodel. Author’simage.
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Research Activitiesand Synthesis
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Research Methodology
The methodology for this research
was a qualitative case study.
Thisapproach wasappropriate fora numberof reasons.Thecase study focused on two subjectgroups:health care designers
and health care managersat variousjob levels.The case wasbounded by two large institutional health care systems in whichthe two subjectgroupswork. The method facilitated exploring
phenomenon within the bounded areasin order to understandthe subjects’opinionsaboutoperational logistics,successes,
challenges,opportunities,and currentprocessesused to achievetransformational change.
Research Questions
Primary
Howmightthe applicationofdesignmanagementmetho
supporttransformationalchangewithintheinstitutionalcaresector?
Health CareDesigners
(MArch, ID, GD)
Health CareManagers
(MD, MBA, MHA)
Transformational
Change
SixSigma
LeanSix Sigma
TQM
Design
Thinking
Human-Centered
Design
DesignManagement
People&
Process
People&
People
People&
Buildings
Bucolo,Wrigley,& Matthews(2012)a xe a a r c o 2 1 3
runden & Hagood (2012)
o c wo o 2 9 2 9
LUMA Institute (2015)o ne s 2 1 3
a xe a a r c o 2 13
Research Space
Institutional
Health CareSector
The research space wasdefined asthe intersection of health care
designers,health care managers,transformational change,andinstitutional health care.Figure 9 identifiesrelevant literature andassociated concepts.
Figure9. Research space. Identifiesthreeareasofinvestigation and literaturerelevance. Author’simage.
a og u n a e y 2 1 4e r 2 1 2
m a z , a m a m ur y , garwa 2
chroeder,Linderman,e e, oo 2
chroeder,Linderman,e e, oo 2
o Lean SixSigma(2012)
u er y 2Parameswaran,Raijmakers(2010)
o a ns so n- ö er g, o o a , e n a ya 2 1 3c o rn cn e e r 2 1 2
ar n 2 9
erry (2004)e rr y e m an 2ohmer(2009)
rs ensen 2o ne s 2 1 3a m , Z mr n g, u z
u c e r 2 1a n s, o e a , e av ey ,T o ma s, y on , 2 1 1 .
Types of interactions that impact change
Outsideof ResearchSpace
HealthCareInnovation
DecisionMakers/
Managers
HospitalAdmins
GraphicDesigners
Arch &Interior
Designers
UX/IxD
HealthCare
ConsumerSector
HealthCareClinical
PracticeSector
Research Activitiesand Synthesis
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Consent Forms
Research ProjectExplanation
The followinginformation providesan introduction to the “Health De signer:A strategy to supportchangresearch projectto be conducted in St.Louis,MissourifromJanuary 20 15 to April 2015.
ResearcherBioEnrique Von RohrisaDesign Managementgraduate studentatthe Savannah College of Artand Designresearch constitutesthe final projecttoward amaster’sdegree.Von Rohrcurrently teachescommunicatdesign and ispartof the administration atthe SamFox School of Design and Visual ArtsatWashingtonUniversity in St.Louis.The projectisbeingconducted outside of hisrolesatWashington University.
Purpose of the StudyThe purpose of thisstudy isto understand how mightthe application of design managementmethodolosupporttransformational change within the institutional healthcare sector?
Sub-QuestionsThe research will be guided by the followingsub-questions:Whatare successesof the institutional healthcare sector? (1IH)Whatare challengesforthe institutional healthcare sector? (2IH)Whatisthe definition of transformational change in the contextof institutional healthcare? (1TC)Whatare the techniquesused to fostertransformational change? (2TC)How istransformational change sustained in institutional healthcare? (3TC)Whatare managementmethodsused in healthcare? (1DM)Whatisthe definition of design managementin the contextof institutional healthcare? (2DM)Who are leadersof design managementactivity in healthcare? (3DM)
DataCollection MethodologyDatawill be collected primarily through interviewsand secondary sources.These will include designprofessionalsattraditional firms,designerswithin healthcare settings,aswell asinstitutional healthcaprofessionals.Additional secondary research in literature reviewswill be conducted to evaluate bestprand trendsof how design and design managementisbeingused in non-traditional ways.
DataManagementAll datawill be anonymized duringfinal production of the research results.Individual interview datawistored on two external hard drives,all of which will be erased afterone yearof the interview date.
ContactInformationThisprojectisbeingconducted through the Design ManagementProgramatthe Savannah College of ADesign.Foradditional information please contactProfessorReginaRowland,Ph.D.at rrowland@scad.
Pre–Interview DiscussionFigures10 and 11 concern the ResearchProject Explanation andInformedConsentForm .
The pre–interview discussion structure isoutlined in Table 13.
Table13. Pre–interviewdiscussion steps.
Step Time Interviewer Subject Supplies
1 3 min >Give subjectthe ResearchProjectExplanation and read each partwithsubject. >Explain thatthey can keep thiscopy.
Listen/Review Envelopewith forms
2 2 min >Give subjectthe InformedConsentForm and read each partwith thesubject. >Requestthatthey sign the formattheend. >Retrieve the formand place inenvelope.
Listen/Review Envelopewith forms
Figure10. Research project explanation. Sampleoftheformused to discussthenatureofthe project with subjectspriorto theinterview. Author’simage.
Research Questions Matrix
S ub -Q ue st io ns W ha t d o we ne ed toknow?
Why dowe need toknowthis?
What kind of datawill answerthequestion?
Where can Ifind thisdata?
What type of datacollection methodswill be used?
Whodowecontact?
When doweneed toknow?
What are welearning?
What might we bemissing?
1.Whatare the successesinthe institutional healthcare sector?
