8 Master Process connecting the parts Core Process Customer-focused value chainSupport, Relationship, & Information Processes Integrated with CoreSystems Tools, Places leverage human factors and processesMoments of Truth Proactive: shows “we care”, makes efficient, avoids waste vs. reactiveDesired Outcomes and Inputs Driven-by and linked-to strategy, environmental realityRoles Show how each person contributes and recognizes personal stylesMeasures Measure new things, esp. “soft” Balanced scorecard – lead, lag
10 Storyboard to understand & design the Stories Chapter / SceneIntroductionRegistrationService EncounterDischargePost-DischargePlanArriveRegisterCheck-inLabTreatTherapyRoomEducateDispositionCheck-outFollow-upStagePatient NeedsOur IntentImpressionsPhysical ElementsBehaviorsMechanisms
11 Hospital System Experience Design STORYBOARD Registration ON-STAGEMECHANISMSCHAPTERSCENERecovery AreaPlan. & Coord.Home, Work, Hospital(They call us or we call them.)Check-inPre-op HoldingBusiness Follow-up Home or WorkCheck-outExit RouteRegistrationService EncounterDischargePost DischargeIntroductionBehavior Physical Cues IntentProcess People Tools PlaceKnow 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&TKnow 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.ArriveEntrance: Parking or CurbCheck-in, RegisterDesk: Main, Women’s, ED, Patient floor (after Main)LabEndo, Cath, Pulmo. Func, Echovascular Labs(short duration)EDEROR Suite /Day SurgerySleep LabOut PatientImaging(In-Patient, Out-Pt, Day Surgery)EducatePatient RoomDischarge DispositionClinical Follow-upHome or WorkExperience Follow-upRehab / Diagnosis & Therapy‘C’ SectionNurseryNICUTransitions / Hand-offsHallwaysKnow 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 & DeliveryThe PhaseActivity or Purposeon a given ‘Stage’ (place)Info. ExchangeOutside the Hospital(Call, Internet, Physician, Media, Friends)In the HospitalExperiential 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 ParkingGolf Cart (Shuttle)Safety Code Blue Stations In Parking LotCovered EntranceWater FeatureStrategically Placed Benches – Parking Lot, To EntranceInner CourtyardLabyrinthTreatment Areas:Sub Waiting Areas With Comfortable And Bariatric SeatingConsultation Rooms For Private Conversations With Physician/Healthcare TeamLobby And Public Areas:Simplistic, Intuitive Layout Of Public AreasWayfinding Strategies (Universal Signage, Central Admitting/Registration)Chapel And Meditation RoomLearning CenterUse Of Natural Design Elements (Wood Accents, Stonework)Comfortable And Bariatric SeatingPlayer Piano And Coffee Bar In LobbyWireless Internet AccessRoom Service With High Quality Foods (Self Regulated Diet)Concierge ServiceStaff Experience Design Elements:Tranquility RoomsTeam RoomsDual Clean/Dirty Utility RoomsProvision Of Linen In Each RoomDedicated Staff EntranceComfortable Break RoomsExperience “Immersion” During Orientation And BeyondInnovation / Improvement processTime In Motion StrategiesDual OmnicellsProvision Of Routine Equipment In Each Room (E.G. NIBP, Lift Equip)Physician Design Elements:Covered ParkingParking Additionally Located Adjacent To EDComfortable Physician Lounge With Amenities (Off Courtyard)Child Care OnsiteMOB With Covered WalkwayInpatient Rooms:Daybeds For Family In Med/Surg And ICURecessed Rooms From HallwayDouble (Double Size Or Two Beds?) Day Beds For Family In Post-partumInteractive TV (Includes Many Options)Larger Rooms For Family SpaceAdditional Storage Space For Patient/Family ValuablesLift EquipmentRe-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 thatLarge useful signs.Helpful person along the way.Easy parking; Roving volunteers give attention (even at night).Cluttered spaces. Distracting; Disconnected; Shadows; Glare; Confusing layoutNoise: 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 measurementNoise: loud and crowded; Cold room; More blanketsLong wait before surgeryDidn’t pay attention to patient info. providedNo one owning bad behavior."Nothing we can do until Monday"Exposed in gown -need more privacyNo 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 sleepNo privacy in gownPlastic charts on metal racks make a lot of noise.Unappetizing food - wretched.Uncomfortable chairsRoom type, furnitureWhen JCAHO was here, did not see anyone for a long time - they took priorityFamily 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 infoBuild 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 HospitalCost EstimateNeed: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 stepsRoutine 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.SafetySee/ 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?PersonalizedLearn 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 RelevantEngageFlowAdapt
13 Fundamentals of Design: Be Relevant Include the “soft” with the “hard”:Understand Patient’s needs & expectations vs. Our intentClose the gapSeek 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:ImpressionsConceptsSymbolsPhysical elementsThe five sensesMemorabiliaBehaviorsWhatWhoWhereWhenUse the 3 key mechanisms to deliver the experience:PeopleToolsPlacesAddress positive & negative cues & the 5 senses that form impressionsRecognize what should be “on-stage” & when things should be “off- stage.”
15 Fundamentals of Design: Flow Build meaningful stories:ChapterSceneStageTransitionsConnect the Patient & their Care Team to the next:ProcedureServiceTimePlace…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:CommunicationCollaborationCaringCooperation.
16 Learn what’s important in the Story: Understand Discuss & Plan Try Fundamental: AdaptLearn what’s important in the Story:UnderstandDiscuss & PlanTryReportExperimentBe opportunisticPilotShare learningInnovateConstantly improve.
17 Context …a whole system approach Strategy Management System Strategic Purpose & CommitmentVision, Mission, ValuesStrategic ImperativesThe Environment of Trends & OpportunitiesFundamentalsStoryboardRoadmap to sequence ImplementationMaster ProcessInfluencing People Governance & PoliciesExperience Design PrinciplesCulture Design based on Values
18 Principles New Paradigms for implementing Experience Design Bring the Strategy out and aliveGet good at ConnectingEngage the Soft with the HardBuild meaningful StoriesLearn what’s important in the StoryAdapt the role of leadershipBring clarity and focus to vision, valuesBuild self-confidenceCoach and reinforceHave faith.
19 Experience Design: A Framework for Patient Care DiscussionExperience Design: A Framework for Patient CarePhoto: Seton Family of Hospitals
20 Experience Design: A Framework for Patient Care FundamentalsBe RelevantEngageFlowAdaptStoryboardChapterSceneStageTransitionsMaster ProcessMoments of TruthCore ProcessSupport & Information ProcessesSystems & ToolsDesired Outcomes & InputsRolesMeasures