Health Care: A Strategy for Supporting Change - DMGT 748 - spreads

8/20/2019 Health Care: A Strategy for Supporting Change - DMGT 748 - spreads

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M.A. Final Project

Health Care: A Strategy for Supporting Change

M.A. Final Project | Process Book | SCAD DMGT 784

Synthesize

Communicate

Clarify

Eval

Con

Translate

Play

Draw

Balance

Structure

Foster

Determine

Implement

Figure 1. Cover image. Exploring the relationship between design,management, and transformational change. Author’s image.


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Health Care: A Strategy for Supporting Change

Enrique L. Von Rohr


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Introduction

Thisproject employed principlesand methodsof design

management,the effective use of design strategy,operaconstraints,and businessobjectivesto generate astrateapproach thatsupportsinstitutional health care manag

and designers.

HealthCare: A Strategyfor Supporting Changeshowcasethe developmentof MergeCare,an approach for facilitat

the adoption of design-led methodsinto existingprocesimprovementsystemswith the goal of supportingchangduringnew initiatives.Research,prototype developmen

testingwere conducted overa ten-week period.The prodemonstrateseach step of thisprocess aswell asthe fin

prototype.Interview subjectsincluded managersand de

within two health care companiesthatprovided rich insthe culture of theirorganizations,how they currently mchange,and whatthey believe mightsupportfuture initCommon strengthswere identified in both targetaudien

asthe ability to translate,communicate,iterate,and synThese organizationsalso have astrongculture of inquiry

subjectsdemonstrated the desire to adoptnew methodswould improve theirwork and supportclients. The heter

systemsand human factorswithin health care contributneed forintegratingnew approachesand methodsintoexistingprocesses.


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Dedication Acknowledgment

I dedicate thiswork to my friend,companion,advisor,and

amazinglife partner,MelissaVon Rohr.Thank youforyourconstantlove,support, encouragement,and forgivingme thespace to take thislong journey.Thank youalso forthe many

reviewsyou have done to make thisprojectcomplete. And to mychildren,thank youfor yourpatience and giftof time thatI hope

to return tenfold.

Itis with greatpleasure thatI acknowledge and thank th

have helped me complete thisproject.

Tomy professors, particularlyRegina Rowland, PhD:Tha

foryour dedication,perseverance,and leadership in guidgrowth and instillingconfidence in me to build anew fut

have changed my mind forthe betterand opened the doexpansive chapterin my life.

Tomy classmates: Thank youfor yourconstantsupport aencouragement,for stretching the boundary of my com

and pushingme to explore the richnessof thisemergingspecial thanksto my lastquartercohorts, Johan Verstra

Kangjun Seo foryourconstructive reviewsof my final pr

And to my otherclassmatesJashuaPlotkin,Erika S.Rose,Shannon D.Simon, and Yirun Xu:it hasbeen alearningexwatchingyourprojects develop and discussourcollectivchallengestogether.To pastcollaboratorsJason Spinksa

Benson:thank youfor yourthoughtful teamwork!And thto Jason Millsforbeing my St.Louisclassmate on the gro

Thank youall formakingthe experience well worth the j


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Table of Contents

Project Framing. . . . . . . . . . . . . . . . . . . . . . . . . 11–13Subject ofStudy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Problem Statement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Target AudienceDescription . . . . . . . . . . . . . . . . . . . . . . . . . .12

PurposeofProject . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Scopeof Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

S ig ni fic an ce o f t he S t ud y . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 3

Project Positioning . . . . . . . . . . . . . . . . . . . . . . 15–33O pportu nity Statemen t . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Positioning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17–29

Z AG St ep s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1

ValueProposition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

OnlinessStatement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Research Activities and Synthesis . . . . . . . . . . . . 35–60Research Space. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

R es ea rc h M et ho do lo gy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 7

Research QuestionsMatrix . . . . . . . . . . . . . . . . . . . . . . . . . . .38

Consent Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39

R es ea rc h P ro to co ls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 0 – 41

Research Activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Data, Analysis& Synthesis. . . . . . . . . . . . . . . . . . . . . . . . . 43–58

R es ea rc h I ns ig ht s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 9

Research Fin din gs at aGlan ce . . . . . . . . . . . . . . . . . . . . . . . . .60

Design Opportunities and Criteria, Reframing. . OpportunitiesforDesign Matrix. . . . . . . . . . . . . . . . . .

