European Book Launch - RSD Symposium, Oslo


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  • Why I’m enrolled in this field. My experience with online publishing, CDSS, and clinical reference portals.Getting closer & closer to the clinician’s situation & seeing their utterly fragmented universe of systems.And most of them have no time or patience. And we are so rarely able to really design to the way they think …
  • See the connection? Mayeroff’s definition: Care is an exchange that helps others grow, and it grounds us ever more among the circle of others we care for. “There must be growth in the other”
  • 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.
  • Is there a conflict between a systems view and patient-centeredempathy? Empathic design has been a strong trend over the last 5 years, and it has influenced our approaches toward research, interviewing, app & service design. Its necessary but not sufficient – clinicians are often
  • 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
  • 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.
  • Example by St Mike’s HDL, which produced a series of web-accessible design documentaries feat personal monologues by current patients dealing with cancer. They started with short films with hired actors, but as they learned discovered how much impact real people had on the helping people living with cancer in the community. Notice the themes linked to different life stages.
  • 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.
  • European Book Launch - RSD Symposium, Oslo

    1. 1. Design for Care Design Research for HumanCentred Healthcare Peter Jones Copyright © 2013, Peter Jones Redesign Network OCAD University, Toronto
    2. 2. Booksite (Code: DFCRSD) Practice network @designforcare Publishing Innovations • Design series, design values • Print + PDF, Kindle, ePub • Images free on Flickr • Not about “selling books” • Book as a medium for field & practice development • Continuous process, not an “end” Copyright © 2013, Peter Jones
    3. 3. Why this book. Copyright © 2013, Peter Jones
    4. 4. Where care lives. Copyright © 2013, Peter Jones
    5. 5. 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 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
    7. 7. Information & Online Services Copyright © 2013, Peter Jones
    8. 8. Devices & Medical Products Zero diabetes armband concept Mauro Amoroso Toshiba CT scanner Timesulin insulin pen Copyright © 2013, Peter Jones
    9. 9. Experiences Philips CAT “dollhouse” sim Copyright © 2013, Peter Jones magazine Philips Design, from Coroflot
    10. 10. TO SERVICES & CONTEXTS … Copyright © 2013, Peter Jones
    11. 11. Yet we are fragmenting Design Thinking in Healthcare • • • • • • • User Experience / Interaction Design Service Design Evidence-Based Design Environmental Design Participatory Design Generative Design Radical Innovation • Bridging discipline: Sociotechnical systems Copyright © 2013, Peter Jones
    12. 12. Contexts of Care Design SERVICE 12 Copyright © 2013, Peter Jones
    13. 13. Copyright © 2013, Peter Jones
    14. 14. 1. People, not users nor patients. People behave as Health Seekers. 2. Hospitals / Practices, cultural & business. Cultural & business design sustain an enterprise in a community / system. 3. Healthcare is a service system. Service systems are designable. Copyright © 2013, Peter Jones
    15. 15. Design Geographies Each level has a skillset. Complexity increases with each .0 Number of stakeholders > Need for collaboration > But design skills do not transfer up Healthcare may demand all 4. At least > 1 designer And > 1 clinician And > 1 manager Copyright © 2013, Peter Jones
    16. 16. 1 We are all Health Seekers • We do not self-identify as patients • Can we design for persons? • We all seek health – not “optimal” or perfect but a homeostasis adapted 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. Copyright © 2013, Peter Jones
    17. 17. 1 2 Two points have highest leverage – Primary care & Recovery Copyright © 2013, Peter Jones
    18. 18. Health seeking includes information seeking across media. Knowledge acquisition for making sense of health. Make the most of starting points! Copyright © 2013, Peter Jones
    19. 19. Health seeking design research From observing to representing to interpreting to co-creating Copyright © 2013, Peter Jones
    20. 20. Design Documentaries by Health Design Lab Copyright © 2013, Peter Jones 1
    21. 21. 2 Care as Clinical Service • Care “designed” today for efficiency & cost. • Patient experience is not a standard of design / care. • Patient-centered is not a new “user-centered” Risk of patient becoming a customer … Service systems include care teams, IT, community • Design research differs by care context: Sequential, Iterative, Complex, Emergent Copyright © 2013, Peter Jones
    22. 22. Healthcare AS a design practice Copyright © 2013, Peter Jones 2
    23. 23. Clinical Design 1.0 – 4.0 1.0 Care design for the health seeker in their own world Fostering self-care & preventive awareness 2.0 Clinical encounter, exam, tests, diagnosis & treatment 3.0 Healthcare team, care planning & practice management 4.0 Care organizations, organizational strategy, business model design & healthcare policy HIT is not separate - connects to each sociotechnical system. Copyright © 2013, Peter Jones
    24. 24. Health-seeking in Context of Care Copyright © 2013, Peter Jones 2
    25. 25. 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.
    26. 26. Redesigned as a service system - coordinated work practices, org protocols, patient communication Atrial Fibrillation System Redesign The improvement of individual experience is a product of designed healthcare. Good, but not systemic. Service design must scale. 26 Copyright © 2013, Peter Jones
    27. 27. CD2.0 - Afib Personas & Care Tools Copyright © 2013, Peter Jones 2
    28. 28. 3 Healthcare Systems • (To date) Big Box Healthcare is disrupted by cost & policy, not by innovation … • Business, cultural & tech innovation. (The system is not just a collection of services) • How should these social systems be designed for total health outcomes? Copyright © 2013, Peter Jones
    29. 29. How does a patient fall through the cracks? Copyright © 2013, Peter Jones 3
    30. 30. 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. Copyright © 2013, Peter Jones • 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. 3
    31. 31. Continuity of Care by IDEO + CHCF IDEO +©California HealthCare Foundation , 2012 Copyright 2013, Peter Jones Project Synapse 3
    32. 32. Value to Patient expressed as … • 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
    33. 33. Can we distribute care resources among different points of connection? Copyright © 2013, Peter Jones
    34. 34. Strategic Foresight – Specialized Care Copyright © 2013, Peter Jones
    35. 35. Copyright © 2013, Peter Jones
    36. 36. Peter Jones, Ph.D. @designforcare` Copyright © 2013, Peter Jones