EMPATHETIC INNOVATION IN HEALTH CARE

A FOCUS ON THE PATIENT EXPERIENCE

HUMAN CENTERED DESIGN PROCESS

ABOUT THE COURSE

THE PATIENT’S POINT OF VIEW

INSTRUCTORS

COURSE DESCRIPTION

THE PATIENT’S CONTEXT

THE PATIENT FROM MULTIPLE PERSPECTIVES

SYNTHESIS AND DESIGN

QUESTION PROMPT LISTS - STEPHANIE BAKER

THE PATIENT EXPERIENCE

DECODING PRESCRIPTIONS - STEPHEN GREN

PATIENT CARE MAP - ERIC BOAM

THE HELPFUL PATIENT BILL - SYLVIA HU

WHY AM I WAITING? - KELSEY BUCHMAN

HEALTHY EATING IN HEALTH CARE - BRIANNA JENSEN

SLEEP IN THE ICU - MADELINE FOLKE

EDUCATION LIBRARY FOR PATIENTS - NIRMAL SHAH

HOSPITAL HOSTS - KAITLIN ZUSPAN

DESIGN INTERVENTIONS

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TABLE OF CONTENTS

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ABOUT THE COURSE

“This unique class provided students with a wonderful opportunity to see and experience the complexity of delivering health care from a variety of perspectives. Yet, firmly focused on the needs and emotions of the patient and their families. It also helped show that design and design thinking can be a new model for interdisciplinary problem solving and a catalyst for change. It helped bridge between the rational, quantitative, emotional, qualitative and helped imagine and build a people centered future.” - Jim Agutter

“Our use of empathic design principles to guide the course encouraged students to go beyond their typical approaches to class work and begin to experience health care issues from different vantage points. The experiential learning as well as the perspectives of the health care stakeholders emboldened student ownership in solving the challenges faced at a hospital in their community.” - Lee Ellington

INSTRUCTORSJIM AGUTTER // LEE ELLINGTON

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Most individuals have had an encounter with the medical system either directly or as a family member or friend in the last year. Because of increased options for health care and greater accessibility to health information, patients have become highly discriminating consumers in deciding where to obtain health care. Health care providers are now searching for ways to better the patient experience as a way to decrease health care costs, provide more patient centered care and increase customer retention.

This inter-disciplinary course explored the medical patient experience through a multi-perspective lens. It was a journey through the issues and complexity involved in providing an exceptional patient experience within a health care setting. During this hands-on research workshop, students from a variety of disciplines were engaged in lectures, activities, exercises and projects that were grounded in trans-disciplinary thinking. This was accomplished within a “design thinking” framework. This approach focused on generating innovation through observation, reflection, creativity, integration and implementation. Thus positioning design as a positive force in society and a catalyst for change. It helped bridge between the rational, quantitative, emotional, qualitative and helped imagine and build a people centered future.

During the first part of the course, students were be exposed to empathetic observation strategies where they participated in

simulated patient admissions and observed rounds with a health care team. Students also began to explore the different perspectives of health care delivery through lectures by hospital administrators, insurance providers, physicians, nurses, patients, family members, architects and interior designers. This aided the students in understanding the kaleidoscope of issues that are involved in creating an exceptional patient experience.

Using these experiences and insight as background material, students developed innovative concepts that enhance the patient experience. These concepts addressed such broad themes as the hospital or clinic environment, communication issues, access to health care and system/processes. For the completion of the course, students presented their ideas to the University of Utah Hospital with the potential to implement one or more ideas into the hospital environment.

The goal was to provide students with a unique, hands-on experience that helped them understand many of the different perspectives of individuals committed to providing an exceptional patient experience. Through this experience, it was hoped that undergraduate students would gain a broader understanding of the complexity of delivering health care and how to innovate within the boundaries of an established system. In the end, our objective was to provide students a unique educational experience that would help them develop into broad-thinking, innovative leaders.

