Innovation by Design in Patient Experience
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This presentation was given to a medical audience in Toronto in 2014. It discusses the research that supports design-based innovation in the patient experience. For further details contact me at dunne@rotman.utoronto.ca
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Innovation by Design in Patient Experience
- 1. Not by Accident, but by Design How to Innovate in the Patient Experience 2014-‐07-‐02 David Dunne, Ph.D.
- 2. 2014-‐07-‐02 David Dunne 2 My credentials: my grandfather was a designer. L
- 3. 2014-‐07-‐02 David Dunne, Ph.D.
- 4. Summary • Patient experience is all about getting the right outcomes – not “patient satisfaction” • Design of patient experience is an act of conscious creation • There are massive opportunities to solve healthcare problems through design … • … for example … • How the process works • Case study: Mayo Clinic Center For Innovation • Challenges and how to deal with them 2014-‐07-‐02 David Dunne, Ph.D.
- 5. PATIENT SATISFACTION IS NOT PATIENT EXPERIENCE 2014-‐07-‐02 David Dunne, Ph.D.
- 6. Patient satisfaction is not patient experience • To think of patient experience is to see the experience from the patient’s perspective • Patient satisfaction is typically a short-term quantitative score that misspecifies the experience and obscures the story • Well-designed patient experiences achieve desirable goals for all: satisfaction vs. outcome is a false dichotomy 2014-‐07-‐02 David Dunne, Ph.D.
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- 8. The era of paternalis/c medicine, where the doctor knew best and the pa/ent felt lucky to have him, has ended. We don’t worship authority figures anymore. Our health-‐care system has become impersonal, mechanized, and hollow, and it has failed millions of people, many of whom want to find a way to regain control of their own medical decisions. Michael Specter “The Operator” The New Yorker Feb 4 2013 Read more: hJp://www.newyorker.com/reporMng/2013/02/04/130204fa_fact_specter? printable=true¤tPage=2#ixzz2KjLIuKHd 2014-‐07-‐02 David Dunne, Ph.D.
- 9. Patient experience = patient satisfaction surveys 2014-‐07-‐02 David Dunne, Ph.D.
- 10. 2014-‐07-‐02 David Dunne, Ph.D.
- 11. Can we reframe this? • Instead of thinking of patient satisfaction and health outcome as either-or, can we see them as linked? • Patient satisfaction measures are influenced by: – Outcomes – Expectations – Human interaction – Process … etc. • A good experience is a good process that leads to a good outcome 2014-‐07-‐02 David Dunne, Ph.D.
- 12. Says who? 2014-‐07-‐02 David Dunne, Ph.D.
- 13. 2014-‐07-‐02 David Dunne, Ph.D. If we put a fraction of the effort into understanding the patient experience that we invest in understanding diseases, we could immeasurably improve healthcare
- 14. DESIGN IS AN ACT OF CONSCIOUS CREATION 2014-‐07-‐02 David Dunne, Ph.D.
- 15. Design is an act of conscious creation • The needs of the individual user/patient are paramount* • Design thinking does not come naturally: it requires training, method and attitude. Most of all, attitude • Its purpose and methods are different from science. It proceeds by learning from low- resolution/low-risk field trials. 2014-‐07-‐02 David Dunne, Ph.D. *(P.S. Frustrated staff do not deliver good paMent experiences)
- 16. Nobody experiences the system; they experience their own pathway through it 2014-‐07-‐02 David Dunne, Ph.D. What is the “lived experience” of healthcare from the patient’s perspective?
- 17. 2014-‐07-‐02 David Dunne, Ph.D.
- 18. 2014-‐07-‐02 David Dunne, Ph.D.
- 19. This (well-intended) finger wagging is often ineffective … 2014-‐07-‐02 David Dunne, Ph.D. We are different from patients We do not understand their experience, because: • We don’t see everything they see • We don’t live their lives • All patients are not the same • We are biased observers
- 20. There is a better way 2014-‐07-‐02 David Dunne, Ph.D. Understand Frame Create Patient- Centred Design Develop a deep, empathetic, intimate understanding of the context patients live in Define the problem to be solved as the patient would define it Explore – i.e. make – solutions to learn more
- 21. Medicine, Science and Design are different ways of thinking 2014-‐07-‐02 David Dunne, Ph.D. Synthe'c)Analy'c) Symbolic) Real) Science& Design&Medicine& Analy&c( Symbolic( Synthe&c( Symbolic( Synthe&c( Real( Analy&c( Real( Owen 2007 Design proceeds by thoroughly understanding patients’ lives, by making connections, by experimenting to explore the problem. Medicine proceeds by testing hypotheses one at a time, by understanding before acting and by doing no harm.
