Understanding Patient Engagement

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What is patient engagement? How do we create it? This talk proposes that focusing on human qualities and applying user experience design processes can help health information technology professionals with this key goal.

Understanding Patient Engagement

  1. 1. Understanding Patient Engagement Elizabeth Bacon HIMSS Usability Task Force Jan 21, 2014
  2. 2. Agenda • Introduction • Quest for patient engagement Strategy for digital health engagement Case study: Find Wellness Last note, Q&A • • • Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  3. 3. Introduction Liz Bacon 1999-2002 Cooper 2002-2007 St. Jude Medical 2007-2010 IxDA Director/Vice-President 2007-now Devise 2012 2012-now Elizabeth Bacon Providence Health & Services Find Wellness Understanding Patient Engagement HIMSS Task Force - Jan 2014
  4. 4. UX Sundial model “UX” is an umbrella term for a range of disciplines UX specialties operate on a spectrum of “soft” skills: • Understanding • Definition • Communication Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  5. 5. Agenda • • • • • Elizabeth Bacon Introduction Quest for patient engagement Strategy for digital health engagement Case study: Find Wellness Last note Understanding Patient Engagement HIMSS Task Force - Jan 2014
  6. 6. Healthcare is broken (sorry!) “Healthcare is broken. ... We have set up a delivery system that is fragmented, unsafe, not patient-centered, full of waste, and unreliable. Despite the best efforts of the workforce, we built it wrong. It isn't built for modern times." * * Dr. Donald Berwick (who oversaw Medicare & Medicaid) as quoted by Richard Anderson at http://riander.blogspot.com/ Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  7. 7. “Behavior change” • We can’t “motivate behavior change” • • Paternalistic view that removes individual agency Instead, we facilitate behavior change ** “Teachable moments” Where we usually reside ** from Dr BJ Fogg, Director of Persuasive Tech Lab at Stanford University, as presented at Healthcare Experience Design conference on March 27, 2012 Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  8. 8. Healthcare’s new goal • Quest for patient engagement • One way to assess engagement is the “Patient Activation Measure” (PAM) model ** * diagram from Insignia Health Solutions http://www.insigniahealth.com/solutions/patient-activationmeasure Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  9. 9. Improving behavior • Results suggest that improved behaviors follow on increased activation* * from Health Services Research publications by Judith Hibbard, et al. such as http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC1955271/ Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  10. 10. To increase activation We need to: • build patients’ confidence • build patients’ understanding • grow their skills • facilitate healthy behaviors • address inevitable back-sliding Is that all? Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  11. 11. Engage personally • We have to understand individuals, first and foremost • Healthcare system needs to treat the whole person, across all our life contexts Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  12. 12. Connected world • We have to reach and activate people wherever they are, whenever they act • Digital channels are key cost-effective, modern way to extend the reach of care delivery system Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  13. 13. Problem: it’s all transactions Each encounter for a patient with the healthcare system is a distinct, separate transaction. ! • • Elizabeth Bacon It’s rare for any transaction to be related to earlier transactions. It’s not yet happening that today’s transactions are related to FUTURE transactions… Understanding Patient Engagement HIMSS Task Force - Jan 2014
  14. 14. From transactions to engagement 21st century business models must evolve from systems of records and transactions to systems of engagement * Elizabeth Bacon http://www.dachisgroup.com/2011/06/movingbeyond-systems-of-record-to-systems-ofengagement/ * Understanding Patient Engagement HIMSS Task Force - Jan 2014
  15. 15. How it looks today • Kind of ecommerce model — but applied to the vital business of health Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  16. 16. Must consider context Arguably healthcare’s greatest IT problem is the plethora of disconnected, 3rd party systems that ostensibly support care delivery ! • Must always consider the bigger picture: the patient’s perspective Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  17. 17. Alternative care models We do have to explore and embrace alternatives • • Accountable Care Services: new business model being explored by delivery systems and encouraged by government regulation Moving from fee-for-(face-to-face)-service to fee-for-quality-outcomes demands greater efficiency at scale ! • Elizabeth Bacon Question remains, how will quality be measured? Understanding Patient Engagement HIMSS Task Force - Jan 2014
  18. 18. What can we do in our work? If HIT systems of record can’t even manage related transactions well, or be proactive, then how can we expect to build patient engagement and facilitate behavior change? ! Let’s keep in mind a few things, focusing on positively-oriented, real human traits… Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  19. 19. People are emotional Decision making is compromised when negative emotions hold sway. ! ! ! “Emotion may interfere with patients' understanding of the risks and tradeoffs of treatment options and with their ability to make good decisions. … Group Health Cooperative in Washington state saw a 26% and 38% drop in hip and knee surgery rates, respectively, after the HMO adopted video and written patient decision aids.” * Research as discussed in Modern Health Care article published 2013-12-07 Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  20. 20. Not all are health literate “Health literacy and health numeracy are something that is a problem for everyone, even college-educated folks and doctors.”* ! When we receive upsetting health news, we’re often in one of the worst positions to absorb information and act rationally. * Quote from Catharine Clay, director of shared decision making education and outreach for the Dartmouth Institute of Health Policy and Clinical Practice, in Modern Health Care article ibid Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  21. 21. Can’t we just ask people? The most satisfied patients have a 26% higher mortality rate, AND Had 9% higher medical costs; Spent more on drugs; and Were more likely to be admitted as inpatients.* ! So, no, we can’t just ask people whether they’re satisfied and be done… * Researchers at University of California-Davis analyzed responses from 51,946 adults between 2000 and 2007 for the national Medical Expenditure Panel Survey, as covered by Advisory.com Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  22. 22. Focus on quality of life "Quality of life happens to be the element that is most important in motivating people to deal with an illness.”* This may sound obvious, but it speaks to how people want to feel in their engagement with the healthcare system. * Noreen Clark, director of the Center for Managing Chronic Disease at the University of Michigan, as quoted in “The Simple Idea That Is Transforming Health Care” http://online.wsj.com/article/SB10001424052702304450004577275911370551798.html Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  23. 23. People exist in context Patients have families whose feelings weigh on their decisions ! Patients may also be caretakers — or have caretakers ! Individuals operate according to their own goals and values (albeit within broad behavioral categories that we can identify through research) Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  24. 24. Agenda • • • • • Elizabeth Bacon Introduction Quest for patient engagement Strategy for digital health engagement Case study: Find Wellness Last note Understanding Patient Engagement HIMSS Task Force - Jan 2014
