muskegon family care & mad*pow human-centered design session › wp-content › uploads › 2019...

Muskegon Family Care & Mad*Pow Human-Centered Design Session

June 15, 2016

IntroductionBackgroundGoalsDay1ResearchDay2Co-designworkshopRecommendationsNextSteps

Schedule

OURTEAM

OlgaElizarova,DDS,MPHBehaviorChangeAnalyst JenniferSmerdel,Experience

Strategist

SamanthaDempsey,BehaviorChangeandExperienceDesigner

DanaOrtegonSeniorContentStrategist

StockardSimonSeniorVisualExperienceDesigner

KimDowdSeniorExperienceResearcher

DustinDiTommasoSVPBehaviorChangeDesign

CiaraTaylorExperienceDesigner

Howdidwegethere?

Everyyearatourcompanyweget40hoursofpersonalvolunteertimethatwecanuseaswelike.

Thisyearwewereseekingforanopportunitytoapplyourknowledge,skillsandtimetotheareaofourpassion:healthcare,andmorespecificallytoimprovingpatient-clinicianinteractions.Inotherwords,applyourvolunteertimetodosimilarworkthatwegettodoforourclientsonadailybasis.

WegotluckytobeintroducedtoRamonaWallacethroughourfriend.Ramonawasfacilitatingourcommunication,helpingustoframetheproblem,connectustopeopleatMFC,organizethelogisticsofprettymucheverythingincludinghostingusinherlovelyhouse.Shewasawonderfulpointofcontactandsupporttousthroughoutthewholeproject.

BACKGROUND

Whyarewehere?

HUMAN-CENTEREDDESIGNMethodologiesandApproach

OurApproach

Human-CenteredDesign(“DesignThinking”) is“acreativeapproachtoproblemsolving.It’saprocessthatstartswithpeopleyou’redesigningforandendswithnewsolutionsthataretailormadetosuittheirneeds.”-IDEO

HUMAN-CENTEREDDESIGN

OurApproach

Co-Designisacreativeprocessbywhichdesigners partnerwithproblemownerstofacilitatethecollaborativecreationofsolutionsthatbestmeettheirneeds.

Thisprocessviewsdesignersasprocessfacilitatorsratherthansolecreatorsofsolutions,andpresentsproblemownersassubjectmatterexperts.

HUMAN-CENTEREDDESIGN

Interview&ObserveHUMAN-CENTEREDDESIGN

IdeateHUMAN-CENTEREDDESIGN

PrototypeHUMAN-CENTEREDDESIGN

IterateHUMAN-CENTEREDDESIGN

BACKGROUND

ProblemDefinitionMFCisaPCMHexperiencinghighratesofpatientnoshowsandlowpatientengagement.

Existinginterventions• anautomaticvoiceremindersystem• ahumanoutreach(calls,mail)toremindpatientsoftheirupcomingappointments.

BACKGROUND

UnderstandingtheEnvironment

*Basedontheclinic’sstaffinterviews,theseinterventionsdidn’tshowsignificantimprovementinratesofnoshow.

Highnoshowratesarepartiallyduetopatientsnotfindingtheirclinicalappointmentsvaluable.

Thereforeweneedto:• Understand whatpatientsfindvaluableintheirappointments• Identify barriers thatkeeppatientsfromcomingtotheappointments• Improveexperienceofthepatient-clinicianinteractionssothatboth

cliniciansandpatientswouldfindtheappointmentsmorevaluable

BACKGROUND

OurHypothesis

GoalsClinicReducetherateofnoshows/missedappointments,increasepatientsatisfactionandoverallappointmentexperience(qualityimprovementinitiative)

PatientImprovepatient’sperceptionofvalueofaclinicalappointment,improvepatientsatisfactionandoverallappointmentexperience

ClinicianReducetheinefficienciesintheworkflowcausedbynoshows,increasepatientengagement&involvementintheprocessofshareddecision-making

DAYONE@MFCResearchintheClinic

Wespentthefirstdayconductingresearchinthefieldconductingco-designactivitieswithpatients inthewaitingroom,observingstaff membersatwork,andinterviewingpatientsandprovidersabouttheirexperiences,expectations,andvaluesduringanappointment.

