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Not by Accident, but by Design
How to Innovate in the Patient
Experience
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
2014-­‐07-­‐02	
   David	
  Dunne	
   2	
  
My credentials: my grandfather was a
designer.
L	
  
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
Summary
•  Patient experience is all about getting the right
outcomes – not “patient satisfaction”
•  Design of patient ex...
PATIENT SATISFACTION IS NOT PATIENT
EXPERIENCE
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
Patient satisfaction is not patient
experience
•  To think of patient experience is to see the
experience from the patient...
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
The	
   era	
   of	
   paternalis/c	
   medicine,	
   where	
   the	
   doctor	
   knew	
   best	
  
and	
   the	
   pa/en...
Patient experience = patient satisfaction
surveys
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
Can we reframe this?
•  Instead of thinking of patient satisfaction and
health outcome as either-or, can we see them as
li...
Says who?
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
If we put a fraction of the effort into understanding the patient
experien...
DESIGN IS AN ACT OF CONSCIOUS
CREATION
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
Design is an act of conscious creation
•  The needs of the individual user/patient are
paramount*
•  Design thinking does ...
Nobody experiences the system; they
experience their own pathway through it
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
 ...
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
This (well-intended) finger wagging is
often ineffective …
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
We are differen...
There is a better way
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
Understand
Frame
Create
Patient-
Centred
Design
Deve...
Medicine, Science and Design are
different ways of thinking
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
Synthe'c)Analy...
THERE ARE MASSIVE OPPORTUNITIES TO
SOLVE HEALTHCARE PROBLEMS
THROUGH DESIGN
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
There are massive opportunities to solve
healthcare problems through design
•  Many studies support the link between
exper...
The elephant in the room: adherence
14% to 21% never fill their original prescriptions.
60% cannot identify their own medi...
Patient choice and health outcomes
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
SOME OTHER CHOICES
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
Memorial’s rehab center prepares
patients for home
The sweet spot: making patients happy
and saving money
2014-­‐07-­‐02	
  
hJp://www.youtube.com/watch?v=16p9YRF0l-­‐g	
  	...
How a Dutch fly keeps costs in line
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
HOW THE PROCESS WORKS
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
To understand design thinking, you need
to understand three things
2014-­‐07-­‐02	
   David	
  Dunne	
   31	
  
ObservaMon...
PCD emphasizes ‘lived experience’
•  Focus on groups of individuals, not ‘general
public’
•  Empathy – attempting to see t...
Diabetes: the old way
"The	
  needles	
  were	
  enormous,	
  and	
  
they	
  came	
  with	
  liJle	
  pumice	
  stones	
 ...
A problem well-framed is a problem
solved
•  We do not accept the problem ‘as given’ but
look to reframe it based on
–  Pa...
CHANGING FOCUS AT SINAI EMERG
INITIAL	
  FRAME:	
  
“WHY	
  CAN’T	
  I	
  GET	
  ANY	
  
PRIVACY?”	
  
REFRAMED:	
  
“WHY	...
Get physical, early and often
•  Prototypes can be
anything
–  Rough models
–  Role plays
–  Sketches/collages
•  They for...
Supporting these is
an extensive toolkit
2014-­‐07-­‐02	
   David	
  Dunne	
   37	
  
… and the right attitude
2014-­‐07-­‐02	
   David	
  Dunne	
   38	
  
Empathy … to appreciate the user’s problem even
when...
A nonlinear, iterative process
2014-07-02
UNDERSTAND CONTEXTREFRAME
CREATE
STATE AND RESTATE THE PROBLEM:
WHO NEEDS WHAT B...
MAYO CLINIC CENTER FOR INNOVATION
CASE STUDY
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
Igniting a SPARC
•  SPARC (see/plan/act/refine/communicate)
was started in 2000
•  This became the Center for Innovation (...
The intent: to understand and improve
the delivery of care
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
Redesigning outpatient practice: Jack
and Jill rooms
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
Based	
  on	
  the	
 ...
CFI Mission, Goals and Approach
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
 Mission
The Center for Innovation's missi...
The CFI’s process
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
The RED engineering project
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
Goal
Pay for performance è enhanced need for ...
What they learned
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
In the middle of a lot of stress and acute illness, we w...
What they did
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
Exploration and Experimentation
•  Mapped the experience
•  ...
CHALLENGES AND HOW TO DEAL WITH
THEM
2014-­‐07-­‐02	
   David	
  Dunne,	
  Ph.D.	
  
