UPMC Neuro Clinic Service Design

Designing for the Clinic Experience Service Design Patients Family for UPMC Presbyterian Neurosurgery Clinic Carnegie Mellon School of Design UPMC Center for Quality Improvement & Innovation Service Design · Fall 2007 Staff Dr. Kassam Melissa Cliver · Jamin Hegeman · Kip Lee Leanne Libert · Kara Tennant

UPMC Center for Quality Improvement & Innovation Our liaison with the clinic Given Problems Wayﬁnding Wait time Work ﬂow

Research Observation Interviews with staff & patients Surveys Data collection

The Patient Experience

“Has he been in to see the patient in room seven yet? She’s getting restless after being in there for an hour.” – Nurse

Staff Experience

“We all have our meltdowns. It goes around the ofﬁce.” – Nurse

A View of Dr. Kassam

“If they call me today, they’ll get in. Kassam has never said no.” – Clinical Secretary

Synthesis

Service Blueprint of Presby Neuro Clinic Service of Presby Neuro Clinic PHYSICAL Front Waiting Front Waiting Front Hallway Exam MRI & Exam MRI & Door Tag Waiting Check-out EVIDENCE Desk Room Desk Room Desk Room Chart Room Chart Room Room Check-out, PATIENT Sign In Wait Check-in Wait Responds Follow to Wait in Answer Wait Ask Return Wait Pay, & ACTIONS Exam Rm Exam Rm Questions Questions Door Tag Leave Line of Interaction ONSTAGE Call Escort to Check Meet Dr. Process & CONTACT Welcome Process Patient Vitals & Exam Rm Ask Quest Kassam Check-out PERSON Line of Visibility BACKSTAGE Get See Other Grab Check Place in Take See Other See Other See Other CONTACT Patient Patients Patients Door Tag Patients Patient Kassam Away Patients PERSON Chart Location Bin Chart Brings Chart in Grab Kassam Door Tag To Be Chart Gets Quick Back Seen Bin from Bin Review Chart Write Rm Check Taken by # on Patient Dictation Staff Schedule Location Line of Internal Interaction SUPPORT Records/ Bin Chart Records/ Debbie’s Door Tag Schedule Database Chart Cart Database System Storage PROCESSES System System System System System

Lack of wait time interactions Service Blueprint of Presby Neuro Clinic PHYSICAL Front Waiting Front Waiting Front Hallway Exam MRI & Exam MRI & Door Tag Waiting Check-out EVIDENCE Desk Room Desk Room Desk Room Chart Room Chart Room Room Check-out, PATIENT Sign In Wait Check-in Wait Responds Follow to Wait in Answer Wait Ask Return Wait Pay, & ACTIONS Exam Rm Exam Rm Questions Questions Door Tag Leave Line of Interaction ONSTAGE Check CONTACT PERSON Welcome ? Process ? Call Patient Escort to Exam Rm ? Vitals & Ask Quest ? Meet Dr. Kassam ? Process & Check-out Line of Visibility BACKSTAGE Get See Other Grab Check Place in Take See Other See Other See Other Kassam CONTACT Patient Patients Patients Door Tag Patients Patient Away Patients PERSON Chart Location Bin Chart Brings Chart in Grab Kassam Door Tag To Be Chart Gets Quick Back Seen Bin from Bin Review Chart Write Rm Check Taken by # on Patient Dictation Staff Schedule Location Line of Internal Interaction SUPPORT Records/ Bin Chart Records/ Debbie’s Door Tag Schedule Storage Database Chart Cart Database System System System PROCESSES System System System