DAY1:RESEARCH

Part1:Appointments&Scheduling

Methods

Observations&Interviews• Schedulers• Clinicians• Patientmanagers• DentalAdministrators

DAY1:RESEARCH


ThemeA:Population’shealthandbarrierstohealth• Multiplechronicissues• Manybarrierstogoodhealth• Don’tprioritizehealth,thinkaboutprevention,ortakepersonal

responsibilityfortheirhealth• Lowhealthliteracy(nutrition)• Chaotichomeenvironments

DAY1:RESEARCH


ThemeB:Scheduling• Coordinatingmandatorynewdentalpatientorientation

• Patientsfrustration• QuestionsarisearoundHIPAApapers

• Patientsrarelyusepatientportaltoscheduleappointments• Day-ofSchedulerandrobremindercalls

DAY1:RESEARCH


ThemeC:Noshows/cancellations

Patientstellstafftheymissappointmentsbecause…• Transportationissues(40-50%ofallcancellations)• Illness• Fear&anxiety• Weather• Conflictswithworkschedules• Familyobligations• Mistrust• Mindset• Forgetfulness

DAY1:RESEARCH


ThemeC:Noshows/cancellations(cont.)

• Doublebooking&overbooking• Unclearfollow–upproceduremissedappointments• Cancelationfollowedbyimmediaterescheduling

DAY1:RESEARCH


ThemeD:Appointments

• Multi-personclinicvisits

• Clinicstaffbelievedthefollowingcomponentsmakeavisitvaluable:– Patientexperience– Personalconnection– Measurableprogress– Communication&Connection– Judgment-freezone– Checkout

DAY1:RESEARCH


ThemeE:Casemanagers&followup

• Unclear&frustratingcasemanagerreferrals• Patientswithcasemanagerstendtobemoreadherentandhavemore

healthimprovements(betterlabwork,lessERutilization,etc.)

• Strugglesforcasemanagers:– Charting/billing– Coldhand-offsfromproviders– Knowingwhentofollow-upwithpatientswhoaredoingwell.– Patientscomplainingthattheycan’tgetenoughpainmedication

DAY1:RESEARCH

Part2:WaitingRoomActivities

MethodsMini-activities

– “GraffitiWall”question– Fill-in-theblankform“Whatwouldmakeyourappointment

awesome?”– “MyIdealClinic”checklist

DAY1:RESEARCH


Theme1:“GraffitiWall”question“Whatmakesanappointmentawesome?”• Patientsdidnotrespond towaitingroomgraffitiwalls

– Involvereceptionist(s)– Increasetimeavailabletointeractwithgraffitiwall

DAY1:RESEARCH


Theme1:“GraffitiWall”question“Whatmakesanappointmentawesome?”• Cliniciansdidrespond.Themainthemewasmutualunderstandingand

clarity addvalueandstrengthentheprovider/patientrelationship.• Approachingpatientswithapositiveandupbeatattitudefreeof

judgmentorassumptions• Allowingpatientstotelltheirstoriesandaskquestions• Addressingpatientsbynameandshowingthemthatyoureallycare• Givingpatientsclear,accurateinformation• Makingsurepatientsunderstandwhattodowhentheyleavetheoffice• Incentivesasrewardsformeetinghealthgoals(thesearen’tcurrentlyusedmuch)

DAY1:RESEARCH


Theme2&3:Fill-in-theblankform&ChecklistActivities• Longwaittimesandperceptionofwastingtime(85%)• Convenientappointmenttimes• Kindness,honestyandgoodadvice• Gymintheclinic(71%)• Abilitytochoosetheirdoctorforeachvisit(71%)• Exerciseclasses,cookingclasses,safetyclasses,andhealthyworkshops.• Patientportal(57%)• Availabilityofchildcareduringtheirappointments(~43%)• Zeropatientsidentifiedthattheywouldwantonlinevisits

