UC CANCER CENTER
NEUROLOGY
RADIOLOGY
Patients and their caregivers face an overwhelming amount of changes to their life when they are diagnosed with cancer. They are immediately introduced to an entirely new world–from terminology to treatment options to navigating the hospital. It is critical that the UC Cancer Center (UCCC) offers patients the best experience and the clearest means of education throughout their trajectory. Working with Live Well allowed the UCCC team to learn more about what is going well, what is less successful, what the pain points are, and how to prioritize all of this information. UCCC will be able to deliver better care by understanding what clinicians, patients, and caregivers experience. During the initial kick-off meeting, the Live Well team and UCCC team collaborated in a co-creation session to figure out who the key stakeholders are throughout the prostate cancer patient journey. The main insight from this meeting was that this journey is highly personal and dynamic. Every choice a patient has along their path opens more educational challenges.
The team benchmarked different visual styles of journey mapping, compared highly ranked institutions, educational tools, and gathered existing supportive resources from internal and external sources.
During the research presentation, the Live Well team and UC Cancer Center team did a co-creation activity involving persona development and scenario planning. A key insight from the research phase was that in order to improve a patient’s anxiety and mental state, it is necessary to provide them clearer education and awareness around treatment. It was also agreed upon that all patients prefer human guidance above all but would benefit from a variety of digital and analog tools that could adapt to individual learning styles and personalities.
Through conducting 20 interviews, the Live Well team determined that all patients prefer human guidance above all but would benefit from a variety of tools that adapt to both their learning style and personality. The team began creating educational tools to help enable and extend human support.
Different tools used during this phase included interviewing, a card sorting activity with patients, visualizing the patient journey map, and persona development.
The Live Well team decided to focus on three different methods to deliver educational resources to patients: an information hub website, educational video suite, and an interactive patient journey map.
This semester’s work is the second phase of a partnership between UC Gardner Neuroscience Institute (UCGNI) and the Live Well Collaborative seeking to optimize the patient experience at UCGNI, specifically emphasizing the journeys of stroke and brain tumor patients. During the first phase, personas were developed and patient pain points were identified along the patient journeys.
During the research phase, the Live Well team worked to interview stakeholders regarding the patient journeys, experience, and pain points. The team observed in clinic, conducted an online card sorting survey, and used the card sorting activity with patients in clinic. The team also met with MyChart analysts, IT at UC West Chester, and completed a walkthrough of Epic Bedside. Additionally, the team researched healthcare initiatives and benchmarked existing tools.
Using the human-centered design process of Live Well, the team proposed and developed prototypes of scalable support services that could provide personalized suites of human and technological resources designed to empower, encourage, educate, and assist patients throughout all phases of their experience at UCGNI. The team did several rounds of analog and digital prototyping. They then developed several tools including analog health binders, a MyChart mobile prototype, educational videos, animated videos, and further developed patient journeys and personas.
Download Ideation Presentation
Live Well's final presentation included prototypes and recommendations to improve the existing care system. This encompassed the human, analog, and digital proposals which aim to improve the overall patient journey and experience. The final deliverables included a MyChart Mobile prototype, MyChart poster prototypes, analog health binder prototypes, educational video prototypes, and our human components—nurse navigators, care coordination, and the implementation of a mentorship program.
At the initial kick-off meeting, the Live Well team ran many activities with members of the UC Gardner Neuroscience Institute (UCGNI) to develop a better understanding of the scope of the project. The first activity allowed UCGNI members to brainstorm challenges they are all facing in their respective departments or the institute as a whole. The Live Well team then grouped these challenges to find overlap. Once the challenges were grouped by Live Well, UCGNI team also developed groups and then chose a challenge to create a journey map with. The UCGNI members broke down what resources they already had as a team, outside resources that were needed, and potential roadblocks while trying to get to the goal state. In doing these activities, the Live Well team was able to not only able to begin forming personas but also start a conversation surrounding what obstacles each type of patient might encounter along their journey.
During the Kick-off activity session, the UCGNI team developed three challenges they think are being faced:
“Families are lacking knowledge of the disease process and how to best advocate for their loved ones.”
“Existence of system silos in combination with poor communication results in system failures and bad experiences.”
“Patients need clear and timely information because they are overwhelmed, confused, and scared.”
With these challenges in mind, the Live Well team started the research phase by conducting interviews, mapping of the patient journey for both brain tumor and stroke patients, benchmarking, and mapping the UCGNI ecosystem.
