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A Framework for Patient Care

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Presentation on theme: "A Framework for Patient Care"— Presentation transcript:

1 A Framework for Patient Care
Experience Design A Framework for Patient Care presented by Art Frohwerk Clearpath, LLC in collaboration w/ Quantum at Meeting of the Minds Toronto June 23, 2010

2 It’s About Connections!
Engaging People Challenging Vision Relevant Processes Useful Tools & Systems Comfortable Places Appropriate Measures Transformational Strategies Creating Meaningful Stories

3 Experience Design Framework
Context …a whole system approach Strategy Management System Strategic Purpose & Commitment Vision, Mission, Values Strategic Imperatives The Environment of Trends & Opportunities Experience Design Framework Roadmap to sequence Implementation Influencing People Governance & Policies Experience Design Principles Culture Design based on Values

4 Big Picture Framework Fundamentals Storyboard Master Process

5 Master Process to orchestrate “The Organization’s Way” to best do business

6 Master Process to orchestrate “The Organization’s Way” to best do business
“Moments of Truth” Measures Opportunities Core Process Roles Inputs Desired Outcomes Info. & Support Processes Support Systems

7 Community-scale Master Process

8 Master Process connecting the parts
Core Process Customer-focused value chain Support, Relationship, & Information Processes Integrated with Core Systems Tools, Places leverage human factors and processes Moments of Truth Proactive: shows “we care”, makes efficient, avoids waste vs. reactive Desired Outcomes and Inputs Driven-by and linked-to strategy, environmental reality Roles Show how each person contributes and recognizes personal styles Measures Measure new things, esp. “soft” Balanced scorecard – lead, lag

9 Storyboard to understand & design the Stories

10 Storyboard to understand & design the Stories
Chapter / Scene Introduction Registration Service Encounter Discharge Post-Discharge Plan Arrive Register Check-in Lab Treat Therapy Room Educate Disposition Check-out Follow-up Stage Patient Needs Our Intent Impressions Physical Elements Behaviors Mechanisms

