The document discusses the re-imagination of prenatal care at the Mayo Clinic, focusing on transforming low-risk prenatal services through technology and service design to enhance the wellness experience for expectant parents. It emphasizes the need for a patient-centered approach that fosters communication and continuous support between visits, enabling mothers to feel empowered and connected to their care team. The project seeks to shift the perception of prenatal care from a medical model to a holistic wellness experience, enhancing autonomy and confidence among patients.

1. Marnie Meylor | Mayo Clinic Center for Innovation
@marniejo
Re-imagining prenatal care
as a wellness experience
through service design
October 2nd, New York City

2. Service Design Global Conference | October 2015
Transforming low-risk prenatal care by leveraging technology
and redesigning services
OBJECTIVE
How might we provide additional ways for people to connect
with the OB practice in ways that de-medicalize care and
empower expectant parents to feel both supported and
confident in their own intuition?
OB Nest Project

3. Service Design Global Conference | October 2015
Center for Innovation
Methodology
14 Experiments
Online Communities
Text-a-Nurse
Video-Appointments
Video-in-a-Friend
Confirmation Calling
Tummy Photos
Tracking “Just Come In” Advice
Video Nurse Visits
Your Care Options
Proactive calling
At-Home Measurement
Drop-in Care Stations
Technology Access
Patient-CenteredTeam Care

4. Service Design Global Conference | October 2015
Examples of the range of issues and
questions that come up between visits:
CURIOSITY CONCERN
wait until next appointment call inon my own
How much swelling is too
much swelling?
Where do I go to find a
maternity swim suit? The baby hasn’t
been kicking...
I’m not feeling the baby
move consistently yet...
What brand of vitamin
should I take?
I’m going on vacation
next week...
I’m bleeding...
THE CARE NAVIGATION VISIBLE TO THE PATIENT VIA THE PHONE LINE
VISIT VISIT
The range of issues women
have during pregnancy

5. Service Design Global Conference | October 2015
CURIOSITY CONCERN
wait until next appointment call inon my own
been kicking...
I’m not feeling the baby
move consistently yet...
What brand of vitamin
should I take?
next week...
I’m bleeding...
OB / CNM
NURSE CALL ROOMAPPOINTMENT
COORDINATORS
THE CARE NAVIGATION VISIBLE TO THE PATIENT VIA THE PHONE LINE

6. Service Design Global Conference | October 2015
CURIOSITY CONCERN
wait until next appointmenton my own call in
4 WEEKS UNTIL NEXT APPOINTMENT
CONCERNCURIOSITY
wait until next appointment call inon my own
LESS THAN 1 WEEK UNTIL NEXT APPOINTMENT
I haven’t felt my baby move.
Should I be concerned?
Example issue
Patient’s willingess to wait
until her next appointment
VISIT VISIT

7. Service Design Global Conference | October 2015
VISIT VISIT VISIT VISIT
BETWEEN VISITS
DURING VISITS
One-dimensional, Provider-centric
perception of Continuity of Care
No perception of continuity,
lack of connection to OB
VISIT VISIT VISIT VISIT
DRUMBEAT
Impact on patient experience

8. Service Design Global Conference | October 2015
CONCEPTION DELIVERY 6w12 18 – 20w6-8w 36w
m
om
’sanxie
ty
THE “EMOTIONAL HUMP”
I’m pregnant!
ANXIETY
A typical pregnancy experience
CONCEPTION DELIVERY 6w12 18 – 20w6-8w 36w
m
om
’sanxie
ty
THE “EMOTIONAL HUMP”
I’m pregnant!

