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Designing for
the Clinic Experience
Service Design
                                                   Patients     Family
for UPMC Presbyterian
Neurosurgery Clinic
Carnegie Mellon School of Design
UPMC Center for Quality Improvement & Innovation
Service Design · Fall 2007
                                                    Staff     Dr. Kassam
Melissa Cliver · Jamin Hegeman · Kip Lee
Leanne Libert · Kara Tennant
UPMC Center for Quality
Improvement & Innovation
Our liaison with the clinic
Given Problems
Wayfinding
Wait time
Work flow
Research
Observation
Interviews with staff & patients
Surveys
Data collection
The Patient Experience
“Has he been in to see the
 patient in room seven yet?
 She’s getting restless after
 being in there for an hour.”
– Nurse
Staff Experience
“We all have our meltdowns.
 It goes around the office.”
– Nurse
A View of Dr. Kassam
“If they call me today,
 they’ll get in. Kassam
 has never said no.”
– Clinical Secretary
Synthesis
Service Blueprint of Presby Neuro Clinic
Service           of Presby Neuro Clinic
    PHYSICAL                   Front      Waiting     Front     Waiting        Front     Hallway      Exam        MRI &       Exam          MRI &     Door Tag    Waiting     Check-out
    EVIDENCE                   Desk       Room        Desk      Room           Desk                   Room        Chart       Room          Chart                 Room          Room

                                                                                                                                                                              Check-out,
    PATIENT                    Sign In     Wait      Check-in     Wait      Responds     Follow to    Wait in     Answer
                                                                                                                              Wait
                                                                                                                                          Ask          Return
                                                                                                                                                                    Wait        Pay, &
    ACTIONS                                                                              Exam Rm     Exam Rm     Questions              Questions     Door Tag                  Leave


Line of Interaction


    ONSTAGE                                                                     Call     Escort to
                                                                                                                   Check
                                                                                                                                           Meet Dr.                           Process &
    CONTACT                Welcome                   Process                   Patient                            Vitals &
                                                                                         Exam Rm                 Ask Quest                 Kassam                             Check-out
    PERSON

Line of Visibility


  BACKSTAGE                      Get                            See Other    Grab                                 Check      Place in                  Take       See Other
                                         See Other                                                   See Other
   CONTACT                     Patient
                                          Patients               Patients   Door Tag                  Patients
                                                                                                                  Patient    Kassam                    Away        Patients
   PERSON                       Chart                                                                            Location      Bin                     Chart


                                                                 Brings                  Chart in            Grab              Kassam
                                                                Door Tag                  To Be              Chart            Gets Quick
                                                                  Back                   Seen Bin          from Bin            Review


                                                                      Chart              Write Rm                                           Check
                                                                    Taken by               # on                                             Patient   Dictation
                                                                      Staff              Schedule                                          Location


Line of Internal Interaction


   SUPPORT                                           Records/                                           Bin                                            Chart                  Records/
                          Debbie’s                                          Door Tag                             Schedule                                                     Database
                          Chart Cart                 Database                                         System                                          Storage
  PROCESSES                                                                 System                                System
                                                                                                                                                      System                   System
                                                      System
Lack of wait time interactions
Service Blueprint of Presby Neuro Clinic
    PHYSICAL                   Front      Waiting     Front     Waiting        Front     Hallway      Exam        MRI &       Exam          MRI &     Door Tag    Waiting     Check-out
    EVIDENCE                   Desk       Room        Desk      Room           Desk                   Room        Chart       Room          Chart                 Room          Room

                                                                                                                                                                              Check-out,
    PATIENT                    Sign In     Wait      Check-in     Wait      Responds
                                                                                         Follow to    Wait in     Answer
                                                                                                                              Wait
                                                                                                                                          Ask          Return
                                                                                                                                                                    Wait        Pay, &
    ACTIONS                                                                              Exam Rm     Exam Rm     Questions              Questions     Door Tag                  Leave


Line of Interaction


    ONSTAGE                                                                                                        Check
    CONTACT
    PERSON
                           Welcome
                                            ?        Process
                                                                  ?             Call
                                                                               Patient
                                                                                         Escort to
                                                                                         Exam Rm       ?          Vitals &
                                                                                                                 Ask Quest     ?           Meet Dr.
                                                                                                                                           Kassam                   ?         Process &
                                                                                                                                                                              Check-out


Line of Visibility


  BACKSTAGE                      Get                            See Other    Grab                                 Check      Place in                  Take       See Other
                                         See Other                                                   See Other               Kassam
   CONTACT                     Patient
                                          Patients               Patients   Door Tag                  Patients
                                                                                                                  Patient                              Away        Patients
   PERSON                       Chart                                                                            Location      Bin                     Chart


                                                                 Brings                  Chart in            Grab              Kassam
                                                                Door Tag                  To Be              Chart            Gets Quick
                                                                  Back                   Seen Bin          from Bin            Review


                                                                      Chart              Write Rm                                           Check
                                                                    Taken by               # on                                             Patient   Dictation
                                                                      Staff              Schedule                                          Location