11 Hospital System Experience Design STORYBOARD Registration
ON-STAGE MECHANISMS CHAPTER SCENE Recovery Area Plan. & Coord. Home, Work, Hospital (They call us or we call them.) Check-in Pre-op Holding Business Follow-up Home or Work Check-out Exit Route Registration Service Encounter Discharge Post Discharge Introduction Behavior Physical Cues Intent Process People Tools Place Know who I am, have my info: Know & contact my key contacts, my Physician, the plan. Information/ logistics needed to prepare: Learn date, time, when/where, parking, arrival. Pre-admission testing? What to bring. Length of stay. Know where Family goes. Impact on Family. What should I do with my usual medication routine? Confirm schedule, timing, what to bring. Answer last-minute questions. What I should bring: How much to pay, when. Insurance coverage. Pre-register info. Define team: Select Physician. Team coordinated? Role of Family? Comfort of Interaction: Easy of access. Empathy. Save time. Find way easily: Get to ER when ER needed. Travel, find, park. Physically able to get inside. Surface parking close to the entrance for high-priority Patients – wound care, handicapped, D&T Know where my Family, friends go and how to contact them. Security of hospital. Know who I am. Treated as an individual. Don’t get lost, delayed. Aleve worries. No unexpected waits, distractions, embarrassment. Sense that people, info. is well-coordinated. Attentiveness: Responsive. Staff is coordinated with Physicians, Nurses, other Staff. Learn and Explain progress. Expected changes. Keep me informed about my baby, the purpose of his/her tests, & how he/she is doing. Comfort, Safety: No distractions, embarrassment, pain. Care & Competence show empathy, explain. Personalized – Access to my medical record. Explain next steps. Estimate when I can leave, what I will have, need. When there is a death, how do I handle it? What are all the details? Who do I call? When am I leaving today? Physicians coordinated & timely. Comfort, Safety: No unexpected waits, distractions, embarrassment, pain. May I talk with a Chaplain? Ready to go. Ask final questions. Anything else Seton can do? Provide what I will need. Escort: Offer how to get there. Assure who to talk to, who will know me. Get needed materials. Understand when I will get my bill and who to call if I have questions. How many bills will I get & from who? Comfort, Safety: No unexpected waits, distractions, embarrassment, pain. Do I understand what I need to continue & complete the healing process? Am I confident to heal – mind, body, spirit? What should I do if I have a problem? a question? Who to call? Am I going to be able to control my pain? How? Describe how to get around, who takes care of dependents. When am I ready to go? Coordinate with others and get what I need – meds, equip, helpers, instructions, Family. Am I really OK to go to next level of care? Learn what will happen next – on my own. Understand instructions. Can’t read or interpret (Post acute care big need work being done w/ unfunded Patients). What do I do if I lost info or instructions? What to do if deviation? Who to call? Supplies available & understood. Manage meds. Not forgotten. Called, gave contact info. Is it working? Anything needed? How do I feel? Follow-up call if needed. What will I get? Understand my bill. Arrive Entrance: Parking or Curb Check-in, Register Desk: Main, Women’s, ED, Patient floor (after Main) Lab Endo, Cath, Pulmo. Func, Echovascular Labs (short duration) ED ER OR Suite / Day Surgery Sleep Lab Out Patient Imaging (In-Patient, Out-Pt, Day Surgery) Educate Patient Room Discharge Disposition Clinical Follow-up Home or Work Experience Follow-up Rehab / Diagnosis & Therapy ‘C’ Section Nursery NICU Transitions / Hand-offs Hallways Know who I am: Be confidential. Treated as individual. Personalized. Know who I am: Be confidential. Treated as individual. Personalized – Access to my information. How was the experience? Listen and clarify. What are the details? Not forgotten. Called, gave contact info. Anything needed? How do I feel? Labor & Delivery The Phase Activity or Purpose on a given ‘Stage’ (place) Info. Exchange Outside the Hospital (Call, Internet, Physician, Media, Friends) In the Hospital Experiential Bundles: ‘Scene’-specific procedures and behaviors, using predetermined tools, in a given place (‘Stage’), carried-out by specific roles to create an intended experience. Grounds: Valet Parking Golf Cart (Shuttle) Safety Code Blue Stations In Parking Lot Covered Entrance Water Feature Strategically Placed Benches – Parking Lot, To Entrance Inner Courtyard Labyrinth Treatment Areas: Sub Waiting Areas With Comfortable And Bariatric Seating Consultation Rooms For Private Conversations With Physician/Healthcare Team Lobby And Public Areas: Simplistic, Intuitive Layout Of Public Areas Wayfinding Strategies (Universal Signage, Central Admitting/Registration) Chapel And Meditation Room Learning Center Use Of Natural Design Elements (Wood Accents, Stonework) Comfortable And Bariatric Seating Player Piano And Coffee Bar In Lobby Wireless Internet Access Room Service With High Quality Foods (Self Regulated Diet) Concierge Service Staff Experience Design Elements: Tranquility Rooms Team Rooms Dual Clean/Dirty Utility Rooms Provision Of Linen In Each Room Dedicated Staff Entrance Comfortable Break Rooms Experience “Immersion” During Orientation And Beyond Innovation / Improvement process Time In Motion Strategies Dual Omnicells Provision Of Routine Equipment In Each Room (E.G. NIBP, Lift Equip) Physician Design Elements: Covered Parking Parking Additionally Located Adjacent To ED Comfortable Physician Lounge With Amenities (Off Courtyard) Child Care Onsite MOB With Covered Walkway Inpatient Rooms: Daybeds For Family In Med/Surg And ICU Recessed Rooms From Hallway Double (Double Size Or Two Beds?) Day Beds For Family In Post-partum Interactive TV (Includes Many Options) Larger Rooms For Family Space Additional Storage Space For Patient/Family Valuables Lift Equipment Re-transcribe typed prescriptions resulting in disastrous errors. Didn’t attempt