Re-imagining Prenatal Care as a Wellness Experience Through Service Design - Marnie Meylor, Mayo Clinic Center for Innovation
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DAY ONE – OCT 2nd 2015 at Global Service Design Conference NYC MORNING SESSIONS / / QUALITY OF LIFE more info at: http://bit.ly/1GSeSDT
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Re-imagining Prenatal Care as a Wellness Experience Through Service Design - Marnie Meylor, Mayo Clinic Center for Innovation
- 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”
- 11. Service Design Global Conference | October 2015 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