Activity Session
During this phase, the Live Well team worked to synthesize the information gathered through the interviews and tours to create a draft of the patient journeys for both the brain tumor and stroke patients. The goal of this activity was to figure out if the team was missing any points in the journey and to answer some questions that had been generated throughout this process. With pens and post-its, the UCGNI team went to work marking and annotating the graphic the team had created.
Next Steps
Moving into the ideation phase the Live Well team will solidify patient journeys based on feedback from activity session, develop a photo journey, develop a pain point matrix, and develop personas
Throughout this second phase, the Live Well team determined that a big opportunity area is the transition of care for patients. Using this as an “umbrella," the team took insights from the interviews and secondary research and then determined that three categories came to the forefront:
+ Coordination of Care
+ Education
+ Connection to Resources
With these categories in mind, the Live Well team began looking at the top institutes that provide top notch transition of care for their patients, both for brain tumor and stroke patients. While looking at these institutes’ programs, the team began to plot them along a spectrum ranging from completely tech-oriented to human-centered. The goal for looking at these institutes was to see what is already being done and what is the most successful.
Looking along the tech vs. human-centered spectrum, there is a fine line between pushing too far with technology to the point of alienating the patients and determining what information has the need of human interaction.
By consolidating insights and feedback over the course of the semester, the Live Well Team identified three areas of opportunities to be the focus for both stroke and brain tumor patients.
+ Access: Timely Access to Services
+ Stability: Psycho/Social Challenges
+ Clarity: Conceptual Wayfinding/Education
To address these opportunity areas, the Live Well team proposed a Supportive Services System, which is a scalable prototype support service that could provide a personalized suite of human and technological resources designed to empower, encourage, educate & assist patients throughout all phases of the experiences at UCGNI. This support system service would pull from resources all across UC Health, both existing and potentially new. Ideally, this type of service could help with all patients, not just those in UCGNI.
Journey Maps
To be able to communicate the potential of the proposed supportive service system, the Live Well team developed six personas and ran through their “journey” from before diagnosis, to inpatient, and all the way back to outpatient. This humanized patient’s journeys and brought them to life. Below is an example of a journey map the team presented, which included a bio page, the patient’s journey, and then the journey with potential interventions from the supportive services system.
This collaborative project between UC Health Radiology and Live Well Collaborative addresses the identified opportunity of providing an interactive imaging report for patients. The goal is to develop an interactive imaging report that provides simple access to scan information and reduces confusion by providing easier to understand terminology.
During the research phase, the Live Well team conducted primary research by interviewing various stakeholders, and conducting a series of surveys. These stakeholders involved included patients, radiologists, oncologists, schedulers, and other clinical staff. The team mapped out the current patient experience and identified pain points. The team had difficulty finding lung patients to interview and the lack of data resulted in a pivot in the project direction. Moving forward, the team focused solely on mammography and breast screening patients.
The Live Well team presented the initial prototypes for a redesign of MyChart, a health app currently used at UCHealth, and revised patient reports. The team identified a lack of educational resources and a lack of humanized, patient-centric language. These concepts included new interactive elements like radiology scan images, health impact visualizations, and various educational resources.
The Live Well team presented the final deliverables to the UC Health team, which included the prototype for a revised MyChart app, and revised patient report letters.
The redesigned MyChart app added an entire new section for radiology reports, which included interactive tools for patients to use in order to learn about their results and what impact these results have on their health.
The redesigned patient letters were rewritten with more humanized, sympathetic language and reorganized for strong visual hierarchy and streamlined communication.
The Livewell team worked with UC Health Radiology to identify the key pain points for radiology patients as they enter for a scan. The goal for the team was to create a video that educates patients on what they can expect when getting a CT or MRI. This process involved interactions with referring physicians, radiologists, and patients.
During the research phase, the Live Well team worked to write and revise the scripts for patient videos. The team decided the best option was to create 3 videos. The first is a general overview of the scan process, the second for specifics of a CT scan, and the last for specifics of an MRI scan. The team also worked to identify the possibilities for a patient to radiologist consultation service.
The goal of the project was to understand the optimal CT and MR outpatient experience at UC Radiology. This informed the development of services and programs that will meet those identified needs. Live Well’s design thinking process translated patients’ needs into recommendations for multiple design opportunities with a project pipeline for the UC Health team to prioritize. Live Well was also able to leverage existing resources in innovative ways by engaging with members of UC Radiology's core team.