The challenges
•  Lack of (or passive) on-the-ground
cooperation
•  Mental models:
–  It’s about pampering patients/custom...
The major risks
•  Isolation and lack of cooperation
•  Getting overloaded with incremental
projects
•  Lack of department...
Fortunately, others have faced these
challenges
Strong, public, vocal top-level support
Project work:
Find early wins
Prot...
Summary
•  Patient experience is all about getting the right
outcomes – not “patient satisfaction”
•  Design of patient ex...
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Innovation by Design in Patient Experience

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This presentation was given to a medical audience in Toronto in 2014. It discusses the research that supports design-based innovation in the patient experience. For further details contact me at dunne@rotman.utoronto.ca

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Transcript of "Innovation by Design in Patient Experience"

  1. 1. Not by Accident, but by Design How to Innovate in the Patient Experience 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  2. 2. 2014-­‐07-­‐02   David  Dunne   2   My credentials: my grandfather was a designer. L  
  3. 3. 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  4. 4. Summary •  Patient experience is all about getting the right outcomes – not “patient satisfaction” •  Design of patient experience is an act of conscious creation •  There are massive opportunities to solve healthcare problems through design … •  … for example … •  How the process works •  Case study: Mayo Clinic Center For Innovation •  Challenges and how to deal with them 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  5. 5. PATIENT SATISFACTION IS NOT PATIENT EXPERIENCE 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  6. 6. Patient satisfaction is not patient experience •  To think of patient experience is to see the experience from the patient’s perspective •  Patient satisfaction is typically a short-term quantitative score that misspecifies the experience and obscures the story •  Well-designed patient experiences achieve desirable goals for all: satisfaction vs. outcome is a false dichotomy 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  7. 7. 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  8. 8. The   era   of   paternalis/c   medicine,   where   the   doctor   knew   best   and   the   pa/ent   felt   lucky   to   have   him,   has   ended.   We   don’t   worship  authority  figures  anymore.  Our  health-­‐care  system  has   become   impersonal,   mechanized,   and   hollow,   and   it   has   failed   millions  of  people,  many  of  whom  want  to  find  a  way  to  regain   control  of  their  own  medical  decisions.     Michael  Specter   “The  Operator”   The  New  Yorker  Feb  4  2013     Read  more:   hJp://www.newyorker.com/reporMng/2013/02/04/130204fa_fact_specter? printable=true&currentPage=2#ixzz2KjLIuKHd   2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  9. 9. Patient experience = patient satisfaction surveys 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  10. 10. 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  11. 11. Can we reframe this? •  Instead of thinking of patient satisfaction and health outcome as either-or, can we see them as linked? •  Patient satisfaction measures are influenced by: –  Outcomes –  Expectations –  Human interaction –  Process … etc. •  A good experience is a good process that leads to a good outcome 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  12. 12. Says who? 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  13. 13. 2014-­‐07-­‐02   David  Dunne,  Ph.D.   If we put a fraction of the effort into understanding the patient experience that we invest in understanding diseases, we could immeasurably improve healthcare
  14. 14. DESIGN IS AN ACT OF CONSCIOUS CREATION 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  15. 15. Design is an act of conscious creation •  The needs of the individual user/patient are paramount* •  Design thinking does not come naturally: it requires training, method and attitude. Most of all, attitude •  Its purpose and methods are different from science. It proceeds by learning from low- resolution/low-risk field trials. 2014-­‐07-­‐02   David  Dunne,  Ph.D.   *(P.S.  Frustrated  staff  do  not  deliver  good  paMent  experiences)  
  16. 16. Nobody experiences the system; they experience their own pathway through it 2014-­‐07-­‐02   David  Dunne,  Ph.D.   What is the “lived experience” of healthcare from the patient’s perspective?
  17. 17. 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  18. 18. 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  19. 19. This (well-intended) finger wagging is often ineffective … 2014-­‐07-­‐02   David  Dunne,  Ph.D.   We are different from patients We do not understand their experience, because: •  We don’t see everything they see •  We don’t live their lives •  All patients are not the same •  We are biased observers
  20. 20. There is a better way 2014-­‐07-­‐02   David  Dunne,  Ph.D.   Understand Frame Create Patient- Centred Design Develop a deep, empathetic, intimate understanding of the context patients live in Define the problem to be solved as the patient would define it Explore – i.e. make – solutions to learn more