Complex workflow Presby Neuro Clinic Service Blueprint of PHYSICAL Front Waiting Front Waiting Front Hallway Exam MRI & Exam MRI & Door Tag Waiting Check-out EVIDENCE Desk Room Desk Room Desk Room Chart Room Chart Room Room Check-out, PATIENT Sign In Wait Check-in Wait Responds Follow to Wait in Answer Wait Ask Return Wait Pay, & ACTIONS Exam Rm Exam Rm Questions Questions Door Tag Leave Line of Interaction ONSTAGE Call Escort to Check Meet Dr. Process & CONTACT Welcome Process Patient Vitals & Kassam Exam Rm Ask Quest Check-out PERSON Line of Visibility BACKSTAGE Get See Other Grab Check Place in Take See Other See Other See Other Kassam CONTACT Patient Patients Patients Door Tag Patients Patient Away Patients PERSON Chart Location Bin Chart Brings Chart in Grab Kassam Door Tag To Be Chart Gets Quick Back Seen Bin from Bin Review Chart Write Rm Check Taken by # on Patient Dictation Staff Schedule Location Line of Internal Interaction SUPPORT Records/ Bin Chart Records/ Debbie’s Door Tag Schedule Storage Database Chart Cart Database System System System PROCESSES System System System

Flow dependent on Dr. Kassam Clinic Service Blueprint of Presby Neuro

Needs Patient Staff Dr. Kassam Feeling welcome Better workﬂow Spend quality time with patients Actual wait time Locating Dr. Kassam and each other See everyone Respect Communication Support Staff Space and comfort Making a difference Time Distractions

It’s more than wayﬁnding, wait time, and workﬂow. The experience is the relationship between patients, staff, and Dr. Kassam within the given space.

Opportunities Embrace Wait Time Inform, engage, and comfort patients? Improve Workﬂow Fewer tasks, less distraction, and better communication? Balance Kassam Support his efforts to help patients, but also ﬁnd time for himself and support his staff.

Sharing our research, gaining their trust.

Engaging the staff in the design process.

“Embrace wait time.” Direction from Center for Quality Improvement & Innovation.

We explored concepts for all three opportunities...

But decided to focus more on the patient experience. Why? Opportunity for the greatest impact Client focusing on workﬂow More physicians in the future will reduce strain on Dr. Kassam Client nudging us that way

We moved and removed chairs to affect the patient experience. Before After

Because we involved the staff in our process, they really helped us gain access to patients.

Experience Cards Designed to engage patients and elicit ideas from them on what the experience could be.

Eleven Exam Room Interviews “We’ll talk about anything to anyone. Entertain us.” “The first time I came, my mom and cousin were in the waiting room for three hours. My mom finished a book. That was really hard for me.” “Our town has one traffic light.” “I come by myself now. I don’t bring my family anymore. I’m my own woman.” “I’m about to get brain surgery. I don’t want to play checkers!”

Patient Journey t it isi vis tv it it rs re ﬁ sit isi t vis vis n ca is/ i v u p u p cti o ar y no s pv er y t-op w- w- te m ag -o g llo llo De Pr i Di Pre S ur Pos Fo Fo >

Emotions patient emotions family emotions Support Needs patient support needs family support needs Waiting Needs family waiting needs patient waiting needs Information Needs family info needs patient info needs t it isi vis stv it it ar e fir t it vis vis s/ isi vis p p tio n yc os i v y p -u -u ec ar gn op er -o ow ow et rim a e- rg st ll ll D P Di Pr Su Po Fo Fo

New Pre-op Post-op Returning Patient Patient Patient Patient Curious Can’t think Dazed Thankful Emotions Hopeful Overwhelmed Feels bad about Understanding family waiting Feels bad about Self-concerned Bored family waiting Mixed feelings: Confusion laughing crying Blessed Confusion Shock and relief Emotional Support Transportation Transportation Transportation Support Someone to collect info Someone to collect info Physical care Needs Someone to make Physical care arrangements Distractions Special treatment Distractions More engaging Waiting distractions Needs Interactions Schedule Testing info Possible symptoms Wait time Information Valet Surgery info/procedure Medical education Schedule/other appt. Needs Place to stay Reality: good/bad Medical translation Don’t want to repeat personal info Wait time Wait time Schedule/other appt. Sign-in process Sign-in process Wait time

New Concepts Spending more time with patients inspired new concepts.