9. Service Design Global Conference | October 2015
CONCEPTION DELIVERY 6w12 18 – 20w6-8w 36w
m
om
’sanxie
ty
THE “EMOTIONAL HUMP”
I’m pregnant!
ANXIETY
A typical pregnancy experience
CONCEPTION DELIVERY 6w12 18 – 20w6-8w 36w
m
om
’sanxie
ty
THE “EMOTIONAL HUMP”
I’m pregnant!
The level of interest women
perceive coming from their
OB CareTeam

10. Service Design Global Conference | October 2015
VISIT
SIGNALS
... is sickness care
... is a dangerous process
... requires specialist care
Low-risk pregnancy...
Pregnancy is a MEDICAL EXPERIENCE
REDUCES
Autonomy
Confidence
Self-Awareness
Empowerment
The clinic’s “Gravitational Pull”

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D
ECENTRALIZE MAYO-OB
RE-
CENTRALIZE MOM
I come to Mayo OB to
get prenatal care for
myself and my baby
Mayo OB helps me feel
confident about the care I give
myself and my baby, and I know
OB is there for me if I need them.
Shifting a clinic’s culture from
“sick care” to wellness care

12. Service Design Global Conference | October 2015
D
ECENTRALIZE MAYO-OB
RE-
CENTRALIZE MOM
ACTIVATE
SIGNAL Wellness & Normalcy
Joy & Celebration
Autonomy
Confidence
Self-Awareness
Empowerment
Partners
Families
Relatives & Friends
Communities
STRENGTHEN
D
ECENTRALIZE MAYO-OB
RE-
CENTRALIZE MOM
ACTIVATE
SIGNAL Wellness & Normalcy
Joy & Celebration
Autonomy
Confidence
Self-Awareness
Empowerment
Partners
Families
Relatives & Friends
Communities
STRENGTHEN
INCREASING
CONNECTEDNESS
REDEFINING
CONTINUITY OF CARE
Shifting a clinic’s culture from
“sick care” to wellness care