  21. 21. Medicine, Science and Design are different ways of thinking 2014-­‐07-­‐02   David  Dunne,  Ph.D.   Synthe'c)Analy'c) Symbolic) Real) Science& Design&Medicine& Analy&c( Symbolic( Synthe&c( Symbolic( Synthe&c( Real( Analy&c( Real( Owen  2007   Design proceeds by thoroughly understanding patients’ lives, by making connections, by experimenting to explore the problem. Medicine proceeds by testing hypotheses one at a time, by understanding before acting and by doing no harm.
  22. 22. THERE ARE MASSIVE OPPORTUNITIES TO SOLVE HEALTHCARE PROBLEMS THROUGH DESIGN 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  23. 23. There are massive opportunities to solve healthcare problems through design •  Many studies support the link between experience and outcome •  Increased importance of chronic conditions, where the patient is main actor •  Patients make choices … and not always choices you’d like •  Well-designed experiences reduce cost and make patients happier and healthier 2014-­‐07-­‐02   BUT  every  paMent  is  different  …  and   experiences  the  same  processes  differently       David  Dunne,  Ph.D.  
  24. 24. The elephant in the room: adherence 14% to 21% never fill their original prescriptions. 60% cannot identify their own medications 30% to 50% ignore or compromise medication instructions 25% admissions related to poor self- administration. 12% to 20% take other people's medicines. … AND BTW … For a chronic disease like diabetes, 95% of treatment is self-administered   2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  25. 25. Patient choice and health outcomes 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  26. 26. SOME OTHER CHOICES 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  27. 27. Memorial’s rehab center prepares patients for home
  28. 28. The sweet spot: making patients happy and saving money 2014-­‐07-­‐02   hJp://www.youtube.com/watch?v=16p9YRF0l-­‐g     David  Dunne,  Ph.D.  
  29. 29. How a Dutch fly keeps costs in line 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  30. 30. HOW THE PROCESS WORKS 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  31. 31. To understand design thinking, you need to understand three things 2014-­‐07-­‐02   David  Dunne   31   ObservaMon   Quant  &   qual   interviews   Storytelling   Understanding   the  user  and   context   Rapid   prototyping   Bodystorming   Walk   throughs   Making  as  a   way  of   thinking   Root  causes   PerspecMve  flips   Systems  thinking   User  experience   Reframing  the  problem  
  32. 32. PCD emphasizes ‘lived experience’ •  Focus on groups of individuals, not ‘general public’ •  Empathy – attempting to see the experience from the patient’s perspective •  Understand what drives behaviour so we can achieve better outcomes •  NOT the same as ‘pampering’ patients 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  33. 33. Diabetes: the old way "The  needles  were  enormous,  and   they  came  with  liJle  pumice  stones   so  that  you  could  sharpen  them.   They  oken  became  dull  and   developed  barbs  on  the  end.  And  in   order  to  sterilize  them  they  had  to   be  boiled  for  twenty  minutes."   2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  34. 34. A problem well-framed is a problem solved •  We do not accept the problem ‘as given’ but look to reframe it based on –  Patient perspective –  Underlying issues –  Analogies •  Reframing is more important than brainstorming 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  35. 35. CHANGING FOCUS AT SINAI EMERG INITIAL  FRAME:   “WHY  CAN’T  I  GET  ANY   PRIVACY?”   REFRAMED:   “WHY  ARE  THERE  SO   MANY  PEOPLE  AROUND?”   2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  36. 36. Get physical, early and often •  Prototypes can be anything –  Rough models –  Role plays –  Sketches/collages •  They force you to get your idea clear and explicit •  They help others to see what you are talking about •  They allow patients to respond, experience and comment 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  37. 37. Supporting these is an extensive toolkit 2014-­‐07-­‐02   David  Dunne   37  
  38. 38. … and the right attitude 2014-­‐07-­‐02   David  Dunne   38   Empathy … to appreciate the user’s problem even when they are very different from you Curiosity … “mind of a child” who keeps asking “why?” Openness … to different forms of knowledge and to new perspectives Nonattachment … to one’s own ideas, or to those of the team Mindfulness … to see the inherent possibilities
  39. 39. A nonlinear, iterative process 2014-07-02 UNDERSTAND CONTEXTREFRAME CREATE STATE AND RESTATE THE PROBLEM: WHO NEEDS WHAT BECAUSE WHY? DEVELOP DESIGN PRINCIPLES EXPLORE SOLUTIONS DRAW, MAKE, DO REFINE AND ITERATE DEVELOP PATIENT INSIGHT UNDERSTAND THE SYSTEM ITERATE:   WHAT  DO  OUR  FINDINGS   INDICATE  ABOUT  THE  PROBLEM?   ITERATE:   WHAT  DO  OUR   SOLUTIONS  TELL  US   ABOUT  THE  PROBLEM?     ITERATE:   WHAT  INSIGHTS  MAY   LEAD  TO  SOLUTIONS?   WHAT  DO  OUR   SOLUTIONS  SUGGEST   WE  NEED  TO  KNOW?   UNDERSTAND REALITY FRAME THE NEED CREATE POSSIBILITY David Dunne, Ph.D.