The research phase involved a combination of primary research (stakeholder interviews and observations) and secondary research (literature review from previous semester). With the help of resources from the UC Health Radiology team, findings from the literature review provided a solid platform for the team’s initial understanding of imaging modalities.
Following the secondary research, the Live Well team moved into stakeholder interactions, where they met with 5 Physicians, 6 Technologists and roughly 20 patients (2 in-depth patient interactions). For in-depth patient interactions, the team used a tool called experience mapping. This tool utilized a general outline of all significant points along a journey and required patients to map out their experiences along that journey. When conducting the interviews, the team took notes on what patients were doing, experiencing, feeling, and thinking along their clinic journey.
For the interaction with clinicians, a pie chart was developed to have different Physicians describe their time spent on clinic vs. research/administration. After the interviews, the team synthesized all the information and identified patterns among the interviews.
The team created stakeholder personas to illustrate the various characteristics and population of patients as well as a thorough outline of a patient's journey based on the interviews. The team also identified all the positive and negative experiences stakeholders face at each step of the process. Three areas of opportunity were identified.
PATIENT ACTION PLAN
Staff members provided assistance that helps patients navigate their day at UC Health, including other appointments and procedures.
EDUCATIONAL TOOL
Provided unbiased information that educates the patient and prepares them for their clinical experience with a focus on the imaging process.
CONNECTED CARE
Provide assistance to the staff so that they can be connected and share the same level of information. This will help them deliver better patient care. Moving forward, the team decided to focus more on an Educational Tool.
Live Well hosted the Ideation meeting with UC Radiology team and GE Healthcare team on July 11, 2018. The ideation presentation started off with the LWC team describing the two different tools that were developed for the stakeholder interactions throughout this phase. In the first interaction, the team used a questionnaire to get the idea from different stakeholders of what components should be included in the patient engagement tool.
In the second interaction, the LWC team consolidated the results received from the 29 questionnaires and created an interactive exercise in which participants could build their own educational tool that also addressed connected care and a patient action plan. The insights gained from using these co-creation tools informed concept development direction. After discussing the results from the data collected, the LWC team presented the insights that they translated from the two interactions to create the 11 opportunities.
The LWC team then split UC Radiology into 3 groups and present the 11 opportunities in 3 stations: Information Sharing, Transforming Culture and Brand Identity, and Understanding Radiology. Within each station, the LWC team presented different concepts with potential solutions supported by insights drew from both Research and Ideation phase. Following this, the 3 UC Radiology groups prioritized the 11 opportunities on a timeline of immediate need to distant need.
The ideation meeting ended with groups sharing their thoughts on prioritizing these opportunities. During the refinement phase, the LWC team will follow the opportunity ranking result and translate insights and feedback from the stakeholder co-creation interactions to detail top ranked solutions and a process book documenting all previous research.
Live Well hosted the refinement presentation with UC Radiology and GE Healthcare on August 15th, 2018. The refinement presentation started off with the LWC team presenting the project pipeline and the ideal patient journey which was embedded with the 10 opportunities identified from Ideation phase. The refined concepts were based off of the qualitative and quantitative research during all three phases. The LWC team then led an in-depth discussion with both UC Radiology team and GE Healthcare team on the metrics, project implementation plan and future steps for all 10 opportunities, with a focus on the top three chosen from last phase: Redefining the Experience, Humanizing the Process and Process Tracker.
During the refinement process, the LWC team gained insights from interactions with 16 different stakeholders who have been involved in this project from the beginning that enabled the team to improve the feasibility and reasonability of the opportunities, as well as establish a more developed patient journey out of the 10 opportunities. In order to validate the opportunities and put together the project pipeline, the LWC team also utilized the trend forecasting method which suggested 6 major trends around imaging. In addition, considerations and criteria for a successful project at UC Radiology were developed in order to ensure the increase of patient satisfaction. Last but not least, the LWC team also proposed 10 research topics for UC Radiology team for future publications.
As a follow-up after the Refinement presentation, LWC team has a weekly meeting with GE Healthcare to discuss the next steps and schedule a meeting at GE in Milwaukee to present the work and outcomes. Meanwhile, LWC is also working with the Radiology team on presenting the work to a larger audience at UC Health.
This project is a continuation of the previous semester’s work.