to validate correctness. Could not alter permissions form to indicate no student Physicians. Need to know what to eat/not to eat before surgery Connecting not easy- played phone tag …………………… Place and way to indicate special information. Overheard concerns. Discomfort; Wait; Charging to park; we're the only hospital that does that Large useful signs. Helpful person along the way. Easy parking; Roving volunteers give attention (even at night). Cluttered spaces. Distracting; Disconnected; Shadows; Glare; Confusing layout Noise: loud TV, distractions, food channel; Muffled; Cold. Hard; Too Hot; Too Cold; Drafty. Free-for-all, individualistic; Disconnected: no one sees you sitting; Confusing; Wait; Wonder. Left me to 'chase things down’; Complained about problems; Distracted: Told to 'sit‘ (when it hurt); Waited w/o explanation. Acted bored; No rush in ED – treated as routine. Machines looked cold. Cold x-ray; Hard surface; "It hurts" Surprise; Told "no problem" when there was. Rude - acted like no 'big deal' • not open after. 25 min before evaluated. Too busy; Don't notice; "Never a Triage Nurse.“ No rush – routine, Wonder; Bad measurement Noise: loud and crowded; Cold room; More blankets Long wait before surgery Didn’t pay attention to patient info. provided No one owning bad behavior. "Nothing we can do until Monday" Exposed in gown -need more privacy No accommodations for family members. Machines looked cold and hard. Cold x-ray; Hard surface; "It hurts" Phys therapist telling patient how they should feel about wearing robe. No clear indication of when patient would be in room. Trash cans too full, housekeeping not coming around. Interior courtyards not all that pleasant to look at. TV remotes don't work. Pharmacy not on site. No beds for family to sleep No privacy in gown Plastic charts on metal racks make a lot of noise. Unappetizing food - wretched. Uncomfortable chairs Room type, furniture When JCAHO was here, did not see anyone for a long time - they took priority Family wait for patient to arrive in room, not know when. Improper fit: bandage, sling. Ortho told me to get films- "I have to drive around!" Memorabilia & ceremony is important!! Post name of care giver. Deal w/ all kinds of calls, bills, advice, etc. because Hospital could not work with three insurance coverage's to resolve payment. Lab work billed incorrectly because Dr. doesn't provide proper insurance info Build Partner relationships-Outpatient Hall Monitors; Online Experience Providers; Fire Departments; Churches, Community Groups; “Walgreens”-In house; Food Delivery; Alternative Medicine; Health Club, 24 Hour Fitness; Wal-Mart-Diapers; Pet- Care; Support Groups; Spa, Massage to Patient’s Room; Education; Techno. support - outside of Hospital Cost Estimate Need: Friendly, understanding, listen & follow-up. Info ready; No financial pressure; Flexible if info not available. Immediately ready (initiation);<5 min. effort; Immediately go to next steps Routine but engaged w/ present person & situation. Responsive. Fresh air. Live plants. Seek guidance: Discuss symptoms, potential need, Physician options, second opinion. Learn: What’s available? What’s the process? How long it takes? Info. needed to provide. Check on info: My pre-registration, schedule. Directions to hospital & where to park. Physician background. My financial responsibility: Understand what will be covered by insurance (In? Out?) Comfort of interaction: Manage fear, grief, denial, anger, depression, acceptance. Courtesy, efficient, competent, empowered. Welcoming, calming: Treated well. Aleve fears/worries. Courteous prepayment process. Ready: for my arrival. Know who I am, why I’m here. Coordinate care/info./Physician. Remember me from previous visits – esp. repetitive lab, therapy, wound care. Avoid long waits, repetition Use what I brought. Accurate data & verification. Understand: what I’m signing. Remind me where to go. Easy way-finding, understand process & flow. Estimate length of stay (physician at PreAdmit) & cost. Sense Competence of Staff. Aleve worries. Trust other to make decision for me when I can’t. Safety See/ talk with my Physician. Be checked-on. Get an explanation of the procedure. Sense that people are competent & well-coordinated. Comfort & Aleve worries. Answer questions. Be checked-on. Keep me warm & comfortable. Coordinated with my Physician. Sense that people are competent & well-coordinated. Let me know what to expect. No unexpected waits, distractions, embarrassment. When will my results be available to my Physician and when will I hear about them? Learn how I am doing. Know how long it will take. Explain progress. Expected feelings. Explain purpose of what is going on. Know who is coming to see me. Provide secondary diagnosis (e.g. Diabetes diagnosis in hospital). Provide diagnosis-specific process / flow (e.g. Cancer). Physicians are coordinated with other Physicians, Nurses, Staff, etc. Describe medications/therapies needed, available. Goals expected. Comfort: No unexpected waits, distractions, embarrassment, pain. How can this be easier on my family? Acknowledge the uncertainty & discuss how to ask questions. Who do we contact if there is a question? who is on-call? Personalized Learn how I am doing. Explain progress. Expected feelings. Describe medications/therapies needed, available. Comfort, Safety: No unexpected waits, distractions, embarrassment, pain. Care show empathy, explain. Not forgotten. Let me know what I should expect. Someone is connected to me. They’ve focused on me. Attentive. Responsive. Assess my condition. Verify history. Get ready for treatment. Learn what happens. Care to listen, show empathy, discuss, explain. Not forgotten. Attentive. Responsive. Courteous. Comfort & safety. How can I keep from catching something? What do I do if I’m hungry, thirsty, cold, etc.? How do you maintain cleanliness? Get treated. Learn what it feels like. Know when we will start. Why am I not the priority? What is the system to keep me informed about my wait time (i.e. “Now calling number X…”)? How will I communicate (bilingual, multicultural, hearing impaired)?