13. Service Design Global Conference | October 2015
F CARE
care
mom’s schedule
sparency
n to resources
y, continuity, and relationships
level of licensure
4ENTS
S
SHIFT IN
ROLE SHARED CONTINUITY & RELATIONSHIPS
SHIFT IN
ROLE SHARED CONTINUITY & RELATIONSHIPS
SHIFT IN
ROLE STAFF OPERATING AT HIGHEST LEVEL OF LICENSURE
NOBN
5-8 10-12
NOBR
18-20
ULTRASOUND
36
ROB
Hi, I’m Mary, your
nurse.
Hi Jane, how are
you feeling?
SEPARATE NURSE PANELS
PUSH & PULL
RN BACK-UPNURSE
OB/CNM BACK-UPOB/CNM
Mom and Nurse are continuously connected using the Asynchronous
Communication Tool, so both feel comfortable with the time between visits
RN
PRENATAL
CARE GUIDE
OB/CNM
EXPERT GUIDANCE
& OVERSIGHT
PAC
CARE EXPERIENCE
PLANNER
CA
CONNECTED CARE
SPECIALIST
EMPOWERED
CARE MANAGER
MOM
NURSES ONLY HAVE THE ABILITY TO BE REACTIVE... NOT PROACTIVE
.5 FTE
SHARED PANELS
BE TRANSPARENT ABOUT NURSE
THE NURSES WERE THE “BETWEEN VISIT CARE” BEFORE, THEY JUST DIDN’T HAVE THE TOOLS OR THE PERMISSION.
CONCEPTION DELIVERY 6w12 18 – 20w6-8w 36w
NOBN NOBR
ROB
I’m pregnant!
ROB ROB ROB
Post-partum
Ultrasound
THE “EMOTIONAL HUMP”
THE “ANXIETY” HUMP
OB CONNECTED
CARE MODEL
BLUEPRINT
Leverage 1.5 – 2-hour time investment
Patient’s nurse uses the Asynchronous
Communication App to schedule time
to follow-up with mom after delivery
Patient’s personal nurse
INVESTMENT PHASE CONNECTED PHASE PREP PHASE DELIVERY/POST-PARTUM
Visit Pre-OB 5-8 12 18-20 FLEX 28 36 38+ DELIVERY 1w Post-Partum 6w
Prescheduled Prescheduled Express Care Scheduling Model Prescheduled Video / Phone Call
Interaction/Duration Call to schedule
OB care
NOBN Visit
2 hrs
NOBR Visit
45-60 min
Ultrasound Visit
45 min
Check-in
20 min
Glucose
testing
ROB Visit
Group B StrepTest
15-20 min
ROB Visit
15-20 min
Post-Partum Phone Call
/ Video Chat
15 min
Post Partum Visit
15-20 min
CareTeam Member PAC Patient’s Nurse OB/CNM Patient’s Nurse Nurse or OB/CNM OB/CNM OB/CNM Patient’s Nurse OB/CNM
Tasks • Schedule NOBN
visit
• Direct mom
to online OB
space (online
communities)
• NOBN Standard Education
• Explain Rhythm of Care,
What to expect (infographic)
• Establish relationship
and how to connect
• NOBR Standard Care
• Fetal Doppler
Training
• Review ultrasound
• Standard 18-20w education
• Fundal Height Training
Ongoing Activities:
• Data Collection/Interpretation
• Proactive Communication
viaText
Option
for Virtual
Check-in
Standard Care based
on Gestation
Standard Care
based on
Gestation
• Congratulate mom,
discuss delivery,
lactation, healing,
depression issues, etc.
• Opt out of 6w Post-
partum (if applicable
Standard Care
Behind the Scenes Staff MFM Physician
Tasks View Ultrasound
Supporting Staff PAC/CA CA CA CA CA CA CA
Tasks Setting up tools – technical
assistance
Prescheduling future OB Visits
Rooming Technical assistance,
if needed
Rooming Rooming Rooming Rooming
Patient-facingTools Online Communities
Mayo Clinic Guide to a Healthy Pregnancy / OB Connect – Mobile App
Asynchronous Communication Proactive Communication
At-Home Measurement Kit (Doppler, scale, BP cuff, Photo App)
Mayo-Campus Drop-in Care Stations
Alternative Connection Methods Video ROB Capability
Infastructure Modifications Express Care Scheduling System
Patient Panels Visualizations
Establish expectations on how to
connect between 18 and 36 weeks
If mom miscarries, her
nurse calls her to follow-up
D
ECENTRALIZE MAYO-OB
RE-
CENTRALIZE MOM
FROM A SICKNESS CLINICAL MODEL
CONCERN
wait until next appointment call in
How much swelling is too
much swelling?
The baby hasn’t
been kicking...
I’m not feeling the baby
move consistently yet...
min
I’m going on vacation
next week...
I’m bleeding...
HE CLINIC, BETWEEN VISITS
OB / CNM
NURSE CALL ROOMPACs
VISIT VISIT VISIT
LACK OF CONTINUITY OUTSIDE OF CLINIC WALLS
The only member of the team that matters to
patients is their provider and it is very difficult
to connect with them outside of appointments
(unless they have a personal relationship or
workaround.)
