CASE STUDY Four Applications of Patient Avatars in System ... › - › media › Advisory-com › ... · The team used the avatars to anchor system changes on actual patient journeys.

Article by Global Forum for Health Care Innovators

Published - March 27, 2020 • 15-min read

CASE STUDY

Four Applications of Patient Avatars

in System Redesign

How one Welsh health board used avatars to drive system reconfiguration

pg. 2© 2020 Advisory Board • All rights reserved

CASE STUDY

Table of contents

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . pg. 04

Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . pg. 05

Application 1: Understand the population holistically. . . . . . . pg. 06

Application 2: Depoliticise system redesign. . . . . . . . . . . . . . pg. 08

Application 3: Test the new system layouts . . . . . . . . . . . . . . pg. 09

Application 4: Communicate system changes to the public. . pg. 10

Results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . pg. 12

Related. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . pg. 13

Four Applications of Patient Avatars in System Redesign


CASE STUDY

Overview


The challenge

Around the world, health systems are reconfiguring themselves to deliver integrated

care and manage population health. Too often, they do so without a firm

understanding of who their patients are or what they need, and without telling

stakeholders why they are changing or rearranging services. Systems frequently

end up with final configurations built around the provider instead of the patient. This

leads to pushback from stakeholders who feel their needs aren’t being addressed.

The organisation

Hywel Dda University Health Board is an integrated health and social care system

serving 384,000 people in midwest Wales. Hywel Dda funds and manages acute,

primary, community, mental health, and dental care, as well as services for people

with disabilities across its provider sites. In 2017, Hywel Dda began a decade-long

reconfiguration process to transform from a ‘health system’ into a ‘wellness system.’

The approach

Hywel Dda’s transformation team created a profile for the Jones family, a seven-

person set of avatars that mirror their population’s most prevalent health and social

care needs. The Jones family served as Hywel Dda’s 'change anchor,' helping the

team to understand their patients, craft new system designs, test them, and

communicate changes to the public.

The results

After failing twice to reconfigure services in the early 2000s due to stakeholder

pushback, Hywel Dda is now implementing the changes that came from their

redesign process. The transformation team credits their success to the Jones

family. Not only has the family helped create a patient-centred system and foster

stakeholder buy-in, but it also has gained international notoriety as systems in

England, Canada, and Norway are replicating Hywel Dda's avatars.

Source: “Hywel Dda – Our Big NHS Change,” Hywel Dda University Health Board, 19 April 2018, wales.nhs.uk/sitesplus/doc uments/862/bc-

mainconsultationdocum entvers ion1.pdf; Hywel Dda University Health Board; Global Forum for Health Care Innovators interviews and analysis..


CASE STUDY

Approach

Source: Hywel Dda University Health Board; Global Forum

for Health Care Innovators interviews and analysis.


How Hywel Dda used patient avatars to

drive system reconfiguration

In 2017, Hywel Dda sought to reconfigure their health system using a multi-

staged transformation process. There were many tactics in Hywel Dda’s

transformation, but this document focuses specifically on the four applications of

their patient avatar family. System leaders credit the avatar family as the main

ingredient in their success.

The four applications

During two years of transformation planning, Hywel Dda found that their patient

avatars could solve four problems identified during their reconfiguration process:

01 Understand the population holistically

02 Depoliticise system redesign

03 Test new system layouts

04 Communicate system changes to the public


CASE STUDYCASE STUDY


Understand the population holistically01

The transformation team gathered and analysed clinical and behavioural needs

data from the 2011 Welsh Census, Hywel Dda’s 2016 Health Needs

Assessment, the 2017 West Wales Population Assessment, and surveys from

the Public Health Wales Observatory before creating each member of the Jones

family. This process identified the region’s most prevalent population health

needs and revealed in-depth details about potential patients. With this

information, Hywel Dda crafted a set of seven avatars to represent the

population and their unique needs, each one being an archetypal patient that

could walk into a Hywel Dda facility at any time.


mainconsultationdocum entvers ion1.pdf; “Understanding the Needs of Our Local Population,” Hywel Dda University Health Board, 19 April 2018, http://www.wales.nhs.uk/sitesplus/docum ents/862/BC-T D3- UnderstandingNeeds- Vers ion1.pdf; Hywel Dda University Health Board;

Global Forum for Health Care Innovators interviews and analysis.

Meet the Jones family1

1. The family originally contained just six members. The transformation team later added

Gareth to represent a healthy person in the system whose social factors may lead to poor outcomes later on in life.

http://www.wales.nhs.uk/sitesplus/documents/862/BC-TD3-UnderstandingNeeds-Version1.pdf


CASE STUDY


Source: “Hywel Dda – Our Big NHS Change,” Hywel Dda University Health Board, 19 April 2018,

wales.nhs.uk/sitesplus/docum ents/862/bc-m ainconsultationdocum entv ersion1. pdf; Hywel Dda University Health Board, Wales, UK; Hywel Dda University Health Board; Global Forum for Health Care Innovators interviews and analysis.