COURSE DESCRIPTION

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HUMAN CENTERED DESIGN PROCESS

HUMAN CENTERED DESIGN:THE PATIENT’S POINT OF VIEW

PATIENT

ANXIETYFEAR

UNCERTAINTYUNFAMILIARITY

UNACCOMPANIEDAPPREHENSION

OPTIMISMTRANQUILITYUNDERSTANDING

CONFIDENCECOMFORT

HOPERELIEFASSURANCE

TRUST

STRESSWORRY

DISORIENTED

PAIN

Before suggesting ways to enhance the patient experience, we had to first understand the experience the patient has. We tried to understand as many aspects of what the patient experiences through interviews with patients, patient simulations, patient observations and even drawing on our own experiences. We tried to gain and empathetic understanding of the emotional, psychological, and physiological aspects, as well as environment and physical context. These findings were recorded and then documented. We began to sort and analyze what we found in order to find patterns and other commonalities that were beyond the surface of our initial understanding. We wanted to dig as deep as possible to find the roots of the patient’s experience.

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HUMAN CENTERED DESIGN:THE PATIENT’S CONTEXT

UNACCOMPANIED

TRANQUILITYANXIETY

UNCERTAINTY

UNFAMILIARITY

TRUST

OPTIMISM

UNDERSTANDING

CONFIDENCE

WORRY

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HUMAN CENTERED DESIGN:THE PATIENT FROM MULTIPLE PERSPECTIVES

DOCTORS

NURSES FAMILY &FRIENDS

ADMINISTRATORS

INSURANCE

PATIENT

ARCHITECTS &DESIGNERS

After spending a few weeks with the patient’s point of view, we shifted our focus to all the external people who play a critical role in shaping the experience. This included interviews with hospital administrators, health care architects and wayfinding designers, family and friends of patients, insurance agents, nurses and clinicians, and doctors. We also spent some time following doctors while they did rounds as a way to contextualize the different points of view.

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HUMAN CENTERED DESIGN:SYNTHESIS AND DESIGN

ITERATIVEDESIGN

PROCESS

SYNTHESIS

REFINE

DESIGN

EVALUATE

PROTOTYPE

PROCESS MAPPING

STORYTELLING

DESCRIPTIVE ANALYSIS

DIAGRAMMING

OBSERVATION

VISUALIZATION

RESEARCH

Once the interviews and contextual research was completed, we synthesized our findings and used that as a basis to begin the design phase. Following an iterative design process, we generated ideas and prototyped them to a certain level before presenting them to one another to receive critical and constructive feed back. We refined our ideas based on the feedback and then repeated the process.

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DESIGN INTERVENTIONS

THE PATIENT EXPERIENCE:SHORT STAY SURGERY SCENARIO

The patient experience has many different facets and incarnations. We focused on the short stay surgery scenario and the patient experience in the context of that process. The short stay surgery experience, as we observed it, is mapped below with each milestone along with a description of each key event experienced by the patient.

WAITING ROOMHOSPITAL STAYPREPARATIONS

LEAVE HOME

AT HOSPITAL

FIRST CONTACTThe patient’s first contact with the hospital is where the patient experience begins and may occur in a variety of forms; advertising, family or friends being admitted, an emergency, by telephone, by word of mouth.

Once the patient has checked in they make their way to the short stay surgery waiting area. Here they wait until they are called back to have their pre-operation assessments. The waiting time varies from case to case and can rarely be predicted.

The patient has arrived for their hospital stay and checks in.

PRE-OPERATIONASSESSMENTS

CONSULTATIONThis is generally the first formal contact with the hospital and clinicians in a short stay surgery scenario.

Once the consultation ends and a trip to the operating room is determined, there are a variety of preparations that the patient has to make ranging from paper work to transportation arrangements.

The patient is taken from the waiting room to a private room where they are assessed by various clinicians including the surgeon, anesthesiologist, operating nurses, and resident doctors. The patients also change out of their regular clothes and into the surgical gowns provided by the hospital. This is the last stage before the surgery where family members are allowed to accompany the patients.