DAY1:RESEARCH

Part3:Post-AppointmentPatientInterviews

MethodsInterviewswithpatients

• An8-questionmoderator’sguidewasusedtofacilitatesemi-structuredinterviews

DAY1:RESEARCH


Findings• Feelinglikeacliniciancaredaboutthemasapersonanddiscussedtheir

issues• Generallylikedtheircurrentclinicians• Awareoftheirunhealthybehaviorsandlookedtotheircliniciantohelp

themavoidthem(advice)andkeepthemontrack.

DAY1:RESEARCH


Findings(contd.)Worstpartsofanappointmentaccordingtothepatients:

– Worrying– Takingtimeoffwork– Waiting

• Betweenwhenthenurseleavesandthedoctorshowsup.Onepatient,whohadtwoyoungchildrenwithhersaid,“Ispent18-20minutesjuststaringatthewall”.

• Longwaitstoscheduleanappointment.

DAY1:RESEARCH

Limitations• Smallsamplesize

– Nopatientinterviewsinthedentaldepartment– Eachmoderatorinteractedwithlessthan10people

• Selectionbias– Giftcardincentivesforparticipation– Patientsforthepost-appointmentinterviewscameonlyfrom2clinicianswhovolunteeredtoparticipate– Nointeractionwithnoshowspatients

• Samplingbias– WeonlyinterviewedpatientswhocameintothecliniconaFridayafternoon.Allresultsshouldbe

validatedwithagroupofpatientswhohaveappointmentsatdifferenttimesandondifferentdaysoftheweek.

• Inabilityto reachouttopeoplewhodon’tshowupfortheirappointmentsonthesameday,becausetheydisappearfromthesystem

• Lackoftime– Forexample,wewereunabletospeaktogroupatMFCresponsibleforpatienttransportation– MoretimewouldalsohaveyieldedmoreresponsesontheGraffitiWall,frombothpatientsandclinicians– Wealsoonlyspoketopatientsfor2-5minutesoutofrespectfortheirtime.Moretimespentwitheach

patientcouldresultindeeperfindings.• Lackofequipment

– Noopportunitytolistenintotheschedulingcalls• Norecordings

– Allfindingsrelyonthemoderator’snotes.

DAY1:RESEARCH

DAYTWO@MFCCo-DesignWorkshop

Wespenttheseconddayconductingaco-designworkshopwithclinicians,patients,andstafftogainaholisticunderstandingoftheproblemareaandidentifypotentialsolutions.

Duringthisworkshop,facilitatorsguidedparticipantsthroughoutvarious activities helpingthemdocumenttheirexperiences, understanddifferentperspectives,andultimately createprototypes thatwouldimprovethevalueofaclinicalappointment forbothpatientsandclinicians.

DAY2:CO-DESIGNWORKSHOP

Activity:SuperPowers

• Patience• Listening2• UnconditionalLove• HugeSmile• PassionforMFC&itsMission• MedicalExperiencewithFQHC/PCMH• Patientmanagement&education• Beingpositiveandupbeat• Peoplearound• Creativity• Empathy• FactFinding


TheSuperpowersoftheMFCTeam!

Activity:CirclesofMe


MostValuableThingsandRelationships:• Immediatefamily• Personalhealth• Faith

IntermediateValueThingsandRelationships:• Closefriends• Traveling&Reading• Community

LessValuableThingsandRelationships:• Movies• Food&Eatingout• Shopping

Activity:DefiningHealth

• Letyouknowifyouarehealthy• Givegoodadviceonmaintaininggoodhealth• Provideeducation,communicationandbetrustworthy• Beaguideandapartnerinnavigatingthe“sea”ofthethingsthatyoucan’tcontrolandcoachaboutthingsthatyoucanimprove:healthyeating,skills,meaning,growing,connection,nature

• Provideinformationtoyou(what/whyandhowtoreachyourgoals)andlisten

• Helprestorefaithinyourownhealth• Understandyou• Provideprofessionalexpertise,encouragement&friendship• Beahealer• Doeverythingsheorhecantohelpme• Care,helpandbenice


WhatistheRoleofaDoctor?

