Experience Design A Framework for Patient Care presented by Art Frohwerk Clearpath, LLC in collaboration w/ Quantum at Meeting of the Minds Toronto June.

Experience DesignA Framework for Patient Care

presented by Art FrohwerkClearpath, LLCin collaboration w/ Quantum

at Meeting of the MindsTorontoJune 23, 2010

Useful Tools & Systems

Transformational StrategiesCreating Meaningful Stories

Relevant Processes

Comfortable Places

Engaging People

It’s About Connections!

Appropriate Measures

Challenging Vision

Context …a whole system approach

The Environment of Trends & Opportunities

Roadmap to sequence Implementation

Experience Design Principles

Strategy Management SystemStrategic Purpose & Commitment•Vision, Mission, Values•Strategic Imperatives

Culture Design based on Values

Influencing People Governance & Policies

Experience Design

Framework

Big Picture Framework

StoryboardFundamentals

Master Process

Master Process to orchestrate “The Organization’s Way” to best do business

Desired Outcomes

Core Process

Master Process to orchestrate “The Organization’s Way” to best do business

Info. & Support Processes

Inputs

Opportunitie

s

Opportunitie

s

RolesRoles

“Moments of Truth”

Support Systems

Measures

Measures

Community-scale Master Process

- Gather information - Analyze results - Conduct tests - Generate reports - Bill- Gather information - Analyze results - Conduct tests - Generate reports - Bill

CollectRequirements

Set-up &Conduct Test

DeliverReports

Evaluate & Dictate Report

CollectRequirements


DeliverReports


OB PATIENT

LABORATORY

PHYSICALTHERAPY

Admit Prep TreatmentEvaluate Recover Evaluate Follow-upCheckout

COMMUNITY &INFORMATION

MEDIA

AMBULATORY PATIENT HOME HEALTH

PHARMACY

Interpret Validate Prep/Dispense Check & InformOCCUPATIONALHEALTH

LONG TERM CARE FACILITY

Information,Education,

Interpretation

Treatment PatientHistory & Medical

Records

BehaviorModification

Compliance Monitor

PRODUCT SUPPLIERS

EMPLOYERS

ALLIED PROVIDERS

AdministrationHuman

ResourcesQuality

ResourcesNursingMaterials

ManagementPlant ServicesMedical StaffExecutive

Leadership

Management Reporting Finance

& AccountingInformation

ManagementOutpatient Clinic

Area Services

GENERAL EDUCATION

Deliver

DIETARY SERVICESER

RADIOLOGY

Put Patient in room - take Vitals, History, Physical Assess.

Make roundsDocument Patient information & Assemble chartConduct selected Patient educationPrep, Dispense/Mix meds., & Monitor Patient needsSupport Physician procedures, effortsCoordinate communications & Access info./materials

Refer to Critical CareSupport Outpatient testing

Support Health programsSupervision of StaffOngoing Staff education

SchedulingManage Database - Cancer RegistryCollect data & reconcile data for BillingCheck charges & delete if Hospital duplicatedLook-up information

Maintain a System plan & maintain & repair/upgradeMaintain the System & on-going improvementsStandardize & purchase all PC’s, most software, etc.

Receive requests & identify needsAssign staff & scheduleDevelop & coordinate plans & put into databaseDo process design as necessaryCommunicate with users & managementDo projects, install, test & documentSurvey Departments after work done

Conduct on-going Staff education

Supervision of Staff:- Maintenance, Security

Facility Management ( 4 properties):- Write Policies - Safety, Security, Plant Operations- Monitor HVAC, Test Fire systems- Manage Phone system (#’s, line expansion), Cable TV- Maintain generator/emergency power, logs- Materials (finishes, etc.)- Hazardous Waste- Track Vendor service reports, Track Construction documents

(rehab, new buildings)- Generate Reports, Track incident variance reports- Preventative Maintenance program (equipment, Systems)- Attend numerous meetings

Material Distribution:- Create “Pick-list”- Fill Order- Remove from Inventory Control

Receiving:- Buy standard commodities- Receive & Inspect- Print & Apply Stickers (Patient billable only)

Forms (>1000 different) & Matl. Mgmt. Standards:Request-Design-Review-Define use,#,etc.-Approve-Print-Distrib.

Quality Assurance facilitator:- Assess- Plan- Implement- Evaluate

Staff & Community Education (annual & routine):- Identify Needs- Identify Solutions- Make Available- Deliver- Measure success

Corporate Compliance & Quality Reports

Evaluate Patient indicationsIdentify & Order testsAccess information Develop diagnosisFormulate treatmentDocument patient data

Conduct selected Patient education

Conduct procedures

Ongoing medical & quality systems education

Provide Administrative support to CEO functionOverview Operational PerformanceAnalyze & Interpret DataRecommend ActionsInteract with Industry & Allied groups, organizationsWork with Physicians & Departments to resolve

questions, issuesAssure response to Patient complaintsOversee capital projects

- e.g. new building, dining area, ER waiting areaConduct/Participate in meetings - e.g. Budget, Board,

Medical Staff, Patient Services, Dept. heads, etc.Oversee Community Relations & Educational activities

Recruit new employeesInterviewHireOrient

Assure Compliance Review timesheets for payrollLiaison for Employees to Administration & InsuranceAnswer questions of Employees