Whatisworking? Whatdoesitlook like? How doesitwork?Actual programsthathaveworked.
To learn fromgood examplesto apply to others.Can itbereplicated? If so,how and howmightDMGT supportit? Setcontextforsuccess.
Listof case studiesorprojectsthatare workingwell.
>Institutional health careprofessionals >Secondary research
>Interview >Unique method >Secondary research
>Subject1 >Subject2 >Subject5 >Subject7 >Subject10
> E nd of un i t3 W ha td oe sr ea l su cc e sslook like forinstitutionalhealth care so thatwemightincorporate itintothe productto market.
Nothavinga largeenough sample size.Whatisreally bigversusjust aspecificdepartment.
2.Whatare the challengesin the institutional healthcare sector?
Whatisnot workingwell? Arethere clear,bigproblemsthatare system-wide? Are theyobservable or understandable?
To know if there is consensuson the typesof challengesthatpeople see in thisspace.
Listof large-scalechallenges.Storiesofdaily problemsthatkeeprecurringthatare partofthe largerchallenge.
>Institutional health careprofessionals >Secondary research
>Interview >Unique method >Secondary research
>Subject1 >Subject2 >Subject5 >Subject7 >Subject10
> E nd of u n it3 F un da m en tal c h al l en g esin thisspace.
Otherchallengesthatmightnotseemlarge atfirst,butdo contribute tosystemicchallenges.
3.Whatis the definition oftransformational change inthe contextof institutionalhealth care?
How isthe termunderstoodand whatare some examples?Isthissomethingthat hindersbroaderhealth care progress?
To understand if the subjectsview transformational changeasan actual function of theinstitution.
Descriptionsofsignificantchangesthathave occurred in theorganization.
>Institutional health careprofessionals >Designersin health carepractices
>Interview >Unique method >Secondary research
>Subject1 >Subject2 >Subject5 >Subject8 >Subject10
> E nd of u n it3 U nd e rstan di n g of“transformationalchange” by designersandhealth care managers.
Examplesin the healthcare space thatareof asufficiently largescale to be deemedtransformational.
4.Whattechniquesare usedto foster transformationalchange?
Whattacticsare used to startand sustain change? Are therespecifictypesof tools?
To gain a deeperunderstandingof the toolsand stepsthatleadto transformational change.Who leadsthis?
The exacttype oftechniquesorsystemsused,such asLean orSixSigma.
>Institutional health careprofessionals >Secondary research
>Interview >Unique method >Secondary research
>Subject1 >Subject2 >Subject5 >Subject8 >Subject4
> E nd o f u ni t 3 T ec hn iq ue s fo rtransformational change.
Transformational changemay be acommonmethod acrossallorganizations.
5.How istransformational
change sustained ininstitutional health care?
Effective activitiesoractions
to sustain change.Whatarethe barriersto change?
To know how sustainable long-
termchange is.Whatneedstobe overcome?
Tacticsthatsupported
the long-termchange.
>Institutional health care
professionals >Secondary research
>Interview
>Unique method >Secondary research
>Subject1
>Subject2 >Subject5 >Subject6 >Subject4
> E nd of un i t3 I f th er e a r e a n y
barriersto enactingtransformational changeprograms.
Insightfromthose
atthe very top of theorganization.
6.Whatmanagementmethodsare used in healthcare?
Isanythingunique abouthealth care and theapplication of designmanagement?
To compare againstwhatmightbe deemed as “traditional”managementprocesses.
Specificexamplesorprojectsthatmighthave used adesignmanagementprocess.
>Institutional health careprofessionals >Designersin health carepractices
>Interview >Unique method >Secondary research
>Subject1 >Subject2 >Subject5 >Subject7 >Subject10
> E nd of un i t3 A p ossib l e d ee pe rconnection betweendesign managementandhealth care.
There may be no uniquemethod forhealth care.
7.Whatis the definition ofdesign managementin thecontextof institutionalhealth care?
Whatdoesadesign processreally look like foraffectingchange in institutional healthcare?
To know if people are alreadydoingsimilarthings.To knowwhatthe differentsubjectsconsiderto be adesign process.
Specificdefinitionsandexamplesof designprocesses.
>Institutional health careprofessionals >Designersin health carepractices
>Interview >Unique method >Secondary research
>Subject3 >Subject4 >Subject11 >Subject12
> E nd of un it3 T h e p er c ep tion of th erole orneed fordesign ininstitutional health care.
Subjectsmay notknowDMGT,asitisayoungfield.
8.Who are leadersof designmanagementactivity inhealth care?
Who are the leadinginstitutionsorgroupsusingdesign to drive bigchange inhealth care?
Are there unique leadershipskillsthatcould be supportedby aDMGT process? Who outthere isdoinga greatjob?
Published informationand articlescitingthesuccessof the groups.
>Designersin health carepractices >Online datamining >Contactfromliteraturereviews
>Interview >Unique method >Secondary research
>Subject3 >Subject4 >Subject6 >Subject11 >Subject12
> E nd of u n it3 W ho a re c on sid er e dleaders? Whattoolsare they usingto affectchange?
Smallergroupsthatarenotwell published due toproprietary information,which isacommonchallenge in health care.
Table12. Sub-question matrix.
PrimaryResearchQuestion:
Howmightthe applicationofdesignmanagementmethodologiessupporttransformationalchangewithintheinstitutionalhealthcaresector?