- 22. THERE ARE MASSIVE OPPORTUNITIES TO SOLVE HEALTHCARE PROBLEMS THROUGH DESIGN 2014-‐07-‐02 David Dunne, Ph.D.
- 23. There are massive opportunities to solve healthcare problems through design • Many studies support the link between experience and outcome • Increased importance of chronic conditions, where the patient is main actor • Patients make choices … and not always choices you’d like • Well-designed experiences reduce cost and make patients happier and healthier 2014-‐07-‐02 BUT every paMent is different … and experiences the same processes differently David Dunne, Ph.D.
- 24. The elephant in the room: adherence 14% to 21% never fill their original prescriptions. 60% cannot identify their own medications 30% to 50% ignore or compromise medication instructions 25% admissions related to poor self- administration. 12% to 20% take other people's medicines. … AND BTW … For a chronic disease like diabetes, 95% of treatment is self-administered 2014-‐07-‐02 David Dunne, Ph.D.
- 25. Patient choice and health outcomes 2014-‐07-‐02 David Dunne, Ph.D.
- 26. SOME OTHER CHOICES 2014-‐07-‐02 David Dunne, Ph.D.
- 27. Memorial’s rehab center prepares patients for home
- 28. The sweet spot: making patients happy and saving money 2014-‐07-‐02 hJp://www.youtube.com/watch?v=16p9YRF0l-‐g David Dunne, Ph.D.
- 29. How a Dutch fly keeps costs in line 2014-‐07-‐02 David Dunne, Ph.D.
- 30. HOW THE PROCESS WORKS 2014-‐07-‐02 David Dunne, Ph.D.
- 31. To understand design thinking, you need to understand three things 2014-‐07-‐02 David Dunne 31 ObservaMon Quant & qual interviews Storytelling Understanding the user and context Rapid prototyping Bodystorming Walk throughs Making as a way of thinking Root causes PerspecMve flips Systems thinking User experience Reframing the problem
- 32. PCD emphasizes ‘lived experience’ • Focus on groups of individuals, not ‘general public’ • Empathy – attempting to see the experience from the patient’s perspective • Understand what drives behaviour so we can achieve better outcomes • NOT the same as ‘pampering’ patients 2014-‐07-‐02 David Dunne, Ph.D.
- 33. Diabetes: the old way "The needles were enormous, and they came with liJle pumice stones so that you could sharpen them. They oken became dull and developed barbs on the end. And in order to sterilize them they had to be boiled for twenty minutes." 2014-‐07-‐02 David Dunne, Ph.D.
- 34. A problem well-framed is a problem solved • We do not accept the problem ‘as given’ but look to reframe it based on – Patient perspective – Underlying issues – Analogies • Reframing is more important than brainstorming 2014-‐07-‐02 David Dunne, Ph.D.
- 35. CHANGING FOCUS AT SINAI EMERG INITIAL FRAME: “WHY CAN’T I GET ANY PRIVACY?” REFRAMED: “WHY ARE THERE SO MANY PEOPLE AROUND?” 2014-‐07-‐02 David Dunne, Ph.D.
- 36. Get physical, early and often • Prototypes can be anything – Rough models – Role plays – Sketches/collages • They force you to get your idea clear and explicit • They help others to see what you are talking about • They allow patients to respond, experience and comment 2014-‐07-‐02 David Dunne, Ph.D.
- 37. Supporting these is an extensive toolkit 2014-‐07-‐02 David Dunne 37
- 38. … and the right attitude 2014-‐07-‐02 David Dunne 38 Empathy … to appreciate the user’s problem even when they are very different from you Curiosity … “mind of a child” who keeps asking “why?” Openness … to different forms of knowledge and to new perspectives Nonattachment … to one’s own ideas, or to those of the team Mindfulness … to see the inherent possibilities
- 39. A nonlinear, iterative process 2014-07-02 UNDERSTAND CONTEXTREFRAME CREATE STATE AND RESTATE THE PROBLEM: WHO NEEDS WHAT BECAUSE WHY? DEVELOP DESIGN PRINCIPLES EXPLORE SOLUTIONS DRAW, MAKE, DO REFINE AND ITERATE DEVELOP PATIENT INSIGHT UNDERSTAND THE SYSTEM ITERATE: WHAT DO OUR FINDINGS INDICATE ABOUT THE PROBLEM? ITERATE: WHAT DO OUR SOLUTIONS TELL US ABOUT THE PROBLEM? ITERATE: WHAT INSIGHTS MAY LEAD TO SOLUTIONS? WHAT DO OUR SOLUTIONS SUGGEST WE NEED TO KNOW? UNDERSTAND REALITY FRAME THE NEED CREATE POSSIBILITY David Dunne, Ph.D.