Line of Internal Interaction


   SUPPORT                                           Records/                                           Bin                                            Chart                  Records/
                          Debbie’s                                          Door Tag                             Schedule                             Storage                 Database
                          Chart Cart                 Database               System                    System      System
  PROCESSES                                           System                                                                                          System                   System
Complex workflow Presby Neuro Clinic
Service Blueprint of
    PHYSICAL                   Front      Waiting     Front     Waiting        Front     Hallway      Exam        MRI &       Exam          MRI &     Door Tag    Waiting     Check-out
    EVIDENCE                   Desk       Room        Desk      Room           Desk                   Room        Chart       Room          Chart                 Room          Room

                                                                                                                                                                              Check-out,
    PATIENT                    Sign In     Wait      Check-in     Wait      Responds
                                                                                         Follow to    Wait in     Answer
                                                                                                                              Wait
                                                                                                                                          Ask          Return
                                                                                                                                                                    Wait        Pay, &
    ACTIONS                                                                              Exam Rm     Exam Rm     Questions              Questions     Door Tag                  Leave


Line of Interaction


    ONSTAGE                                                                     Call     Escort to
                                                                                                                   Check                   Meet Dr.                           Process &
    CONTACT                Welcome                   Process                   Patient                            Vitals &                 Kassam
                                                                                         Exam Rm                 Ask Quest                                                    Check-out
    PERSON

Line of Visibility


  BACKSTAGE                      Get                            See Other    Grab                                 Check      Place in                  Take       See Other
                                         See Other                                                   See Other
                                                                                                                             Kassam
   CONTACT                     Patient
                                          Patients               Patients   Door Tag                  Patients
                                                                                                                  Patient                              Away        Patients
   PERSON                       Chart                                                                            Location      Bin                     Chart


                                                                 Brings                  Chart in            Grab              Kassam
                                                                Door Tag                  To Be              Chart            Gets Quick
                                                                  Back                   Seen Bin          from Bin            Review


                                                                      Chart              Write Rm                                           Check
                                                                    Taken by               # on                                             Patient   Dictation
                                                                      Staff              Schedule                                          Location


Line of Internal Interaction


   SUPPORT                                           Records/                                           Bin                                            Chart                  Records/
                          Debbie’s                                          Door Tag                             Schedule                             Storage                 Database
                          Chart Cart                 Database               System                    System      System
  PROCESSES                                           System                                                                                          System                   System
Flow dependent on Dr. Kassam Clinic
 Service Blueprint of Presby Neuro
Needs
Patient             Staff                 Dr. Kassam
Feeling welcome     Better workflow        Spend quality
                                          time with patients
Actual wait time    Locating Dr. Kassam
                    and each other        See everyone
Respect
                    Communication         Support Staff
Space and comfort
                    Making a difference   Time
Distractions
It’s more than wayfinding,
wait time, and workflow.
The experience is the relationship between
patients, staff, and Dr. Kassam within the
given space.
Opportunities
Embrace Wait Time
Inform, engage, and comfort patients?
Improve Workflow
Fewer tasks, less distraction,
and better communication?
Balance Kassam
Support his efforts to help patients,
but also find time for himself and
support his staff.
Sharing our research,
gaining their trust.
Engaging the staff
in the design process.
“Embrace wait time.”
 Direction from Center for Quality
 Improvement & Innovation.
We explored concepts
for all three opportunities...
But decided to focus more
on the patient experience.
Why?
Opportunity for the greatest impact
Client focusing on workflow
More physicians in the future
will reduce strain on Dr. Kassam
Client nudging us that way
We moved and removed chairs
to affect the patient experience.




Before                     After
Because we involved
the staff in our process,
they really helped us
gain access to patients.
Experience Cards
Designed to engage patients
and elicit ideas from them on
what the experience could be.
Eleven Exam Room Interviews
“We’ll talk about anything to anyone.
 Entertain us.”
“The first time I came, my mom and cousin
 were in the waiting room for three hours.
 My mom finished a book. That was really
 hard for me.”
“Our town has one traffic light.”
“I come by myself now. I don’t bring
 my family anymore. I’m my own woman.”
“I’m about to get brain surgery.
 I don’t want to play checkers!”
Patient Journey
                                                          t
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                               vis                  tv                                                               it                  it
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                            re                   fi
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     cti
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                  ar
                       y
                                           no
                                             s                         pv        er
                                                                                    y
                                                                                         t-op              w-                  w-
   te            m                       ag                          -o         g                       llo                 llo
De            Pr
                i
                                       Di                         Pre       S ur      Pos             Fo                  Fo

                                                              >
Emotions                                                                                                    patient emotions




                                                                                                                    family emotions




   Support Needs
                                                                                                                    patient support needs


                                                                                                 family support needs



   Waiting Needs                                                                      family waiting needs
                                                       patient waiting needs




Information Needs                                                                                 family info needs




                                                                                                 patient info needs

                                                                           t
                                                  it                    isi
                                               vis                   stv                                                           it                     it
                                         ar
                                           e                      fir                     t                    it               vis                    vis
                                                                s/                     isi                  vis               p                      p
                         tio
                            n          yc                    os
                                                               i                      v           y       p                 -u                     -u
                       ec         ar                       gn                      op          er       -o                ow                     ow
                     et        rim                        a                      e-          rg       st               ll                     ll
                    D         P                         Di                     Pr          Su       Po               Fo                     Fo
New                 Pre-op                    Post-op                   Returning
              Patient             Patient                   Patient                   Patient
              Curious             Can’t think               Dazed                     Thankful
  Emotions    Hopeful             Overwhelmed               Feels bad about           Understanding
                                                            family waiting
              Feels bad about     Self-concerned                                      Bored
              family waiting                                Mixed feelings:
                                  Confusion                 laughing crying           Blessed
              Confusion
                                                            Shock and relief