EnrollmentBadgesBenefits ( vacation, sickness, insurance, etc.)Interpersonal issues

Catalyze Strategy Stimulate movement to meet challenges of MissionProvide for Education, Growth, & ContinuityFacilitate setting Standards for performance & outcomesBe the senior communicator to:

CommunityBoardMedical StaffEmployers

Provide senior oversight to Payor, clinical, & businessprocesses through championing of Teams

Develop & maintain the plan for key measuresDevelop reportsProduce reportsDistribute when & as needed

Data Processing & Patient Accounting(see above)

Accounting:Pay BillsMaintain Capital Assets log

(Health & Wellness to Employers & Employees)- Schedule Patients & be chain-of-custody to

Drug screens- Collect Patient data, dictate/document - Track-down chart, deficiencies,

& FAX needs list- Deliver Results & Reenter Patient Regist.- Billing info. to system for Employer, TPA,

Managed Care, Patient

Get Order

Initiate &Schedule

GatherData

CheckoutEvaluation& Diagnosis

FormulateTreatment

PatientArrival

ProviderFollow-up

PatientCompliance

Correspondence / ROIAssemble Transcription CodingAnalysis Deficiency Analysis Chart Completion

Audit / Second Bill Bill Patient Close AccountInitiate CollectionsGather Billing Data Enter Data Inquiry of EligibilitySubmit Bill Remittance PostEdit BillGenerate Bill / EditPATIENT ACCOUNTING

MEDICAL RECORDS

Medical StaffCoordination

Liaison between Medical Staff & HospitalMaintain Physician information & credentialing dataInform Departments of new PhysiciansRemind Physicians - insurance, reappointment, etc.Track procedures per PhysicianCoordinate reappointment of Physicians every 2 yrs.Maintain minutes of Medical Staff meeting

Conduct literature searches

Manage Library

Operate internal Newsletter

HospitalInformationClinic NameLocation AddressLocation Phone #Service/SpecialtiesMissionCapacityAmenitiesPhysicians’ NamesFeesQualifications/TrainingInsurance Participation

PatientDemographics

NameAddressSexAge, DOBPhones - Home, WorkResponsible Party

Parent, Guardian“Next of Kin”, Emergency

ContactEmployer, OccupationDays/Week of WorkMarital StatusSocial History

PatientMedical History

Previous Medications/Drug History

Previous Medical ProblemsPrevious Treatments/TestsPrevious Physicians/

AdmissionsPrevious SurgeriesFamily History InformationAllergiesCurrent Meds, Former MedsClinical InformationOther

InsuranceInformationInsurer NameType of InsuranceCopaymentCard Number

(policy #, phone #, etc.)Supplements/Attachments

(e.g. Medicare)Contract RequirementsContractual AdjustmentsEligibilityMultiple Insurers

PrimarySecondary

Current ProblemsSymptomsChief ComplaintReferralVital SignsWeight - HeightPulse - B/P

Physical ExamProblem ListPatient SatisfactionSelf Care - Dress, FeedLife Quality Indicator

SchedulingInformationRoom/EquipmentPatient PhysicianAttending Physician Admitting PhysicianSupport PersonnelEquipmentAppointment InformationInsurer Information

Billing/InsuranceInformationPatient Name Patient Type (In., Out., ER, etc.) Advance Beneficiary Notice

(“ABN”)Advance DirectivePayor NameEmployerPayment HistoryCurrent BalanceProvider Number Diagnosis/Billing CodesComplaintsAccountingFace SheetBill Type (Phys., Hosp., etc.)

PharmacistInformationNameAddressPhone/Fax NumberCredentials

Protocols &ProceduresPhysician Practice ProtocolsFlow Sheets-Care PathsRegulationsHMO, Other Insurance

GuidelinesTest/Treatment ProceduresCode of ConductValue StatementsPolicies

DiagnosisInformationPhysician HandwritingPhysician DictationICD-9 CodesTreatment Protocols/

ProceduresPharmacopoeia (e.g.)

PharmaceuticalInformationPrescription PadsAllergiesPhysician Name, Address,

Phone #, License #, DEA#sPatient NameDateMedication List, Names

Quantities, Doses,Interactions

SignatureDrug InteractionsPatient Information Sheet

Test InformationTest OrderedMRIs, CTs, ENGs,

MCDs, etc.Lab Data, X-Ray DataResults ReportsAdvance Beneficiary Notice

Therapy SitesNameAddressPhone Number

Test SiteInformationNameAddressPhone NumberOrdering PhysicianInsurer Approved Site for

Laboratory TestingRadiology TestingAncillary Testing

TreatmentInformationResultsPhysical TherapyOccupational TherapyConsultantsApproved by Third Party

PayorsFollow-upTime in System

Employee/StaffInformation

NameAddressPhone, Fax, Pager, E-mailCredentialsAvailability/Schedule

PhysicianInformation

NameAddressPhone, Fax, Pager, E-mailSocial Security #DependentsResumeAvailability/Schedule

Materials & SuppliersDescription, Part #’s, CostSuppliers NameSupplier Info.