Each member of our Hywel Dda family is a potential user of

our care and support system. All of our stakeholders were

able to identify with at least one member.”

Dr Meinir Jones, Clinical Director of TransformationHywel Dda University Health Board

Each Jones family member received a personal backstory that brought them to

life. Incorporating personal details into the avatars allowed stakeholders to relate

to them as human beings with social needs, not just as patients.

In the example below, Rhys‘s medical history is coupled with a social and

behavioural background that allowed Hywel Dda's stakeholders to better

understand him holistically.

Rhys Thomas (son-in-law to Alun and Mari Jones) is 52 years

old. He lives in Tumble, Wales with his wife Sioned, their

daughter Lianne, and her son Ben. Rhys is a long-distance lorry

driver and is away from home a couple of nights a week. He is

originally from Cardiff and is a staunch supporter of Cardiff City

Football Club. He likes to watch their matches on Sky Sports,

ideally with a couple of pints in the pub with his mates. Rhys is

a heavy smoker and very overweight (BMI1 36). Sioned is trying

to improve his diet at home, but he often resorts to fast food

when he is on the road. Rhys doesn’t really do any exercise,

and he says this is because his knee is painful. He rarely visits

his GP but did go recently about his bad knee.

Rhys’s story, from Hywel Dda’s

consultation document

1. Body mass index.




Depoliticise system redesign02Hywel Dda’s transformation team led several design workshops during which

stakeholders—local politicians, patients, staff from Hywel Dda facilities, social

service providers, and more—pitched ideas for the newly reconfigured system.

In the first workshop, conversations quickly became a territorial back-and-forth

about winning and losing services. The transformation team needed a way to

refocus everyone on why they were reconfiguring in the first place—to improve

care for patients.

The team used the avatars to anchor system changes on actual patient journeys.

Once they introduced the Jones family, there was a tangible shift in the system

design workshops. Stakeholders—who previously argued over which hospitals

might gain or lose certain services—now focused on pressure testing each

system layout option with the family top-of-mind. "Is this system good enough

for the Jones family?" became their mantra.

Source: Hywel Dda University Health Board; Global Forum

for Health Care Innovators interviews and analysis.

We found that people got very fixated on whose hospitals

would change. For the next workshop, we approached

system design through the lens of the family. It tapped

into people’s own families, they could say ‘Oh that’s like my

mum, my grandma.’ It focused us on patients’ needs rather

than where services move.”

Libby Ryan-Davies, Strategic Programme DirectorHywel Dda University Health Board




Test new system layouts03Through an iterative process of design workshops and staff feedback sessions,

stakeholders and the transformation team created 25 designs for what the system

could look like in the future. When workshop participants—the transformation team

and stakeholders—narrowed their list to three layouts, they needed to test how

each potential layout would actually affect patients’ care journeys.

The workshop participants used the Jones family to add a level of critique to these

final three layout options. Using each family member's back story, they crafted a

realistic medical scenario for the avatars and charted their care journeys through

each of the three proposed options.

In the example below, the workshop participants charted Alun’s journey through the

current system as well as the three proposed systems after he has a coughing fit.


mainconsultationdocum entvers ion1.pdf; Hywel Dda University Health Board; Global Forum for Health Care Innovators interviews and analysis.

Alun Jones is 80 years old. He lives in an old, two-storey house in Newcastle Emlyn

with his wife, Mari. Alun is a retired electrician and is still quite a handyman,

although it’s not so easy now that his sight is failing due to a cataract. Aside from

his wife, Alun’s passion is rugby and he follows the Carmarthen Quins. He loves to

watch the home games and is able to drive to the match. Alun enjoys his daily walk

to the local shop to get the newspaper and always does the crossword. He smokes

a pipe, although Mari wishes he didn’t. Alun is a non-insulin dependent diabetic and

takes medication to control it. He has a history of heart disease and had a heart

attack when he was 70 years old. Alun and Mari visit their daughter Sioned in

Tumble regularly, sometimes overnight so they can spend time with their

granddaughter and great-grandson.

Alun’s story, from Hywel Dda’s consultation document


CASE STUDY

Source: “Hywel Dda – Our Big NHS Change,” Hywel Dda University Health Board, 19 April 2018,

wales.nhs.uk/sitesplus/docum ents/862/bc-m ainconsultationdocum entv ersion1. pdf; Hywel Dda University Health Board, Wales, UK.


This is just one example of Hywel Dda’s scenario-planning process. The

workshop participants repeated this process for every family member.

1. The ‘Now’ option.

2. Note that future options 2 and 3 have the same pathways for this specific case. This is not representative of all seven family members' scenario mappings.

Future options 2 and 3

• Alun, who has

been coughing for several days, feels

increasingly unwell over the Easter

break.

• He calls 111 and a paramedic arrives.

The paramedicdiscusses the case

with the GP after-hours service

on the telephone.

• They agree that Alun needs to be

admitted to the hospital with

suspectedpneumonia.

Now

Future option 1

• Admission: Ambulance takes Alun to

Prince Philip Hospital Medical Admissions Unit.

