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Copyright © 2013, Peter Jones
Design for Care
Human-Centeringin Healthcare Service Systems
Peter Jones Redesign Network
OCAD University, Toronto
Copyright © 2013, Peter Jones
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
Copyright © 2013, Peter Jones
“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
Copyright © 2013, Peter Jones
Copyright © 2013, Peter Jones
And we are not helping systemically …
• User Experience / Interaction Design• Service Design • Evidence-Based Design• Environmental Design• Participatory Design• Generative Design• “Disruptive” Innovation
Copyright © 2013, Peter Jones
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.
Copyright © 2013, Peter Jones
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
Copyright © 2013, Peter Jones
• 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
Copyright © 2013, Peter Jones
Contexts of Care Service
9
Drugs & Tests
About my
Condition
Patient RecordsM
edical
Knowledge
Doc
tor
- Pa
tient
Hos
pita
l set
ting
Hea
lthca
re
Team
CONTE
XT of C
ARESERVICE
INFORMATION
Copyright © 2013, Peter Jones
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
Copyright © 2013, Peter Jones
How do People Use Health Information ?
Copyright © 2013, Peter Jones
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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Copyright © 2013, Peter Jones
Copyright © 2013, Peter Jones
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.
Copyright © 2013, Peter Jones
Health seeking includes information seeking & explores alternatives.
Knowledge acquisition for making sense of health issues.
One channel we have some access to.
Copyright © 2013, Peter Jones
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
Copyright © 2013, Peter Jones
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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Copyright © 2013, Peter Jones
Healthcare AS a design practice
Copyright © 2013, Peter Jones
Copyright © 2013, Peter Jones
Health-seeking in Context of Care
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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
Copyright © 2013, Peter Jones
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
Copyright © 2013, Peter Jones
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.
3
Copyright © 2013, Peter Jones
Copyright © 2013, Peter Jones
How does a patient fall through the cracks?
Copyright © 2013, Peter Jones
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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3
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Atrial Fibrillation System Redesign
Can care service design scale to the system level?
Service system - coordinated work practices, org protocols, patient communication
Copyright © 2013, Peter Jones
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.
Copyright © 2013, Peter Jones
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.
Copyright © 2013, Peter Jones