- Contact Phone, AddressAuthorizationContracts

RegulationsMedicalClinicalEmploymentBusiness & FinanceFacility & Property

Sym

ptom D

iagn

ostic

Info

rmat

ion

App

oint

men

t

Adm

issi

ons

Gui

delin

es

Tre

atm

ent

Opt

ions

Pre

Cer

tific

atio

nof

Insu

ranc

e

Med

ical

His

tory

Cas

eM

anag

emen

t

Pro

cess

Exp

ecta

tions

Orie

ntat

ion

to F

acili

ties

Sat

isfa

ctio

nS

urve

y

Pai

nS

tatu

s

Dis

ease

Info

.

Inst

ruct

ions

Com

preh

ensi

on&

Com

plia

nce

Sig

ns &

S

ympt

oms

Opt

ions

Mea

ning

of

Con

ditio

ns

Whe

re

do I

go? E

xpla

nat

ion

of Is

sues

Tre

atm

ent

Opt

ions

Abi

lity

for

Com

plia

nce

Adv

anc

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irect

ives

& P

atie

ntR

ight

s

Dia

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ticIn

form

atio

n

Pre

scrip

tions

& o

ther

Fol

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-up

Pre

scrip

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& o

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Fol

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-up

Sat

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urve

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Pai

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Inst

ruct

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Com

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Com

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nce

Sig

ns &

S

ympt

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Pre

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tion

& o

ther

Fol

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-up

Rec

over

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Bac

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Bac

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Bac

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Sat

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urve

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Wha

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Exp

lan

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Issu

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Edu

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Ass

essm

ent

Edu

catio

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Ass

essm

ent

Sat

isfa

ctio

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urve

y

Sat

isfa

ctio

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urve

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Sat

isfa

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urve

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CARDIO PULMONARY

OB PATIENT

Sat

isfa

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urve

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19

99, 2

003,

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7, A

. Fro

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unity

HEAL

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stem

.TRA

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RMAT

ION.

1-1

2-09

.ppt

Community Health System PARTS OF THE MASTERSOCIAL SERVICES

Keep abreast of Community resources & available servicesRespond to Patient callsCoordinate with Agencies & Insurance- help discover how to pay- provide support systems

Provide after-care planningContact FamilySupport ER Patient needs

Ser

vice

s

PATIENT SELF-CARE

Insurance

IN-PATIENT Dis

ease

Inf

o.T

reat

men

t P

lan

Com

preh

ensi

on(a

bilit

y to

und

erst

and)

Pre

para

tion

for

Hom

e

Clinical:- Identify Patient needs, conditions- Collect, Screen per protocols, Combine papers - Generate an Order for the Kitchen- Revise Orders per paper slips

Management:- Gather Patient satisfaction data- Develop reports

Production:- Work with Kitchen to develop recipes & menus- Spot check food (temperature, quality, etc.)




•Assisted Living•Nursing Home•Convalescent•Senior Centers

Coordinate & Visit SchoolsEvaluate Athletes & Doc.Treat as possible (70%)Refer to Physician (20%, !0%)Follow-up calls to ParentsMonitor Physical Therapy Pats.Work with Orthopedic. PhysiciansAccess records as needed


SwitchboardPatientsInsurance companies


CashieringBill Medicare, Medicaid, Insurance,

PatientsRecord PaymentsPurge AccountsStudy manualsCorrect Billing problemsSearch for information

MailAccounts Receivable & CollectionsManage processesDevelop reports

Register- Collect Patient data- Check eligibility

Develop impressionTreat critical problems

Get recordsReview chartDocument diagnosis, meds., etc.

Order tests




Order tests

Conduct TestsGive EducationProvide Prep MaterialsTake History, Needs


SPORTSMEDICINE

CALLCENTER

BUSINESSOFFICE

Communicate & Coordinate

Gather Patient Data & Assure

RegulatoryCompliance

BillConduct Patient Care

Document & Distribute Info.

Manage Logistics & Schedule

of Care







of Care







of Care

Collect Transport AnalysisProcessReportResults

DistributeResults


DistributeResults

REGISTRATION

In-Patient, Out-Patient, Home Health:- Physician referrals- Gather new info. & Access info. in system- Conduct tests & assessments- Analyze results- Provide Care - Assure compliance & report CQI info.- Fill-out forms & Generate reports- Bill


AMBULATORY SURGERY

8

9

10

7

5

4

3

6

Find Learn Buy

STORESGovernmentManufacturingServicePrivateSmaller Companies

Safety TreatmentsDiseasesFirst Aid FitnessSafety TreatmentsDiseasesFirst Aid Fitness

2 Pharmaceuticals

Instruments & SuppliesBioTech

Medical Devices

Publications

Insurance Broker

Managed Care & TPA

Reinsurer

Submit Interpret Explanationof Benefits

Coverage Inform Submit Interpret Explanationof Benefits

Coverage Inform

Insurance Provider1

REGULATION - Administration

DES

IRED

OU

TCO

MES

Optimum PatientQuality of Life


Minimal CostMinimal Cost

Maximum Patient Security


Maximum Medical Knowledge


Easy AccessEasy Access

CommunityInfluencingProcesses:

Schools Radio Churches TelevisionAssociations Internet Businesses Paper - Periodicals, Mailers

Key Support Processes:

REGULATION - Clinical

Critical Information:

Momentsof Truth:Issues for Informed

Decision Making &

Defining Points of Quality

CO

RE

PRO

CES

S

RN CALL LINE

RN HOME VISITS

CHARITIES & AGENCIESRed Cross

Nutritional SupplementInformation Management, Communications, & ComputerEquipment, Durable Medical, & Instrument Materials Services

Others

TherapiesTherapies

HospiceHospice

Fitness CentersFitness Centers

ClinicsClinics

Specialty PhysiciansSpecialty Physicians

INSURANCE

GeneticsGenetic Risks …

EnvironmentWeather: Air, Water, PollutionRadiation Sources

Social Values: Life Worth Religious Beliefs Artificial Life Support Distribution of Resources

Population Demographics, Psychographics:Access to Care, Handicaps AgeFinancial

Special Interest

Industry Associations

Knowledge Sources

Point-of -Care TestingStat TestingLocal, Regional TestingReference LabClinical StudiesApplied ResearchAcademic ResearchDisease Center -Regional, InternationalCollegesUniversities

Government Agencies - Administrative (OSHA, EPA, NBS, etc.)Legislative PolicyTaxes, Fines, and other Incentives

Government Agencies - Clinical, Medical (FDA, NIH, CDC, etc.)Industry Standards (AMA, CLMA, etc.)

PreAdm TESTING

Any complex system is best optimized by first recognizing all the parts and influencing forces. Then, we determine how they connect, or need to connect, in order to deliver the desired outcomes. From here, we assure the roles, skills, and relationships; the tools and systems; the behaved beliefs; and the measures and incentives needed are available to predictably operate and deliver the intended performance. This way, the various paths of designing a solution can be sequenced to manage interdependencies, monitored, and implemented in a meaningful order and adapt based on actual context.

- Gather information - Analyze results - Conduct tests - Generate reports - Bill- Gather information - Analyze results - Conduct tests - Generate reports - Bill

CollectRequirements


DeliverReports


CollectRequirements


DeliverReports


OB PATIENT

LABORATORY

PHYSICALTHERAPY

Admit Prep TreatmentEvaluate Recover Evaluate Follow-upCheckout

COMMUNITY &INFORMATION

MEDIA

AMBULATORY PATIENT HOME HEALTH

PHARMACY

Interpret Validate Prep/Dispense Check & InformOCCUPATIONALHEALTH

LONG TERM CARE FACILITY

Information,Education,

Interpretation

Treatment PatientHistory & Medical

Records

BehaviorModification

Compliance Monitor

PRODUCT SUPPLIERS

EMPLOYERS

ALLIED PROVIDERS

AdministrationHuman

ResourcesQuality

ResourcesNursingMaterials

ManagementPlant ServicesMedical StaffExecutive

Leadership

Management Reporting Finance

& AccountingInformation

ManagementOutpatient Clinic

Area Services

GENERAL EDUCATION

Deliver

DIETARY SERVICESER

RADIOLOGY

Put Patient in room - take Vitals, History, Physical Assess.

Make roundsDocument Patient information & Assemble chartConduct selected Patient educationPrep, Dispense/Mix meds., & Monitor Patient needsSupport Physician procedures, effortsCoordinate communications & Access info./materials

Refer to Critical CareSupport Outpatient testing

Support Health programsSupervision of StaffOngoing Staff education

SchedulingManage Database - Cancer RegistryCollect data & reconcile data for BillingCheck charges & delete if Hospital duplicatedLook-up information

Maintain a System plan & maintain & repair/upgradeMaintain the System & on-going improvementsStandardize & purchase all PC’s, most software, etc.

Receive requests & identify needsAssign staff & scheduleDevelop & coordinate plans & put into databaseDo process design as necessaryCommunicate with users & managementDo projects, install, test & documentSurvey Departments after work done

Conduct on-going Staff education

Supervision of Staff:- Maintenance, Security

Facility Management ( 4 properties):- Write Policies - Safety, Security, Plant Operations- Monitor HVAC, Test Fire systems- Manage Phone system (#’s, line expansion), Cable TV- Maintain generator/emergency power, logs- Materials (finishes, etc.)- Hazardous Waste- Track Vendor service reports, Track Construction documents

(rehab, new buildings)- Generate Reports, Track incident variance reports- Preventative Maintenance program (equipment, Systems)- Attend numerous meetings

Material Distribution:- Create “Pick-list”- Fill Order- Remove from Inventory Control

Receiving:- Buy standard commodities- Receive & Inspect- Print & Apply Stickers (Patient billable only)

Forms (>1000 different) & Matl. Mgmt. Standards:Request-Design-Review-Define use,#,etc.-Approve-Print-Distrib.

