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Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
Design for Care O'Reilly webcast
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Design for Care O'Reilly webcast

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Service design as if we cared

Service design as if we cared

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  • 1. Copyright © 2013, Peter JonesDesign for CareService design as if we caredO’Reilly webcast June 5, 2013Peter JonesRedesign NetworkOCAD University, Toronto
  • 2. Copyright © 2013, Peter Jones“What if Designers were careprofessionals?”Enabling those who serve peopleseeking care: Health practice & careorganizations.• People not patients.• Systemic, touches every sector• Connects across disciplines• Cases, Methods, ExperiencesRethinking Care1. Design as Caregiving2. Co-Creating Care3. Seeking HealthRethinking Patients4. Design for Patient Agency5. Patient-Centered Care ServiceRethinking Care Systems6. Innovating Points of Care7. Designing Healthy Information Technology8. Systemic Design in Healthcare Innovation9. Futures in Service Innovationdesignforcare.com@designforcareDesign for Care:Innovating Healthcare Experience
  • 3. Copyright © 2013, Peter JonesOnline seminar – agenda• The Book• Observations• Service Design in Healthcare• Three Contexts• Brief Cases• Some Discussion…
  • 4. Copyright © 2013, Peter Jones
  • 5. Copyright © 2013, Peter JonesWicked 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.
  • 6. Copyright © 2013, Peter JonesYet Healthcare …Manages process by Six SigmaFixes what can be measuredIsolates problemsLikes hard evidenceDislikes ambiguityAbhors undue risk
  • 7. Copyright © 2013, Peter JonesAnd Designers …Not understood in healthcare rolesFragmented by role & disciplineUnclear potential for creativecontributionRole in research unclearGet placed in dead-ends, IT or publicwebsiteAre not rewarded for creative risks …
  • 8. Copyright © 2013, Peter JonesWhere do you fit the design practice?
  • 9. Copyright © 2013, Peter JonesComplex care - a design practice?Sequential – Standardtreatments in acute careIterative – Problemsolving for complex &chronic ++
  • 10. Copyright © 2013, Peter JonesAnd 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…
  • 11. Copyright © 2013, Peter JonesMeanings of Care“Man finds . . . his place by finding appropriateothers that need his care and that he needs tocare for. Through caring and being cared forman experiences himself as part of nature;we are closest to a person or an idea when wehelp it grow.”Milton Mayeroff, On Caring
  • 12. Copyright © 2013, Peter JonesCare in ServiceA healthcare system, public policy, clinic, …Cares for Patients & their circle of careRelativesFriendsImmediate CommunityHow does design for care offer care as service?
  • 13. Copyright © 2013, Peter Jones
  • 14. Copyright © 2013, Peter JonesLevels of Design … PracticeComplexity increases with eachComplexity & management skillsNumber of stakeholders >Need for collaboration >> 1 designer and > 1 clinicianHealthcare applications often require all4 levels of knowledge.But design skills do not transfer up
  • 15. Copyright © 2013, Peter Jones• Integrating clinical & community services• ACO - Distributed care models• Design for “habitation health”• Service design for 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 infection control
  • 16. Copyright © 2013, Peter JonesService 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.
  • 17. Copyright © 2013, Peter Jones3 Contexts of sociotechnical systems
  • 18. Copyright © 2013, Peter Jones1. People, not users or patients. Interactwith services as Health Seekers.2. Hospitals, Cultural & business context.Cultural design of meaning.3. Healthcare as a Service System.Integration of everything.
  • 19. Copyright © 2013, Peter JonesWe 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.1
  • 20. Copyright © 2013, Peter JonesA BTwo points have highest leverage – Primary Care & RecoveryPromise of care experience
  • 21. Copyright © 2013, Peter JonesIDEO + CHFC Project Synapse1Continuity of Care• Patients feel they are left on their own to figure outnext steps.• Patients with serious health issues work around thesystem to get the best care.• Episodic and disjointed care hides valuableconnections.• Both patients and physicians doubt the reliability of(reported) health data.
  • 22. Copyright © 2013, Peter JonesContinuity of Care by IDEO + CHCF Project SynapseIDEO + California HealthCare Foundation , 2012 1