HOSPITALCHECK-IN

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DESIGN INTERVENTIONS:WHERE THEY ENHANCE THE PATIENT EXPERIENCE

The different design interventions provide support and enhance the patient experience in different ways. Each intervention is mapped in context with the patient experience to show where and when they augment the patient experience.

AT HOME

LEAVE HOSPITAL

ANESTHESIA

PATIENT VISITS

DISCHARGE

HOME CARERECOVERY

SURGERY

An interview is conducted by the anesthesiologist as a part of the pre-operation assessments. As a part of the interview, the anesthesia is also administered and the patient is escorted to surgery.

Family and friends are allowed to visit and remain with the patient once again beginning with the patient being placed in the recovery unit.

Discharge consists of the patient being determined fit to leave. A family or friend is required to accompany the patient. The discharge nurse provides the patient with all the information necessary to continue the recovery process a once they leave the hospital. Prescriptions are given and the patient changes back into their own clothes.

Once the patient leaves the hospital, the patient experience doesn’t end. Support is required throughout the recovery process to insure a full recovery.

The surgery is performed on the patient by the surgical team as per the decision of the patient.

The patient is taken from the surgery to a post-anesthesia care unit where they are closely monitored for a few hours. They are then taken to a permanent room in the recovery unit.

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WAITING ROOMHOSPITAL STAYPREPARATIONS

PRE-OPERATIONASSESSMENTSCONSULTATION

HOSPITALCHECK-IN

QUESTION PROMPT LISTSSTEPHANIE BAKER

A patient’s ability to communicate with the doctors and clinicians is critical to their care. Good communication is also critical to a patient having a favorable experience. In order for the communication to be successful, the patient must feel both confident and comfortable as well as have the opportunity to articulate their questions and concerns.

Patients are rarely experts in medicine and the anxiety they feel, especially in early phases of their care, makes them apprehensive. These two factors inhibit asking questions and voicing concerns. Since the expertise of the patient is limited, they often don’t know what kinds of questions to ask or even what questions are appropriate. Anxiety and apprehension often occupy the patient’s mind to the extent that they are unable to focus the appropriate amount of attention on what is at hand. Without that focus, the patient struggles to communicate adequately.

In order to assist the patient in communicating with the doctor, as series of question prompts were conceived These prompts help the patient know which questions are appropriate to ask as well as serve as a dialogue starter. Having a few appropriate questions to start

the channel of communication breaks the uneasy tension and helps the patient feel more in control of their situation.

The question prompts are put together in a list and the lists are broken into different sheets that are specific to a each doctor or clinician that the patient might come in contact with. They range from the surgeon to the anesthesiologist and from the discharge nurse to the patient’s primary care nurse. Each question is geared to be appropriate to the communication with that specific staff member.

Each list is equipped with space for the patient to write the responses from the staff member as well as write questions of their own as they come to mind, since these things tend to inevitably be forgotten with everything else taking place throughout the patient’s care.

The lists help the patient create proper communication throughout their care as well as help the patient feel more comfortable and in control as opposed to being anxious and apprehensive. They also help record valuable information from the clinicians and increase the productivity of the time spent with them.

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ANESTHESIA PATIENT VISITS HOME CAREDISCHARGE

WAITING ROOMHOSPITAL STAYPREPARATIONS

PRE-OPERATIONASSESSMENTS

HOSPITALCHECK-IN

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PATIENT CARE MAPERIC BOAM

The hospital can be a very foreign place for a patient. The environment is strange and the language can be hard to understand leading the patient to feel lost, isolated and displaced. Not only is the hospital a foreign place, but so is the care process. More often than not, and especially for first time patients, there is little understanding as to how the patients care will unfold and what steps the patient will take.

Providing a patient with a map of their care gives them a better understanding of where they are going and what they will be experiencing along the way. The map is a description of the entirety of their care organized chronologically. The map is carried with them throughout their hospital stay and beyond to support them at critical moments in their care.