              Emotional Support   Transportation            Transportation            Transportation
   Support                        Someone to collect info   Someone to collect info   Physical care
    Needs                         Someone to make           Physical care
                                  arrangements



              Distractions        Special treatment         Distractions              More engaging
   Waiting                                                                            distractions
    Needs                                                                             Interactions




              Schedule            Testing info              Possible symptoms         Wait time
Information   Valet               Surgery info/procedure    Medical education         Schedule/other appt.
     Needs    Place to stay       Reality: good/bad         Medical translation       Don’t want to repeat
                                                                                      personal info
              Wait time           Wait time                 Schedule/other appt.
              Sign-in process     Sign-in process           Wait time
New Concepts
Spending more time with patients
inspired new concepts.
low cost

  Cost/Value                                                                                                               Stages of Care
                                                                                 wheelchair with
                                                                                 regular seating areas                     suite of cards
            coat rack              clinic graduation
                                   certificate                                                                              Kassam fact sheet
                                                                                      note-taking kit
                                              ambient music                                                                Neurosurgery
                                                                                                    Wall of Hope           common terms
                                                                                                                           glossary



                                                       patient-use
                                                       phone

                                                                                                                partitioned
                                                                                      food & drink cart         waiting area
low value                                                                                                                                  high value
                                                                            no front desk
                                                                                              video testimonials
                                              rotating museum                                      USB memory stick
                                              artwork exhibits                                     for patient records

                                                                                        waiting room TVs
                        calming                        closed-circuit TV
                                                                                            Kassam TV                       real-time
                        water fountain                 to watch surgery
                                                                                                                            wait tracker
                                                                                                          patient
                                                                                                          transportation
                                              LCD screens                                                                  patient information
                                              for dynamic art                                                              for visually impaired

                                                                                                    computer kiosks
                                            wait room        wait room
                                            food servers     librarian      mentor                        patient advocate

                                                                     high cost
low cost

  Cost/Value                                                                                                               Stages of Care
                                                                                 wheelchair with
                                                                                 regular seating areas                     suite of cards
            coat rack              clinic graduation
                                   certificate                                                                              Kassam fact sheet
                                                                                      note-taking kit
                                              ambient music                                                                Neurosurgery
                                                                                                    Wall of Hope           common terms
                                                                                                                           glossary



                                                       patient-use
                                                       phone

                                                                                                                partitioned
                                                                                      food & drink cart         waiting area
low value                                                                                                                                  high value
                                                                            no front desk
                                                                                              video testimonials
                                              rotating museum                                      USB memory stick
                                              artwork exhibits                                     for patient records

                                                                                        waiting room TVs
                        calming                        closed-circuit TV
                                                                                            Kassam TV                       real-time
                        water fountain                 to watch surgery
                                                                                                                            wait tracker
                                                                                                          patient
                                                                                                          transportation
                                              LCD screens                                                                  patient information
                                              for dynamic art                                                              for visually impaired

                                                                                                    computer kiosks
                                            wait room        wait room
                                            food servers     librarian      mentor                        patient advocate

                                                                     high cost
Concept Validation                                                                                                                                 Soothing Music


                                                                Glossary of Neurosurgery Terms


                                                                                                                                                                      Patient Information Card


                                                                                                                                                                                                          Mary arrives at the clinic for her pre-op visit. She’s          The waiting room is filled with soothing music,
                                                                                                                                                                                                          exhausted from all the testing and feels very stressed.         which helps to calm her, reducing some of her anxiety
                                                                                                                                                                                                                                                                                                                        a
                                                                                                                                                                                                                                                                          and stress.

Wall of Hope
                                                                  On Adam’s first visit to the clinic, the         In the exam room, the doctor and nurse         Adam thumbs through the glossary the
                                                                  check-in nurse gives him a glossary of          list off a number of procedures and            nurse gave him earlier and learns what
                                                                  common terms used in neurosurgery.              medical terms that Adam does not know.         all of those terms mean. He feels less
                                                                                                                  He feels confused and overwhelmed.             anxious about the process.




                                                                                                            Dr. Kassam Fact Sheet                                       Debbie hands the nurse her patient                 The nurse swipes the card in the reader,   Her medical history and information
                                                                                                                                                                        information card to begin her clinic               then Debbie enters a pin number.           prints out for her to verify. Debbie’s
                                                                                                                                                                        appointment.                                                                                  glad she doesn’t have to recite any
                                                                                                                                                                                                                                                                      information or fill out paperwork.
                                                During their wait time, they
                                                                           y
                                                notice a wall with testimonials
                                                from previous patients.
                                                         vious




   Bonnie and her husband arrive at
   the clinic for the first time, anxious
   and tired.
                                                                                                             Bonnie sees comments of those
                                                                                                                                       t
                                                                                                             before and after surgery an finds
                                                                                                                                       nd
                                                                                                                                      and
                                                                                                             some comfort and assuranc  ce.
                                                                                                                                assurance.
                                                                                                             She is not the only one.