Activity:Memorablevisit

StrengthsofMFC• Havingspecialists(bridgespatientsneeds)• FriendlyStaff• Compassion/caring• Communication

– Open-endedquestions– Silenceasanopportunityforpatientstoexpressthemselves&sharetheirstory– Activelistening– Followthrough

• “Superpowercape”– Knowingeachotherssuperpowersandusingthem– Helpingotherswheninneed

• Facilitatingshareddecision-making• Humanizationofhealthcareexperience(beyondjustphysical– spiritual,community)• Time


Activity:Memorablevisit

Opportunities• Utilizerole-playinternally

– Implementduringmonthlygatheringswithproviders&staff– Modelcompassionateinteractionsthathaveoccurredtosharewithotherprovidersand

staff• Sharegreatsuccessstoriesasaclinic• “Reset”foreachnewpatient(clinicians)

– Treateverynewpatientwithempathy.Trytothinkhowmuchdidthepatientsgothroughbeforetheycametotheappointment

• Makepatientsfeelcaredforduringeachvisit• Askopen-endedquestions

• Maketheappointmentprocessmoretransparenttothepatientstomakethemfeelcomfortable.

• Helpdealwithstigmaandfearofbeingjudged(addiction,reallypoorhealth)


Limitations• Samplesize

– Wehad14participantsintheworkshop.Inordertovalidatethefindingsidentified

• Selectionbias– Themajorityofparticipantswerestaffoftheclinic,although3

providersand2patientsparticipatedaswell.Wewouldsuggesthavingaslightlylargerratioofpatients- to-clinicianstocreateacomfortableenvironmentforpatientstosharetheirthoughtsandideas.

• Lackoftime– Moretimewouldhaveyieldedmorevaluableideas&solutionsthat

couldaddvaluetotheclinicalappointment.


RECOMMENDATIONS

AftercollaboratingandobservingwithMFCwehavecreatedasetofrecommendationstohelpaddressfindingsidentifiedduringourresearch.

TheserecommendationscombineourpersonalunderstandingoftheMFCprocessesandworkflow,patients’feedback,andmostimportantlythelivingexperienceofcliniciansandstaffmemberswhoworkatMFC.

Thesearemeanttoprovidestrategyandguidancetoaddressingidentifiedopportunities.AsexpertsinMFClifeandprocess,itisuptoyoualltodecidehoworiftoimplementanyoftheserecommendations

RECOMMENDATIONS

StrategicRecommendations

OverallNewPatients

– Makemandatorynewpatientorientationsmoreinteractiveandvaluabletothepatients• Motivationalinterviewingelements• Barrieridentification• Clinicianpresenceattheorientation

– Thinkaboutalternativewaystoconductnewpatientorientations:teleconferences,mailingpaperwork,etc.

RECOMMENDATIONS

OverallScheduling

– Appointmentsoutsideofregularworkhours– Selectionofdoctorforeachvisit– Educateabouttransportationservicesandimproveeaseof

availability– Ensurethatparentandchild’sappointmentsarenotscheduled

simultaneously– Considerwaystoidentifyandprovideaccompanimentfor

patientswhomaybeunfittocometoanappointmentalone.

RECOMMENDATIONS

OverallAppointmentexperience

– Implementgoodpracticesandstrengthsofindividualssystemicallythroughdoingpersonneltraining,writingscripts,etc.

– Don’tinvestinexpandingtelemedicine.Patientswantface-to-faceinteractions.

– Maximize“wasted”waitingtimebygivingpatientssomethingtodowhiletheywait—inthewaitingroomandintheexamroom.

– Reducenegativeperceptionsofwaittimebylettingpatientsknowifthedoctorisrunningbehindorifwaittimesarelongerthanusual.