The care map is broken down into six different stages of the patient’s care; at home (pre-hospital), pre-operation and check-in, the procedure, recovery, discharge and finally home care. Each section is then broken down into specific activities and events. The events are described in detail so that the patient has the appropriate information at each step along the way. Also given to the patient in the map, is an indication of who they will be interacting with along the way, whether or not they can

have family accompany them and if there is a form they will need to complete. This helps the patient and their family plan ahead and be prepared with the appropriate personal information.

Breaking the map into sections helps the patient focus on the more immediate events and not feel overwhelmed by the entirety of the process. Basing the map around a time line helps them know exactly where they are in the process at any given moment. They can look back as well as look forward and be prepared for what is coming next.

Included in the care map is a place to store hand outs and other information given along the way. It organizes and structures the information given. There is also space to write questions, thoughts, concerns and instructions in context of the overall experience.

Feelings of being lost, confused and nervous are eliminated by the knowledge of where the patient is going. The organization and support the care map provides continues to benefit the patient long after they have left the hospital and are continuing their care on their own. By eliminating much of the unknown, the patient feels less anxiety and fear which leads to a better experience.

ANESTHESIA PATIENT VISITS DISCHARGE HOME CARERECOVERYSURGERY

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WAITING ROOMPRE-OPERATIONASSESSMENTS

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WHY AM I WAITING?KELSEY BUCHMAN

Nobody likes to wait. Waiting makes people uneasy, frustrated, stressed and even upset. Without knowing why there is a wait, these feelings increase, attitudes worsen and it becomes difficult to deal with one another. These feelings can ruin an experience and overshadow the bigger picture.

In the hospital, there are often times when the patient is waiting, but like in other settings, they don’t always know whay they are waiting. Helping patients understand some of the interworkings of the hospital can help eliminate the frustration that comes with waiting and also gives the patient and opportunity to be empathetic.

The “Why Am I Waiting” card handed out to a patient contains two stories. One is about a patient who had complications with their procedure which caused the doctor to have to spend more time than was scheduled with the patient during the surgery. The other story is about a doctor who, because of their skill and expertise, was called away to an emergency.

The underlying theme of both these stories is that the doctors and staff provide the best care possible for each patient, even if it means breaking the set schedule.

Along with the “Why Am I Waiting” card, the patient is given the chance to make the most of their waiting time. In each waiting area, there would be a station where the patient could make personal “business” cards to hand out to staff members throughout their hospital stay. These cards help the patient feel important as well as provide the staff with a few personal details about each patient to help them form a friendly bond.

The hospital staff, from doctors to janitors, would also have personally “business” cards that they would in turn give to the patients. This act of trading cards creates a relationship between the two parties and helps them remember names, faces and interests. Also, once the patient leaves the hospital, they have a way to remember everyone who took part in helping them have a successful recovery.

PATIENT VISITS DISCHARGERECOVERYSURGERY

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SLEEP IN THE ICUMADELINE FOLKE

Sleep is an important part to the recovery process in the ICU. Studies show that while patients generally get an acceptable amount of sleep, the quality of that sleep is low and it is usually fragmented throughout the night and day. Patients rarely make it into the restorative sleep stages, which is critical to recovery as well as a great patient experience. The goal is to enable patients to get a higher quality of sleep during their hospital stay to promote the healing process and increase the overall comfort. The lack of sleep might also increase the length of the stays in the hospital as well.

Alarms, lights,and clinician interruptions are the leading causes of the fragmented sleep. Add in the fact that patients are in an unfamiliar environment and often times managing considerable pain and its easy to see why the sleep is inadequate.

One intervention that would help patients get better uninterrupted sleep is to coordinate the nighttime interruptions from the clinicians. Instead of entering the room constantly, the visits could be consolidated and there would be less visits throughout the night, allowing the patient to have longer periods of sleep. With longer stretches of uninterrupted sleep, it is more likely that the patients will reach the restorative sleep stages.