                    University of Pittsburgh
                    Medical Center
Center for Quality Improvement & Innovation

                                                                                                            Helen is concerned with her surgery.           She is given a sheet providing facts                Helen is reassured that she is in
                                                                                                                                                           and information on Dr. Kassam.                      good hands. She is able to focus on
                                                                                                                                                                                                               other things.
Validation with Patients
Operating Room
Developed a greater empathy for the patients
and families going through this experience.
Design Implications
Provide patients with access to resources
so they feel in control of their experience.
Embody the comfort Dr. Kassam provides.
Increase interaction between patients
and Dr. Kassam and his staff.
Concept and Process Book
Holistic view of the clinic
Sharing what we learned
Providing concept ideas
to further explore and
continue the work that        Design for
                              the Clinic
we started                    Experience


                              Concepts for
                              UPMC Presbyterian
                              Neurosurgery Clinic

                              Carnegie Mellon School of Design
                              Service Design Fall 2007

                              Melissa Cliver
                              Jamin Hegeman
                              Kipum Lee
                              Leanne Libert
                              Kara Tennant
Current State
                                                                                               CURIOUS
Lack of interaction at different points
throughout the journey creates a barrier                     PERSONABLE
between patients and their families and
the positive experience of being with
                                                                                           ANXIOUS
                                                                          CLEAR
Dr. Kassam and his staff.                                                                         CONFUSED
                                                        EXPERIENCED

                                                                      UNDERSTANDING
                                               ACCOMODATING                                   OVERWHELMED

                                                                             AT EASE                       UPSET
                                            ANSWERS

                                                                              CARING
                                                            DR. KASSAM                                PATIENT
                                            COMFORTING

                                                                              CONFIDENT
                                           A TEAM
                                                                       REASSURING                        FAMILY
                                                          STAFF
                                               DIRECT
                                                                      TRUST-WORTHY           FRUSTRATED
                                                         WARM
                                                                                                       SCARED
                                                           GOOD HUMORED
                                                                                          UNCERTAIN
Ideal State
                                                                           CURIOUS
Continual interaction extends the
positive experience of being with                   PERSONABLE                            CLEAR
Dr. Kassam and his staff to the
patients and their families, putting                                             ANXIOUS
them at ease and giving them                                 EXPERIENCED                          CONFUSED
control of their experience.
                                                                                     OVERWHELMED
                                       ACCOMODATING            UNDERSTANDING
                                                                                          AT EASE

                                  ANSWERS                                                              UPSET

                                                           DR. KASSAM
                                                                                PATIENT                CARING
                                   COMFORTING


                                 A TEAM                                                       FAMILY
                                                   STAFF
                                                                  REASSURING

                                          DIRECT                        TRUST-WORTHY              CONFIDENT
                                                           WARM                      FRUSTRATED

                                                                           SCARED
                                                   GOOD HUMORED                        UNCERTAIN
Patients     Family                              Patients     Family




                            Staff     Dr. Kassam                             Staff     Dr. Kassam




Clinic Staff Meetings                              Clinic Staff Locator
Needs met                                          Needs met
•   Forum for discussion                           •   Finding each other
    and reflecting                                      and Dr. Kassam
•   Team-building                                  •   Reduction in tasks
Patients     Family                                  Patients     Family




                         Staff     Dr. Kassam                                 Staff     Dr. Kassam




PCP Direct Link                                 Wait-time Indicator

Needs met                                       Needs met
•   Support his staff                           •   Desire to see everyone

•   Time for himself                            •   Time for himself
                                                •   Better communication
Patients     Family                       Patients     Family




                            Staff     Dr. Kassam                      Staff     Dr. Kassam




Gift from the Clinic                               Wall of Hope

Needs met                                          Needs met
•   Comfort                                        •   Reassurance

•   Feeling of good will                           •   Information
    from staff                                     •   Distraction
Welcome Booklet
Embodying Dr. Kassam and the clinic
  Comfort
  Confidence
  Warmth
  Humor
Bringing Dr. Kassam to the waiting room
Increasing staff service delivery role
Layout of the Book
front cover   back cover                                                               page 1                                                                                                                                                                    page 2



                  If you want to learn more about me or
                  the clinic, visit the clinic’s website. It has
                  a lot of good information and videos.
                  neurosurgery.pitt.edu/minc

                                                                                                                                                                                                                                                                     I know you don’t want to be here.
                                                                                                                                                                                                                                                                     I know you don’t want to know me.

                                                                                                                                                                                                                                                                     But the best thing that could happen
                                                                                                                                                                                                                                                                     is to know me.



                                                                                                                                                                                                                                                                     I’ve performed more than 3,000 neurosurgical procedures. More than
                                                                                                                                                                                                                                                                     800 are what’s called minimally invasive endoscopic procedures.
                                                                                                                                                                                                                                                                     And I’m a person first. I’ll be direct and treat you like a friend.
                                                                                                                                                                                                                                                                     Occasionally, I may even make you laugh.




page 3        page 4                                                                   page 5                                                                                                                                                                    page 6




                  It’s minimally invasive brain surgery                                    I work with a great team, and could                                                                                                                                       My staff and I see a lot of patients,
                  through the nose. This requires no                                       not do my job without them. They can                                                                                                                                      and provide attention and care to
                  incisions and patients can often be                                      answer a lot of your questions. Trust                                                                                                                                     all. We know this sometimes leads to
                  discharged within two days.                                              them as you trust me. We’re here for                                                                                                                                      backups. But I hope you’ll understand
                                                                                           you the whole way through.                                                                                                                                                and trust I’ll see you as soon as I can.