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Research Protocol: Interview Card Sorting Exercise
DesignProcess
TransformationalChange
ManagProc
B ui ld E va lu at e
C on ne ct Fo st er
D et er mi n e M ob il iz e
Encourage
R e co g ni z e T r an s la t e
Weave
U nd er st an d
Communicate
M on ito r
Clarify
B al an ce
Discover
Define
Develop
Explore
Iterate
Play
Visualize
Synthesize
Draw
Implement
Card Sorting Unique Method
Thisunique method wasadapted froma 2013study by MillerandMoultrie.They called ita “card sorting” method and theirstudy
focused on understandingthe skills of UKfashion industry leadersthathad “design” in theirjob titles.This card sortingadaptationevaluated subjects’understandingof design,management,and
transformational change by providinga collection of words(Figure 14)identified fromliterature reviewsrelated to these three
areas.The intentwas to capture subjects’personal associationswith activitiesin the contextsof their jobsand how they rated
theirstrengths in each (Figure 15).
The card sortingstructure is outlined in Table 15.
Table15. Card sort steps.
Step Time Interviewer Subject Supplies
1 2 min >Place materialsin frontof subject. >Place page in frontof subjectwithwordsrandomly arranged to the left. >Ask subjectto arrange wordsnextt o
the word “Me” based on how oftenthey do thattype of activity. >State thatthey have 5 minutestocomplete thiswork. >Additional “blank” cardsare providedin case there are otherwordstheywould like to add.
>Watch andlisten
Envelopewith 11x17paperandwords
2 5 min >Watch and documentany type ofcommentsubjectshave in the process
>Arrangewords
NA
3 2 min >Once done,tape all wordsin place. >Then ask subjectsto rate on ascaleof 0–10 how well they think theyperformeach one of the activities. >State thatthey have 5 minutestocomplete thistask.
>Watch andlisten
Tape andpen
5 5 min >Watch >Label wordson ascale of0–10
Figure14. Card sort words. Ten wordsareidentified in eachcategory. Only ten minutesarealloted forthisactivity. Twoblank cardsareprovided in theevent asubject would liketoadd to thecollection. Author’simage.
Research Protocols: Interview Questions Field Notes Form
Interview Questions: Field Notes
TargetSubject: Designer
Record the followinginformation fromeach interviewee.
Inter vi ewer __________________________
Interviewee __________________________
Date/Time __________________________
Company Name __________________________
A ddr es s __________________________
UnderstandingRoles1. Tell me alittle aboutyourrole and how longhave youbeen doingthistype of work?
2. Tell me aboutyourbackground thatled to an interestand work inhealthcare?
Institutional Health care Sector(IH)3. Whatkindsof thingsdo youthink are workingwell in healthcare? (1IH1)
4. Are there particulartypesof healthcare challengesthatyouhave found difficultto solve? (2IH1)
5. Whatprocessesdo yousee people usingto solve complexoperational functionsin healthcare? (2IH2)
Transformational Change (TC)6. How would youdescribe some large changesthathave occurred forsome of yourclients? (1TC1)
7. How do yousee large change projectsidentified and started foryourclients? (2TC1)
8. Are there specificmetricsorreasonsthatmustbe metto initiate large changes? (2TC2)
9. How are projectsfacilitated? (2TC1)
10.Are there communicationsortoolsyou observe to be effective insupportinglarge change? (3TC1)
11.Whatkindsof barriersto sustaining change overtime have youobserved? (3TC2)
Design ManagementMethodologies(DM)12.Whattypesof processor managementtoolsare used in yourwork? (1DM1)
13.Are there toolsyouthink work betterthen others? (1DM2)
14.How would youdescribe the design process? (2DM1)
15.In whatwaysdo youthink yourwork followsthat design process? (2DM2)
16.How are innovative or“outof the box” type projectsstarted in healthcare and who leads them? (3DM1)
Interview
Figures12–13 representthe Interview Questions Guides.Theguidesincluded space forsubject name,date,time, and location
where the interview occurred.
The interview discussion structure isoutlined in Table 14.
Table14. Interviewdiscussion steps.
Step Time Interviewer Subject Supplies
1 35min
>Turn on recorder >Settimer >Begin to ask questions
R es po nd E nv el op ewithInterviewQuestionsguide
2 1 >Instructsubjectthatthe interview partisdone and we will now do aquickexercise. >Place Interview Questions notesintoenvelope.
NA Envelope
Figures12–13 . Interviewquestionsfield guide. Pageswithquestionsused duringsubject interviews. Author’simage.
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Data: Card Sort by Subject TypeS ub j ec t T yp e H D H D H D H D H D H D
Subject # 3 4 6 9 11 12
Code Word Total Av
DP P lay 4 5 4 2 8 6 29 4.8
DP Draw 4 1 8 10 6 6 35 5.8
DP Discover 2 5 3 9 8 8 35 5.8
DP Define 2 5 10 8 6 6 37 6.1
DP Iterate 2 8 7 8 7 8 40 6.6
DP Explore 9 5 3 6 9 10 42 7.0
DP Develop 9 10 6 9 4 6 44 7.3
DP Implement 7 10 6 9 5 8 45 7.5
DP Visualize 7 8 7 7 9 8 46 7.6
DP Synthesize 9 5 8 9 10 8 49 8.1
S ub -To ta l 5 5 6 2 6 2 7 7 7 2 7 4 4 02
MP Structure 2 5 2 6 4 8 27 4.5
MP Balance 9 1 2 8 4 4 28 4.6
MP Budget 4 10 1 5 4 4 28 4.6
MP Ensure 7 5 6 8 3 4 33 5.5
MP Monitor 7 5 5 9 4 6 36 6.0
MP Negotiate 4 10 5 5 6 8 38 6.3
MP P lan 4 10 2 9 7 6 38 6.3
MP Understand 2 8 9 9 8 6 42 7.0
MP Communicate 7 10 9 10 10 6 52 8.6
MP Clarify 9 10 9 8 10 8 54 9.0S ub -To ta l 5 5 7 4 5 0 7 7 6 0 6 0 3 76
TC Determine 2 5 8 5 1 2 23 3.8
TC Foster 2 5 1 7 3 8 26 4.3
TC Mobilize 4 10 2 9 3 6 34 5.6
TC Build 4 10 6 4 7 6 37 6.1
TC Encourage 2 8 2 7 8 10 37 6.1
TC Weave 7 8 7 7 4 6 39 6.5
TC Connect 2 5 8 9 10 6 40 6.6
TC Recognize 9 5 8 7 8 6 43 7.1
TC Evaluate 9 8 4 8 7 8 44 7.3
TC Translate 9 5 9 8 6 8 45 7.5
Su b-To ta l 5 0 6 9 5 5 7 1 5 7 6 6 3 68
Table16. Card sortingresearch datafor health caredesigners.