Outside of appointments, moms feel that the
rest of the staff is an obstacle to connecting to
their provider.
Patients are not confident in the information
sharing between departments, staff or
providers.
Because of the complex navigation that is
required to get a question answered outside of
appointments, moms find it time-consuming
and frustrating to access OB between visits.
MOMS ARE DOING WHAT THEY’RE TOLD TO DO
Moms trust that they are following a rhythm
of care that their providers have intentionally
designed – they assume that there is medical
rationale behind their pattern of visits.
Moms rely on the appointments as
confirmation that their pregnancies are on
track; Only their providers can reassure that
they and their babies are healthy.
Many moms are unclear of what specific risks
their providers are monitoring for, and do not
understand the purpose of the routine
measurements taken during visits.
t
before, so I mean if they say
m coming in and doing that.”
me around and I’m only
hey tell me… I’m feeling my
e”
NAVIGATION
VISIT VISIT VISIT
CONCERN
CURIOSITY CONCERN
wait until next appointmenton my own call in
4-5 WEEKS UNTIL NEXT APPOINTMENT
CURIOSITY
wait until next appointment call inon my own
1-2 WEEKS UNTIL NEXT APPOINTMENT
VISIT
BECAUSE OF THE BURDEN OF ACCESSING OB
BETWEEN APPOINTMENTS the closer moms
get to their appointments, the greater
the concern needs to be to contact OB
ARE
VISIT
MEANS THE CLINIC IS AT THE CENTER OF CARE, NOT MOM
HOW DO WE CREATE A CLINICAL PROCESS
THAT BETTER LEVERAGES THE 99% OF CARE
THAT OCCURS OUTSIDE OF THE CLINIC
D
ECENTRALIZE MAYO-OB
RE-
CENTRALIZE MOM
SIGNALS
... is sickness care
... is a dangerous process
... requires specialist care
Low-risk pregnancy...
Pregnancy is a MEDICAL EXPERIENCE
REDUCES
Autonomy
Confidence
Self-Awareness
Empowerment
I come to Mayo OB to
get prenatal care for
myself and my baby
BETWEEN VISITS
DURING VISITS
One-dimensional, Provider-centric
perception of Continuity of Care
No perception of continuity,
lack of connection to OB
Mayo OB helps me feel
confident about the care I give
myself and my baby, and I know
OB is there for me if I need them.
TO A WELLNESS CLINICAL MODEL
TRANSFORM
A PRACTICE
ACTIVATE
SIGNAL Wellness & Normalcy
Joy & Celebration
Autonomy
Confidence
Self-Awareness
Empowerment
Partners
Families
Relatives & Friends
Communities
STRENGTHEN
WE KNOW WHAT WE NEED TO DO...
IT’S THE HOW THAT’S TRANSFORMATIVE
INCREASING
CONNECTEDNESS
REDEFINING
CONTINUITY OF CARE
VISIT VISIT VISIT
OB NEST ONLINE CARE COMMUNITY
OB PHONE LINE
AT HOME MEASUREMENT
ASYNCHRONOUS COMMUNICATION
OB helps mom
Mom helps herself
VISIT VISIT
{
{
PACs
Mary
NURSE
TEAM
OB / CNM
VISIBLE PROCESS TO PATIENT INVISIBLE PROCESS TO PATIENT
SHIFT IN
RHYTHM
PROVIDE UNOBSTRUCTED ACCESS TO CARE
ACCESS TO REASSURANCE ON MOM’S SCHEDULE
SHIFT IN
RHYTHM
SHIFT IN
RHYTHM
PROVIDE UNOBSTRUCTED ACCESS TO CARE
ACCESS TO REASSURANCE ON MOM’S SCHEDULE
SYSTEM FLEXIBILITY & TRANSPARENCY
SHIFT IN
ROLE OB AS A GUIDE AND CONNECTION TO RESOURCES
NOBN
5-8 10-12
NOBR
18-20
ULTRASOUND
36
ROB
PRESCHEDULED VISITS
FLEXIBLE SCHEDULING
(express care model)
Conversation in beginning to set
expectations around rhythm of
care throughout pregnancy
Online Care Communities
Video-in-A-Friend
Proactive Calls
AND HERE IS WHY!!!!
PRESCHEDU
NURSES ONLY HAVE THE ABILITY TO BE REACTIVE... NOT PROACTIVE
NURSES AND CLINICAL STAFF ARE ALREADY PROVIDING CARE AT A DISTANCE –
JUST NOT GIVEN THE TOOLS/PROCESSES TO BE SUCCESSFUL???
any care happening outside of clinic can only be reactive, nurses and clinical staff are not given the tools to be proactive.
DRUMBEAT
MOM’S ENTIRE PREGNANCY JOURNEY IN CONTEXT
HYPOTHESES ABOUT FUTURE RELATIONSHIP WITH CARE
PREGNANCY
ST
1
DELIVERY
ST
1
PREGNANCY
ND
2
CONCEPTION 12 18 – 20w6-8w
NOBN NOBR
CONCEPTION 12 18 – 20w6-8w
Ultrasound
CONCEPTION 6
NO
I’m pregnant!
NOBN
NOBR
ROB
US
m
om
’sanxie
ty
THE “EMOTIONAL HUMP”
I’m pregnant!
Proactive, Open-dialogue between visits