Quality Assurance facilitator:- Assess- Plan- Implement- Evaluate

Staff & Community Education (annual & routine):- Identify Needs- Identify Solutions- Make Available- Deliver- Measure success

Corporate Compliance & Quality Reports

Evaluate Patient indicationsIdentify & Order testsAccess information Develop diagnosisFormulate treatmentDocument patient data

Conduct selected Patient education

Conduct procedures

Ongoing medical & quality systems education

Provide Administrative support to CEO functionOverview Operational PerformanceAnalyze & Interpret DataRecommend ActionsInteract with Industry & Allied groups, organizationsWork with Physicians & Departments to resolve

questions, issuesAssure response to Patient complaintsOversee capital projects

- e.g. new building, dining area, ER waiting areaConduct/Participate in meetings - e.g. Budget, Board,

Medical Staff, Patient Services, Dept. heads, etc.Oversee Community Relations & Educational activities

Recruit new employeesInterviewHireOrient

Assure Compliance Review timesheets for payrollLiaison for Employees to Administration & InsuranceAnswer questions of Employees

EnrollmentBadgesBenefits ( vacation, sickness, insurance, etc.)Interpersonal issues

Catalyze Strategy Stimulate movement to meet challenges of MissionProvide for Education, Growth, & ContinuityFacilitate setting Standards for performance & outcomesBe the senior communicator to:

CommunityBoardMedical StaffEmployers

Provide senior oversight to Payor, clinical, & businessprocesses through championing of Teams

Develop & maintain the plan for key measuresDevelop reportsProduce reportsDistribute when & as needed

Data Processing & Patient Accounting(see above)

Accounting:Pay BillsMaintain Capital Assets log

(Health & Wellness to Employers & Employees)- Schedule Patients & be chain-of-custody to

Drug screens- Collect Patient data, dictate/document - Track-down chart, deficiencies,

& FAX needs list- Deliver Results & Reenter Patient Regist.- Billing info. to system for Employer, TPA,

Managed Care, Patient

Get Order

Initiate &Schedule

GatherData

CheckoutEvaluation& Diagnosis

FormulateTreatment

PatientArrival

ProviderFollow-up

PatientCompliance

Correspondence / ROIAssemble Transcription CodingAnalysis Deficiency Analysis Chart Completion

Audit / Second Bill Bill Patient Close AccountInitiate CollectionsGather Billing Data Enter Data Inquiry of EligibilitySubmit Bill Remittance PostEdit BillGenerate Bill / EditPATIENT ACCOUNTING

MEDICAL RECORDS

Medical StaffCoordination

Liaison between Medical Staff & HospitalMaintain Physician information & credentialing dataInform Departments of new PhysiciansRemind Physicians - insurance, reappointment, etc.Track procedures per PhysicianCoordinate reappointment of Physicians every 2 yrs.Maintain minutes of Medical Staff meeting

Conduct literature searches

Manage Library

Operate internal Newsletter

HospitalInformationClinic NameLocation AddressLocation Phone #Service/SpecialtiesMissionCapacityAmenitiesPhysicians’ NamesFeesQualifications/TrainingInsurance Participation

PatientDemographics

NameAddressSexAge, DOBPhones - Home, WorkResponsible Party

Parent, Guardian“Next of Kin”, Emergency

ContactEmployer, OccupationDays/Week of WorkMarital StatusSocial History

PatientMedical History

Previous Medications/Drug History

Previous Medical ProblemsPrevious Treatments/TestsPrevious Physicians/

AdmissionsPrevious SurgeriesFamily History InformationAllergiesCurrent Meds, Former MedsClinical InformationOther

InsuranceInformationInsurer NameType of InsuranceCopaymentCard Number

(policy #, phone #, etc.)Supplements/Attachments

(e.g. Medicare)Contract RequirementsContractual AdjustmentsEligibilityMultiple Insurers

PrimarySecondary

Current ProblemsSymptomsChief ComplaintReferralVital SignsWeight - HeightPulse - B/P

Physical ExamProblem ListPatient SatisfactionSelf Care - Dress, FeedLife Quality Indicator

SchedulingInformationRoom/EquipmentPatient PhysicianAttending Physician Admitting PhysicianSupport PersonnelEquipmentAppointment InformationInsurer Information

Billing/InsuranceInformationPatient Name Patient Type (In., Out., ER, etc.) Advance Beneficiary Notice

(“ABN”)Advance DirectivePayor NameEmployerPayment HistoryCurrent BalanceProvider Number Diagnosis/Billing CodesComplaintsAccountingFace SheetBill Type (Phys., Hosp., etc.)

PharmacistInformationNameAddressPhone/Fax NumberCredentials

Protocols &ProceduresPhysician Practice ProtocolsFlow Sheets-Care PathsRegulationsHMO, Other Insurance

GuidelinesTest/Treatment ProceduresCode of ConductValue StatementsPolicies

DiagnosisInformationPhysician HandwritingPhysician DictationICD-9 CodesTreatment Protocols/

ProceduresPharmacopoeia (e.g.)

PharmaceuticalInformationPrescription PadsAllergiesPhysician Name, Address,

Phone #, License #, DEA#sPatient NameDateMedication List, Names

Quantities, Doses,Interactions

SignatureDrug InteractionsPatient Information Sheet

Test InformationTest OrderedMRIs, CTs, ENGs,

MCDs, etc.Lab Data, X-Ray DataResults ReportsAdvance Beneficiary Notice

Therapy SitesNameAddressPhone Number

Test SiteInformationNameAddressPhone NumberOrdering PhysicianInsurer Approved Site for

Laboratory TestingRadiology TestingAncillary Testing

TreatmentInformationResultsPhysical TherapyOccupational TherapyConsultantsApproved by Third Party

PayorsFollow-upTime in System

Employee/StaffInformation

NameAddressPhone, Fax, Pager, E-mailCredentialsAvailability/Schedule

PhysicianInformation

NameAddressPhone, Fax, Pager, E-mailSocial Security #DependentsResumeAvailability/Schedule

Materials & SuppliersDescription, Part #’s, CostSuppliers NameSupplier Info.

