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Design for Care
Human-Centering
in Healthcare Service Systems

Peter Jones

Redesign Network
OCAD University, Toronto
Copy...
designforcare.com

Booksite (DFCRSD)

caredesignnetwork.com Practice network
@designforcare

Structure & Story
•
•
•
•
•
•...
Design for Care:
Innovations in Healthcare Experience
“What if Designers were included
in the team as care professionals?”...
Copyright © 2013, Peter Jones
And we are not helping systemically …
•
•
•
•
•
•
•

User Experience / Interaction Design
Service Design
Evidence-Based De...
Sociotechnical Service Systems
Service systems are innovations of value, IT
systems, resources, & stakeholders.
Value co-c...
Sorting Out Design
Complexity increases at each .0
Number of stakeholders >
Need for collaboration >
Multi tech, multi-des...
• Integrating clinical & community services
• ACO - Distributed care models
• Design for “healthy habitation”
• New busine...
Contexts of Care Service
SERVICE

9
Copyright © 2013, Peter Jones
3 Human-Centered Contexts
1.

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

2.

Clinica...
How do People Use Health Information ?

Copyright © 2013, Peter Jones
1

Health Seekers

• None of us self-identify as patients.
• Use an empathic design approach.
• We all seek health, as a s...
Copyright © 2013, Peter Jones
Information Touchpoints
1.
2.
3.
4.

Understand what is wrong.
Gain a realistic idea of prognosis.
Make the most of consul...
Health seeking includes information
seeking & explores alternatives.
Knowledge acquisition for making
sense of health issu...
Patients Like Me
•
•
•
•
•

Started by one individual
with a personal concern
Grew from ALS to all
types of disease profil...
2

Clinical Services

• Care “designed” today for efficiency & cost.
Not to deliver a superior value or experience.
• Pati...
Healthcare AS a design practice

Copyright © 2013, Peter Jones
Copyright © 2013, Peter Jones
Health-seeking in Context of Care

Copyright © 2013, Peter Jones
Layered on Clinical & Technical Work
Multiple IT resources / interfaces
Cross-context cognitive tasks

A continuous sensem...
IDEO + CHCF

Project Synapse

Continuity of Care
• Patients feel they are left on their
own to figure out next steps.
• Pa...
Value to Patient
• Represent what I truly care
about
• Present information in a way I
can relate to
• Help me cross-check ...
3

Healthcare Systems

• Big Box Healthcare is huge, disrupted by cost &
policy, not innovation …
• Innovation of business...
Copyright © 2013, Peter Jones
How does a patient fall through the cracks?

Copyright © 2013, Peter Jones
CD1 - CD4

1

3

2

Atrial Fibrillation Care
Many health services treat chronic &
complex illness as exceptions. Patients ...
Atrial Fibrillation System Redesign
Can care service design scale to the system level?

28

Copyright © 2013, Peter Jones
...
Value-Based Care
Porter & Lee in Oct HBR, with Cleveland Clinic:
• Integrated practice units
• Cost & outcomes measurement...
Designing Services to Scenario
• Healing fragmented information & workflow is #1
• Discontinuity of care is both dangerous...
Copyright © 2013, Peter Jones
Peter Jones, Ph.D.
@designforcare
designforcare.com
peter@redesignnetwork.com`

Copyright © 2013, Peter Jones
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Peter jones rsd2 launch