low cost Cost/Value Stages of Care wheelchair with regular seating areas suite of cards coat rack clinic graduation certiﬁcate Kassam fact sheet note-taking kit ambient music Neurosurgery Wall of Hope common terms glossary patient-use phone partitioned food & drink cart waiting area low value high value no front desk video testimonials rotating museum USB memory stick artwork exhibits for patient records waiting room TVs calming closed-circuit TV Kassam TV real-time water fountain to watch surgery wait tracker patient transportation LCD screens patient information for dynamic art for visually impaired computer kiosks wait room wait room food servers librarian mentor patient advocate high cost

Concept Validation Soothing Music Glossary of Neurosurgery Terms Patient Information Card Mary arrives at the clinic for her pre-op visit. She’s The waiting room is filled with soothing music, exhausted from all the testing and feels very stressed. which helps to calm her, reducing some of her anxiety a and stress. Wall of Hope On Adam’s first visit to the clinic, the In the exam room, the doctor and nurse Adam thumbs through the glossary the check-in nurse gives him a glossary of list off a number of procedures and nurse gave him earlier and learns what common terms used in neurosurgery. medical terms that Adam does not know. all of those terms mean. He feels less He feels confused and overwhelmed. anxious about the process. Dr. Kassam Fact Sheet Debbie hands the nurse her patient The nurse swipes the card in the reader, Her medical history and information information card to begin her clinic then Debbie enters a pin number. prints out for her to verify. Debbie’s appointment. glad she doesn’t have to recite any information or fill out paperwork. During their wait time, they y notice a wall with testimonials from previous patients. vious Bonnie and her husband arrive at the clinic for the first time, anxious and tired. Bonnie sees comments of those t before and after surgery an finds nd and some comfort and assuranc ce. assurance. She is not the only one. University of Pittsburgh Medical Center Center for Quality Improvement & Innovation Helen is concerned with her surgery. She is given a sheet providing facts Helen is reassured that she is in and information on Dr. Kassam. good hands. She is able to focus on other things.

Validation with Patients

Operating Room Developed a greater empathy for the patients and families going through this experience.

Design Implications Provide patients with access to resources so they feel in control of their experience. Embody the comfort Dr. Kassam provides. Increase interaction between patients and Dr. Kassam and his staff.

Concept and Process Book Holistic view of the clinic Sharing what we learned Providing concept ideas to further explore and continue the work that Design for the Clinic we started Experience Concepts for UPMC Presbyterian Neurosurgery Clinic Carnegie Mellon School of Design Service Design Fall 2007 Melissa Cliver Jamin Hegeman Kipum Lee Leanne Libert Kara Tennant

Current State CURIOUS Lack of interaction at different points throughout the journey creates a barrier PERSONABLE between patients and their families and the positive experience of being with ANXIOUS CLEAR Dr. Kassam and his staff. CONFUSED EXPERIENCED UNDERSTANDING ACCOMODATING OVERWHELMED AT EASE UPSET ANSWERS CARING DR. KASSAM PATIENT COMFORTING CONFIDENT A TEAM REASSURING FAMILY STAFF DIRECT TRUST-WORTHY FRUSTRATED WARM SCARED GOOD HUMORED UNCERTAIN

Ideal State CURIOUS Continual interaction extends the positive experience of being with PERSONABLE CLEAR Dr. Kassam and his staff to the patients and their families, putting ANXIOUS them at ease and giving them EXPERIENCED CONFUSED control of their experience. OVERWHELMED ACCOMODATING UNDERSTANDING AT EASE ANSWERS UPSET DR. KASSAM PATIENT CARING COMFORTING A TEAM FAMILY STAFF REASSURING DIRECT TRUST-WORTHY CONFIDENT WARM FRUSTRATED SCARED GOOD HUMORED UNCERTAIN

Patients Family Patients Family Staff Dr. Kassam Staff Dr. Kassam Clinic Staff Meetings Clinic Staff Locator Needs met Needs met • Forum for discussion • Finding each other and reﬂecting and Dr. Kassam • Team-building • Reduction in tasks

Patients Family Patients Family Staff Dr. Kassam Staff Dr. Kassam PCP Direct Link Wait-time Indicator Needs met Needs met • Support his staff • Desire to see everyone • Time for himself • Time for himself • Better communication