OpportunitiesforDesign Map . . . . . . . . . . . . . . . . . . .

D esign Criteriaf orP rototype . . . . . . . . . . . . . . . . . . . .

Reframing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Prototype Development and Testing . . . . . . . . PrototypeIdeas . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Concept Development Process. . . . . . . . . . . . . . . . . . .

Concept Testingwith Target Audience . . . . . . . . . . . . .

Concept TestingFindings. . . . . . . . . . . . . . . . . . . . . . .

Validation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Final Design to Market . . . . . . . . . . . . . . . . . .Final Prototype. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Bu sin es s Model Can vas . . . . . . . . . . . . . . . . . . . . . . . .

Business/Implementation Plan . . . . . . . . . . . . . . . . . .

Conclusions and Recommendations. . . . . . . . .Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . .


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Project Framing

Design

Health Care

Manage


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Project Framing

Scope of Project

ContextThe contextforthis projectwas the challengesfaced by the

institutional health care sector.These challengesinclude theprocessimprovementmethodsand strategiesthatmanagersanddesignersuse to supportcare in hospital settings.

Content

The contentof the project included design process,designmanagement,businessmanagement,processimprovement

methods,and transformational change strategies.

SubjectsThe subjectswere designersthatwork for institutional healthcare systemsand institutional health care professionals,such as

decision makersand managersof operations.

Subject of Study

The research investigated how individuals in two institutionalhealth care systems use design and management methodsto support transformational change.

Problem Statement

JohnHalamka,MD,ChiefInformationOfficeof BethIsrael

DeaconessMedicalCenterinBoston statesthathealthcare intheUnitedStatesisof poorvalue,significantcostandless thanoptimal

outcomes(Jones,2013).Halamkasuggeststhatinnovationandreconsiderationof modelsofservice andinstitutionalpracticeare

neededinorder tocreate continuouscareandsupport.

The PatientProtection andAffordableCare Act (PPACA)signed

into law by PresidentBarack Obamaon March 23,2010,is an

effortto improve how health care is managed atmultiple levels.The PPACA reflectsthe challengesthat have existed in the UnitedStateshealth care systemforsome time.Reformingthe system

through transformational changesin termsof patientcoverage,coststructure, and patientcare will continue to be along-termchallenge.Strategiesto supportthe institutional health care

systemsthatcare for and manage patientsare needed by thedesign industry (Jones,2013).

Target Audience Description

Two subjectgroupswere identified forthis study.Group one

wascomposed of institutional health care managerswho focuson processimprovementmethodsto support transformational

change.The second subjectgroup wascomprised of designerswho seek opportunitiesfor greaterengagementin the

institutional health care sectorand wish to develop tools they canuse to supportchange.

Purpose of Project

The purpose of thisprojectwas to uncoverorganizational barriersto operational culture in orderto develop methodsthatsupportmanagersand designerswho intend to lead transformational

change in health care institutions.

LocationThelocationof theprojectwas inthe St.Louis,Missourire

morethen20 milesfromthe citycenter.Subjectswere intattheiroffices atvarioushealthcare systemsfacilities.

TimelineThe projectbegan on July 1, 2014 with secondary researc

lasted through January 4,2015.The primary research anddevelopmentbegan of January 5,2015 and lasted throug

March 11,2015.

