Design for Care O'Reilly webcast

Copyright © 2013, Peter Jones
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
• Clinical teams communication &
coordination
• 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.
1

A B
Two points have highest leverage – Primary Care & Recovery
Promise of care experience

IDEO + CHFC Project Synapse
1
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

Copyright © 2013, Peter JonesIDEO + California HealthCare Foundation, 2012
• 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
2

• ACO - Distributed care models
• Clinical teams communication &
coordination
• 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

29
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?
3

• 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

Design for Care O'Reilly webcast

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