• Treatment: His diagnosis is confirmed.

He remains in the hospital for several days to receive IV antibiotics and

oxygen therapy.

• Admission: Ambulance takes Alun to

the new urgent care hospital, where he is admitted.

• Treatment: After a 72-hour period, he

is discharged to a ‘step-down’ bed in the community hospital near his home

to continue his treatment and see more visitors.

• Admission: Family takes Alun to

Prince Philip Local Hospital, where he is admitted.

• Treatment: After a 72-hour period, he

is discharged to a short-stay bed near his home to continue his treatment and

see more visitors.

The team charted Alun’s care through the current system1 and the three future

layout options.2 In the current system, an ambulance takes him in, and he stays in

the hospital for several days before being discharged. In the new options, he is

taken either to a new urgent care hospital or to a current hospital that will be

repurposed as a community hub. In either case, he stays for only a short time before

being discharged to a community bed closer to home to recover with his family. In

the new models a full care team sees him—as opposed to just a specialist.

Alun’s care journey



Teulu Jones/The Jones Family

We have a family—Teulu [Welsh for “family”] Jones—who are helping test and show how our

different proposals could affect someone like you. They aren’t a real family, but they have been

designed to be typical of the patients we care for in the Hywel Dda area. We will never capture

all the different types of people we care for—that is why the consultation is seeking everybody’s

views—but they do help us to think about our proposals and what they could mean through the

eyes of our patients and communities. You will read in this document what changes to health and

care members of Teulu Jones would see in our proposals, and we hope these help you think

about what these changes could feel like for you.


Communicate system changes to the public04

As Hywel Dda narrowed in on a few system layout options,

they began seeking feedback from the public. The

transformation team marketed this large-scale

reconfiguration through the lens of the Jones family. The

team presented their three final layout options to the public

in an 88-page consultation document. The document

described the system’s case for change and current

challenges, and explained how the Jones family would be

cared for differently under each proposal. This allowed

people in the community to not only see the new layouts,

but also understand what care pathways could look like in

the future for their own health needs.


mainconsultationdocum entvers ion1.pdf; Hywel Dda University Health Board; Global Forum for Health Care Innovators interviews and analysis.

60,000Number of people who responded to the consultation through surveys, community information sessions, and petitions

From the consultation document

http://www.wales.nhs.uk/sitesplus/documents/862/BC-MainConsultationDocumentVersion1.pdf


CASE STUDY


mainconsultationdocum entvers ion1.pdf; Hywel Dda University Health Board, Wales, UK; “Our big NHS change Animation with Subtitles,” YouTube, 19 April 2018, https://www.youtube.com/watch?time_continue=312&v=NF w7lHmB Xks&feature=em b_logo; Hywel Dda University

Health Board; Global Forum for Health Care Innovators interviews and analysis.


The transformation team also created videos featuring the Jones family

members either narrating the changes (pictured below) or experiencing different

medical scenarios. These videos were distributed through social media and

played on lobby monitors in their clinical sites and local colleges. The videos

helped the community to engage with the family, even if people could not read

the whole consultation document.

https://www.youtube.com/watch?v=NFw7lHmBXks&feature=emb_logo

https://www.youtube.com/watch?v=dhaKLH0VCr8&feature=emb_logo


CASE STUDY

Results

CASE STUDY

The avatars anchored the system reconfiguration to patient needs at the

beginning of this process in 2017, and will continue to do so for the entire 10-

year transformation journey. There are already signs that the reconfiguration is a

success.

• Community engagement enabled by the family: Over 60,000 community

members and staff engaged with Hywel Dda during the public consultation

period through surveys, community information sessions, social media,

and petitions.

• Specific care pathway redesign: Clinicians and system planners are now

orienting the system’s trauma and stroke service redesign work around the

Jones family.

• International notoriety: Soon after Hywel Dda created the Jones Family,

BBC profiled the avatars in a short video. Systems in England, Canada, and

Norway are picking up Hywel Dda’s applications of patient avatars to prevent

stakeholder pushback during upcoming discussions on system

reconfiguration. Some health system leaders have planned future conference

calls and visits with Hywel Dda to learn more about their process.

While Hywel Dda’s new reconfiguration has not yet been fully implemented, the

transformation team credits their ability to focus their system design on patients

to the Jones family.


How we know it’s working


mainconsultationdocum entvers ion1.pdf; Hywel Dda University Health Board, Wales, UK; “Hywel Dda uses fictional family in healthcare scenarios,” BBC News, 31 January 2018; Hywel Dda University Health Board; Global Forum for Health Care Innovators interviews and analysis.1. People ages 16 and older, 319,145 out of 384,000 total citizens.

https://www.bbc.com/news/av/uk-wales-42881815/hywel-dda-uses-fictional-family-in-healthcare-scenarios


CASE STUDY

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CASE STUDY

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CASE STUDY Four Applications of Patient Avatars in System ... › - › media › Advisory-com › ... · The team used the avatars to anchor system changes on actual patient journeys.

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