DelimitationsThe study did notinclude cliniciansin health care practicconsumerhealth care productsor theiragents, norothe

disciplinesthatmake up the institutional health care secalso did notinclude small health care practicessuch as d

officesor largerinsurance payersand pharmaceutical cothatfocus on health care.


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Project Positioning

Build Evaluate

Connect Foster

D et er mi ne M ob il iz e

Encourage

R ec og ni ze T ra ns la te

Weave

DesignProcess

Discover

Define

Develop

Explore

Iterate

Play

Visualize

Synthesize

Draw

ImplementTransform-

ationalChange


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Project Positioning

Opportunity Statement

The research contributed to the field of designmanagement by:

1. Demonstratinghow adesign-led method can be used tofostereffective collaboration and sustain change.

2. Helpinghealth care managersand designersintegrate design-led strategicapproachesinto day-to-day activities.

3. Clarifyinghow health care professionalscan supportchange

by embeddingdesign-led expertise into their processes.

An opportunity existed to conduct research in the institutional health caresector of St. Louis. The study investigated what strategies were being usedby design and management to support transformational change.

The health care sector hasmany specialized components.Designersoften bringa variety of backgroundsand approachesto

supportspecificproducts orservices. In orderto effectsystemicchange,design managersneed to develop modelsand toolsthatsupporthealth care innovation fromwithin the systemitself.

There isagrowingneed fordesigners and,more broadly,design

managementto understand the complexemotional and culturalconditionsof the health care field in orderto supportthe sector

effectively (Jones,2013).Equally,health care practitionersarelookingto design managementfornew strategiesto develop and

sustain many activities(Jones,2013).The institutional health caresector,which isthe strategic managementside of health care,needsnew modelsand approachesfor implementing

change initiatives.

Competitor/Collaborator Analysis

The marketanalysisreviewed a range of institutional health care

structuresat the national level.These structures,of varyingsize,incorporated eithertransformation change orinnovation into

theircurrent systems.Additional not-for-profitorganizationswereevaluated thatfocused on health care,includingone company

thatfocused on transformational change strategies.A review ofthe institutions’websites,includingthe t erminology used andthe typesof projects initiated,wasused to evaluate the degree

to which innovation orprocessimprovementmethodologies

were incorporated into toolkitsand methodspresented fortransformational change.

Positioning:Overview

Regional Health Care Systems

Eighthealth care systemsof varyingscales were analyze

St.Louis region.Websiteswere reviewed forthe words“transformation” and “innovation” to evaluate if they ha

centers,or initiativesthataddress these areasand whatthey mightbe usingto effectchange.


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Project Positioning

> Integrated consultingbusiness

> Clearmethodology and steps

> Toolsto supportchange

> BusinessConsultancy

> Engineering

> Financial Services

> Government

> Pharmaceuticals

> A model with added consultingservicesand software can createholistictoolsets

> A clearmethod thatis shared withall providesconfidence

> Variouschannelscan be used forthe model

Objectives:What is theirnetwork’s value?

Members:What categories dotheyfall into?

Channel:What is theentrypoint totheir network?

Lessons:What canthey teachus forournetwork?

Collaboration Opportunities:Wheredoweoverlap?

Approach:How dothey createvalue?

> Online portal

> On-ground site visits

> Coaching

> E-learning

> Theirmethod servesothersectorsaswell ashealth care

> Clearprocessin place

> Global officesoffer internationalperspectivesand knowledge base

> Toolsexistfor visualizingprocesses

Changefirst

Changefirstisa consultingcompany thatsupportsall typesof businesseswith change initiatives.They have sixstepsthat

are guided by whatthey call a learn , apply ,and embed process.They also provide trainingworkshops,e-learningmodules,andcoaching(http://www.changefirst.com).