For example, a patient might receive a medication every four hours from a nurse and a phlebotomist might need to draw blood every two hours. Since the actions are on a uniform schedule, it would be simple to coordinate them so that both clinicians enter the room at the same time. Likewise, vital sign checks could be handled in the same visit as well as other lab draws.

Another important aspect to consider is the culture of sleep. When we are in our own homes, we have a ritual for going to bed every night. We may not realize it, but it is a part of what helps us fall asleep. Sometimes its brushing our teeth or reading a book. It could also be changing our clothes into pajamas. When we travel or sleep outside our own comforts, we seek to recreate as much of this ritual as possible.

The ICU could adopt an approach that helped patients form some sort of ritual or routine for sleep. Whether it involves incorporating some aspects of a patients own ritual and routine or creating their own, it would go a long way when it comes to helping patients sleep. Some examples of ICU specific interventions might be different colored scrubs for night nurses, dimming of lights at a specific hour, lowering of alarm sound volume or giving patients an extra blanket.

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PATIENT VISITS DISCHARGE HOME CARERECOVERY

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HOSPITAL STAYPREPARATIONSCONSULTATION

HOSPITALCHECK-IN

DECODING PRESCRIPTIONSSTEPHEN GREN

Patients receive large quantities of information during their visits with doctors and clinicians. In a hospital setting, there is even more information given in large quantities upon discharge. Much of this information relates to prescription drugs and other medication. The patients need to know about the medication, how to use it and what to be cautious of so that they can continue their care at home.

The common practice is to give patients printed information from the drug manufacturer and accompany it with specific verbal instructions. They are also given a prescription which is then printed on the bottle or package. Often times the patients are overwhelmed with everything they need to remember and the instructions on the bottles are not as clear as the patient needs. The patients are also recovering and can be in an altered state of mind due to anesthesia.

In order to increase the likelihood that the patients will have the precise information they need when they leave the clinician’s care, the information should be provided in a format that is clear as well as customized. It should include a treatment regimen, warning signs and contact information in case of problems. It would also reinforce the instructions that the discharge nurse provides to the patient.

Along with providing a patient with detailed information about their medication, it is important that the labels on the prescription bottles are also evaluated and changed to be more helpful for patients. The label on the prescription bottle is generally the first place patients look when trying to gather dosage and other information about the drug. The instructions should be concise but adequate.

Adapting this information for each patient and making it simple and easy to understand is important in maintaining proper communication between patients and clinicians. Some patients have difficulty reading or can’t read at all. Others don’t understand English well enough to understand scientific words and medical instructions. Being able to overcome those barriers is fundamental to making the care universal.

What about the doctors and nurses who have to create these instructions? Its important that the program and interface that would generate these instructions is as simple and user friendly to the clinicians as the instructions are to the patients. The goal is to not overburden or create extra work, but rather to help patients continue to care for themselves outside of the watchful eye of the health care professionals.

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HOME CAREDISCHARGE

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THE HELPFUL PATIENT BILLSYLVIA HU

The bill is often the last contact the patient has with the hospital. It is the last impression the hospital leaves once the care is complete. The billing statements that patients receive from many health care institutions are difficult to understand from a patient’s perspective. This often leads to increased anxiety and additional questions.

This idea proposes to augment the bill so that it becomes helpful, easy to understand and decreases questions and anxiety. The goal is to present the information on the patient’s bill in a way that is useful for the patient and not just for the hospital’s billing department. Studying the bill from a patient’s point of view uncovers a few changes that would make the bill much more patient centric.

Patient bills sometimes need a key to help them decipher the information on the bill. Sometimes the bill comes in multiple pages with the information split. This makes it harder to identify necessary information quickly. Patients often need to provide insurance carriers with information from the bill as well as communicate easily about it. Organizing the bill to facilitate its use in this application can ease a patient’s frustration.

A patient’s care doesn’t end when the patient leaves the hospital. Neither does their concern about their condition. Reducing unnecessary stress and frustration helps the patient recover quickly and fully. It keeps their memory of their care amiable and makes them more likely to return in the future.

