M. D. Anderson Case Study:Creating a Hospital Website that

Drives ValueSeptember 16th, 2009

• M. D. Anderson Case Study in 3 Parts

• Creating an effective web strategy and executive facilitiation

• User-centered approach to web design

• Challenges and lessons learned

• Does your current website serve your users and drive organizational goals?

Agenda & Introductions© Copyright 2009

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• Leading academic medical center, located in Houston, Texas

• Ranked #1 for cancer care by U.S. News & World Report

• Treated 89,000 patients in 2008, including over 29,000 new patients

• Nearly 13,000 patients in clinical trials

• First in number of grants awarded and total grant funding from National Cancer Institute

• 6,000 students and trainees during 2008

• 17,000 employees (including 1,500 faculty) and 1,400 volunteers

M. D. Anderson Cancer Center © Copyright 2009

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Tower Strategies• National healthcare consulting firm

• Focused on improving clinical and business processes through comprehensive web strategies

• Assist organizations in shifting from an internal view to a customer perspective and drives business transactions

• Consultants are clinicians, operating executives and marketers

• Technology and vendor agnostic

• Seek to leverage an organization's existing investments

Tower Strategies© Copyright 2009

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Navigation Arts• Full-service web consultancy providing expert advisory, design, and

development services

• Leaders in user experience design

• Create experiences that are simple, satisfying, compelling and memorable while achieving business goals

• Service areas include:Web Strategy Usability Testing

User Research Content Strategy

Information Architecture Content Management System Implementation

Visual Design and Branding Web and Application Development

NavigationArts© Copyright 2009

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Evolution of the Web in Healthcare

Leverage

Lead

Innovate

Self-Service Transactions, Dynamic Content

Interaction, Collaboration and Personalization

Remote Disease and Wellness Management

ParticipateStatic, Published Content

Evolution of the Web in Healthcare

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Changing the Face of Business• Healthcare websites have historically been designed “inside-out”

• Few dispute the need to change the focus to the external customer

• What do customers want?

• Personalization• Self-service• Interaction

• What does the organization want?

• Reduction in operating costs• Technology integrated into existing processes• Educated, prepared patients

Changing the Face of Business© Copyright 2009

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e-Commerce

Clinical Trials

News/ Research

Patient Education

Videos, Materials Search, Be AlertedWatch, Rate

Purchase, Donate

Cancer Patient

Worried Well

Family/Friend

Caregiver

Referring MD Referring MD Staff

Read, Rate and Discuss

Example Transactions

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New Web Governance

Enterprise Internet Strategy Steering TeamRole: Prioritization, funding and executive oversight

DOMAIN TEAMSROLE: IDENTIFYING AND RESPONDING TO PROJECT REQUESTS, PROJECT COORDINATION

New Web Governance© Copyright 2009

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PrioritizingPrioritizing© Copyright 2009

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Changing to an Enterprise Governance Model for the Web• Historically departments submitted requests to the web department on

an as-needed basis• The web team integrated content, technology, business process to

create a customer service• Without an overall strategy – the requests would overflow the web work

queue and the site would continue to evolve unevenly• By determining feature requirements by customer, an overall 3-5 year

plan was developed based on organizational priorities• The plan priorities were recommended by each of the domain teams and

approved by the enterprise governance teams

Changing to an Enterprise Governance Model for the Web

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Information Services:Movin from What to HowInformation Services: Moving from What to How

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Changing to an Enterprise Governance Model for the Web• Conducted interviews with executive

sponsors and business owners to identify business drivers and opportunities to enhance processes via the Web

• Identified 12 customer types

• Documented 202 project ideas

• Determined key trends between web project requests and identified 7 core requests

• Analyzed existing development and support skill-sets and staffing model

Tower’s Project Activities

• Recommended and facilitated a sustainable, objective governance structure

• Ascertained low-hanging fruit to create early momentum

• Provided project management and lead support for quick-wins

• Created a multi-disciplinary team to manage branding oversight and standards for the web

• Conducted a gap analysis

• Developed a 3-5 year web strategic plan that included transition plan from the current state

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A Successful Web Experience Balances User Needs with Business GoalsNavigationArts conducted an in depth analysis of M. D. Anderson’s environment by conducting the following activities:

• HelpDesk• Patient Services• Care Centers• Patient Education• Volunteer Services• Physician Services• Researchers, Scientists• Development• Trainee and Alumni Affairs• Graduate School• School of Health Sciences

• One-on-One Patient Interviews- Learning Center- Hospitality Center

• Family Advisory Council • New Patient Orientation• Analyzed User Data from Logs• Web Survey of Current Users• Referring Physician Survey • Conducted User Testing

Interview Stakeholders Evaluate User Needs

A Successful Web Experience Balances User Needs with Business Goals

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Research Using a Multi-pronged ApproachIt’s important to understand more than just what users tell you about using the web:• It’s essential to understand the processes they must go through, the problems they may encounter or fear they will, the concerns they have in order to make decisions.

• It’s also important to understand the way they actually behave, and the information they really seek out.

• Usage patterns• Popular content• Referring Web sites• Referring terms• Countries of origin

NeedsGoalsTasksBehaviorsAttitudesContext

• Audience types• Web-based Tasks• State of Mind• Satisfaction• Understanding

Research Using a Multi-pronged Approach

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Determining Priorities in Wide Audience BasNavigationArts concluded that the typical Web site visitor falls onto the following categories of need which defined priority among users:

Critical Essential OperationalAudiences that have a critical or time sensitive need for information who are also critical to the organization in terms of acquisition and patient care. For them, the Web is likely to be the front door to the organization and must prioritize content and tasks that meet their needs.