Overview
Table 16 representsall datafrom the “health care designer”subjects.Datais sorted accordingto design process(DP),
managementprocess(MP),or transformational change (TC).Table 17 representsdatafrom the “health care manager” subjects
and all datawassorted in the same way asTable 16.
Insights
Sortingthe datarevealed that health care designersandmanagershad the conceptof synthesizein common when looking
atthe top 2 words. Thisword wasassociated with the “designprocess.” Forthe “managementprocess,” the common words
between the two subjecttypes were communicateand clarify .For“transformational change,” the common word was translate.
The wordsthatscored highestwere synthesize , communicate ,clarify ,and translate.The wordsthat scored the lowestwere the
same within each group: play , draw , balance , structure , determine ,and foster .
Research Activity
Overview
The research wasconducted overa two-week period fromJanuary 19 to 30,2015.A total of 6 designersand 6 managerswere
interviewed attwo St. Louishealth care companies.The designersand managersranged in role type and level,butall had either a
creative or managerial role supportingtransformational change,innovation and large scale projects.All subjectswere responsible
forsupportingchange initiativesin theirorganizationsatvariouslevels.The interviewswere conducted within aone-hourtime frame.All interviews were recorded and transcribed upon
completion.Photographswere taken of the subjectsduringthesigningof the consentforms and duringthe card sortingactivity.
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S u bj e ct T yp e H M H M H D H D H M H D H M H M H D H M
Subject # 1 2 3 4 5 6 7 8 9 10
Code Word
MP Balance 5 2 9 1 6 2 2 8 8 2
MP Structure 6 2 2 5 0 2 5 8 6 5
MP Budget 6 2 4 10 3 1 5 5 5 5
DP Play 1 8 4 5 6 4 8 4 2 2
TC Determine 3 3 2 5 10 8 9 7 5 6
DP Draw 2 4 4 1 9 8 2 8 10 2
DP Define 5 5 2 5 7 10 2 7 8 2
TC Foster 7 5 2 5 8 1 7 5 7 7
MP Ensure 7 1 7 5 9 6 7 5 8 5
MP Monitor 4 3 7 5 7 5 9 6 9 3
TC Build 8 7 4 10 8 6 4 6 4 6
DP Discover 4 8 2 5 8 3 9 5 9 8
TC Weave 6 8 7 8 8 7 3 5 7 8
DP Develop 6 9 9 10 0 6 9 5 9 5
TC Mobilize 8 5 4 10 9 2 8 8 9 7
MP Negotiate 7 2 4 10 8 5 10 10 5 5
TC Recognize 4 8 9 5 5 8 7 6 7 7
TC Evaluate 5 6 9 8 8 4 8 8 8 3
MP Understand 5 6 2 8 7 9 7 8 9 8
DP Explore 3 8 9 5 9 3 7 8 6 7DP Visualize 3 8 7 8 10 7 8 5 7 4
MP Plan 7 7 4 10 1 0 2 8 9 9 7
TC Encourage 6 8 2 8 10 2 10 6 7 10
TC Translate 3 7 9 5 7 9 8 10 8 7
DP Iterate 7 9 2 8 10 7 10 5 8 10
TC Connect 8 9 2 5 10 8 10 8 9 9
DP Synthesize 5 8 9 5 7 8 9 7 9 10
MP Clarify 2 5 9 10 10 9 10 9 8 6
MP Communicate 5 6 7 10 10 9 10 10 10 6
DP Implement 9 7 7 10 10 6 10 10 9 10
HD Totals 160 205 167 225
HM Total s 157 176 229 221 211 18
Data: Card Sort all Data
Table18. Card sortingresearch data.
Overview
Table 18 showsall dataentered, based on how the subjectsnumbered each word duringinterviews.Subjects were firstasked
to place the wordsin proximity to the word “Me” based on howoften they did thatwork in theirjobs. Subjectswere then asked to
rate on ascale of 0–10 how they thoughtthey supported changethrough the wordslisted on each circle.The datais sorted based
on the average totalsfromlow to high.
“HM” indicateshealth care managersand “HD” noteshealth care
designers,all workingwithin two large health care systems inSt.Louis, Missouri.A total of 6 designersand 6managerswere
interviewed.The codeswere “MP” formanagementprocess,“DP”fordesign process,and “TC” for transformational change.
Insights
A review of the datarevealed thatthe most common activities
forall subjectswere visualize , plan , encourage , translate , iterate ,connect , synthesize , clarify , communicate ,and implement.This
suggeststhat,on average,these wordssupport change in thesubjects’activities.
Health care professionalsscored atotal of 30 pointshigheroverallthan designers.Thissuggeststhathealth care managerswere
more engaged in change within theirjobsthan designers.
Analysis: Synthesis by Subject Type
– +How welldoyou thinkyou support changethroughtheseactivities?