- Contact Phone, AddressAuthorizationContracts

RegulationsMedicalClinicalEmploymentBusiness & FinanceFacility & Property

Sym

ptom D

iagn

ostic

Info

rmat

ion

App

oint

men

t

Adm

issi

ons

Gui

delin

es

Tre

atm

ent

Opt

ions

Pre

Cer

tific

atio

nof

Insu

ranc

e

Med

ical

His

tory

Cas

eM

anag

emen

t

Pro

cess

Exp

ecta

tions

Orie

ntat

ion

to F

acili

ties

Sat

isfa

ctio

nS

urve

y

Pai

nS

tatu

s

Dis

ease

Info

.

Inst

ruct

ions

Com

preh

ensi

on&

Com

plia

nce

Sig

ns &

S

ympt

oms

Opt

ions

Mea

ning

of

Con

ditio

ns

Whe

re

do I

go? E

xpla

nat

ion

of Is

sues

Tre

atm

ent

Opt

ions

Abi

lity

for

Com

plia

nce

Adv

anc

e D

irect

ives

& P

atie

ntR

ight

s

Dia

gnos

ticIn

form

atio

n

Pre

scrip

tions

& o

ther

Fol

low

-up

Pre

scrip

tions

& o

ther

Fol

low

-up

Sat

isfa

ctio

nS

urve

y

Pai

nS

tatu

s

Inst

ruct

ions

Com

preh

ensi

on&

Com

plia

nce

Sig

ns &

S

ympt

oms

Pre

scrip

tion

& o

ther

Fol

low

-up

Rec

over

y &

Bac

k to

Wor

k

Bac

k to

Wor

k

Bac

k to

Wor

k

Sat

isfa

ctio

nS

urve

y

Wha

t do

I ne

ed?

Am

I do

ing

enou

gh? Dia

gnos

ticP

roce

ss

Pre

Cer

tific

atio

nof

Insu

ranc

e

Dia

gnos

ticP

roce

ss

Exp

lan

atio

nof

Issu

es

Edu

catio

n &

Ass

essm

ent

Edu

catio

n &

Ass

essm

ent

Sat

isfa

ctio

nS

urve

y

Sat

isfa

ctio

nS

urve

y

Sat

isfa

ctio

nS

urve

y

CARDIO PULMONARY

OB PATIENT

Sat

isfa

ctio

nS

urve

y

19

99, 2

003,

200

7, A

. Fro

hwer

kCo

mm

unity

HEAL

THSy

stem

.TRA

NSFO

RMAT

ION.

1-1

2-09

.ppt

Community Health System PARTS OF THE MASTERSOCIAL SERVICES

Keep abreast of Community resources & available servicesRespond to Patient callsCoordinate with Agencies & Insurance- help discover how to pay- provide support systems

Provide after-care planningContact FamilySupport ER Patient needs

Ser

vice

s

PATIENT SELF-CARE

Insurance

IN-PATIENT Dis

ease

Inf

o.T

reat

men

t P

lan

Com

preh

ensi

on(a

bilit

y to

und

erst

and)

Pre

para

tion

for

Hom

e







•Assisted Living•Nursing Home•Convalescent•Senior Centers





CashieringBill Medicare, Medicaid, Insurance,

PatientsRecord PaymentsPurge AccountsStudy manualsCorrect Billing problemsSearch for information

MailAccounts Receivable & CollectionsManage processesDevelop reports




Order tests




Order tests



SPORTSMEDICINE

CALLCENTER

BUSINESSOFFICE







of Care







of Care







of Care


DistributeResults


DistributeResults

REGISTRATION



AMBULATORY SURGERY

8

9

10

7

5

4

3

6

Find Learn Buy

STORESGovernmentManufacturingServicePrivateSmaller Companies

Safety TreatmentsDiseasesFirst Aid FitnessSafety TreatmentsDiseasesFirst Aid Fitness

2 Pharmaceuticals

Instruments & SuppliesBioTech

Medical Devices

Publications

Insurance Broker

Managed Care & TPA

Reinsurer

Submit Interpret Explanationof Benefits

Coverage Inform Submit Interpret Explanationof Benefits

Coverage Inform

Insurance Provider1

REGULATION - Administration

DES

IRED

OU

TCO

MES



Minimal CostMinimal Cost





Easy AccessEasy Access

CommunityInfluencingProcesses:

Schools Radio Churches TelevisionAssociations Internet Businesses Paper - Periodicals, Mailers

Key Support Processes:

REGULATION - Clinical

Critical Information:

Momentsof Truth:Issues for Informed

Decision Making &

Defining Points of Quality

CO

RE

PRO

CES

S

RN CALL LINE

RN HOME VISITS

CHARITIES & AGENCIESRed Cross

Nutritional SupplementInformation Management, Communications, & ComputerEquipment, Durable Medical, & Instrument Materials Services

Others

TherapiesTherapies

HospiceHospice

Fitness CentersFitness Centers

ClinicsClinics

Specialty PhysiciansSpecialty Physicians

INSURANCE

GeneticsGenetic Risks …

EnvironmentWeather: Air, Water, PollutionRadiation Sources

Social Values: Life Worth Religious Beliefs Artificial Life Support Distribution of Resources

Population Demographics, Psychographics:Access to Care, Handicaps AgeFinancial

Special Interest

Industry Associations

Knowledge Sources

Point-of -Care TestingStat TestingLocal, Regional TestingReference LabClinical StudiesApplied ResearchAcademic ResearchDisease Center -Regional, InternationalCollegesUniversities

Government Agencies - Administrative (OSHA, EPA, NBS, etc.)Legislative PolicyTaxes, Fines, and other Incentives

Government Agencies - Clinical, Medical (FDA, NIH, CDC, etc.)Industry Standards (AMA, CLMA, etc.)