Groups who are essential to the organization in terms of awareness and access. For them, the Web site represents information and functionality they need to better understand and interact with M. D. Anderson. The Web site must provide intuitive pathways for these audiences while not confusing critical audiences.

M. D. Anderson has a working relationship with these audiences and wants to provide targeted content for them. These groups may visit the site less frequently or have an indirect need for information and services.

• Potential Patients• New Patients • Current Patients• Primary Caregivers• Referring Physicians and their Staff

• Volunteers• Donors• Survivors• Extended Family and Friends• Potential Employees• Students• Trainees• External Health Professionals (Faculty,

Nurses, Allied Health Professionals, Mid-level Providers, Researchers, Scientists)

• Public

• Media • Current Employees• Retirees• Dependents• Alumni• Suppliers/Vendors• Partners/Affiliates• Community Educators• International Embassies and

Governments

Determining Priorities in Wide Audience Base

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Understanding Audiences’ Mental ModelsThese models define the differences in the way users think about and go about looking for information:

Physical Campus and Place to Work

Educational and ResearchInstitution

Hospital and Treatment Center

Understanding Audiences’ Mental Models

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What Did The Research Tell Us?We needed to take the emphasis off of the organizational structure and reducethe focus on promotional activities, and focus on creating a user-centricexperience and facilitate actions users will want to engage in.

• Align content to the user’s mental model of M. D. Anderson. Acknowledge the unique needs of different audiences and provide experiences that address each.

• Provide contextual cross-linking, topic focused searches, index lists, and expose critical content throughout the site to facilitate the different ways users go about looking for information.

• Recognize that the majority of users do not come through the homepage; ensure that all pages have appropriate context and avoid dead-ends.

• Design an experience on the Web that demonstrates the excellence and expertise of the organization while raising awareness and facilitating access.

An Effective Site Structure:• Has a coherent underlying concept• Anticipates users’ questions• Balances breadth and depth• Provides more than one way to

get to content

What did the Research Tell Us?© Copyright 2009

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Providing Context through Peripheral Vision

Each of the primary user groups have some unique information needs and some needs that overlap with other groups.

(1)Build brand perception through an understanding of the breadth of the organization.

(2)Answer user needs through the depth and relevance of information.

Providing Context through Peripheral Vision

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The Answer?Create equal paths for patients and professionals with a focus on patients and their families through contextual tools and exposed access to critical in-depth information…

The Answer?© Copyright 2009

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Access to Business or General Information

Primary User Focused Navigation

Direct Access to Deeper more Contextually Relevant Information

Key Tasks Drive Action – Meets Prioritized Goals of Business and Users

Paired with Real Stories

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Challenges• Very large site to be migrated/updated

• Old site: about 10,000 pages• New site: about 4,500 pages• Vast content: text, images, multi-media, links, etc.

• Old department-centric Information Architecture• Didn’t start out as such years ago, but evolved that way• Natural “undertow” from the organization• Natural mental model for staff, but rarely helpful to site visitors

• Simultaneous web content management system (WCMS) upgrade/development

• Necessary: old WCMS could not support new concepts• Added complexity & difficulty to execution within project timeframe

Challenges© Copyright 2009

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Challenges• Staff turnover during project

• Represents a step backward as team learns new concepts• Recession = constraints on filling vacancies and use of contractors

• Multiple vendor relationships• Worked with four agencies at different points• Complementary roles and expertise• Used web-based collaboration tools, frequent conference calls,

selected face-to-face meetings• Impact of new URLs on search engine rankings

• New Information Architecture = 99.9% new URLs• Predictable short-term fall in search engine rankings• Manageable with mitigation strategy

Challenges© Copyright 2009

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Lessons Learned• Buy-in and support from top management and governance structure

crucial to overcome local resistance to change• Alignment is vital anyway if this is a business strategy• Difficult to convince some staff that departmental IA isn’t best• Leverage when “special interests” argue against the greater good

• Build alliances with other key departments• Can’t do it alone• Projects are discussed & debated outside of one department’s range

of vision, so need friends and allies• Use of contractors can free up staff to work on the “new”

• Pro: builds buy-in by current staff & deeper/faster hands-on experience

• Con: time to ramp contractors up & make them effective; adds cost

Lessons Learned© Copyright 2009

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Lessons Learned• Tight project tracking, including daily status checks on key deliverables

• Projects have many moving parts• Needs formal project management PLUS informal approaches• Nagging helps

• Maintain flexibility/adaptability during life of the project – things will NOT go according to original plan

• Many surprises along the way – lots of “unknown unknowns”• Content isn’t always what you think it is• Technology helps & hinders• Flexibility can also be stressful to project team

Lessons Learned© Copyright 2009

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Lessons Learned• New site launched in May 2009• Post-launch:

• Site visits from search engines did drop 28% in month following• Site visits from search engines recovered and now up 12% versus

pre-launch• Total search engine rankings up• Patient self-referrals up 14% versus same months in 2008

• Next Steps• Proposed next phase to senior leadership• Got approval for analysis & planning during FY2010• Goals: “portal” capabilities; personalization/customization; better

targeted marketing; new improvements in customer service

Results & Next Steps© Copyright 2009

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Questions?Alan PowellDirector of Internet ServicesM.D. Anderson Cancer Center

Sue Sutton, RN, PhDPresident and CEOTower Strategies877-309-0400

Denise LodgeSenior ConsultantNavigationArts703-584-8920

Questions?© Copyright 2009

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