VisualizeSynthesize ImplementPlayDraw DesignProcess
C om mu n ic a te C la r if yBalance Structure
E va lu ate C on ne ctTranslateFosterDetermine
UniquetoHealthCareDesigners
UniquetoHealthCareManagers
Overview
Figure 16visualized 6 wordsin common between health caredesignersand managersthatranked low on how well the subjects
believed they do these thingsin supportof transformationalchange.Fourwords representingwhatsubjectsbelieved they do
well in supportof change rose to the top of the scale.However,2unique wordsranked high for designerscompared to managers.
Insights
Figure 16clarifiescommon challengesfor both health care
designersand managers.It wasrevealingthat the same wordsexisted forboth subjecttypes. Thisinsightmay informstrategies
to help designersand managersachieve these activitieswhenleadingchange type activities.
The visualization also helped identify the top common strengthsfordesignersand managerswhen supportingchange.In addition,
there were unique wordsforeach subjectt ype – visualizeandevaluatefordesignersand implementand connect formanagers.
Figure16. Visualization by subject type. Thisfigureidentifiesboth common strengthsaswell assomeuniquequalitiesfordesignerscompared with managers. Author’simage.
TransformationalChange
Management Process
DesignProcess
ManagementProcess
TransformationalChange
LEGEND
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Research Activitiesand Synthesis
C d S t D t D i & MC d S t D t M
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Card Sort Data: Designers & Managers
n s r u c i on s pr ovi e o s u j e c s :Step 1: Arrange wordsin proximity to “Me”
a se on ow o e n you o a yp e o a c v yin yourjob.The closerto “Me” the more youdo
a y pe o a c v y n y ou r o . 5 m nStep 2: On ascale of 0–10 how well do youthinkyou su p por c a n g e r ou g e se a c v e s.(5 min)There are two blank cardsif there area o na n gs y ou o a yo u e e a reimportantto include.
Insights
Figure 22 isa composite of all subjects’card sortingactivities.Lookingat the placementof the wordsin Figure 20 and Figure 21
revealed some differencesbetween health care designers andmanagersin institutional health care environments.
Designersappearto do lessactivity in theirjobs compared to
whatthey believe contributesto change in theirwork.Thisreflectsa disconnectbetween theirability to supportchange andthe amountof time they spend doingthatactivity in theirjobs.
Managersappearto do more activity in theirjobsthat isequally
reflective of supportingchange.The similarity in amountoftime and ability suggeststhey may be more invested in change
activitiesfor theircompany.
Figure22. Compositeofall subjects’card sort results. Thevisualization layesubjects’card sort exercisesonto oneimageand identified thetop wordsfrowith thecorrespondingcolor. Author’simage.
Card Sort Data: Managers
n s r u c i on s pr ovi e o s u j e c s :Step 1: Arrange wordsin proximity to “Me”
a se on ow o e n you o a yp e o a c v yin yourjob.The closerto “Me” the more youdo
a y pe o a c v y n y ou r o . 5 m nStep 2: On ascale of 0–10 how well do youthinkyou su p por c a n g e r ou g e se a c v e s.(5min)There are two blank cardsif there area o na n gs y ou o a yo u e e a reimportantto include.
Overview
Figure 21layersthe 6 managersubjects’card sortexercises ontoeach other.A filterwas applied to each in orderto see asmany of
the wordsas possible,aswell as to identify density and proximityto “Me.” In addition,the top 3 words identified in Figure 16 were
layered in to help explore any related trends.To build thismap,subjectswere asked to place each word in proximity to “Me”
based on how often they did thattype of work in their jobs.Indoingso, abaseline of common job activitieswere identified foreach of the subjecttypes.
Figure21. Compositeof6 managers’card sort results. Thevisualization layers6 healthcaremanagers’card sort exercisesonto oneimageand identified thetop wordsfromFigure16 with thecorrespondingcolor. Author’simage.
DesignProcess
ManagementProcess
TransformationalChange
LEGEND
Research Activitiesand Synthesis
Card Sort Synthesis: Amount vs AbilityCard Sort Data: Synthesis
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Card Sort Synthesis: Amount vs. Ability
Iterate
Translate
Budget
Play Draw
UnderstandPlan Communicate
Amount:Averagelocation ofactivity relativeto “Me.”
Farther = Less activity Closer = Mote Activity
A
Insights
Figure 24 illustratesacoupleof interestingrelationships
between amountof activityand ability. Communicateand
translateare activitiesthat bothdesignersand managersdo
more often in theirjobs.Thesewordsalso gethigh marksforsupportingchange.
Atthe opposite end, play and
draw are done the least and donotsupport change well. Iterate
wasthe only word designersandmanagersboth do more often;however,it wasnot an activity
they believed supported change.
On average,subjectsillustratedthatthese activitieswere done
the leastamountin theirjobs.
On average,subjectsillustratedthatthese activitieswere done
the mostamountin theirjobs.
Onbe
lea
Figure24. Synthesisof card sort relationship ofamount and ability. Theillustrationrepresentstheamount oftimesubjectsspend on an activity in their jobsand theirabilityto makea connection between activities. Author’simage.
Card Sort Data: Synthesis
Understand
Plan
Play
Foster
Build
Translate
Iterate
Draw
Me
–
+
n s r u c i on s pr ovi e o s u j e c s :Step 1: Arrange wordsin proximity to “Me”
a se on ow o e n you o a yp e o a c v yin yourjob.The closerto “Me” the more youdo
a y pe o a c v y n y ou r o . 5 m nStep 2: On ascale of 0–10 how well do youthinkyou su p por c a n g e r ou g e se a c v e s.(5min)There are two blank cardsif there area o na n gs y ou o a yo u e e a reimportantto include.
