Vidya Priya Rao, Founder, Customer Experience, Marketing, and Service Design Thinking Consultancy, Innovatus Marketers Touchpoint, gives an insight on how a hospital can shift from volume- to value-based care by using design thinking and a holistic service minded approach
India has seen an increase in life expectancy and the rise of chronic illnesses. At the same time, current models of healthcare delivery are increasingly becoming unsustainable to manage this shift from volume (diagnose and treat) to value (prevent and manage) based care.
With technology playing a lead role, there is a seismic shift in patient expectations of an ‘always-on’ approach to care, disrupting the dynamics of the patient-provider relationship. Today’s patients have more choice and options when it comes to handling their own recovery, along with increased health insurance burden. In turn, healthcare providers are needed to understand the non-linear, multi-stage patient journey via the different channels and touch points.
While, doctors, nurses, support staff, clinics and hospital management teams may perform well as stand-alone experts, but they often do not form interprofessional centres of treatment excellence – let alone, service and patient centeredness. To add to this, hospitals have to deal with the discomfort and insecurities of doctors and nursing staff due to new technology interventions and the need to improve the bottom line and drive down costs, while enhancing performance and patient satisfaction under the value-based care model.
Prescription to design future hospital
To adopt a patient-centric lens and a holistic service-minded approach requires a shift in thinking. The hospital management team cannot confuse restructuring this complex digital disruption with traditional methods – myopic cost slashing, digitalisation of standard operation procedures and haphazard efficiency gains through in-house process improvements. On similar lines, for the sake of value creation and eagerness for cost savings, they can’t make ‘less value’ departments or clinics, redundant activities, overhead costs, and slack resources as their popular targets. They can’t compromise with safety, supervision, security, and surveillance requirements since zero risks often come at the cost of zero conveniences.
While technology will be a significant component in providing patient care in the digital future, it is even more critical for hospitals to strengthen the human element to support hospital-physician-patient relationship. A better understanding of the patient population, enables them to be proactive and effective at managing their health. This is where design thinking makes it entry with its human-centric problem-solving approach, allowing hospitals to empathise with patients and their families while driving a measurable return on investment.
The first step, of design thinking, is to understand the myths and realities about what patients expect from digital healthcare, their current frustrations. The next step is how should the hospital go about designing the service by removing the lumps and bumps that make them annoying, and shape the service experiences that really work not just for the patients, but also all the relevant stakeholders. And finally, hospitals should continually add magic via new services and make them compelling to keep patient attention and build lasting value.
Indian hospitals will not be the first to adopt these principles. It has been tried and tested by Mayo Clinic, Rotterdam Eye Hospital, Stanford Hospital and many more, and all are reaping the benefits of having invested in design thinking. Their teams use a variety of digestible tools and techniques like objective observation, patient journey maps, expectation maps, service safaris, cultural probes, co-creation and so on, they challenge conventional ways of thinking in healthcare.
Innovation to increase OPD efficiency
Here’s a scenario that illustrates how innovative design principles applied to redesign the OPD can lead to create more efficient healthcare delivery, higher quality, improved patient experience, and outstanding outcomes.
At a leading hospital, the OPD area was always a bustling area, and there was a general perception that the department was overloaded and overworked, and there was always long wait times for patients. The design team, comprising design leaders, doctors, clinic administrators, medical staff and others, set out to understand how can this be changed. The first outcome was to make sure that the OPD team offer the safest and highest possible quality care to their patients while ensuring it’s profitable and operation is sustainable. The second outcome was to make sure that a positive first impression gets shaped in the minds of the patients and those who accompany them.
Empathise and find the problem
The team observed, interviewed patients and their families, focussed discussions with the OPD team, analysed the insights generated by the software used by them and were able to understand the bottlenecks.
The key areas they identified were:
- Patient dissatisfaction: A typical patient would be stressed with the medical condition, fearing the results of the diagnosis and would be juggling to balance work and family responsibilities, as well as transportation. In few cases, they could also have financial concerns and language barriers. For a visit to the OPD, the patient had to wait in front of the registration desk, at the doctor’s office, at the cashier’s counter, at the laboratory for getting a test done or collecting report, pharmacy and in between appointments – leaving them exhausted, unable to take much-required rest. They also felt lost, as to how to cope up with the daily chores.
- Appointment bookings: Poorly managed patient list and appointment bookings, most of the patients were walk-ins with prior appointment and took one on the spot. As a result, the software showed it as both underutilised and overbooked. There was no mandate to capture the follow-up appointment schedule, to help map the patient to the same attending doctor.
- Case note management: Different doctors, could attend the patient while treating the same case. As the physicians were adopting different ways to manage case notes, often it was not entered timely in the hospital database, resulting in patient repeating the same information minus the notes of the previous doctor if they forgot to get the prescription, resulting in dissatisfaction for patients and staff.