RECOMMENDATIONS

OverallAppointmentexperience

– Gapbetweenpatientandclinicianexpectations.Askpatientstogivetheirexpectationsfortheappointment— inoralorwrittenform.Makesuretoaddresstheirexpectationsduringthevisit.

– Avoidinformationoverload.

– Thetherapeuticvalidityofbeinglistenedto.

– Childcareduringappointments.

RECOMMENDATIONS

Overall

Postappointmentexperience&followup– Consistentno-showfollow-upprocedure

• Recordthereasonforthemissedappointmentandtrytoreschedulethemrightaway

• Findawaytoallowpatientsnottoscheduleappointmentsthattheydon’tintendtokeep.Ask,“Doyouwanttomakeanotherappointment?”ratherthantellthemthattheyshould.

– Standardizeeducationmaterials&toolsacrossallMFCproviders.– Offerpatientswaystotakeanactiveroleintheirhealth(exercise,

cooking,andsafetyclasses,healthyworkshops)– Findwaystoprioritizehealthinthecommunity.

RECOMMENDATIONS

Overall

• Considerdoingsimilarco-designworkshopswiththeclinicstaffandprovidersasawaytosolveproblemsandimplementgoodpracticesandstrengthsconsistentlythroughouttheentireclinic.

• Thinkaboutdifferentwaysthatstaff’sandprovider’s“superpowers”canbeusedintheirdailyrolesattheclinic

• Thinkaboutdifferentwaysthatcurrentappointments’strengthscanbeenhancedandimplementedwidely

RECOMMENDATIONS

Overall

• Consideraddressingtheopportunitiesduringtheappointmentthatparticipantsidentified– Ensurepatientsdon’tfeellikeaburdentoaprovider– Askpatientsabouttheirexpectationsbeforetheappointmentandtry

toaddresspatientsconcerns• Transparencyaroundprocess• Engageandeducatepeopleabouthealthonacommunitylevel.• Addresspovertyasalargersystemicproblem(violence,depression,

addiction)

RECOMMENDATIONS

PROTOTYPES

Prototype1:DaycareatMFCPROTOTYPES

HypothesisPatients who have children under the age of 13 are more likely to miss their appointments, because they are distracted and stressed when they have children with them in the exam room, and as a result the appointment is less valuable to them.

SolutionDaycare – onsite free “drop in” daycare where patients who have an appointment at the MFC can leave their children while using their clinic services (medical, dental, counseling, wellness workout). After the appointment is finished patients will pick up their children.


Benefits

• Provider and patient have less stress or distraction during the appointment

• Reduces no shows by providing additional value to the clinical appointment

• Increases provider’s productivity• Improves patient experience or perception of key aspects of care (quality

improvement)• Helps retention & recruitment of new patients• Marketing effort• Aligns with MFC’s mission and goals of Patient-Centered Medical Home• Sends the message that MFC values family• Improves children’s health/utilization of preventative health services

through providing health education to children while they are at the daycare center

Prototype2:Redesignthewaitingexperience

PROTOTYPES

HypothesisWhen patients arrive to their appointment they have to wait to see clinician for 30 min-2 hours. They get upset and frustrated. This affects their appointment experience and willingness to come to next appointment.

SolutionThe valuable appointment time should begin as soon as a patient walks through the door of the clinic. We need to redesign patient’s waiting time experience to provide general education during the time when they have to wait to see clinician. It would reduce the perception of this time as “wasted”. Two types of education can be delivered:

1) Waiting rooma. Passive – use existing TV screens -> general educationb. Active – gazebo -> general education

2) Exam rooma. Passive - use existing TV screens -> specifi c education / general educationb. Active – 1:1 with medical assistant or clinical resident -> specifi c education/

general education

Prototype2:RedesignthewaitingexperiencePROTOTYPES

Benefits

• Addresses patients biggest complaint: wait time by changing perception of the time as “wasted”