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  • Complexity, communicating, & collaborating across boundaries
  • Complexity, communicating, & collaborating across boundaries
  • Three spheres or activity systems – each a very different context for design methods and systemic design. Design for Care covers the spectrum of healthcare applications from individual to industry – but (I have found) no designer or even researcher that works effectively across all. Yet to become more effective we need to better understand the critical problem areas, trends, business and cost drivers, technologies, and human experiences in each of these sub-sectors. For any of us to design end-to-end, we have to know how to connect with the adjacent touchpoints.
  • These are three fundamental domains of healthcare that present the most significant design opportunities. All 3 complex systems, each with its own problems, methods, boundaries.
  • Let’s start with the individual human context. Why Health seekers? We’re not patients. A person’s health seeking is a continuous process of taking steps toward better health, before during and after any type of encounter with healthcare. Health seeking, as with other human motivations such as pleasure seeking or status seeking, represents an individual journey toward relatively better health. For a very healthy person, an ideal of perfect fitness may be an authentic health seeking journey. For a cancer sufferer, relative health may be a matter of surviving treatment and fighting for gains in remission. Being a patient is an exceptional situation, then, when we require treatment or professional care. But people don’t claim patiency as a role, except perhaps in the activist context of ePatient for example. Instead, the target of design for individual health
  • Let’s start with the individual human context. Why Health seekers? We’re not patients. A person’s health seeking is a continuous process of taking steps toward better health, before during and after any type of encounter with healthcare. Health seeking, as with other human motivations such as pleasure seeking or status seeking, represents an individual journey toward relatively better health. For a very healthy person, an ideal of perfect fitness may be an authentic health seeking journey. For a cancer sufferer, relative health may be a matter of surviving treatment and fighting for gains in remission. Being a patient is an exceptional situation, then, when we require treatment or professional care. But people don’t claim patiency as a role, except perhaps in the activist context of ePatient for example. Instead, the target of design for individual health
  • The health seeking journey shows layers of context and changes over time. As a “consumer” here, the health seeker deals with her personal sphere and seeks information, support and resources from her immediate circle of family and community toward meeting health goals. Design goals for the health seeker (in this journey view) might include:Connecting Elena to her immediate family to support her Caregiver role (through electronic media, printed artifacts such as notes and reminders, and multi-sensory media.Direct support for Elena to inform and manage her family’s health needs. Connecting her with any services for which she has regular touchpoints. Emotional support as a caregiver, for helping sustain her motivation and keep track of health progress.Easy update and tracking of her interaction with clinical services and healthcare systems.
  • In one view, everything is “designed” by intention or not, by design teams or managers, clinicians and staff. Obviously not the function of design disciplines. Healthcare one of the last fields to be served by Multi-Disc design teams – for many reasons. The biggest one being that cost and risk drivers constrain how clinical and hospital service experiences have been provided. That existing system, mgt, process infrastructures are built to resist simple or experimental changes. A clinical version of scientific management and IndEgr have effectively designed current services. They work, and admins know how to manage them. Change would be disruptive and risky. But the value proposition for service and interaction design is not well defined or understood. Do we understand their work practice enough to make a compelling case to change?
  • Also includes sequential + followup and continuous care. Not really a spectrum – different designs for care practice for each.
  • CD levels are associated with complexity, as D1 – D4 are. In this view, of care services, Elena touches on each of the different modes of CD: CD1 with online communities (not complex), CD2 at Primary (lots of std procedures that could be better orchestrated), CD3 in the way multi-clinician treatments are designed, CD4 for the continuity across diagnoses and encounters.
  • Transcript of "Peter jones rsd2 launch"

    1. 1. Design for Care Human-Centering in Healthcare Service Systems Peter Jones Redesign Network OCAD University, Toronto Copyright © 2013, Peter Jones
    2. 2. designforcare.com Booksite (DFCRSD) caredesignnetwork.com Practice network @designforcare 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! Copyright © 2013, Peter Jones Twitter handle
    3. 3. Design for Care: Innovations in Healthcare Experience “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 Copyright © 2013, Peter Jones designforcare.com @designforcare 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
    4. 4. Copyright © 2013, Peter Jones
    5. 5. 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
    6. 6. 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
    7. 7. 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. Copyright © 2013, Peter Jones Adapted from Humantific , 2007-2013
    8. 8. • 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
    9. 9. Contexts of Care Service SERVICE 9 Copyright © 2013, Peter Jones
    10. 10. 3 Human-Centered Contexts 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. Copyright © 2013, Peter Jones
    11. 11. How do People Use Health Information ? Copyright © 2013, Peter Jones
    12. 12. 1 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. Copyright © 2013, Peter Jones
    13. 13. Copyright © 2013, Peter Jones
    14. 14. Information Touchpoints 1. 2. 3. 4. Understand what is wrong. Gain a realistic idea of prognosis. Make the most of consultations. 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. Copyright © 2013, Peter Jones Coulter, A., Entwistle, V., & Gilbert, D. (1999). Sharing decisions with patients: Is the information good enough? British Medical Journal, 318, 318–322.
    15. 15. 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
    16. 16. 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-ified Engaged Self-informing medical decision-making ePatients as community activists – health promotion • • Copyright © 2013, Peter Jones
    17. 17. 2 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 Copyright © 2013, Peter Jones
    18. 18. Healthcare AS a design practice Copyright © 2013, Peter Jones
    19. 19. Copyright © 2013, Peter Jones
    20. 20. Health-seeking in Context of Care Copyright © 2013, Peter Jones
    21. 21. 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
    22. 22. IDEO + CHCF 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. IDEO + © 2013, Peter Jones California HealthCare Foundation , 2012 Copyright
    23. 23. Value to Patient • 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 IDEO +©California HealthCare Foundation, 2012 Copyright 2013, Peter Jones
    24. 24. 3 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. Copyright © 2013, Peter Jones
    25. 25. Copyright © 2013, Peter Jones
    26. 26. How does a patient fall through the cracks? Copyright © 2013, Peter Jones
    27. 27. CD1 - CD4 1 3 2 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. Copyright © 2013, Peter Jones Morra, et al (2010). Reconnecting the pieces to optimize care in Atrial Fibrillation in Ontario.
    28. 28. Atrial Fibrillation System Redesign Can care service design scale to the system level? 28 Copyright © 2013, Peter Jones Service system coordinated work practices, org protocols, patient communication
    29. 29. 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
    30. 30. 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
    31. 31. Copyright © 2013, Peter Jones
    32. 32. Peter Jones, Ph.D. @designforcare designforcare.com peter@redesignnetwork.com` Copyright © 2013, Peter Jones
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