In the define stage, the team tries to understand ‘what are implications of wait time in the OPD and how does it impact the perception of care?’ The team asked this simple series of questions, often trying to break through the stereotypes and assumptions. A partial list is shared: Should 50 waiting patients be funnelled through multiple front desks to receive care in the fifteen available exam rooms? Must the patients be left idle in the impersonal waiting room while they wait for care? Should there be an easy way to book an appointment to cut down patient wait time? Can the patient view the medical reports on their laptop, mobile device as well as the physician’s computer screen, without having to go to collect it? How can the hospital have access to the previous case history and treatment record from other hospitals? Is there a better and efficient way to utilise OPD space and the patients’ time? The answers were: “No. No. Yes. Yes. Yes. Yes!”
In the ideation phase, the multi-disciplined team brainstormed the different alternatives to address inefficiencies, critically reviewed the existing constraints interfering with patient care. The team prioritised what is the best doable idea in a limited time frame and what would be a logical next step beyond it. The exercise also helped the team see how working smarter could lead to better care for patients and a happier and more productive staff.
Based on the most promising ideas, small-scale informal experiments was designed to refine the concept aimed to eliminate waste within the system and get the buy-in from the larger team for formal adoption. If this worked, this was adopted by other departments as well.
Some highlights from the work are:
- Better bookings: If an OPD patient required to come for a follow-up, the appointment was given well in advance and recorded in the software. They were also educated to call and book an appointment via the different channels available before coming for an unscheduled visit, to minimise wait time.
- Improving use of appointment slots: As the patient case history, medical reports was available with the doctor, they could spend more time ensuring the patient has a thorough understanding of their health status. The next step was to integrate data from personal monitoring devices with the hospital systems.
- Usage of the patient wait time: Health coaches were around to inspire and educate patients to better manage his/ her care and how to track the progress or to how to seek any clarifications at a later date using the hospital app. It helped reduce patient anxiety and improve service quality.
- Centralising case notes: A new process for storing notes centrally and providing access to the concerned staff.
There was initial frustration with the extent of deep-dive being done, but as the work took shape and many of the experiments succeeded, it became evident that the changes were making a significant impact and the internal scepticism declined. The hospital team realised that a better design had a positive impact not only patients but also their professional life and the momentum picked up.
Design a value-based care model
Those players who think “beyond the hospital walls” will be able to deliver value across the full breadth of the patient experience. Looking upstream, hospitals may consider value-driving initiatives such as more efficient diagnosis to identify the root cause of the disease and even disease prevention. Looking downstream, disease management opportunities abound in the areas of patient monitoring and treatment adherence to prevent readmissions.
To redesign a future-ready hospital, they should use design thinking to address the following questions, and pass the stress test to assure the stakeholders that they are ‘better,’ ‘leaner,’ ‘different,’ and ‘disruptive.’
- How to reimagine care management and innovate the models for the front-, middle-, and back-office service delivery to define service from the patient’s perspective, considering them as a cornerstone for co-value creation?
- Which combinations of services (personalised medicine, genome based diagnostics and so on) can be offered to reduce re-admission rates and support the recovery process for chronic care management?
- How to ensure patient accountability and empower them to take an active role in their recovery and well-being?
- How to standardise and adopt IT to aid collaboration across multi-user, multi-device environments for end-end disease management with an accuracy of patient data capture and reporting?
- How to manage the shift from functional professional organisation to integrated healthcare providers resembling a hub with outgoing service spokes?
- How to use technology to improve physician consultations, and redesign the traditional exam room?
- How to re-purpose spaces, use distributed facilities and enhance collaboration between different care entities to get closer geographically to patients?
- What are the emerging roles, skill-mix changes and different approaches to workforce planning? What is the expiry date of the current job functions?
- How to add substantial value to the core business or enhance the latter using business development, competency-based diversification or portfolio restructuring?
- What are the steps required to overcome hospital legacies, current structure, core rigidities and constraints with service model redesign?
- How to develop risk-sharing models with insurers, medical device manufacturers, regulators, industry and other providers?
While the hospital gets an internal consensus regarding the digital future, do note there will be considerable uncertainty and challenges to achieve the shared digital vision.
Think beyond today
While the digital future may seem uncertain, players willing to invest in time, money and effort into reshaping deep-rooted systems and attitudes, and embrace supporting technology will lead in the marketplace. By applying and learning design thinking, the hospital and related service organisations can gain the ‘creative confidence’ to make this change happen. It requires a change in mindset from leadership as well so that the doctors, nurses and the support staff are both supported and encouraged to apply their knowledge to provide better care, design more efficient processes, improving the lives of everyone who interacts with the hospital.