Designing the Patient Experience

M

ost hospitals today aspire to be patient centric. As a patient, however, it could be argued that many hospitals are actually more staff-centric rather than patient-centric; designed predominantly on making treatment more operationally efficient and clinical, stripping out ‘unnecessary’ costs out of the system. Conventional thinking might dictate that anything that is truly patient focused provides minimal value and impose additional costs that could be otherwise spent treating patient conditions.

At DesignWorks, the strategy innovation lab at the Rotman School of Management, Business Design is being leveraged to help organizations create new stakeholder value and challenge convention. It draws upon the fundamental principles and practices found in design (e.g., ethnography, prototyping, visualization, systems thinking) to generate more innovative, effective and efficient solutions.

The methods and practices of Business Design are built upon the framework below:

Gear 1 - User Understanding: The ability to empathize with the end user on a deeper level. What do they think, feel, do and what are their challenges? The objective is to understand what do users ultimately need.

Gear 2 - Iterative Prototyping and User Feedback: Thinking broadly and with minimal constraints about what could best meet user’s needs. Making the concepts/ideas tangible and incorporating feedback early in the development process. Through this iterative approach, creative and sometimes wild ideas are refined into powerful and effective solutions.

Gear 3 - Strategic Business Design: Designing the organization’s business model/operating system to effectively deliver and sustain the solution whereupon the system itself becomes a source of advantage.

The following is one of many examples demonstrating the practice of Business Design and the value it contributed in a healthcare setting.

Background:

Princess Margaret Hospital (PMH) is one of Canada’s leading research hospitals, devoted exclusively to cancer research, education and patient care. Their expertise is recognized globally and spans a broad range of specialties including: surgical oncology, chemotherapy, bone marrow transplantation, hematology, advanced medical imaging and radiation therapy.

In partnership with the Conway Foundation, the management team at PMH set out to redesign their Systemic Therapy (chemotherapy daycare and transfusion) facilities which were both overcapacity and required improvement (functionally and aesthetically). Their vision was to create a new space and experience that was truly patient centric and world class. To do so they required a better understanding of what patients go through and what matters to them.

Rather than immediately starting with the architectural design, Rotman DesignWorks was first approached to help the hospital better understand the patient experience, give patients a voice in the project and develop creative solutions that were more integrative and holistic.

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Systemic Therapy Centre at PMH (pre-redesign)

Methodology:

Gear 1 - User Research: Using a design-based approach to field research, the DesignWorks research team (Mark Leung and Eugene Grichko) spent considerable time at the hospital observing the different behaviours and interactions of patients and staff and experiencing key points of the in-hospital patient journey (e.g. commuting, way-finding, checking in, waiting, etc.). This allowed them to gain a better appreciation of what it really feels like to sit for several hours in a warm, crowded room whereupon everyone is ill and to go numb from the whole experience of it all.

Patients were then asked to document how they manage their cancer outside the hospital and how they view the current treatment experience through photography. These exercises gave the team a deeper user understanding and points of interest for further exploration in the patient interviews. The interviews were open-ended and designed to elicit stories and experiences that were full of rich insights into patients’ lives, a departure from the output of conventional surveys and questionnaires. Patients were simply asked to recall the story behind the photo. The team heard powerful stories of how the patient’s dog was their one connection to the real world, how looking at their unused work uniform reminded them that they were not contributing to their family and how the long hallways of the hospital was their ‘long march to the end’. The rich first hand experience and stories helped the team build a much greater sense of empathy towards the patients and generate much deeper insights.

The stories and insights were then subjected to a rigorous analytical process whereupon all the field material was distilled down into the core patient needs. What was unique about this process was that many of the needs identified were often not explicitly articulated by the patient but subconsciously communicated through their actions, stories and comments. The team learned that throughout the treatment process, patients needed: Support and Connectivity with staff and close ones, a greater sense of Holistic Healing on a physical and emotional level, Engagement through knowing what is happening (i.e., during wait times), Empowerment that helps them to feel in control of their situation and Effortless Simplicity in which things are easy to do. All these needs ultimately contribute to reducing patient anxiety and give patients a sense of hope in the treatment and healing process.

Once the needs were clearly identified, patient personas were generated. Personas are not a representation of any one patient as so such much as a consolidation of like minded groups identified from the interviews. They help the ‘solution designers’ better understand such things as who the patients are, what they like, what motivates them and what their needs are, ultimately generating a greater sense of empathy. It is important to note that all the personas and patients have all the needs in common albeit in varying dosages and intensities. The persona if done correctly, can be a powerful tool to ensure future solutions truly resonate with the user (e.g. virtual test subject).