                  Under my direction, the center has pioneered and developed much                                                                                                                                                                                                                                  om                  rse
                                                                                                                                                                                                                                                                                                                Ro         o m r Nu
                  of the technology and instrumentation used during these surgeries.                                                                     it                                                                                                                                                ing          Ro
                                                                                                                              it                      vis                                                                                                                                                             m           to
                                                                                                                           vis                  rst                                                                                  isit                 isit                                         ait         xa          en
                  With continued research and experience, I now use this surgery for                                 are                     /fi                            isit                                    vis
                                                                                                                                                                                                                      it
                                                                                                                                                                                                                                   pv                   pv                                          eW          eE         sid               ut
                                                                                                      on           yc                     sis                                                                                                                                  n               th            th         Re
                  most tumors affecting the skull base.                                             cti        ar                      no                              pv                    er
                                                                                                                                                                                                 y            op                w-u                  w-u                   k-i            in             in          ta           e      k-o
                                                                                                ete          m                     iag                              -o
                                                                                                                                                                                        urg             st-                  llo                  llo                  he
                                                                                                                                                                                                                                                                          c
                                                                                                                                                                                                                                                                                    ait              ait          ee         e m hec
                                                                                            D            Pri                     D                            Pre                      S             Po                    Fo                   Fo                    C            W                W           M         Se         C


                                                                                                                                     2 days - 2 weeks
                                                                                                                                                                         2 days - 4 weeks
                                                                                                                                                                                                                   1 month - 1 year
                                                                                                                                                                                                                                  6 months - 1 year
When they meet him in the exam room, they
                                                                     see that he is indeed personable, and funny,
                                                                     too, just like in the booklet.




Annette is a new patient.
After she and her husband check in,
a front-desk staff member gives them
a welcome booklet, indicating it’s
a message from Dr. Kassam.




                                                                                         In the waiting room, they read Dr. Kassam’s
                                                                                         welcome. They like that he seems personable
                                                                                         and experienced, and are glad to find out
                                                                                         a bit about him.



  Welcome Booklet
  The Welcome Booklet gives new patients an overview of          Needs met                                   Patients      Family

  the overall patient journey, one clinic visit, the staff and   •    Information
  Dr. Kassam in Kassam’s own words.
                                                                 •    Interaction with Kassam
  Since a staff member hands the booklet directly to the
                                                                                                               Staff     Dr. Kassam
  new patient, it also serves as a new line of interaction
  between the staff and patient where there was none before.
Clinic Chat
A Vision for the UPMC Neurosurgery Clinic
Creating a system of interaction,
information, distraction, and support
Extending the comfort of Dr. Kassam and the clinic
Waiting
 Room
 Patient



 Waiting
 Room
 Patient




Messages from patients, staff and Dr. Kassam appear on a large
Clinic Chat display in the waiting room.



                                                                 Common phrases from the Clinic Chat appear in a tag cloud on adjacent
                                                                 display to give viewers a general idea of what’s been discussed.




Clinic Chat
Patients, Dr. Kassam, and staff contribute to an organically           Needs met                                  Patients        Family

formed system that provides information, distraction, and              •    Front-stage/back-stage
a connection with Dr. Kassam and his staff during periods                   interaction
when they cannot be physically present with the patient.
                                                                       •    Information
                                                                                                                    Staff       Dr. Kassam
                                                                       •    Distraction
                                                                       •    Support
Staff have access via hall displays.




Patients can send messages to Clinic Chat
from their phone, personal computer or kiosk
in the waiting room, exam room or at home.



                                                                   Dr. Kassam can reply from the office computer.
Part of a Larger
Information System
Includes information about:
Dr. Kassam
Surgery and Side Effects
Clinic Staff
Prescriptions
Could something like
Clinic Chat work elsewhere?
We think so.
Designing the Experience Together
Patients, staff, and Dr. Kassam contribute to
designing the experience
Wait time is an opportunity to interact with other
patients, staff, and Dr. Kassam
The service extends the comfort of Dr. Kassam and his
clinic and provides information, distraction, and an
experience that is created together with the patients,
which increases patient control
Thank you!

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UPMC Neuro Clinic Service Design