PreAdm TESTING

Any complex system is best optimized by first recognizing all the parts and influencing forces. Then, we determine how they connect, or need to connect, in order to deliver the desired outcomes. From here, we assure the roles, skills, and relationships; the tools and systems; the behaved beliefs; and the measures and incentives needed are available to predictably operate and deliver the intended performance. This way, the various paths of designing a solution can be sequenced to manage interdependencies, monitored, and implemented in a meaningful order and adapt based on actual context.

Storyboard to understand & design the Stories

Introduction Registration Service Encounter Discharge Post-DischargeArrive Register TreatLab DispositionCheck-out

Storyboard to understand & design the Stories

Chapter / Scene

Stage

Patient Needs

Our IntentImpressions

Physical Elements

Behaviors

Mechanisms

Check-in EducateRoomTherapy Follow-upPlan

Experience Design STORYBOARDO

N-S

TA

GE

ME

CH

AN

ISM

SC

HA

PT

ER

SC

EN

E

Plan. & Coord.Home, Work, Hospital

(They call us or we call them.)

Check-inPre-op Holding

RegistrationIntroduction B

ehav

ior

Ph

ysic

al C

ues

I

nte

nt

Pro

cess

Peo

ple

T

oo

ls

Pla

ce

Know who I am, have my info: Know & contact my key contacts, my Physician, the plan.

Information/ logistics needed to prepare: Learn date, time, when/where, parking, arrival. Pre-admission testing? What to bring. Length of stay. Know where Family goes. Impact on Family. What should I do with my usual medication routine?

Confirm schedule, timing, what to bring. Answer last-minute questions.

What I should bring: How much to pay, when. Insurance coverage. Pre-register info.

Define team: Select Physician. Team coordinated? Role of Family?

Comfort of Interaction: Easy of access. Empathy. Save time.

Find way easily: Get to ER when ER needed. Travel, find, park.

Physically able to get inside. Surface parking close to the entrance for high-priority Patients – wound care, handicapped, D&T

Know where my Family, friends go and how to contact them.

Security of hospital.

Know who I am. Treated as an individual.

Don’t get lost, delayed.

Aleve worries. No unexpected waits, distractions, embarrassment.

Sense that people, info. is well-coordinated.

ArriveEntrance: Parking or Curb

Check-in, RegisterDesk: Main, Women’s, ED,

Patient floor (after Main)

EDER

Out PatientTransitions / Hand-offs

Hallways

Th

e P

has

eA

ctiv

ity

or

Pu

rpo

seo

n a

giv

en

‘Sta

ge

’ (p

lace

)

Info. ExchangeOutside the Hospital

(Call, Internet, Physician, Media, Friends)

Info. ExchangeIn the Hospital

Experiential Bundles:‘Scene’-specific procedures and behaviors, using predetermined tools, in a given place (‘Stage’), carried-out by specific roles to create an intended experience.

Grounds:• Valet Parking• Golf Cart (Shuttle) • Safety Code Blue Stations In Parking Lot• Covered Entrance• Water Feature• Strategically Placed Benches – Parking Lot, To

Entrance• Inner Courtyard• Labyrinth

Lobby And Public Areas:• Water Feature• Simplistic, Intuitive Layout Of Public Areas• Wayfinding Strategies (Universal Signage, Central

Admitting/Registration)• Chapel And Meditation Room• Learning Center • Use Of Natural Design Elements (Wood Accents, Stonework)• Comfortable And Bariatric Seating• Player Piano And Coffee Bar In Lobby• Wireless Internet Access• Room Service With High Quality Foods (Self Regulated Diet)• Concierge Service

Physician Design Elements:• Covered Parking• Parking Additionally Located Adjacent To ED• Comfortable Physician Lounge With Amenities (Off Courtyard)• Child Care Onsite• MOB With Covered Walkway

Re-transcribe typed prescriptions resulting in disastrous errors.

Didn’t attempt to validate correctness.

Could not alter permissions form to indicate no student Physicians.

Need to know what to eat/not to eat before surgery

…

Connecting not easy- played phone tag ……………………

Place and way to indicate special information.

Overheard concerns.

Discomfort; Wait;

Charging to park; we're the only hospital that does that

Large useful signs.

Helpful person along the way.

Easy parking; Roving volunteers give attention (even at night).

Cluttered spaces. Distracting; Disconnected; Shadows; Glare; Confusing layout

Noise: loud TV, distractions, food channel; Muffled; Cold. Hard; Too Hot; Too Cold; Drafty.