Insights
Figure 23illustratessubjects’average placementof wordsinthe card sortingexercise.The placementrepresented how often
subjectsdid an activity in theirjobs. Wordsplaced closerto “Me”reflected thatsubjectsdid thatactivity more;conversely,words
placed fartheraway represented less.
More subjectsplaced the words communicate , understand ,andplan closerto the center. These 3 wordswere in the top 15 wordsthatrepresented subjects’ability to supportchange.It suggests
astrong connection between ability and amountof time spentdoingthat activity,potentially identifyinga good setof attributes
to support. When lookingatthe second setof top 3 closestwords,we see 2unique words, translateand iterate ,which are associated
with design and transformation.All other wordsare associatedwith management.
More subjectsplaced the words budget , draw ,and play fartherfromthe center. These were also in the bottom15 words,thus
suggestingacorrelation between lower ability and lessamount
of time spentdoing these activities.However,it doespresentanopportunity to evaluate if these representactivities thatmightsupportchange in otherways.
Figure23. Synthesisofcard sort map. Displaysthe 6 wordsmost frequently placed closeto “Me” and the6wordsmost frequently placed fartherfrom “Me” by subjects. Author’simage.
DesignProcess
ManagementProcess
TransformationalChange
LEGEND
Communicate
Budget
Structure
Clarify
H o w o f t e n d o y o u d o t h a t t y p e o f a c t i v i t y i n y o u r j o b ?
Research Activitiesand Synthesis
InterviewSynthesis: ChallengesInterviewSynthesis: Working
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Interview Synthesis: Challenges
“It’salwaysplayingthestandardsagainst theindividual needs.”
“Anythingthat comesdto individual behaviojust really hard.”
“Thosethingswith crossoverboundariesarethe hard onesto solve.”
“Thepayment modelsand structuresare nottotally aligned yet withthebehaviorsthat youwould want to seethatwould eventually result
in theoutcomesthat youwould want to happen.”
“When you’reinbetween spacesorthey need to bringmultiplethingsto bearon aparticularpatient’sissue, that’swheretheydon’t work so well.”
“All ththattowresp
Insights
Insightsaboutchallengesreflected a very large spread in theissues.Comparingcommentsto the card sortingexercise showed
thatcommunication isan underlyingchallenge acrossall areas.There seemed to be aconstantneed to better understand what
all the differentareasare doingand how to better coordinatetheiractivities. The complexity of problemsbeing solved seemed
to constantly pointto the need forbetter communication andcoordination.Examplesof thisincluded electronic medical recordsystemsand simply makingdecisionsaboutpatients. There wasa
sense thatmuch of the knowledge isthere, butgettingit all in oneplace isachallenge.
In addition,the health care sectorseemed to be lookingoutward
forsolutions. Subjectsare notonly willingto use new ideas,butthey are actively goingout and lookingat otherdisciplinesforknowledge.Thisinsight wasalso reflected in the earliermarket
analysisand the breadth of organizationsin health care thatareusinginnovation toolsto re-engineer how they are operating. Chall
Interview Synthesis: Working
“I think very old paradigmsarebeing challenged.”
“Transparency is anothergood thing.”
“I think aswe’removingmoretowardsafocusonpopulation healthmanagement.”
“Health careworkersdo an amazingjob atworkarounds.”
“Lookingat patientcenteredoutcomesishugenotjust patient
reportedoutcomes.”
“Slowly but aremovingfrom areactivemedicalapproachinto moreof a
preventativepublichealthapproach.”
“I think what isworkingisthat we’realwaystrying toimprovetheforms to supportthefunction, so wespendalot oftimeaskingpeoplehowthey do theirworkand learningtheprocesses,and engagingthe coreunderstanding.”
“I think that outcomescertainly havegotten much betterover theyearsand I think thevoice ofthe customerfocus, we’vehad alot of that asatrendy term about fiveyearsago, andI think we’restill seeingthat maybeinfamily centered care. ”
“I think that health careisbecomingmore nimbleinapplicationsofnew ideasand new treatments.”
“Fundamentally, whathappensin theinpatientroom and theinpatientunit isreasonably goodexperienceformost folks. ”
“We’rereally good at treatingdisease.”
Figure25. Quotationsfrom subject interviews. A selection ofquotesaboutworkingactivity in institutional health care. Author’simage.
Insights
Insightsfrominterviews reflected thatsubjectsbelieved thepeople who are in health care are committed to their jobsand
wantto do well. Patient-centered outcomestopped the mindsformany in partbecause of federal regulations.In addition,there
wasa focuson preventive care asopposed to reactive medicine.The scrutiny hasalso led to more transparency in many of the
organizations’operations.
Subjectsalso expressed agreaterwillingnesson the partof their
organization to adoptnew ideasin orderto solve some of thechallengingissuesfacinginstitutional health care systems.There
wasa culture of constantprocessimprovement.
Health CareDesigners
Health CareManagers
LEGEND
Working
Research Activitiesand Synthesis
InterviewSynthesis: Design ProcessInterviewSynthesis: Barriers
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Interview Synthesis: Design Process
“Design pourorgaseemsadisjointin silos.”
“I think theprocessimprovement pieceand havingthoseworkshopswith theright peopleis important.”
“I think that thedesignprocessisfinding thewayto best utilizetheresourceavailableto support theneedsand theworkflowthat needsto happen.”
“Youare readingbetweenthemassdata and thenbeingable to takethatproblem that younowidentified so clearly.”
“Itthwp
“So I would start by figuringout, definingtheproblem -I’velearned howimportantthat is.”
Insights
Mostsubjects identified the design processas aproblem-solvingprocess.Each had aunique way of describingitor adifferent
application to it,but overall,they all defined itas aproblem-solvingtool. Some equated itwith aprocessimprovementtool
and some used itfor more open-ended exploration of possibilities.