Beginning on Friday, January 10th, the Live Well team has been conducting onsite interviews with patients at the Bone Marrow Transplant Center with the intention of gathering more information straight from the source. Our team is taking the culmination of last semester’s research and running with it, pursuing the short term option laid out in the final design presentation, a website. We believe that a website is the most logical solution, given the very wide demographic of Dr. Anaissie’s patients. We aim to create a user-friendly website that is accessible by both patients and doctors, that improves communication between the two parties and also cuts down on the time the patient has to spend at the hospital.
In the few interviews our team has already conducted, we have already begun to identify certain trends. First off, we have noticed that it isn’t the patient but the caregiver that is most interested in the idea of a website. A resource where they can access all their records, keep track of symptoms, medications, and appointments, etc would be extremely useful for them, since they are the ones coordinating all of this in the first place. Second, we’ve noticed that each patient has different struggles and has different needs that must be monitored. With this in mind, we have agreed that there should be some sort of customizable aspect of each patient’s profile to keep the experience as clean and easy to follow as possible. Patients would work with the hospital to customize a website and profile that specifically caters to each individual, thus creating a uniquely efficient experience for all.
The Live Well team compiled research that they had done for both the infusion space and the website and decided that the most effective way to get responses from patients and staff was to create an experience where they could walk around and be open with their thoughts. In order to execute this, the team categorized information and pinned up several boards of images that represented different directions worth pursuing. The team then opened the conference room at the clinic up to everybody and equipped each person with a pen and a stack of Post-its to leave feedback as they saw fit.
The responses were overwhelming. The responses were very intriguing and provided useful perspectives that designers can sometimes overlook. Afterwards, the Live Well team compiled all of the information from the Post-its and used it to determine next steps in the process. The team decided to explore options that received positive responses and continue communication with the clinic's most valued stakeholders.
On Friday May 2nd, our team presented our final concepts to the UC Health executives at the George L. Strike Bone Marrow Transplant Center. This presentation was the culmination of all of our work throughout this semester and thoroughly detailed our solutions for the problems that we had identified in our previous research. We began by presenting our solutions for the environment redesign project; with finalized floorplans and renders, we were able to give the attendees a very solid idea of what the renovated space would look like, in order to make it easier for them to move forward in making it a reality. We put a fly through animation in the presentation which received very good reactions.
Overall, we accomplished our goal of bringing the space to life, a space that has the potential to provide an unmatched experience at the BMT Clinic, should they choose to move forward with it. After discussing the environment redesign, Dianne got a chance to present her findings from her research of admission/discharge processes at the hospital. Although she had limited time to pitch her idea, the executives were intrigued by her concept and wanted to schedule another meeting to discuss this portion of the project further.
All in all, this presentation and this semester’s project as a whole can be considered a success. We were able to maneuver around all the changes that the BMT Clinic made during the course of the project and we persevered through many setbacks from the administration. Through it all, our team was able to produce a high quality output and to effectively communicate the fruits of our research.
On August 28 the Live Well team visited the Bone Marrow Transplant Center for the first time. The meeting included key members of both teams and was a great introduction to the project for both teams. The Bone Marrow Transplant staff was able to set expectations for the project and explain the importance of the project.
For the first two and a half weeks of the project the Live Well team conducted interviews with both staff and patients of the Bone Marrow Transplant Center. The team also observed the staff’s workflow and processes within the clinic by shadowing them.
Next, the team mapped out a timeline of the process a patient must go through in order to make an appointment to the end of their first appointment at the clinic. Post-it notes were used to delineate different parts of the process including staff member contact, physical space changes and details about the process patients will encounter.
Insights from interviews and observations were then organized into categories, both current and ideal. The categories were emotions, benefits, behaviors, and features. Creating the map allowed the Live Well team to brainstorm many solutions about what an ideal situation would be.
During the ideation phase concept ideas were broken into three categories: short-term, mid-term, and long-term. This was done in order to better organize ideas as well as to show the opportunities across the board for the clinic space, process, communication and amenities.
During the formal concept presentation, the Live Well team split up concept ideas into short-term and long-term solutions. These solutions ranged from simple fixes, such as comment card boxes and patient surveys, to physical space changes that will affect the clinic in the long term. The team then synthesized feedback and used it to inform the final solution.
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The Live Well team also presented several different time studies on the processes within the clinic and how these processes are affected by the pharmacy and lab times depending on which labs and which medication is ordered. These studies showed how the wait times in the clinic vary. Some of the initial results from the comment cards and the survey implemented within the clinic were presented as short term solutions. The surveys and comments were helpful in giving positive feedback as well as suggestions for improvement directly from the patients themselves.