Free-for-all, individualistic; Disconnected: no one sees you sitting; Confusing; Wait; Wonder.Left me to 'chase things down’; Complained about problems; Distracted: Told to 'sit‘ (when it hurt); Waited w/o explanation. Acted bored; No rush in ED – treated as routine.

Too busy; Don't notice; "Never a Triage Nurse.“ No rush – routine, Wonder; Bad measurement

Noise: loud and crowded; Cold room; More blankets

Long wait before surgeryDidn’t pay attention to patient info. provided

No one owning bad behavior.

Cost Estimate

Need:Friendly, understanding, listen & follow-up. Info ready; No financial pressure; Flexible if info not available.Immediately ready (initiation);<5 min. effort; Immediately go to next steps Routine but engaged w/ present person & situation. Responsive.

Fresh air. Live plants.

Seek guidance: Discuss symptoms, potential need, Physician options, second opinion.

Learn: What’s available? What’s the process? How long it takes? Info. needed to provide.

Check on info: My pre-registration, schedule. Directions to hospital & where to park. Physician background.

My financial responsibility: Understand what will be covered by insurance (In? Out?)

Comfort of interaction: Manage fear, grief, denial, anger, depression, acceptance. Courtesy, efficient, competent, empowered.

Welcoming, calming: Treated well. Aleve fears/worries. Courteous prepayment process.

Ready: for my arrival. Know who I am, why I’m here. Coordinate care/info./Physician. Accurate data & verification.

Remember me from previous visits – esp. repetitive lab, therapy, wound care. Avoid long waits, repetition Use what I brought.

Understand: what I’m signing. Remind me where to go. Easy way-finding, understand process & flow. Estimate length of stay (physician at PreAdmit) & cost.

Sense Competence of Staff.

Assess my condition. Verify history. Get ready for treatment. Learn what happens.

Care to listen, show empathy, discuss, explain. Not forgotten. Attentive. Responsive. Courteous.

Comfort & safety. How can I keep from catching something? What do I do if I’m hungry, thirsty, cold, etc.? How do you maintain cleanliness?

Get treated.

Someone is connected to me. They’ve focused on me. Attentive. Responsive.

Learn what it feels like. Know when we will start. Why am I not the priority? What is the system to keep me informed about my wait time (i.e. “Now calling number X…”)? How will I communicate (bilingual, multicultural, hearing impaired)?

Fundamentals of Experience Design

à Be Relevant à Engage à Flow à Adapt

Fundamentals of Design: Be RelevantInclude the “soft” with the “hard”:

– Understand Patient’s needs & expectations vs. Our intent

– Close the gap

q Seek to understand each Patient & Family member as if “standing in their shoes”

q Anticipate & act on the needs & concerns of each Patient & Family member, if possible, before they are voiced.

Pho

to:

Set

on F

amily

of

Hos

pita

ls

Fundamentals of Design: EngageTrigger:

– Impressions • Concepts • Symbols

– Physical elements • The five senses • Memorabilia

– Behaviors • What• Who• Where• When

q Use the 3 key mechanisms to deliver the experience:

-People-Tools-Places

q Address positive & negative cues & the 5 senses that form impressions

q Recognize what should be “on-stage” & when things should be “off-stage.”

Fundamentals of Design: FlowBuild meaningful stories:

– Chapter– Scene– Stage– Transitions

q Connect the Patient & their Care Team to the next:

- Procedure- Service- Time- Place

…so that the Patient never becomes “lost” & we never “drop the ball” in any hand-off.

q Work as a “Healing Team” by sharing & accepting, modeling leadership, & living the 4 C’s:

- Communication- Collaboration- Caring- Cooperation.

Fundamental: AdaptLearn what’s important in the Story:

– Understand– Discuss & Plan– Try– Report

q Experiment

q Be opportunistic

q Pilot

q Share learning

q Innovate

q Constantly improve.

Context …a whole system approach

The Environment of Trends & Opportunities

Roadmap to sequence Implementation

Experience Design Principles

Strategy Management SystemStrategic Purpose & Commitment•Vision, Mission, Values•Strategic Imperatives

Culture Design based on Values

Influencing People Governance & Policies

Fundamentals

Storyboard

Master Process

Principles New Paradigms for implementing Experience Design

1. Bring the Strategy out and alive

2. Get good at Connecting

3. Engage the Soft with the Hard

4. Build meaningful Stories

5. Learn what’s important in the Story

6. Adapt the role of leadership– Bring clarity and focus to vision, values

– Build self-confidence

– Coach and reinforce

– Have faith.

DiscussionExperience Design: A Framework for Patient Care

Pho

to:

Set

on F

amily

of

Hos

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ls

Experience Design: A Framework for Patient Care

Storyboardq Chapterq Sceneq Stageq Transitions

Master Processq Moments of Truthq Core Processq Support & Information Processesq Systems & Toolsq Desired Outcomes & Inputsq Roles q Measures

Fundamentalsq Be Relevantq Engageq Flow q Adapt

Experience Design A Framework for Patient Care presented by Art Frohwerk Clearpath, LLC in collaboration w/ Quantum at Meeting of the Minds Toronto June.

Documents

business slide

vision slide

healing process

patient care

business info

level of care

care competence

care of dependents