Positioning:Competitor/Collaborator Analysis

> University-level organization thatprovidesresearch and knowledgeon bestpractices

> Consindu


MemWhat

ChanWhat i


> Onli

> Publ

> Rese

> Knowledge to leaders

> Patient-centered approach

Cornell University: HealthcareTransformation Project

The Healthcare Transformation Projectat Cornell University

providesconsultingservices to health care leadersin theareasof needsassessment,delivery of bestpractices,strategicpartnerships,and organizational change approaches.Most of

theirpractices appearto be in areasof processimprovementmethods(https://www.ilr.cornell.edu/healthcare).

Table1. Changefirst competitor/collaboratoranalysis.

Adapted from “ Workshops,”“Ourchangemanagement methodology,” “Key featuresofe-change,” “Ourclients,”and “Really embeddingPCI®in yourorganization,”2015, Changefirst.

Adapted from “Who weare,” “What wedo for you,” “Work we’vedone,” “NewHealthcareTransformation Project.

Table2. Cornell University: HealthcareTransformation Project competitor/c


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Project Positioning

> Affiliated with auniversity

> Leadershave track record ofsuccess

> Actasacatalyst

> Health care systems

> Health care teams

> Strategists

> Translation of science to practice

> Bestpractices

> Example model

> How we mightprovide consulting







> Online portal

> Location within partnerschools

> Production of toolkits

> May wantto testourapproach fortheirhealth care clients

> Resourcesto theirstakeholders

> Brokerrelationshipswithinnovation implementationstrategies

Healthcare Transformation Institute

The Healthcare Transformation Institute isa not-for-profitaffiliated with the University of Arizonaand ArizonaState

University.The institute providesknowledge aboutbestpracticesat the intersection of scientificdiscovery,healthcare delivery,and reimbursementservices.They have a

structure,method,and criteriafor workingwith health caresystemsin orderto effectchange on ahigh-level path (http://

healthcaretransformationinstitute.org).

> Internally supportchangesthathelp to adoptexternal innovationbestpractices

> In-ho

> Healsyste


MemWhat

ChanWhat i


> Onli

> Wortheir

> Knowledge to theirleaders

> Trainingfunctional groups

Independence Blue Cross:Center for Health Care Innovation

The Centerprimarily facilitatesinnovation-based activitiesforemployeesof Independence Blue Cross.They are lookingfor

outside opportunitiesto importinto theirstructuresto supportchange and innovation activities(http://www.ibx.com/company_

info/innovation).

Table3. HealthcareTransformation Institutecompetitor/collaboratoranalysis. Table4. IndependenceBlueCross: CenterforHealth CareInnovation compet

Adapted from “Healthcaretransformation institute,” “Strategy and Focus,” “Engineeringto createa health caresystem,”“Vision and Mission,”2015, HealthcareTransformation Institute.

Adapted from “TheCenterfor Health CareInnovation at IndependenceBluecarewith innovation,” “Innovation at work,” 2015, IndependenceBlueCross:C


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Project Positioning

> Large database of research

> Expertadvice

> Longhistory of expertwork

> Global reach

> Strategist

> Think tank

> Educators

> Facilitators

> We may need more depth

> Value of information

> Total businessmodel







> Online portal

> Officesin Cambridge,MA

> Online teachingtools

> Printmaterials

> Mightadopttheir method/toolkit

> Could be apartner

> May validate ourwork

> Resourcesto theirstakeholders

> Brokerrelationships

> Think tank approach

> Hostconferences

> Conveners

Institute for Healthcare Improvement

The Institute for Healthcare Improvement (IHI) is anindependent not-for-profit organization providing resources

to the health care community. IHI serves as a clearinghouseof innovation science in various areas. Along with linking tomany articles, they also produced “A Guide to Idealized Design,”

which combines transformational and design approaches in astep-by-step guide. In addition, IHI has developed the “Triple

Aim” model, which addresses the health of a population,experience of care, and per capita cost. The Institute alsoprovides coursework at various levels for transformational

change leadership (http://www.ihi.org).