12 Fundamentals of Experience Design
Be Relevant Engage Flow Adapt

13 Fundamentals of Design: Be Relevant
Include the “soft” with the “hard”: Understand Patient’s needs & expectations vs. Our intent Close the gap Seek to understand each Patient & Family member as if “standing in their shoes” Anticipate & act on the needs & concerns of each Patient & Family member, if possible, before they are voiced. Photo: Seton Family of Hospitals

14 Fundamentals of Design: Engage
Trigger: Impressions Concepts Symbols Physical elements The five senses Memorabilia Behaviors What Who Where When Use the 3 key mechanisms to deliver the experience: People Tools Places Address positive & negative cues & the 5 senses that form impressions Recognize what should be “on-stage” & when things should be “off- stage.”

15 Fundamentals of Design: Flow
Build meaningful stories: Chapter Scene Stage Transitions Connect the Patient & their Care Team to the next: Procedure Service Time Place …so that the Patient never becomes “lost” & we never “drop the ball” in any hand-off. Work as a “Healing Team” by sharing & accepting, modeling leadership, & living the 4 C’s: Communication Collaboration Caring Cooperation.

16 Learn what’s important in the Story: Understand Discuss & Plan Try
Fundamental: Adapt Learn what’s important in the Story: Understand Discuss & Plan Try Report Experiment Be opportunistic Pilot Share learning Innovate Constantly improve.

17 Context …a whole system approach Strategy Management System
Strategic Purpose & Commitment Vision, Mission, Values Strategic Imperatives The Environment of Trends & Opportunities Fundamentals Storyboard Roadmap to sequence Implementation Master Process Influencing People Governance & Policies Experience Design Principles Culture Design based on Values

18 Principles New Paradigms for implementing Experience Design
Bring the Strategy out and alive Get good at Connecting Engage the Soft with the Hard Build meaningful Stories Learn what’s important in the Story Adapt the role of leadership Bring clarity and focus to vision, values Build self-confidence Coach and reinforce Have faith.

19 Experience Design: A Framework for Patient Care
Discussion Experience Design: A Framework for Patient Care Photo: Seton Family of Hospitals

20 Experience Design: A Framework for Patient Care
Fundamentals Be Relevant Engage Flow Adapt Storyboard Chapter Scene Stage Transitions Master Process Moments of Truth Core Process Support & Information Processes Systems & Tools Desired Outcomes & Inputs Roles Measures

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