• Increases patient satisfaction• Improves patient experience (the doctor saw you for your appointment in 15

minutes after you arrived)• Low cost solution since the infrastructure for this intervention already exists within

the clinic. MFC has TV monitors in the waiting areas and in the exam rooms.• Reduces no shows by providing additional value to the clinical appointment• Delivering health education and raising awareness about important issues• This structure could be first used to educate patients about the patient portal• Improving patient-clinician shared decision-making• It can be applied as way to increase patient participation in the appointment and

help them ask questions that they are interested in, in regards to their reason for visit

• Helps retention & recruitment of new patients• Measure the perception towards MFC as patient-centered medical home (~clinic

values patients and cares).

PROPOSEDPILOTS


In this quasi-experimental study of 200 patients who have children under the age of 13 and have an upcoming appointment with clinician at MFC, 100 control participants will go to an appointment as usual with their children,and 100 participants will be offered a daycare service where parents can drop off their children prior to the appointment and pick them up at the end of their appointment.

Three surveys will take place (1) several weeks prior to the daycare intervention to serve as a baseline and provide the chance to sign up for a daycare at their next appointment; (2) 4-6 weeks later, post intervention to assess initial impact, identify changes in appointment experience, perception of care, perceived value of the daycare service; (3) several weeks-months after the daycare intervention when these patients would have a follow up visit to measure the rate of no shows/missed appointments.

Prototype2:RedesignthewaitingexperiencePROTOTYPES

In this quasi-experimental study of 200 patients who have an upcoming appointment with clinician at MFC 100 control participants will go to an appointment as usual, and 100 participants on the day of their appointments will receive passive and active education in the waiting room and in the exam room.

Three surveys will take place (1) prior to the intervention to serve as a baseline (2) 4-6 weeks post intervention to assess initial impact, identify changes in appointment experience, perception of care, satisfaction with the appointment, perceived length of waiting time, perceived value of provided education; (2) several weeks/months after the intervention when these patients would have a follow up visit to measure the rate of no shows/missed appointments.

Successcriteria/measures

• Statisticallysignificantreductioninnoshows/missedappointmentsamongthetargetedpopulation(baseline:historicalaverage)

• Morethan50%ofpatientswhohavechildrenreportthattheyvaluetheprovideddaycareserviceORmorethan50%ofpatientsreportthatthey valueprovidededucation

• Statisticallysignificant improvementinoverallpatientreportedexperienceorperceptionofcare(baseline:historicalaverage)

• Statisticallysignificant increaseinpostappointmentpatientsatisfaction(baseline:historicalaverage)

• ImprovedperceptionofMFCasapatient-centeredmedicalhome

• Improvedchildren’seducationmeasuredthroughself-report(askingchildren/parents)ORthroughincreasednumber ofpreventivevisitsamongchildrenORimprovementsinselectedhealthmeasures

RECOMMENDATIONSPILOTS

DISCUSSION

NEXTSTEPS

WearethankfulthatwecouldworkwithMuskegonFamilyCare’swonderfulclinicians,staffandpatients.Itwasinsightfultodiveintoyourworkflowandinspiringtoseehowmuchyoucareaboutyourcommunity.

ThiscollaborationwasparticularlyrewardingforusanditsparkedmanyinterestingideasandconversationsbothinsideMad*Powandinthelargerdesigncommunity.Wewouldlovetostayintouchandserveasexpertadvisersandreviewers.Wedefinitelywanttohearhowthethingsaregoing!

NEXTSTEPS

Thankyou,MFC!

Wewanttokeepimprovingthepatient-clinicianinteractionsandbriningvaluetotheappointmentsofpatientswhoreceivecareatFQHClikeMFC.Wewouldbegratefulifyoucouldprovidefeedbackontheworkthatwe’vedoneandanysuggestionsabouthowwecouldmakeitmoreusefultoclinicsandpeoplelikeyouinthefuture.

NEXTSTEPS

Keepintouch!

TheEnd

muskegon family care & mad*pow human-centered design session › wp-content › uploads › 2019...

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