> Partof alarge network of healthcare providers

> Ability to gatherknowledge fromall participants

> Impactsthe whole industry due tobeinga network resource

> Strat

> Educ

> Conn


MemWhat

ChanWhatis


> Onlin > Provide aregistered process

> Offerclear toolsall can use atthe same time

> Help understand existingtools

Joint Commission Center forTransforming Healthcare

Thisnot-for-profit organization issupported by leadingnational health care systemswith the mission of transforming

health care through aset of processimprovementtoolssuch asRobustProcessImprovement, which includes

Lean SixSigmaand Targeted SolutionsTool (http://www.centerfortransforminghealthcare.org).

Table5. InstituteforHealthcareImprovement competitor/collaboratoranalysis.

Adapted from “Vision, Mission, and Values,” “Innovations,”“Education,” “Scienceof Improvement: How toImprove,” and “Open School,” 2015, Institutefor HealthcareImprovement.

Adapted from “About theCenter,” “Projects,” “FAQs,” “Targeted SolutionsToo JointCommission Center for TransformingHealthcare.

Table6. Joint Commission CenterforTransformingHealthcarecompetitor/c


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Project Positioning

> A large-scale facility allowingforrapid prototypes

> Value to the KaiserPermanentesystemand national model

> Only one of itskind in the USA

> A livinglaboratory

> In-house innovation team

> Prototype development

> How aphysical demonstration sitecan garnerenterprise adoption

> Can testmultiple modelsat once

> Role play allowsfora human-centered opportunity to testideas







> Primarily theirphysical site

> Online website with videoexamplesof spacesand projects

> Potential partnerfortesting the

product > Potential adopterof the product

> Showshow an environmentcan

be designed to supportoperationsand lowerthe long-termcost ofinvestment

> Testspotential ROI beforeinvestmentismade

Kaiser Permanente: Garfield Innovation Center

KaiserPermanente isone of the largesthealth systemsinthe country.The Garfield Innovation Centerleadsthe way in

testingnew ideasand implementingthemthrough large-scaleprototypingin modeled hospital environments.Anyone within thenational systemcan visitthe site in orderto prototype within the

physical conditionsand see how operationsmightbe impacted.The physical environmentallows fora human-centered design

approach to exploringproblem-solvingmethods.In addition itprovidesthe opportunity forstakeholderbuy-in fromall teammembers(https://xnet.kp.org/innovationcenter/index.html).

> Innovation teamintegrated into ahealth care system

> Clinician-initiated formationencouragesinstitutionalleadership trust

> In-ho


MemWhat

ChanWhat i


> Faci

> Onli

> Available to theirimmediate

stakeholderson adaily basis > Build transdisciplinary teamsfromprojectonset

> Demonstrate by participatingateach step of process

Mayo Clinic: Center for Innovation

The Centerfor Innovation atMayo Clinicbegan in 2008 andbridgesmedical practice with human-centered design.They

have been the leaderin usingdesign thinking to facilitatethe transformation of health care delivery atall levelsof theorganization.They use a“Connect,Design, Enable” approach to

initiate and delivertheir projects(http://www.mayo.edu/center-for-innovation).

Table7. KaiserPermanente: Garfield Innovation Centercompetitor/collaboratoranalysis.

Adapted from “Who weare,”“What wedo,” and “Howto start,” 2015,Kaiser Permanente: GarfieldInnovation Center.

Adapted from “What WeDo,” “Projects,” and “Transform,” 2015, MayoClinic: C

Table8. Mayo Clinic: Center forInnovation competitor/collaboratoranalysi

ProjectPositioning


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Project Positioning

> A clearinghouse forideas

> Sourcingand evaluatingbestpractices

> In-house innovation teamfor amajorhealth care system

> Criteriaforevaluatinganinnovation

> How to identify and match leadproblemswith an innovation

> Robust“Deep Dive” processforprojects







> Online website

> Theirtoolkit/process

> Toolkitmay have many similar

stepsthatsupporttransformation > May supportnew methodsandposton theirsite

> Knowledge to theirsystem

> Knowledge to broaderhealth careindustry on bestpractices

UCLA Health: Institute for Innovation in Health

The Institute ischarged with identifyingnew opportunitiesanddeliveringtransformational change in health care.They have a

seven-step processforevaluatingan innovation.The Institutealso usesaspectsof design thinkingand processimprovementto evaluate and initiate projects.In addition,they provide a 60-

page toolkitthatwalksreaders through astep-by-step processofinnovation (http://uclainnovates.org).