  • 1. Designing for the Clinic Experience Service Design Patients Family for UPMC Presbyterian Neurosurgery Clinic Carnegie Mellon School of Design UPMC Center for Quality Improvement & Innovation Service Design · Fall 2007 Staff Dr. Kassam Melissa Cliver · Jamin Hegeman · Kip Lee Leanne Libert · Kara Tennant
  • 2. UPMC Center for Quality Improvement & Innovation Our liaison with the clinic Given Problems Wayfinding Wait time Work flow
  • 3. Research Observation Interviews with staff & patients Surveys Data collection
  • 5. “Has he been in to see the patient in room seven yet? She’s getting restless after being in there for an hour.” – Nurse
  • 7. “We all have our meltdowns. It goes around the office.” – Nurse
  • 8. A View of Dr. Kassam
  • 9. “If they call me today, they’ll get in. Kassam has never said no.” – Clinical Secretary
  • 11. Service Blueprint of Presby Neuro Clinic Service of Presby Neuro Clinic PHYSICAL Front Waiting Front Waiting Front Hallway Exam MRI & Exam MRI & Door Tag Waiting Check-out EVIDENCE Desk Room Desk Room Desk Room Chart Room Chart Room Room Check-out, PATIENT Sign In Wait Check-in Wait Responds Follow to Wait in Answer Wait Ask Return Wait Pay, & ACTIONS Exam Rm Exam Rm Questions Questions Door Tag Leave Line of Interaction ONSTAGE Call Escort to Check Meet Dr. Process & CONTACT Welcome Process Patient Vitals & Exam Rm Ask Quest Kassam Check-out PERSON Line of Visibility BACKSTAGE Get See Other Grab Check Place in Take See Other See Other See Other CONTACT Patient Patients Patients Door Tag Patients Patient Kassam Away Patients PERSON Chart Location Bin Chart Brings Chart in Grab Kassam Door Tag To Be Chart Gets Quick Back Seen Bin from Bin Review Chart Write Rm Check Taken by # on Patient Dictation Staff Schedule Location Line of Internal Interaction SUPPORT Records/ Bin Chart Records/ Debbie’s Door Tag Schedule Database Chart Cart Database System Storage PROCESSES System System System System System
  • 12. Lack of wait time interactions Service Blueprint of Presby Neuro Clinic PHYSICAL Front Waiting Front Waiting Front Hallway Exam MRI & Exam MRI & Door Tag Waiting Check-out EVIDENCE Desk Room Desk Room Desk Room Chart Room Chart Room Room Check-out, PATIENT Sign In Wait Check-in Wait Responds Follow to Wait in Answer Wait Ask Return Wait Pay, & ACTIONS Exam Rm Exam Rm Questions Questions Door Tag Leave Line of Interaction ONSTAGE Check CONTACT PERSON Welcome ? Process ? Call Patient Escort to Exam Rm ? Vitals & Ask Quest ? Meet Dr. Kassam ? Process & Check-out Line of Visibility BACKSTAGE Get See Other Grab Check Place in Take See Other See Other See Other Kassam CONTACT Patient Patients Patients Door Tag Patients Patient Away Patients PERSON Chart Location Bin Chart Brings Chart in Grab Kassam Door Tag To Be Chart Gets Quick Back Seen Bin from Bin Review Chart Write Rm Check Taken by # on Patient Dictation Staff Schedule Location Line of Internal Interaction SUPPORT Records/ Bin Chart Records/ Debbie’s Door Tag Schedule Storage Database Chart Cart Database System System System PROCESSES System System System
  • 13. Complex workflow Presby Neuro Clinic Service Blueprint of PHYSICAL Front Waiting Front Waiting Front Hallway Exam MRI & Exam MRI & Door Tag Waiting Check-out EVIDENCE Desk Room Desk Room Desk Room Chart Room Chart Room Room Check-out, PATIENT Sign In Wait Check-in Wait Responds Follow to Wait in Answer Wait Ask Return Wait Pay, & ACTIONS Exam Rm Exam Rm Questions Questions Door Tag Leave Line of Interaction ONSTAGE Call Escort to Check Meet Dr. Process & CONTACT Welcome Process Patient Vitals & Kassam Exam Rm Ask Quest Check-out PERSON Line of Visibility BACKSTAGE Get See Other Grab Check Place in Take See Other See Other See Other Kassam CONTACT Patient Patients Patients Door Tag Patients Patient Away Patients PERSON Chart Location Bin Chart Brings Chart in Grab Kassam Door Tag To Be Chart Gets Quick Back Seen Bin from Bin Review Chart Write Rm Check Taken by # on Patient Dictation Staff Schedule Location Line of Internal Interaction SUPPORT Records/ Bin Chart Records/ Debbie’s Door Tag Schedule Storage Database Chart Cart Database System System System PROCESSES System System System
  • 14. Flow dependent on Dr. Kassam Clinic Service Blueprint of Presby Neuro
  • 15. Needs Patient Staff Dr. Kassam Feeling welcome Better workflow Spend quality time with patients Actual wait time Locating Dr. Kassam and each other See everyone Respect Communication Support Staff Space and comfort Making a difference Time Distractions
  • 16. It’s more than wayfinding, wait time, and workflow. The experience is the relationship between patients, staff, and Dr. Kassam within the given space.
  • 17. Opportunities Embrace Wait Time Inform, engage, and comfort patients? Improve Workflow Fewer tasks, less distraction, and better communication? Balance Kassam Support his efforts to help patients, but also find time for himself and support his staff.
  • 19. Engaging the staff in the design process.
  • 20. “Embrace wait time.” Direction from Center for Quality Improvement & Innovation.
  • 21. We explored concepts for all three opportunities...
  • 22. But decided to focus more on the patient experience. Why? Opportunity for the greatest impact Client focusing on workflow More physicians in the future will reduce strain on Dr. Kassam Client nudging us that way
  • 23. We moved and removed chairs to affect the patient experience. Before After
  • 24. Because we involved the staff in our process, they really helped us gain access to patients.
  • 25. Experience Cards Designed to engage patients and elicit ideas from them on what the experience could be.