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Needs analysis work session and example of a patient persona

Gear 2 - Solution Generation: Building off the patient needs, personas and a deeper understanding of the patient journey, the staff at PMH underwent a group ideation session. Oncologists, pharmacists, nurses, researchers, management and administration were in attendance. The staff were divided into multi-disciplinary groups, assigned a patient persona and journey and were asked to ideate solutions to improve the systemic treatment experience while better meeting their persona’s needs. No constraints were given to encourage a broader pool of ideas. As a result, over 400 ideas and concepts were developed over the course of a 90 min session, the staff was energized from the experience, developed a greater connection with the patients and sense of ownership of the redesign project.

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Images from the Ideation Workshop held with the PMH Staff and DesignWorks

Using the massive volume of ideas generated from the session, the DesignWorks team identified solutions that could be further developed to create a seamless patient experience. To help manage and visualize hundreds of ideas, stories and storyboards about the patient experience were prototyped. Throughout each iteration, different ideas were integrated in combination and feedback was sought from PMH staff until the desired ideal experience was achieved.

Gear 3 - Strategic Business Design: Using the ideal patient experience as the benchmark, a business and operational strategy and roll out plan were developed to ensure that the experience was feasible and ultimately sustainable. The key was to identify the components necessary to ensure that the patient experience would be fully integrated and operationally seamless to all stakeholders. By mapping out the system and experience as a whole, the team was able to identify inefficiencies and opportunities. For example, the team discovered that many of the patient activities were distracting to staff (e.g., patients constantly running up to the check-in counter to make sure they are still in the system, how long they had to wait, asking staff about patient programs, the reluctance to leave the waiting room in fear of losing their spot). The recommendation was to increase the hospital’s focus on IT, employing digital information screens and increasing the range of their patient pagers to ensure that patients remain well informed and confident that they have not been forgotten. While this investment would require additional resources and funding, it was demonstrated that many of the larger initiatives could be done at minimal expense through the effective reallocation of resources and perhaps partnerships (internal and external). If patients remain seated in their chairs, there is less congestion and confusion in the area. If patients are well informed, staff do not have to go in search of patients, re-explain programs and are freed up to focus on more value added activities (i.e. providing treatment). This in turn would eliminate many inefficiencies and could lead to significant time and monetary benefits. There were numerous cases demonstrated where the hospital’s model (i.e. service, people, communication, space, operations and activities) could be adjusted often with minimal disruption to dramatically improve the overall experience and its delivery.

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Ideal patient experience and concept map of the final solution

Key Learnings / Focus Areas:

• First and foremost, The work inspired the design of a world class, patient centric treatment space built around the key themes of calm and comfort; accommodating the multi-faceted, integrated solutions that would operate within (i.e. technology, furniture, services, staff, social interaction).
• Better prioritization of the hospital’s To-Do list by understanding what is truly important to the patient. Dedicating more attention to enhancing the IT infrastructure to accommodate the proposed technology based solutions (i.e. information screens, TV’s, extended range pagers, web portal) to improve communication.
• Opportunity to develop of a specialized Systemic Treatment Chair. Analogous to the seating offered on business class flights, the chair could have multi-functional features (i.e. entertainment, storage, support systems) – it could offload some of the tasks performed by staff and potentially reduce the required square footage per patient, maximizing the usage of existing space.

Final Result:

As a result of the 12 week project, personnel from all levels at Princess Margaret Hospital were introduced and educated on an innovative research method that was truly patient focused and holistic. DesignWorks was able to demonstrate that an ideal experience extends beyond just the physical space of the facility and includes the personnel, services, communication, messages and technology used within. As such, additional effort was dedicated to ensure that all these elements were seamlessly integrated and delivered to the patient.

The research results were instrumental to the architect selection process. Copies of the final report were distributed to all eligible architectural firms. The architects were evaluated on their ability to effectively articulate and execute the patient centric focus of this project via a design competition. This allowed their proposed designs to better resonate with patients and the PMH selection panel. It further challenged the firms to develop ideas and solutions that extended beyond conventional design and be more innovative.

The final report and its contents have now become a powerful tool for in inspiring and evaluating all initiatives being developed for the Systemic Therapy area and the findings are being applied to other areas within the organization. The presentation below helped articulate the potential and the vision for the project and was a powerful tool for communicating to new audiences.

Conclusion

In the context of a hospital, the project demonstrated that design thinking could help create a win-win situation whereupon the patient experience was dramatically enhanced without compromising the core operational factors and economics of the hospital. By understanding what patients truly value, a hospital can actually save the hospital time and money (i.e. unnecessary resources are not directed at non-value added programs, initiatives, etc.).

The Business Design approach has proven to be an effective and powerful tool to help organizations understand what people really value, identify opportunities and solutions fulfill user’s needs and create models to deliver in a sustainable and effective way. This practice has been applied across many sectors (e.g. healthcare, technology, consumer goods, not for profit) and proven to be a useful practice in addressing such healthcare related challenges as managing diabetes, aging and independent living, chronic pain management and navigating the complexities of the healthcare system (Heart Failure & Sudden Cardiac Arrest).

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