> SupportSutterHealth system

> Facilitate innovation activities

> In-homajo


MemWhat

ChanWhat i


> Onli

> Even

> Disseminate knowledge to their

system > Facilitate workshopsfor systemleadersand staff

Sutter Health: The David Druker Centerfor Health Systems Innovation

The Centerbegan in 2010 to advance exploring,creating,anddeployingnew health care in the region.It usesa

human-centered design approach to facilitate developingnewideas.The Centerfocuses on new innovations,as opposed to

improvingexistingstructureswithin the SutterHealth system(http://innovation.pamf.org).

Table9. UCLA Health: Institutefor Innovation in Health competitor/collaboratoranalysis.

Adapted from “Key Activities,” “Innovation at UCLA,” “Resources,”and “Econsult Deep Dive” 2015,UCLA Health: Institutefor Innovation in Health.

Adapted from “Home,” “linkAges,” and “Personalized Health CarePrograms,”Sutter Health: TheDavidDruker Center for HealthSystemsInnovation.

Table10. SutterHealth: TheDavid DrukerCenterfor Health SystemsInnovat

ProjectPositioning


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Project Positioning

Small Large

In-house

Independent

Positioning:2x2 Axis of Organizations

Location vs. Size

The 2x2axisshown in Figure 4 plotsthe relative size of the healthcare organizationsand if transformational change was supported

within the entity.Larger organizationshad more robusttransformational and innovation-oriented teamleaders.They

also had clearmethodologiesto supportchange.Organizationsoutside health care systemsranged in the complexity of methods

and strategiesused to support transformational change.

An opportunity areawasidentified,indicatingthe need for

astrategic approach thatcould supportsmallerhealth careorganizationsin achievingtransformational change.

Organizationsincluded in Figure 4are:

1 . Ch an gefirs t2. Cornell University:Healthcare Transformation Project

3. Healthcare Transformation Institute4. Independence Blue Cross:Center forHealth Care Innovation

5. Institute forHealthcare Improvement6. JointCommission CenterforTransformingHealthcare

7. KaiserPermanente:Garfield Innovation Center8. Mayo Clinic:CenterforInnovation9. UCLA Health:Institute forInnovation in Health

10. SutterHealth:The David DrukerCenterforHealth SystemsInnovation

02

03

04

05 06

10

Figure4. 2x2axis oforganizationssupportingtransformation. Identifiesstructuressupportingtransformational changeacrosstheUnited States. Author’simage.

OpportunityArea

Low

Positioning:2x2 Axis of Approaches to Transformation

Design-led vs. Process Improvement

Many of the organizationsreviewed used avariety of methodsforcreating transformational change.Some took adesign-

led approach with afocuson human-centered innovation fortransformingpartof ora whole system.Others leaned toward

processimprovementunder aSix Sigmaapproach to makeincremental change within units.A few offered strategiesthat

reflected both methods,suggestingthere mightbe anopportunity fordevelopinga meta-method thatcombinesdesign-led and processimprovementstrategies.

