Design for Care O'Reilly webcast

Design for Care Service design as if we cared O’Reilly webcast June 5, 2013

Peter Jones Redesign Network

OCAD University, Toronto

“What if Designers were care professionals?” Enabling those who serve people seeking care: Health practice & care organizations. • People not patients. • Systemic, touches every sector • Connects across disciplines • Cases, Methods, Experiences

Rethinking Care 1. Design as Caregiving 2. Co-Creating Care 3. Seeking Health

Rethinking Patients 4. Design for Patient Agency 5. Patient-Centered Care Service Rethinking Care Systems 6. Innovating Points of Care 7. Designing Healthy Information Technology 8. Systemic Design in Healthcare Innovation 9. Futures in Service Innovation

designforcare.com @designforcare

Design for Care: Innovating Healthcare Experience

Online seminar – agenda

• The Book

• Observations

• Service Design in Healthcare

• Three Contexts

• Brief Cases

• Some Discussion

Wicked problems are …

• Complex (of course)

• Interconnected & changing

• Not “owned”

• Not measurable by progress or impact

• Continuous, have no real end point

• Defined differently by each discipline

… Wicked problems from HWJ Rittel and MW Webber (1973). Dilemmas in a general theory of planning. Policy Sciences 4 (1973), 155-169.

Yet Healthcare … Manages process by Six Sigma

Fixes what can be measured

Isolates problems

Likes hard evidence

Dislikes ambiguity

Abhors undue risk

And Designers … Not understood in healthcare roles

Fragmented by role & discipline

Unclear potential for creative

contribution

Role in research unclear

Get placed in dead-ends, IT or public

website

Are not rewarded for creative risks …

Where do you fit the design practice?

Complex care - a design practice?

Sequential – Standard treatments in acute care Iterative – Problem solving for complex & chronic ++

And Complex is “Wicked” …

• Integrating clinical & community services

• Patient information across care journeys

• Clinical teams communication & coordination

• Redesign the EHR / information as workflow

• Designing the service systems and patient-health experience for clinical services.

• Care system design for new business models

• Patient self-service in local clinics

Meanings of Care

“Man finds . . . his place by finding appropriate others that need his care and that he needs to care for. Through caring and being cared for man experiences himself as part of nature; we are closest to a person or an idea when we help it grow.”

Milton Mayeroff, On Caring

Care in Service

A healthcare system, public policy, clinic, …

Cares for Patients & their circle of care

Relatives Friends Immediate Community

How does design for care offer care as service?

Levels of Design … Practice

Complexity increases with each Complexity & management skills Number of stakeholders > Need for collaboration > > 1 designer and > 1 clinician Healthcare applications often require all 4 levels of knowledge. But design skills do not transfer up

• ACO - Distributed care models

• Design for “habitation health”

• Service design for new business models

• Integrated services + architecture

• Patient-health experience of service

• Redesign EHR / information as workflow

• Innovative & usable wayfinding

• Interior space infection control

Service Design in Healthcare …

• Patient-centered experience design

• Design for population health goals

• Human-centered design

• Design of service systems

• Service design should draw on a research base.

3 Contexts of sociotechnical systems

1. People, not users or patients. Interact with services as Health Seekers.

2. Hospitals, Cultural & business context. Cultural design of meaning.

3. Healthcare as a Service System. Integration of everything.

We are all Health Seekers

• We do not self-identify as patients

• Can we design for a person?

• We all seek health, not perfect, but suited to our lives

• Health seeking journeys are both near-term recovery & full life’s cycle. Including the “healthy death.”

• Design aim is to fulfill care experiences.

Two points have highest leverage – Primary Care & Recovery

Promise of care experience

IDEO + CHFC Project Synapse

Continuity 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.

Continuity of Care by IDEO + CHCF Project Synapse

IDEO + California HealthCare Foundation , 2012 1

• 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 expressed as …

Care as Clinical Service

• Care “designed” today for efficiency & cost.

• Care service is designed as proxy of “delivery” Care Pathways Care Plans Care “Bundles”

• Patient-centered is not the only answer. Service systems include care teams, IT, community

• Contexts of care in Hospital: Sequential, Iterative, Complex, Emergent

• ACO - Distributed care models

• Patient-health experience as clinical services.

• Service design for new business models

• Redesign EHR / information as workflow

• Innovative & usable wayfinding

• Interior space infection control

CLINICAL DESIGN 4.0 Community health Care organizations Org development 3.0 Business model Healthcare teams Care planning Practice management 2.0 Patient encounter Direct exam Diagnosis & treatment 1.0 Care design for Px Fostering self-care Preventive awareness

Design more for value demand

Less for failure demand

• From systems perspective, disease focus is intervention

• Patient context is temporary

• Prevention, adherence, & continuity

• May not flow like a “service”

Health-seeking in Care Context

A health-seeking journey occurs over a lifetime, a continuity that proceeds through youth, adulthood, & older age.

Atrial Fibrillation Care System 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.

CD3 & CD4

Atrial Fibrillation System Redesign The improvement of individual experience is an effect in healthcare. Good, but not systemic. Good service design should scale.

Afib Personas & Care Tools

Hospitals are Cultural

(& Historical) Institutions.

• Cultural, not tech, innovation. (Is a clinic just a collection of services?)

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

• How should clinics create cultural value?

• Technology is (primarily) supply driven. What’s the clinicians & patient demand?

• Lack of effective primary care is a public health problem. Results in avoidable blindness, amputations, strokes, heart attacks, & premature death.

• US residents receive only ½ recommended medical services.

Only 43% of diabetics are treated

37% with hypertension

• Care delivery helped / hindered by EMR infrastructure

Frieden, TR and Mostashari, F. (2008). Health Care as If Health Mattered. JAMA, 299 (8):950-952

The Demand Side?

• Technology is (primarily) supply driven. What’s the clinicians & patient demand?

• Lack of effective primary care is a public health problem. Results in avoidable blindness, amputations, strokes, heart attacks, & premature death.

• US residents receive only ½ recommended medical services.

Only 43% of diabetics are treated

37% with hypertension

• Care delivery helped / hindered by EMR infrastructure

Frieden, TR and Mostashari, F. (2008). Health Care as If Health Mattered. JAMA, 299 (8):950-952

The Demand Side?

In the meantime …

• ACA is disrupting “Big Box” more quickly than tech changes

• Incentive leverage – New patient measures, outcome pay models

• Accountable Care Orgs & decentralized models will deconstruct hospitals

• Greater focus on patient experience

• Form follows function into community care.

• How is technology helping, or not?

Layered on Clinical & Technical Work: Multiple IT resources / interfaces Cross-context cognitive tasks A continuous sensemaking problem Information selection, trust, application, navigation

“Supposedly, everyone working in health care wants the same thing: to help people get and stay healthy. The problem is that everyone can have a different view of the meaning of getting and staying healthy. Lack of consensus among players in a complex system is one of the biggest barriers to innovation. One subgroup's innovation is another subgroup's loss of control.”

Rosabeth Moss Kanter

Health + Care Innovation

Kanter, RM (2011). Why Innovation Is So Hard in Health Care. HBR Blogs.

Peter Jones, Ph.D.

@designforcare

designforcare.com caredesignnetwork.com peter@redesignresearch.com

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