Des
Pro
Interview Synthesis: Barriers
“So thebarriersthat exist alot of timesisalot around theacceptance, so feelingownership orclear understandingof thechangeor thepotential impact ofthechange.”
“Asit relatesto the built environment, thebiggestbarrieris that thepeople that areinvolved inthebeginningare not thepeople that ultimatelyareusing thespaceso there’sno continuity orunderstandingon thepart ofthe peoplethat arecurrently livingin thespacehow thespacewasdesigned to function.”
“Adoption isahugething,yeah.”
“Thebarriersquestionisalwaystoughestbecausethere’ssomany levelsand they’reso strong.”
“Weseealotofturnoveri nthestaff.”
“So one bigoneisourturnoverrate. It seemslikewe can just get
peopletrained on an interventionand then wehavenewmanagement and newstaff. ”
“Turnover. It’sahugefactor.”
“Peoplejust beingset in theirwaysand not wantingtochange.”
“Whilewe’retrying to learn frommanufacturingindustry, we’renot great yetat learninghowto use daily improvementboards. ”
“Ifit’s somethingthey don’tthink about every day, it’sreally not goingto stick.”
“I think turf. Youknow,peopletryingto protecttheirturf, youknow. ”
“No onehasmoretimetodo newstuff.”
Figure27. Quotationsfrom subject interviews. A selection ofquotesaboutbarrierto sustainingchangein institutional health care. Author’simage.
Insights
Barriersto change for the organization were many.Turnoverwasa constantchallenge and wasa significantdisruptor.In
one case,asubject noted thatover40% of the participantthatinitiated aprojectwould no longerbe there when the projectwas
implemented.Many timesformulti-yearprojects the same peoplethatdesigned aspace would no longerbe there to move in.
A second large barrierto change wasadoptingthe idea.Whilemany identified teammeetingsas agood processto gain
alignment,there wasstill an acknowledgmentthatadoption wasdifficult.Otherc hallengesincluded available time to do work or
people beingset in theirwaysof doingthings.
Barriers
Health CareDesigners
Health CareManagers
LEGEND
Research Activitiesand Synthesis
Persona: Sally
“Ourvision iscoming“It wasgreat to seethose financial numbersInterview Synthesis: Management Process
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y
Sally F.
Directorof Activation Management
Age: 31Hight: 5’– 6”
Race: CaucasianEducation: MBA, MPH
s s ginto focus.”
Figure31. Sally personaactivities. Anoverviewofthekindsof activitiesSally hasto do in herday-to-day job aspart ofherlarge-scalechangesupportfunctions. Author’simage.
Figure30. Sally persona. “Youngnurseorfemaledoctor” [Photograph], by P.Marcinski, n.d., Fotolia. Retrieved July7, 2014, from: http://us.fotolia.com/id/21540802
asg ea see se a a be sand knowwe areall on thesamepageabout howto proceed.”
E va lu at e D et er mi ne
BudgetBalance
PlayDraw
Needs Improvement
Overview
Sally isa recentaddition to alarge health care systemin the St.
Louisregion. She hasjustarrived fromCaliforniawhere she wasinthe health care businessmanagingoperationsfor athree-hospital
system.With an MBA and MPH and five yearsat herprior job,where she managed ateamof five people, she will now manage
atwenty-person teamfacilitatingthe openingof a200-milliondollarfacility forpediatrics.This will require all heracumen inunderstandinghow hospitalsof the future will need to run and
manage ateamcharged with documentingthe processandensuringall move into the new spaces.
Environment
Sally isworkingout of atemporary facility thatisoutfitted to
change once the projectis complete,so ithas alarge loft-likequality to it.While she overseesateam of twenty,there are over
one hundred people in thisspace, all very busy on variouspartsofthe project,so itis hard to focusat times.
Skills
Sally isago-getter. She isdirect and professional in her
interactions.She alwayshas to translate information froleadership meetingsto her teammembers.She connects
and isable to implementaroad map addressingaparticHerteam appreciatesherencouragementand ability to
iterate ateach step of the way.
Frustrations
Given the large scale of the new organization, it hasbeedifficultfor Sally to know how to prioritize.Her ability tocompetingopinionsof the variousstakeholdersis hard,
when there are strong-willed doctorsthatdo not wanttono foran answerand are stuck in theirways. She feelssh
really use some help with structuringhow bestto convinherideas will work.If she could only draw the ideas!
DesignPro
TransformaChang
ManagemProces
“Weusein ourdepartmentPlan-Do-Study-Act.” “SixSigma and DMAICis
definitely necessary onsomeprojects.”
“Makesurethat all oftheright peoplearetalkingto each otherI think isone.”
“Thelean and six-sigmablackbelt culturecameinto healthcare, so in essencethey arejust learningfrom otherdisciplines.”
“Nowthat alot ofthatperformanceengineeringisstandard in health care,everyoneislookingforthenext tools, so that iswhy wearelookingforothertoolsfrom otherdisciplines.”
“What wedo haveisstandard operatingprocedurein many ofthethingsthat wedo.”
“... peopleare nevergoingto becogsnor would weeverwant to treat themthat way.”
“Wehaverigidly defined protocolsthat arefollowednot just forscanning, but foreven just the treatmentofpatient information and treatment ofsubjectinformation, treatment of peopleensuringthat theyaregiving theirinformed consent.”
“Weareusingallthesethingsthatwehaveused inhealth careforavery longtimeand wearejustrunningin circlesit seemslike usingthesamestuff.”