Organizationsincluded in Figure 5are:

1 . Ch an gefirs t2. Cornell University:Healthcare Transformation Project

3. Healthcare Transformation Institute4. Independence Blue Cross:Center forHealth Care Innovation

5. Institute forHealthcare Improvement6. JointCommission CenterforTransformingHealthcare

7. KaiserPermanente:Garfield Innovation Center

8. Mayo Clinic:CenterforInnovation9. UCLA Health:Institute forInnovation in Health

10. SutterHealth:The David DrukerCenterforHealth SystemsInnovation

01

02

03

04

06

D e s i g n - l e d

Proce

Figure5. 2x2 axisof approachesto transformation. Identifiesinstitutionsthusedesign-led versusprocessimprovement practices. Author’simage.

Project Positioning


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j g

Positioning:Regional Health Care Systems

Figure 6 plotsthe relative size of the health care company

compared to the numberof transformation supportstaff andstrategiesevidentin the business.

1. AscensionHealthAscension Health isthe largestCatholic, not-for-profithealth

systemin the St.Louisregion.Based in St.Louis,Ascensionhasfacilitiesthroughout the country.A transformational

developmentteamis charged with initiatingclinical innovations(https://www.ascensionhealth.org).

2. BJCHealthCareBJC HealthCare isaregional health systemin the St.Louisarea

with 14hospitals.They have aCenterfor Clinical Excellence thatischarged with supportingtransformation atall levelsof the

organization.Theirmission is to improve clinical care throughinnovation sciences (http://www.bjc.org).

3. Blessing HealthSystemBlessingHealth Systemis afor-profit systemwith sixfacilities

in the Quincy,Illinoisregion. They do nothave transformationalorinnovation supportagentsor teamsaspart of theircorporate

structure (http://www.blessinghealthsystem.org).

4. CoxHealth

CoxHealth isa health care systembased in Springfield,Missouriwith five hospitalsunderitsmanagement.CoxHealth does

nothave an internal structure for supportingcompany-widetransformation or innovation (http://www.coxhealth.com).

5. MemorialHealth System

Memorial Health Systemisa Midwestnot-for-profithealth systembased in Springfield,Illinoiswith seven hospitals.The systemlacksa transformation supportstructure;however,a teamof

individualsare charged with transformational change within theleadership structure (https://www.choosememorial.org).

6. Saint Luke’s HealthSystem

SaintLuke’sHealth Systemisa not-for-profitorganization thatincludes10 hospitalsacrosst he KansasCity region.Itdoes nothave astructure fortransformation beyond afew employeeswho

supportthe practice internally and often hire external experts(http://www.saintlukeshealthsystem.org).

7. SouthernIllinois Healthcare

Southern IllinoisHealthcare isanonprofit,three-hospitalsystemin Southern Illinois.The organization doesnothave atransformational change supportteam, nordo any individuals

within the organization have atitle suggestingthis type ofactivity (http://www.sih.net).

8. SSMHealth

SSMHealthis aCatholic,not-for-profithealthcare systembasedinSt.Louiswith 18hospitalsandaffiliationswith40 ruralhospitals.Theorganizationsupportstransformationthroughsenior

leadershipandotheremployeeswhoare chargedwithclinicaltransformationandinnovation(http://www.ssmhealth.com).

O r g a n i z a t i o n S i z e

TransformationSupport

High

Low

Low High

01

02

03

04

05

06

07

08

Figure6. 2x2 axis ofregional healthcaresystems. Identifieshealth caresystemswith transformational support staffaspart oftheirorganization. Author’simage.

OpportunityArea

An opportunity areaexistsfor supportingtransformational

change forsmallerhealth care systems.A toolkit may provide asolution to supportteamsthat do nothave staff dedicated to thetransformation process.

Zag Steps

1:Who amI? MergeCare isa strategicmethod forsupportinginstitutional healthcare managersduringch ange initiatives.

2:Whatdo I do? The purpose of MergeCare isto supporthealth care managersand designersthrough a combination of design-led and processimprovementphases and stepsto plan,ini tiate,and sustain change.

3:Whatis my vision? The vision of MergeCare isto empowerhealth care professionalswhenfacilitatingoperational changes today and in the future through amixed-method approach.

