peter jones rsd2 launch

Copyright © 2013, Peter Jones

Design for Care

Human-Centeringin Healthcare Service Systems

Peter Jones Redesign Network

OCAD University, Toronto


Structure & Story

• 9 Chapters across health sectors• Rethinking Consumers, Patients, Systems• Innovation of Services, Practice• Research, Methods, Cases• Wrapped around a care story• A Starting Point – not final word!

designforcare.com Booksite (DFCRSD)

caredesignnetwork.com Practice network

@designforcare Twitter handle


“What if Designers were included in the team as care professionals?”

Helping Medicine change from the inside. A design capacity for health practice & care organizations.

• People not patients. • Systemic, touches every sector• Connects across disciplines • Cases, Methods, Experiences

Rethinking Care 1. Design as Caregiving2. Co-Creating Care3. Seeking Health

Rethinking Patients4. Design for Patient Agency5. Patient-Centered Care Service

Rethinking Care Systems6. Innovating Points of Care7. Designing Healthy Information Technology8. Systemic Design in Healthcare Innovation 9. Futures in Service Innovation

designforcare.com@designforcare

Design for Care: Innovations in Healthcare Experience


And we are not helping systemically …

• User Experience / Interaction Design• Service Design • Evidence-Based Design• Environmental Design• Participatory Design• Generative Design• “Disruptive” Innovation


Sociotechnical Service Systems

Service systems are innovations of value, IT systems, resources, & stakeholders.

Value co-creation occurs at each touchpoint.

But today there’s no design process –

Sociotechnical systems – absent service design.


Sorting Out Design

Complexity increases at each .0

Number of stakeholders >Need for collaboration >Multi tech, multi-design, multi-professional

Healthcare services may require all 4 levels of skill & knowledge.

But design skills do not transfer up. Mixed teams always a necessity.

Adapted from Humantific , 2007-2013


• Integrating clinical & community services• ACO - Distributed care models• Design for “healthy habitation”

• New business models• Integrated services + architecture• Clinical teams communication &

coordination

• Patient-health experience of service• Redesign EHR / information as workflow• Patient self-service in local clinics• Patient information across care journeys

• Innovative & usable wayfinding• Interior space for infection control


Contexts of Care Service

9

Drugs & Tests

About my

Condition

Patient RecordsM

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Knowledge

Doc

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INFORMATION


1. Persons, not users - or patients. People are Health Seekers, service customers.

2. Clinical Work Practices. Healthcare business must also be designed.

3. Healthcare system.Design at system level is a service framework.

3 Human-Centered Contexts


How do People Use Health Information ?


Health Seekers

• None of us self-identify as patients.• Use an empathic design approach.

• We all seek health, as a sensemaking process.• The design aim is to fulfill care. Cannot design health.• Design better value for people seeking health.

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1. Understand what is wrong. 2. Gain a realistic idea of prognosis. 3. Make the most of consultations. 4. Understand processes & likely outcomes of tests

& treatments.5. Assist in self-care. 6. Learn about available services & sources of help.7. Provide reassurance & help to cope. 8. Help others understand. 9. Legitimize seeking help 10. Learn how to prevent further illness. 11. Identify further information & self-help groups.12. Identify the best health-care providers.

Information Touchpoints

Coulter, A., Entwistle, V., & Gilbert, D. (1999). Sharing decisions with patients: Is the information good enough? British Medical Journal, 318, 318–322.


Health seeking includes information seeking & explores alternatives.

Knowledge acquisition for making sense of health issues.

One channel we have some access to.


Patients Like Me

• Started by one individual with a personal concern

• Grew from ALS to all types of disease profiles

• Open platform• Moderated community• Patients as their own

source of expertise

• Now a research data set

• ePatient movement• Empowered

E-ifiedEngaged

• Self-informing medical decision-making

• ePatients as community activists – health promotion


Clinical Services

• Care “designed” today for efficiency & cost.Not to deliver a superior value or experience.

• Patient experience is not directly designed. An outcome of well-designed process.

• What does patient-centred mean to you?Can service systems be designed around patient?

• Design research differs by care context: Sequential, Iterative, Complex, Emergent

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Healthcare AS a design practice


Health-seeking in Context of Care


Layered on Clinical & Technical Work

Multiple IT resources / interfaces

Cross-context cognitive tasks

A continuous sensemaking problem, interrupted by emergent events

Information selection, trust, navigation


IDEO + CHCF Project SynapseContinuity of Care

• Patients feel they are left on their own to figure out next steps.

• Patients with serious health issues work around the system to get the best care.

• Episodic and disjointed care hides valuable connections.

• Both patients and physicians doubt the reliability of (reported) health data.

IDEO + California HealthCare Foundation , 2012

Copyright © 2013, Peter JonesIDEO + California HealthCare Foundation, 2012

• Represent what I truly care about

• Present information in a way I can relate to

• Help me cross-check my facts• Help me close communication

loops among my care team• Set me up to have clarifying

and guiding conversations• Clearly lay out the next steps• Show my trajectory over time

Value to Patient


Healthcare Systems

• Big Box Healthcare is huge, disrupted by cost & policy, not innovation …

• Innovation of business, technology, cultures. (The system is not just a collection of services)

• How should these social systems be designed for societal health outcomes?

• Service design of value-based care.

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How does a patient fall through the cracks?


Atrial Fibrillation Care

Many health services treat chronic & complex illness as exceptions. Patients fall between the cracks & are shuttled around, getting fragmented care. By not adapting to the changing reality of the chronic demographic, costs rise as hospitals increase their exception cases.

Morra, et al (2010). Reconnecting the pieces to optimize care in Atrial Fibrillation in Ontario.

CD1 - CD41

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Copyright © 2013, Peter Jones28

Atrial Fibrillation System Redesign

Can care service design scale to the system level?

Service system - coordinated work practices, org protocols, patient communication


Value-Based Care

Porter & Lee in Oct HBR, with Cleveland Clinic:• Integrated practice units • Cost & outcomes measurement• Bundled payments• Integrated care delivery across facilities• Expanded services across geography• IT platform(s) to enable those processes.


Designing Services to Scenario

• Healing fragmented information & workflow is #1• Discontinuity of care is both dangerous & a poor exp• As hospital decentralize, follow with moves to mobile

& distributed information services • IT as managed service > needs service systems design • Much greater focus on patient experience

But PX remains ambiguous in clinical work• Focus on “experience” is misplaced – better design of

service touchpoints will improve this measure.


Peter Jones, Ph.D.@designforcare

designforcare.com

[email protected]`

peter jones rsd2 launch

Health & Medicine