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