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HOME CARE

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HOSPITAL STAYPREPARATIONSCONSULTATION

HEALTHY EATING IN HEALTH CAREBRIANNA JENSEN

Nutrition is an important component in the over all health of a patient. Nutrition contributes to recovery and continued health. As obesity rates continue to increase, nutrition is becoming more and more important. Communicating healthy eating habits to individuals who must change their diets for health reasons is a critical part of helping patients recover.

This idea is for the development of food tastings of healthy foods that can be given to individuals in the hospitals and at clinics around the city. This will help patients actually experience healthy food options and help reinforce their change in habits.

There are many misconceptions about healthy eating. These can be confronted and overcome during patients stay in the hospital by exposing them to healthy alternatives.

One misconception about eating healthier foods is that the food doesn’t taste as good as non-healthy foods. Taste is the biggest factor when it comes to choosing our food. If patients are exposed to healthy food they will find that it tastes just as good as unhealthy alternatives.

Another misconception is that it is more difficult to eat healthy. Sometimes there is also a lack of knowing where to begin. Providing patients with simple reference materials that help them find healthy alternatives helps overcome this challenge. Providing them with the recipes of the healthy food they eat while in the hospital will give them another resource.

Patients will leave the hospital with a better perspective on the value of nutrition and will also have the tools to do it on their own.

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PATIENT VISITS DISCHARGE HOME CARE

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WAITING ROOM

EDUCATION LIBRARY FOR PATIENTSNIRMAL SHAH

Patients can have a curiosity and a desire to learn about what ails them. They look for information about their condition in many different places. These sources include friends, neighbors, family members, the internet, libraries and many more. They don’t always look to medical libraries and journals, where the most trusted information can be found. This could be due to their lack of access to such resources.

Patients also have free time throughout their care. They pass this time in waiting rooms, in patient rooms, and at home. This time is generally occupied with television, magazines and newspapers, but it could be utilized more fully if it was filled with reading medical information and other library resources.

Creating a patient resource library would combine the spare time patients have with their desire to learn about their specific condition. This information commons would be a library with medical information, computer terminals and additional library resources so that patients may spend time, check out information and ask a librarian any questions that they have.

It would ease their mind but it would also help them be better patients. They would gain a better understanding of medical terminology and procedures, confidence in discussing their condition, knowledge for after their care ends and have a better patient experience.

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PATIENT VISITS DISCHARGE HOME CARE

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WAITING ROOMHOSPITALCHECK-IN

Hello and Welcome. Let me show you around.

HOSPITAL HOSTSKAITLIN ZUSPAN

Bridging the communication gap between patients and health care professionals would empower the patient in their care. Despite the best efforts of care providers, the current communication can often times be very one-sided, with clinicians talking and patients mostly listening. Patients can be intimidated by the moment, lack the ability to articulate their concerns, or simply not know what to say. For an effective relationship to exist between the two parties, patients must understand how to communicate about their care and learn how to be better patients.

The implementation of patient educator could bridge this gap. They would encourage them to be active participants in their care process and help them articulate their concerns and how those could be communicated to their clinician. They would also work with family members of the patients to help them be another layer of support to the patient. The patient educator would meet with the patients upon arriving at the hospital and prior to any engagements with physicians.

In order to avoid creating another paid position, this position would be filled by medical students. It could be a volunteer position or integrated as a part of their education. The benefit of having student fill this role is that they would get first hand experience with patients in resolving concerns and delivering critical information. This experience is extremely valuable later on as the students become health care professionals.

In the same way that retail stores and the hospitality industry uses greeters to interface with the public, the hospital hosts would do the same thing. The would help acknowledge the patient, provide a personal touch to the time prior to their care, help ease anxious feelings, provide direction, provide a friendly atmosphere to waiting areas, offer help and most importantly educate the patients on how to be the best patient they can be. The power of the hospital host could be far reaching both among patients but also in the practice of medicine.

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DISCHARGE