  • 26. Eleven Exam Room Interviews “We’ll talk about anything to anyone. Entertain us.” “The first time I came, my mom and cousin were in the waiting room for three hours. My mom finished a book. That was really hard for me.” “Our town has one traffic light.” “I come by myself now. I don’t bring my family anymore. I’m my own woman.” “I’m about to get brain surgery. I don’t want to play checkers!”
  • 27. Patient Journey t it isi vis tv it it rs re fi sit isi t vis vis n ca is/ i v u p u p cti o ar y no s pv er y t-op w- w- te m ag -o g llo llo De Pr i Di Pre S ur Pos Fo Fo >
  • 28. Emotions patient emotions family emotions Support Needs patient support needs family support needs Waiting Needs family waiting needs patient waiting needs Information Needs family info needs patient info needs t it isi vis stv it it ar e fir t it vis vis s/ isi vis p p tio n yc os i v y p -u -u ec ar gn op er -o ow ow et rim a e- rg st ll ll D P Di Pr Su Po Fo Fo
  • 29. New Pre-op Post-op Returning Patient Patient Patient Patient Curious Can’t think Dazed Thankful Emotions Hopeful Overwhelmed Feels bad about Understanding family waiting Feels bad about Self-concerned Bored family waiting Mixed feelings: Confusion laughing crying Blessed Confusion Shock and relief Emotional Support Transportation Transportation Transportation Support Someone to collect info Someone to collect info Physical care Needs Someone to make Physical care arrangements Distractions Special treatment Distractions More engaging Waiting distractions Needs Interactions Schedule Testing info Possible symptoms Wait time Information Valet Surgery info/procedure Medical education Schedule/other appt. Needs Place to stay Reality: good/bad Medical translation Don’t want to repeat personal info Wait time Wait time Schedule/other appt. Sign-in process Sign-in process Wait time
  • 30. New Concepts Spending more time with patients inspired new concepts.
  • 31. low cost Cost/Value Stages of Care wheelchair with regular seating areas suite of cards coat rack clinic graduation certificate Kassam fact sheet note-taking kit ambient music Neurosurgery Wall of Hope common terms glossary patient-use phone partitioned food & drink cart waiting area low value high value no front desk video testimonials rotating museum USB memory stick artwork exhibits for patient records waiting room TVs calming closed-circuit TV Kassam TV real-time water fountain to watch surgery wait tracker patient transportation LCD screens patient information for dynamic art for visually impaired computer kiosks wait room wait room food servers librarian mentor patient advocate high cost
  • 32. low cost Cost/Value Stages of Care wheelchair with regular seating areas suite of cards coat rack clinic graduation certificate Kassam fact sheet note-taking kit ambient music Neurosurgery Wall of Hope common terms glossary patient-use phone partitioned food & drink cart waiting area low value high value no front desk video testimonials rotating museum USB memory stick artwork exhibits for patient records waiting room TVs calming closed-circuit TV Kassam TV real-time water fountain to watch surgery wait tracker patient transportation LCD screens patient information for dynamic art for visually impaired computer kiosks wait room wait room food servers librarian mentor patient advocate high cost
  • 33. Concept Validation Soothing Music Glossary of Neurosurgery Terms Patient Information Card Mary arrives at the clinic for her pre-op visit. She’s The waiting room is filled with soothing music, exhausted from all the testing and feels very stressed. which helps to calm her, reducing some of her anxiety a and stress. Wall of Hope On Adam’s first visit to the clinic, the In the exam room, the doctor and nurse Adam thumbs through the glossary the check-in nurse gives him a glossary of list off a number of procedures and nurse gave him earlier and learns what common terms used in neurosurgery. medical terms that Adam does not know. all of those terms mean. He feels less He feels confused and overwhelmed. anxious about the process. Dr. Kassam Fact Sheet Debbie hands the nurse her patient The nurse swipes the card in the reader, Her medical history and information information card to begin her clinic then Debbie enters a pin number. prints out for her to verify. Debbie’s appointment. glad she doesn’t have to recite any information or fill out paperwork. During their wait time, they y notice a wall with testimonials from previous patients. vious Bonnie and her husband arrive at the clinic for the first time, anxious and tired. Bonnie sees comments of those t before and after surgery an finds nd and some comfort and assuranc ce. assurance. She is not the only one. University of Pittsburgh Medical Center Center for Quality Improvement & Innovation Helen is concerned with her surgery. She is given a sheet providing facts Helen is reassured that she is in and information on Dr. Kassam. good hands. She is able to focus on other things.
  • 35. Operating Room Developed a greater empathy for the patients and families going through this experience.
  • 36. Design Implications Provide patients with access to resources so they feel in control of their experience. Embody the comfort Dr. Kassam provides. Increase interaction between patients and Dr. Kassam and his staff.
  • 37. Concept and Process Book Holistic view of the clinic Sharing what we learned Providing concept ideas to further explore and continue the work that Design for the Clinic we started Experience Concepts for UPMC Presbyterian Neurosurgery Clinic Carnegie Mellon School of Design Service Design Fall 2007 Melissa Cliver Jamin Hegeman Kipum Lee Leanne Libert Kara Tennant