- 40. MAYO CLINIC CENTER FOR INNOVATION CASE STUDY 2014-‐07-‐02 David Dunne, Ph.D.
- 41. 2014-‐07-‐02 David Dunne, Ph.D.
- 42. Igniting a SPARC • SPARC (see/plan/act/refine/communicate) was started in 2000 • This became the Center for Innovation (CFI) in 2008 • CFI uses design approaches: 1. Topic framing 2. Research 3. Design 4. Implementation 2014-‐07-‐02 David Dunne, Ph.D.
- 43. The intent: to understand and improve the delivery of care 2014-‐07-‐02 David Dunne, Ph.D.
- 44. Redesigning outpatient practice: Jack and Jill rooms 2014-‐07-‐02 David Dunne, Ph.D. Based on the observaMon that physical exam takes up a small porMon of Mme ConversaMon room Treatment room
- 45. CFI Mission, Goals and Approach 2014-‐07-‐02 David Dunne, Ph.D. Mission The Center for Innovation's mission is to transform the experience and delivery of health care. Goals • Focus on the human experience to identify needs and design services, products and business models to meet them • Innovate care delivery that's accessible, affordable and value-driven • Collaborate openly — internally and externally • Generate economic value by demonstrating financial return from sustainable delivery models, services and products Approach The Center for Innovation works with a "Think big. Start small. Move fast.™"philosophy. • Connect. Bring people together in new ways inside and outside of Mayo Clinic. • Design. Identify opportunities and realize solutions that transform care delivery and experience. • Enable. Facilitate and accelerate innovation across Mayo Clinic.
- 46. The CFI’s process 2014-‐07-‐02 David Dunne, Ph.D.
- 47. The RED engineering project 2014-‐07-‐02 David Dunne, Ph.D. Goal Pay for performance è enhanced need for better care at lower cost Method ‘Interview and Observation Key Insights • “Patients don’t get vacations”. • Medical and non-medical considerations were interwoven in the dialysis experience, but there were gaps between them. • The patient care team was often patients’ sole source of support – not just medical, but emotional too. Because of this, patients were often reluctant to leave the hospital. • Patients and healthcare providers spoke different languages, but had common goals and intentions.
- 48. What they learned 2014-‐07-‐02 David Dunne, Ph.D. In the middle of a lot of stress and acute illness, we were asking them to make big decisions: do you want dialysis tonight? You don’t need to do it, but of course if you don’t use dialysis you’ll probably die by tomorrow morning … What kind of dialysis do you want? OK, now you’re on dialysis, goodbye; you can be dismissed from the hospital. Good luck with your new life. We realized that this did not set our patients up for success in the future. Dr. Amy Williams, MD, Nephrologist
- 49. What they did 2014-‐07-‐02 David Dunne, Ph.D. Exploration and Experimentation • Mapped the experience • Developed an integrated care team approach that took into account medical and non-medical aspects. • In-depth patient understanding à new educational materials Outcomes • Hospital admissions fell by 40% • Reductions in in-hospital dialysis. • Patient satisfaction, provider and care team satisfaction all increased. • Quality standards were met and there were significant cost savings.
- 50. CHALLENGES AND HOW TO DEAL WITH THEM 2014-‐07-‐02 David Dunne, Ph.D.
- 51. The challenges • Lack of (or passive) on-the-ground cooperation • Mental models: – It’s about pampering patients/customer service/ marketing … all stuff other people do – It’s about low-priority issues – It’s not scientific – It leads to higher costs – It’s too time-consuming • The lure of the incremental 2014-‐07-‐02 David Dunne, Ph.D.
- 52. The major risks • Isolation and lack of cooperation • Getting overloaded with incremental projects • Lack of departmental engagement • Too few visible results 2014-‐07-‐02 David Dunne, Ph.D.
- 53. Fortunately, others have faced these challenges Strong, public, vocal top-level support Project work: Find early wins Protect unallocated time for “banner” projects Engage departmental teams Internal relationship strategy: Communication and engagement Find allies and draw them in Have someone who knows networks intimately Establish and support communities of practice 2014-‐07-‐02 David Dunne, Ph.D.
- 54. Summary • Patient experience is all about getting the right outcomes – not “patient satisfaction” • Design of patient experience is an act of conscious creation • There are massive opportunities to solve healthcare problems through design … • … for example … • How the process works • Case study: Mayo Clinic Center For Innovation • Challenges and how to deal with them 2014-‐07-‐02 David Dunne, Ph.D.