  25. 25. Strategic interaction framework for healthcare • Interaction framework for healthcare is a blended model: – Transactions ≈ ecommerce – Engagement ≈ social media Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  26. 26. Back to the people We have to understand what people value, what their behaviors are today, and what their goals are ! • We can create more engaged patients and facilitate preventative health behaviors when we truly know them… Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  27. 27. Strategy for engagement A digital health engagement strategy boils down to three elements: ! 1. Know the people you want to serve 2. Facilitate behavior change 3. Create systems of engagement ! ! UX processes give us the roadmap Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  28. 28. UX Process Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  29. 29. Know the people Do user research & create persona models — understand your specific domain ! “It depends” — you must focus on your actual contexts of use ! Prioritize IT development by using persona classification to manage different users Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  30. 30. Facilitate behavior change Capitalize on existing healthy behaviors that you now understand ! Ride the motivation wave by becoming embedded into their daily lives ! Serve people’s goals, as articulated by personas ! Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  31. 31. Create engaging systems Move beyond viable and feasible — build desirable experiences ! Desirable Viable Elizabeth Bacon Feasible Understanding Patient Engagement HIMSS Task Force - Jan 2014
  32. 32. Agenda • Introduction Quest for patient engagement Strategy for digital health engagement Case study: Find Wellness • Last note • • • Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  33. 33. Origins of Find Wellness Positive preventative care behaviors include seeking care from practitioners of acupuncture; massage; chiropractic; coaches; counselors; meditation teachers… • CAM is 1% of total healthcare spending: 
 ~$23 Billion in 2013 Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  34. 34. Problem identification It’s hard to use the web to find qualified providers Practitioners are passed around through word-ofmouth ! Providers aren’t very tech savvy or marketing savvy, and they need help running their businesses ! America is still fairly ignorant of the efficacy of many ancient healing modalities Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  35. 35. Spark of wellness Hypothesis: healthy behaviors can be contagious! ! • Facilitate connections and foster a quality source of “help care” • Use PROMs to measure quality and feed that data back into health tracking tools & provider recommendations • Creates longitudinal engagement that benefits all participants Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  36. 36. User research We conducted research to understand people and their real-life situations ! Generative research tool to discover today’s obstacles and opportunities (“unmet needs”) ! Best practice: ethnographic-style research involving interviews and observation in the user’s context Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  37. 37. FW research Met users in context, discussed their current habits and experiences with CAM, identified today’s successes and issues, considered future states… ! • Consumers • Practitioners • HR Directors Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  38. 38. Created personas Archetypal user models based on behavior patterns discovered among target demographic ! • • • • Elizabeth Bacon Keeps us focused on specific needs (while representing the needs of many) Builds a shared understanding of users for team Reduces self-referential design Supports feature prioritization among a set of personas Understanding Patient Engagement HIMSS Task Force - Jan 2014
  39. 39. FW persona set Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  40. 40. Classification & focus Focused on primary personas Janelle & Alexa Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  41. 41. Ideate and model Created paper prototypes of key interactions • Conducted guerrilla usability testing with people like Alexa and Janelle Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  42. 42. Built marketing website Beta sign-ups and build social media connections Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  43. 43. Interactive prototype Created digital prototypes of system • Conducted guerrilla usability testing with people like Alexa and Janelle Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  44. 44. Launched alpha in Oct Focus on acquiring practitioners & building presence Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  45. 45. Engaging search Natural language searches lead to list of qualified providers who serve that health condition Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  46. 46. Engaging health tracking Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  47. 47. Engaging onboarding Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  48. 48. Engaging networking At our launch party in November, practitioners expressed need for a place to network and develop referrals… ! so we created a private LinkedIn group and are scoping referral functionality into our product roadmap. Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  49. 49. Iterate and keep iterating Keep doing it over and over again… ! Add fidelity ! Add learnings from previous iterations ! Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  50. 50. Agenda • • • • • Elizabeth Bacon Introduction Quest for patient engagement Strategy for digital health engagement Case study: Find Wellness Last note Understanding Patient Engagement HIMSS Task Force - Jan 2014
  51. 51. Points of light • Healthcare Experience Design / Healthcare Refactored: conferences that help disseminate design thinking to healthcare decision makers ! • We need a multi-disciplinary effort to get our heads around how to facilitate behavior change and create systems of engagement Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  52. 52. Let’s get more UX designers involved in healthcare! • Reach out to and engage with user experience designers for key initiatives • Bring UX speakers and trainers into your organization • Hook them with your passion for solving wicked problems • Collaborate, collaborate, collaborate! Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  53. 53. Find the right practitioners for your needs • Remember that not every “UX Designer” is equally strong in the skills of UNDERSTANDING, DEFINITION and COMMUNICATION • Match your needs to the right set of UX capabilities Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014
  54. 54. Thank you — let’s keep talking! Email: liz@deviseconsulting.com Slideshare: Elizabeth Bacon Twitter: @ebacon Elizabeth Bacon Understanding Patient Engagement HIMSS Task Force - Jan 2014

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