  • 38. Current State CURIOUS Lack of interaction at different points throughout the journey creates a barrier PERSONABLE between patients and their families and the positive experience of being with ANXIOUS CLEAR Dr. Kassam and his staff. CONFUSED EXPERIENCED UNDERSTANDING ACCOMODATING OVERWHELMED AT EASE UPSET ANSWERS CARING DR. KASSAM PATIENT COMFORTING CONFIDENT A TEAM REASSURING FAMILY STAFF DIRECT TRUST-WORTHY FRUSTRATED WARM SCARED GOOD HUMORED UNCERTAIN
  • 39. Ideal State CURIOUS Continual interaction extends the positive experience of being with PERSONABLE CLEAR Dr. Kassam and his staff to the patients and their families, putting ANXIOUS them at ease and giving them EXPERIENCED CONFUSED control of their experience. OVERWHELMED ACCOMODATING UNDERSTANDING AT EASE ANSWERS UPSET DR. KASSAM PATIENT CARING COMFORTING A TEAM FAMILY STAFF REASSURING DIRECT TRUST-WORTHY CONFIDENT WARM FRUSTRATED SCARED GOOD HUMORED UNCERTAIN
  • 40. Patients Family Patients Family Staff Dr. Kassam Staff Dr. Kassam Clinic Staff Meetings Clinic Staff Locator Needs met Needs met • Forum for discussion • Finding each other and reflecting and Dr. Kassam • Team-building • Reduction in tasks
  • 41. Patients Family Patients Family Staff Dr. Kassam Staff Dr. Kassam PCP Direct Link Wait-time Indicator Needs met Needs met • Support his staff • Desire to see everyone • Time for himself • Time for himself • Better communication
  • 42. Patients Family Patients Family Staff Dr. Kassam Staff Dr. Kassam Gift from the Clinic Wall of Hope Needs met Needs met • Comfort • Reassurance • Feeling of good will • Information from staff • Distraction
  • 43. Welcome Booklet Embodying Dr. Kassam and the clinic Comfort Confidence Warmth Humor Bringing Dr. Kassam to the waiting room Increasing staff service delivery role
  • 44. Layout of the Book front cover back cover page 1 page 2 If you want to learn more about me or the clinic, visit the clinic’s website. It has a lot of good information and videos. neurosurgery.pitt.edu/minc I know you don’t want to be here. I know you don’t want to know me. But the best thing that could happen is to know me. I’ve performed more than 3,000 neurosurgical procedures. More than 800 are what’s called minimally invasive endoscopic procedures. And I’m a person first. I’ll be direct and treat you like a friend. Occasionally, I may even make you laugh. page 3 page 4 page 5 page 6 It’s minimally invasive brain surgery I work with a great team, and could My staff and I see a lot of patients, through the nose. This requires no not do my job without them. They can and provide attention and care to incisions and patients can often be answer a lot of your questions. Trust all. We know this sometimes leads to discharged within two days. them as you trust me. We’re here for backups. But I hope you’ll understand you the whole way through. and trust I’ll see you as soon as I can. Under my direction, the center has pioneered and developed much om rse Ro o m r Nu of the technology and instrumentation used during these surgeries. it ing Ro it vis m to vis rst isit isit ait xa en With continued research and experience, I now use this surgery for are /fi isit vis it pv pv eW eE sid ut on yc sis n th th Re most tumors affecting the skull base. cti ar no pv er y op w-u w-u k-i in in ta e k-o ete m iag -o urg st- llo llo he c ait ait ee e m hec D Pri D Pre S Po Fo Fo C W W M Se C 2 days - 2 weeks 2 days - 4 weeks 1 month - 1 year 6 months - 1 year
  • 45. When they meet him in the exam room, they see that he is indeed personable, and funny, too, just like in the booklet. Annette is a new patient. After she and her husband check in, a front-desk staff member gives them a welcome booklet, indicating it’s a message from Dr. Kassam. In the waiting room, they read Dr. Kassam’s welcome. They like that he seems personable and experienced, and are glad to find out a bit about him. Welcome Booklet The Welcome Booklet gives new patients an overview of Needs met Patients Family the overall patient journey, one clinic visit, the staff and • Information Dr. Kassam in Kassam’s own words. • Interaction with Kassam Since a staff member hands the booklet directly to the Staff Dr. Kassam new patient, it also serves as a new line of interaction between the staff and patient where there was none before.
  • 46. Clinic Chat A Vision for the UPMC Neurosurgery Clinic Creating a system of interaction, information, distraction, and support Extending the comfort of Dr. Kassam and the clinic
  • 47. Waiting Room Patient Waiting Room Patient Messages from patients, staff and Dr. Kassam appear on a large Clinic Chat display in the waiting room. Common phrases from the Clinic Chat appear in a tag cloud on adjacent display to give viewers a general idea of what’s been discussed. Clinic Chat Patients, Dr. Kassam, and staff contribute to an organically Needs met Patients Family formed system that provides information, distraction, and • Front-stage/back-stage a connection with Dr. Kassam and his staff during periods interaction when they cannot be physically present with the patient. • Information Staff Dr. Kassam • Distraction • Support
  • 48. Staff have access via hall displays. Patients can send messages to Clinic Chat from their phone, personal computer or kiosk in the waiting room, exam room or at home. Dr. Kassam can reply from the office computer.
  • 49. Part of a Larger Information System Includes information about: Dr. Kassam Surgery and Side Effects Clinic Staff Prescriptions
  • 50. Could something like Clinic Chat work elsewhere? We think so.
  • 51. Designing the Experience Together Patients, staff, and Dr. Kassam contribute to designing the experience Wait time is an opportunity to interact with other patients, staff, and Dr. Kassam The service extends the comfort of Dr. Kassam and his clinic and provides information, distraction, and an experience that is created together with the patients, which increases patient control