Why we need to rethink our healthcare system — Service Design Approaches for Inclusive Care.
Efficient service design in the healthcare sector requires a clear understanding of its complexities. At the top of these complexities is a deep-rooted cultural landscape in clinical environments. The role of a service designer is to understand and design with as many stakeholders within this sector means understanding that your position is not changing the environmental complexities. Instead, it is to find ways of navigating and mitigating those complexities to provide more simplified, inclusive, and sustainable care.
Recently, I was involved in working on a complex healthcare project that impacted a national level. Several skills were needed to deal with all the complexities of designing for healthcare. Compared to traditional design roles such as User Experience (UX) and interaction design that focus less on complex issues and more on providing solutions that mitigate day-to-day problems. In healthcare, this could be fostering self-care in patients or advising them about preventative measures.
Common service design levels
Service design deals with more complex problems, multiple stakeholders, and an understanding of the value delivered. This requires an understanding of the user experience, business impact and any supporting functions that are not visible in the frontline experience/ interactions, which is achieved through high-quality research. An example of this is a direct medical exam. This design level focuses on better patient experiences, diagnoses, and treatment pathways.
Organisational transformation design is primarily targeted at the organisation. Service design is typically needed in larger, more progressive medical facilities that are constantly reflecting on ways to thrive. Although, MedTech and health start-ups can benefit from the holistic thinking needed when designing solutions that drive impact. At this level, a service designer works with the organisation and health care teams to improve care planning. This could include technological acquisitions, changes to organisational practices, innovative research, and maintaining high-quality standards of care.
Community interaction is a major component of organisational transformation, more so in healthcare. A social transformation design can improve the level of care and even contribute to policy development. This means working with several stakeholders, facilitating change, designing multiple team skills, and doing research on the organisation and its surrounding community.
Going beyond the patient experience
At the core of healthcare, service design is the integration of services for physicians and patients alike. This requires the implementation of varying types of service design. It begins with a patient-centred experience and ripples into the experience of the doctors, nurses, administrators and, in some cases the insurers.
Human-centred design goes beyond the different touchpoints of care therapies and clinical encounters. This approach calls for service design that is directed towards care. Designing for health and designing service systems are equally important. The latter refers to the integration of technologies, work systems, and organisational practices as a service system.
In service design for healthcare, we must take a layered view of care. This starts with adopting a more humanistic view of patients, like seeing each patient as a person who is not defined by their health condition. People interact with services as health seekers. This means we need a well-rounded view of a person’s experience before, during, and after receiving care within the clinical environment.
Healthcare professionals rarely focus on the other aspects of the patients’ lives unless clinically justified. But if we consider how people are experiencing their own lives as a process of health-seeking and maintaining health, we can get a richer view of their journey and provide services across that spectrum.
When implementing change in healthcare, we must understand the cultural design of health institutions and what that means for our societies. Hospitals often have very deep-rooted cultural practices that can make it difficult to adapt to changes. And so, designing with this in mind could ease the transition process.
Designing for the patient experience should not be the only approach hospitals have; it should be part of an integrated view. We need to access patients when they’re in other parts of their lives to understand how they’re finding our messages, what fears they have as they contemplate treatment options, and how medical care will impact their lives. Designing for people to this scale allows us to design for care experiences that go beyond the current delivery.
Prioritising continuity of care
We must cater service design to a person’s understanding of their diagnosis, medical care, their self-care, as well as the communication between different clinicians and specialists. These are all crucial components of primary care. After primary care, people often self-reflect. Physicians usually have no access to this time, which is a highly leveraged point for continuity of service.
Invasive therapies or surgeries come with a lot of aftercare and observation. This is also a point where people receive the value of healthcare. The value received is more than just medical treatment. This provides an opportunity for a different aspect of service for which we need to aim.
Doctor-patient communication is not easy, especially outside the hospital environment. After leaving the hospital, people rely on highly unreliable self-diagnosis and online self-education. People who have more serious health issues often have to work around the system that they’re led through to get the best care.
The episodic care of scheduled visits can be very disjointed, and the connections for information, education, and supplementary treatment can often be missed. So, continuity is a major design issue and one that’s complex enough for designers to get involved.
Continual care encompasses a network of different handoff points, the patient’s perspective, patient needs, and physician needs. A patient might understand their continuity of care in an integrated way when they see a holistic presentation of their care team and their visits. This could be provided with a simple, visually appealing app.
Care as a clinical service
Service design in healthcare is primarily based on the care pathways designed to help institutions map out treatment delivery, facilitate efficient throughput, and identify the right roles and supporting teams. Care plans are developed by interprofessional teams and can be improved by designers to identify the right therapies, follow-up visits, and treatments within the clinic and aftercare.
There are also care bundles, which are ways of organising sequential, iterative, or complex care. Sequential care is typically how clinics are organised to move patients from emergency to a particular unit and then through aftercare. This calls for a look at iterative models of care in service design.
Each medical incident has a different feedback cycle. We must look at the different points of care within hospitals and the everyday lives of clinicians providing the services we’re trying to improve. Physicians often have intense days filled with multiple consultations or medical procedures. Layered onto that clinical and technical work are multiple IT resources and interfaces, as well as cognitive tasks. Clinicians often work based on the flow from electronic health records, identifying the patient and their schedule, to researching their case where needed.
Interacting with multiple systems that have different information interfaces provides a fragmented information experience. Yet, physicians are expected to always perform immaculately. This area isn’t just user experience design or information design. All those systems have different vendors, and we need to integrate those experiences into the institution.
Viewing healthcare facilities as cultural institutions allow us to focus on the demand aspect of primary care. It also means we can create a patient-centred system that provides clear pathways for the integration of services.