  • 23. Copyright © 2013, Peter JonesIDEO + California HealthCare Foundation, 2012• Represent what I truly careabout• Present information in a way Ican relate to• Help me cross-check my facts• Help me close communicationloops among my care team• Set me up to have clarifyingand guiding conversations• Clearly lay out the next steps• Show my trajectory over timeValue to Patient expressed as …
  • 24. Copyright © 2013, Peter JonesCare as Clinical Service• Care “designed” today for efficiency & cost.• Care service is designed as proxy of “delivery”Care PathwaysCare PlansCare “Bundles”• Patient-centered is not the only answer.Service systems include care teams, IT, community• Contexts of care in Hospital:Sequential, Iterative, Complex, Emergent2
  • 25. Copyright © 2013, Peter Jones• Integrating clinical & community services• ACO - Distributed care models• Clinical teams communication &coordination• Patient-health experience as clinicalservices.• Service design for new business models• Redesign EHR / information as workflow• Patient self-service in local clinics• Patient information across care journeys• Innovative & usable wayfinding• Interior space infection controlCLINICAL DESIGN4.0 Community healthCare organizationsOrg development3.0 Business modelHealthcare teamsCare planningPractice management2.0 Patient encounterDirect examDiagnosis & treatment1.0 Care design for PxFostering self-carePreventive awareness
  • 26. Copyright © 2013, Peter JonesDesign more for value demandLess for failure demand• From systems perspective,disease focus is intervention• Patient context is temporary• Prevention, adherence, & continuity• May not flow like a “service”
  • 27. Copyright © 2013, Peter JonesHealth-seeking in Care ContextA health-seeking journey occurs over a lifetime, a continuitythat proceeds through youth, adulthood, & older age.
  • 28. Copyright © 2013, Peter JonesAtrial Fibrillation Care SystemMany health services treat chronic &complex illness as exceptions. Patients fallbetween the cracks & are shuttled around,getting fragmented care. By not adapting tothe changing reality of the chronicdemographic, costs rise as hospitals increasetheir exception cases.Morra, et al (2010). Reconnecting the pieces to optimize care in Atrial Fibrillation in Ontario.CD3 & CD4
  • 29. Copyright © 2013, Peter Jones29Atrial Fibrillation System RedesignThe improvement of individual experience isan effect in healthcare. Good, but notsystemic. Good service design should scale.
  • 30. Copyright © 2013, Peter JonesAfib Personas & Care Tools
  • 31. Copyright © 2013, Peter JonesHospitals are Cultural(& Historical) Institutions.• Cultural, not tech, innovation.(Is a clinic just a collection of services?)• Big Box Healthcare is disrupted by cost, not byinnovation …• How should clinics create cultural value?3
  • 32. Copyright © 2013, Peter Jones• 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, heartattacks, & premature death.• US residents receive only ½ recommended medical services.Only 43% of diabetics are treated37% with hypertension• Care delivery helped / hindered by EMR infrastructureFrieden, TR and Mostashari, F. (2008). Health Care as If Health Mattered. JAMA, 299 (8):950-952The Demand Side?
  • 33. Copyright © 2013, Peter Jones• 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, heartattacks, & premature death.• US residents receive only ½ recommended medical services.Only 43% of diabetics are treated37% with hypertension• Care delivery helped / hindered by EMR infrastructureFrieden, TR and Mostashari, F. (2008). Health Care as If Health Mattered. JAMA, 299 (8):950-952The Demand Side?
  • 34. Copyright © 2013, Peter JonesIn the meantime …• ACA is disrupting “Big Box” more quickly than techchanges• Incentive leverage – New patient measures,outcome pay models• Accountable Care Orgs & decentralized modelswill deconstruct hospitals• Greater focus on patient experience• Form follows function into community care.• How is technology helping, or not?
  • 35. Copyright © 2013, Peter JonesLayered on Clinical & Technical Work:Multiple IT resources / interfacesCross-context cognitive tasksA continuous sensemaking problemInformation selection, trust,application, navigation
  • 36. Copyright © 2013, Peter Jones“Supposedly, everyone working in health care wantsthe same thing: to help people get and stay healthy.The problem is that everyone can have a differentview of the meaning of getting and staying healthy.Lack of consensus among players in a complexsystem is one of the biggest barriers to innovation.One subgroups innovation is another subgroupsloss of control.”Rosabeth Moss KanterHealth + Care InnovationKanter, RM (2011). Why Innovation Is So Hard in Health Care. HBR Blogs.
  • 37. Copyright © 2013, Peter JonesPeter Jones, Ph.D.@designforcaredesignforcare.comcaredesignnetwork.competer@redesignresearch.com

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