Patients Family Patients Family Staff Dr. Kassam Staff Dr. Kassam Gift from the Clinic Wall of Hope Needs met Needs met • Comfort • Reassurance • Feeling of good will • Information from staff • Distraction

Welcome Booklet Embodying Dr. Kassam and the clinic Comfort Conﬁdence Warmth Humor Bringing Dr. Kassam to the waiting room Increasing staff service delivery role

Layout of the Book front cover back cover page 1 page 2 If you want to learn more about me or the clinic, visit the clinic’s website. It has a lot of good information and videos. neurosurgery.pitt.edu/minc I know you don’t want to be here. I know you don’t want to know me. But the best thing that could happen is to know me. I’ve performed more than 3,000 neurosurgical procedures. More than 800 are what’s called minimally invasive endoscopic procedures. And I’m a person first. I’ll be direct and treat you like a friend. Occasionally, I may even make you laugh. page 3 page 4 page 5 page 6 It’s minimally invasive brain surgery I work with a great team, and could My staff and I see a lot of patients, through the nose. This requires no not do my job without them. They can and provide attention and care to incisions and patients can often be answer a lot of your questions. Trust all. We know this sometimes leads to discharged within two days. them as you trust me. We’re here for backups. But I hope you’ll understand you the whole way through. and trust I’ll see you as soon as I can. Under my direction, the center has pioneered and developed much om rse Ro o m r Nu of the technology and instrumentation used during these surgeries. it ing Ro it vis m to vis rst isit isit ait xa en With continued research and experience, I now use this surgery for are /fi isit vis it pv pv eW eE sid ut on yc sis n th th Re most tumors affecting the skull base. cti ar no pv er y op w-u w-u k-i in in ta e k-o ete m iag -o urg st- llo llo he c ait ait ee e m hec D Pri D Pre S Po Fo Fo C W W M Se C 2 days - 2 weeks 2 days - 4 weeks 1 month - 1 year 6 months - 1 year

When they meet him in the exam room, they see that he is indeed personable, and funny, too, just like in the booklet. Annette is a new patient. After she and her husband check in, a front-desk staff member gives them a welcome booklet, indicating it’s a message from Dr. Kassam. In the waiting room, they read Dr. Kassam’s welcome. They like that he seems personable and experienced, and are glad to ﬁnd out a bit about him. Welcome Booklet The Welcome Booklet gives new patients an overview of Needs met Patients Family the overall patient journey, one clinic visit, the staff and • Information Dr. Kassam in Kassam’s own words. • Interaction with Kassam Since a staff member hands the booklet directly to the Staff Dr. Kassam new patient, it also serves as a new line of interaction between the staff and patient where there was none before.

Clinic Chat A Vision for the UPMC Neurosurgery Clinic Creating a system of interaction, information, distraction, and support Extending the comfort of Dr. Kassam and the clinic

Waiting Room Patient Waiting Room Patient Messages from patients, staff and Dr. Kassam appear on a large Clinic Chat display in the waiting room. Common phrases from the Clinic Chat appear in a tag cloud on adjacent display to give viewers a general idea of what’s been discussed. Clinic Chat Patients, Dr. Kassam, and staff contribute to an organically Needs met Patients Family formed system that provides information, distraction, and • Front-stage/back-stage a connection with Dr. Kassam and his staff during periods interaction when they cannot be physically present with the patient. • Information Staff Dr. Kassam • Distraction • Support

Staff have access via hall displays. Patients can send messages to Clinic Chat from their phone, personal computer or kiosk in the waiting room, exam room or at home. Dr. Kassam can reply from the ofﬁce computer.

Part of a Larger Information System Includes information about: Dr. Kassam Surgery and Side Effects Clinic Staff Prescriptions

Could something like Clinic Chat work elsewhere? We think so.

Designing the Experience Together Patients, staff, and Dr. Kassam contribute to designing the experience Wait time is an opportunity to interact with other patients, staff, and Dr. Kassam The service extends the comfort of Dr. Kassam and his clinic and provides information, distraction, and an experience that is created together with the patients, which increases patient control

Thank you!

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UPMC Neuro Clinic Service Design

by Jamin Hegeman

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