  40. 40. MAYO CLINIC CENTER FOR INNOVATION CASE STUDY 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  41. 41. 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  42. 42. Igniting a SPARC •  SPARC (see/plan/act/refine/communicate) was started in 2000 •  This became the Center for Innovation (CFI) in 2008 •  CFI uses design approaches: 1.  Topic framing 2.  Research 3.  Design 4.  Implementation 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  43. 43. The intent: to understand and improve the delivery of care 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  44. 44. Redesigning outpatient practice: Jack and Jill rooms 2014-­‐07-­‐02   David  Dunne,  Ph.D.   Based  on  the  observaMon  that  physical  exam  takes  up  a  small   porMon  of  Mme     ConversaMon  room   Treatment  room  
  45. 45. CFI Mission, Goals and Approach 2014-­‐07-­‐02   David  Dunne,  Ph.D.    Mission The Center for Innovation's mission is to transform the experience and delivery of health care.   Goals •  Focus on the human experience to identify needs and design services, products and business models to meet them •  Innovate care delivery that's accessible, affordable and value-driven •  Collaborate openly — internally and externally •  Generate economic value by demonstrating financial return from sustainable delivery models, services and products   Approach The Center for Innovation works with a "Think big. Start small. Move fast.™"philosophy. •  Connect. Bring people together in new ways inside and outside of Mayo Clinic. •  Design. Identify opportunities and realize solutions that transform care delivery and experience. •  Enable. Facilitate and accelerate innovation across Mayo Clinic.
  46. 46. The CFI’s process 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  47. 47. The RED engineering project 2014-­‐07-­‐02   David  Dunne,  Ph.D.   Goal Pay for performance è enhanced need for better care at lower cost Method ‘Interview and Observation Key Insights   •  “Patients don’t get vacations”. •  Medical and non-medical considerations were interwoven in the dialysis experience, but there were gaps between them. •  The patient care team was often patients’ sole source of support – not just medical, but emotional too. Because of this, patients were often reluctant to leave the hospital. •  Patients and healthcare providers spoke different languages, but had common goals and intentions.
  48. 48. What they learned 2014-­‐07-­‐02   David  Dunne,  Ph.D.   In the middle of a lot of stress and acute illness, we were asking them to make big decisions: do you want dialysis tonight? You don’t need to do it, but of course if you don’t use dialysis you’ll probably die by tomorrow morning … What kind of dialysis do you want? OK, now you’re on dialysis, goodbye; you can be dismissed from the hospital. Good luck with your new life. We realized that this did not set our patients up for success in the future. Dr. Amy Williams, MD, Nephrologist
  49. 49. What they did 2014-­‐07-­‐02   David  Dunne,  Ph.D.   Exploration and Experimentation •  Mapped the experience •  Developed an integrated care team approach that took into account medical and non-medical aspects. •  In-depth patient understanding à new educational materials Outcomes •  Hospital admissions fell by 40% •  Reductions in in-hospital dialysis. •  Patient satisfaction, provider and care team satisfaction all increased. •  Quality standards were met and there were significant cost savings.
  50. 50. CHALLENGES AND HOW TO DEAL WITH THEM 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  51. 51. The challenges •  Lack of (or passive) on-the-ground cooperation •  Mental models: –  It’s about pampering patients/customer service/ marketing … all stuff other people do –  It’s about low-priority issues –  It’s not scientific –  It leads to higher costs –  It’s too time-consuming •  The lure of the incremental 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  52. 52. The major risks •  Isolation and lack of cooperation •  Getting overloaded with incremental projects •  Lack of departmental engagement •  Too few visible results 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  53. 53. Fortunately, others have faced these challenges Strong, public, vocal top-level support Project work: Find early wins Protect unallocated time for “banner” projects Engage departmental teams Internal relationship strategy: Communication and engagement Find allies and draw them in Have someone who knows networks intimately Establish and support communities of practice 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
  54. 54. Summary •  Patient experience is all about getting the right outcomes – not “patient satisfaction” •  Design of patient experience is an act of conscious creation •  There are massive opportunities to solve healthcare problems through design … •  … for example … •  How the process works •  Case study: Mayo Clinic Center For Innovation •  Challenges and how to deal with them 2014-­‐07-­‐02   David  Dunne,  Ph.D.  
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