14. Service Design Global Conference | October 2015
NOBN
5-8 10-12
NOBR
18-20
ULTRASOUND
36
ROB
PRESCHEDULED VISITS
FLEXIBLE SCHEDULING
(express care model)
NOBN
5-8 10-12
NOBR
18-20
ULTRASOUND
36
ROB
PRESCHEDULED VISITS
FLEXIBLE SCHEDULING
(express care model)
Building transparency around the rhythm of care
Conversation in beginning to set
expectations around rhythm of
care throughout pregnancy
Hi Jane, how are
you feeling?
PUSH & PULL
Hi Jane, how are
you feeling?
PUSH & PULL

15. Service Design Global Conference | October 2015
NOBN
5-8 10-12
NOBR
18-20
ULTRASOUND
36
ROB
PRESCHEDULED VISITS
FLEXIBLE SCHEDULING
(express care model)
Conversation in beginning to set
expectations around rhythm of
care throughout pregnancy
Creating diversified access to care
OB PHONE LINE
SELF-MONITORING
SECURE MESSAGINGOB helps
patient
Patient helps
herself
VISIT
{
{
ONLINE CARE COMMUNITY
VISIT
How much swelling is too
much swelling?
Where do I go to find a
The resources available for
the range of issues that
come up between visits:

16. Service Design Global Conference | October 2015
SELF-MONITORING
Patient helps herself
{
ONLINE CARE COMMUNITY
How much swelling is too
much swelling?
Where do I go to find a
maternity swim suit? The baby hasn’t
been kicking...
I’m not feeling the baby
move consistently yet...
What brand of vitamin
should I take?
I’m going on vacation
next week...
I’m bleeding...
OB PHONE LINEONLINE COMMUNITY SECURE MESSAGING
[SELF-DIRECTED] [WITH OB GUIDANCE]
CURIOSITY CONCERN
The resources available for
the range of issues that
come up between visits:
SELF-MONITORING
Examples of the range of issues and
questions that come up between visits:
CURIOSITY CONCERN
wait until next appointment call inon my own
How much swelling is too
much swelling?
Where do I go to find a
maternity swim suit? The baby hasn’t
been kicking...
I’m not feeling the baby
move consistently yet...
What brand of vitamin
should I take?
I’m going on vacation
next week...
I’m bleeding...
THE CARE NAVIGATION VISIBLE TO THE PATIENT VIA THE PHONE LINE
VISIT VISIT
...that meets women where they are

17. Service Design Global Conference | October 2015
SELF-MONITORING
Patient helps herself
{
ONLINE CARE COMMUNITY
How much swelling is too
much swelling?
Where do I go to find a
maternity swim suit? The baby hasn’t
been kicking...
I’m not feeling the baby
move consistently yet...
What brand of vitamin
should I take?
I’m going on vacation
next week...
I’m bleeding...
OB PHONE LINEONLINE COMMUNITY SECURE MESSAGING
[SELF-DIRECTED] [WITH OB GUIDANCE]
CURIOSITY CONCERN
The resources available for
the range of issues that
come up between visits:
SELF-MONITORING
...that meets women where they are

18. Service Design Global Conference | October 2015
Transforming the Status Quo...
CONCEPTION DELIVERY 6w12 18 – 20w6-8w 36w
m
om
’sanxie
ty
THE “EMOTIONAL HUMP”
I’m pregnant!

19. Service Design Global Conference | October 2015
Into an integrated, continuous model of care
CONCEPTION DELIVERY 6w12 18 – 20w6-8w 36w
m
om
’sanxie
ty
THE “EMOTIONAL HUMP”
I’m pregnant!
NOBR
ROB ROB
Post-partum
UltrasoundNOBN

20. Service Design Global Conference | October 2015
PREGNANCY
ST
1
DELIVERY
ST
1
PREGNANCY
ND
2
DELIVERY
ND
2
PREGNANCY
RD
3
DELIVERY
RD
3
PREGNANCY
TH
4
MISCARRIAGE
Into an integrated, continuous model of care

21. Service Design Global Conference | October 2015
What’s Next?

22. Service Design Global Conference | October 2015
Thank you!
Marnie Meylor
meylor.marnie@mayo.edu