“Becausewhat happensisthat person thenleavesand thenthere’sno, youknow,consistency. Thenextperson comesin. Well,
I want it to belike this.Well, that’snot what it’sabout. It’sabout tryingto setup theflowso thateverybody workswell.”
“...likesto haveevents,whetherit’san eventora2P, orsomekind ofLean orSix Sigmaevent,whereyou’reactuallyputtingtwo orthreeusergroupstogetherthat aresharingapatient.”
“...wewrotefourhypothetical patientexperiencesthat startedwith, there’sthephonecall to a woman at worklettingher knowthatherhusband had aheartattack.”
y g
Figure29. Quotationsfrom subject interviews. A selection ofquotesaboutmanagement processesto sustainingchangein institutional health care. Author’simage.
ManagementProcess
Health CareDesigners
Health CareManagers
LEGEND
Insights
Processimprovementmethods were discussed frequently.Theseincluded Lean SixSigma,Plan-Do-Study-Act,and Define Measure
Analyze Improve Control (DMAIC).Variousproject managementtoolswere used,butnone stood outas overarchingbestoptions.
A few noted Human-Centered Design asan emergingtool to solvesome of theircomplexchallenges.Overall,many proceduresare
rigid with setprotocols; thus,there islittle roomfor deviation orinnovation around processorlarge changes.
One overarchingtheme wasthe need forteammeetings –repeatedly,often weekly – in orderto have continuousbuy-in for
processimprovementor fornew initiatives.
Research Activitiesand Synthesis
Research InsightsPersona: Tomas “Weneed anew“Weneed someways to“I need to figureout howto make“Focusingmoreon peoples’behaviorsand
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Insight 1
Health care turnover is a significant problem,often leading to stalling a project or shelvingit altogether.
Insight 2
Adoption and buy-in is difficult to mitigatehealth care because there are so many expstakeholders involved in one clinical settin
Insight 4
Health care is open to adopting new human-centered design strategies in order understandand improve operations and patient outcomes.
Insight 5
Health care managers and designers havedifferent skill sets and methods for solvingproblems, yet they are often tasked withimplementing large projects in collaborati
Tomas C.
Directorof Design Management
Age: 45Hight: 6’– 1”
Race: LatinoEducation: BFA, MA
processto worktogether.”
get peoplecomfortablewith change.”
betterconnectionsamong mycolleagues.”
habitsisgoing to bea betterway to solvesomeof ourchallenges.”
Clarify
EvaluateEvaluateE nc our a ge R ec ogn i ze
Negotiate
S ynth esi ze I m pl em e ntVisualize
Communicate
Translate
DesignProcess
TransformationalChange
ManagementProcess
Doing Well
FosterDetermine
BudgetBalanceStructure
Play Draw
Needs Improvement
Overview
Tomasisa native of St.Louis, Missouri.He received his
undergraduate education atPratt Institute in New York City.Upongraduation,he worked forasmall firm with large retail health care
clients,mostly consumerproductsfor Walgreens.Afterfifteenyearsat New York-areafirms,he returned home to work fora local
firm,continuingwith a health care focus.He then moved to theclientside, joiningan innovation teamat amid-size local healthcare system.He washired forhis graphicdesign skillsand because
he isa good visualizerof information.Much of hiswork had beenclarifyingcomplexsystems through information graphics.
Environment
Tomasworksin a corporate environmentcharacterized by typical
rowsof desksin a large open area.However,the company createdanew space called the “Design Tank” to begin exploringnew
processimprovementstrategiesfor theiroperations.
Skills
Tomasisa greatcommunicatorand useshis design skillsto
visualize and clarify complexconceptsor processesthatare partof the firm’soperations.
Frustrations
He isfrustrated with hisrole – he doesnotget to draw orplayasmuch asin priorroles. Thisis mostly due to the corporateenvironment,buthe hopes innovation will be fostered by the
seniorleadership once they see hiswork. He isfeelinga littlestuck in asystemwith people thatdo notwant to change orexplore new ideas.
Attitude
Tomashasa casual,low-key attitude,and nothingseemsto upsethim.When people startgetting emotional,he tellsa joke to createsome levity.He isgood atrecognizingdetailsabout people and
then evaluatingif itis bestto drop ajoke.
Typical Tasks
Atthe moment,Tomasis dealingwith whatmost designersconsider
superficial activities,i.e. justthe visuals.He wasbroughtin tobe partof largert eam,meetingaround strategy and improving
communicationsand operationsof the company,butit hasbeen slowgoing.His bossis achampion of hiswork and skills,but adoption from
otherswill be slow.
Need and Wants
Tomasfeelshe needsto weave hisway into amore robustrolewithin the company,to validate hisskill forlarger rolesthat leadto innovative waysof supportingpatients.He wantsto make a
difference in the livesof the people thatcome to the hospital.Heknowsthere are inefficienciesand people do notlike being there,so
he really wantsto supportchange.
Figure33. Tomaspersonaactivities. An overviewofthekindsof activitiesTomashasto do in hisday-to-day job aspart ofhis design managementsupport functions. Author’sImage.
Figure32. Tomaspersona. “Man on thewall”[Photograph], by Y. Poirier, n.d.,Fotolia. Retrieved July 7, 2014, from:http://us.fotolia.com/id/60940857
Research Activitiesand Synthesis
Research Findings
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Collective Strengthsfor Change
Synthesize CommunicateTranslate
Makesurethat all oftheright peoplearetalkingto
ach otherI think isone.”
“Try to createthesenseof urgencythat weneed to fixthis, so everybody’son thesamepage.”
Health Care
Designers(MArch, ID, GD)
Health Care
Managers(MBA, MHA)ransparency is another
ood thing.”
Health careworkerso an amazingjob atorkarounds.”
Health care isgood at thesestrategies
Health care isopen to using