4:Whatwave amI riding? Health care lookingto design forinnovation.Processimprovement strategieslack innovation.Processimprovement strategieslack ahuman-cen tered approach.Need to reduce health care costsand errors.Pressuresto improve health outcomes.

5.Who sharesthe brandscape? Large health care systemsthat incorporate design-thinkingstrategiesinto theirmanagement structures,change managementconsultingfirmswith established practices,and think tankswith methodsthatincorporate human-centered design to supportchange.

6.Whatmakes me the only me? MergeCare isthe only design-led and processimprovement strategythatwas created to supportchange for US-based institutional healthcare managersand designers who seek to collaboratively improveoverall operational and patientoutcomesin an era when both large and

small systemsneed new waysto lowercostsa nd manage resources.7.Whatshould I add orsubtract? MergeCare will continue to add the bestmethods thatstrengthen its

offeringsto institutional health care professionals.

8.Who lovesme? Health care managerswho need new strategiesto align teammembersand stakeholders,and designers who are seekingto facilitate betterrelationshipswithin complex institutional health care environments.

9.Who’sthe enemy

10.Whatdo they ca

11.How do I explain

12.How do I spread

13.How do people e

14.Whatdo they ex

15.How do I earn t

16.How do I extend

17.How do I protec

Table11. Zagsteps.

Project Positioning


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Placeholder

32

Value Proposition

MergeCare is for institutional health care managers and designerswho need to support change in complex functional and operationalenvironments. Our strategic approach integrates an intuitive and logicalprocess for evaluating, understanding, and implementing changeinitiatives. We do this by facilitating a set of design-led visual sessions thatclarify opportunities, imagine futures, and codify processes for participantsto implement. Unlike other change strategies that are primarily data-driven,

our approach is based on research that revealed an opportunity to combinea human-centered design and process improvement methods to delivergreater outcome and adoption success. As a result, health care professionalsare better equipped to facilitate innovative change programs becausepeople are at the core of our strategy.

Onliness Statement

MergeCare is the only design-led and process was created to support change for US-based inmanagers and designers who seek to collaboroperational and patient outcomes in an era wsystems need new ways to lower costs and m

Design-Led:Human-CenteredDesign

Figure7. Venn diagram ofnewprocessintdesign management and Lean SixSigmato suggest anewmodel. Author’simage.


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Research Activitiesand Synthesis


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36

Research Methodology

The methodology for this research

was a qualitative case study.

Thisapproach wasappropriate fora numberof reasons.Thecase study focused on two subjectgroups:health care designers

and health care managersat variousjob levels.The case wasbounded by two large institutional health care systems in whichthe two subjectgroupswork. The method facilitated exploring

phenomenon within the bounded areasin order to understandthe subjects’opinionsaboutoperational logistics,successes,

challenges,opportunities,and currentprocessesused to achievetransformational change.

Research Questions

Primary

Howmightthe applicationofdesignmanagementmetho

supporttransformationalchangewithintheinstitutionalcaresector?

Health CareDesigners

(MArch, ID, GD)

Health CareManagers

(MD, MBA, MHA)

Transformational

Change

SixSigma

LeanSix Sigma

TQM

Design

Thinking

Human-Centered

Design

DesignManagement

People&

Process

People&

People

People&

Buildings

Bucolo,Wrigley,& Matthews(2012)a xe a a r c o 2 1 3

runden & Hagood (2012)

o c wo o 2 9 2 9

LUMA Institute (2015)o ne s 2 1 3

a xe a a r c o 2 13

Research Space

Institutional

Health CareSector

The research space wasdefined asthe intersection of health care

designers,health care managers,transformational change,andinstitutional health care.Figure 9 identifiesrelevant literature andassociated concepts.

Figure9. Research space. Identifiesthreeareasofinvestigation and literaturerelevance. Author’simage.

a og u n a e y 2 1 4e r 2 1 2

m a z , a m a m ur y , garwa 2

chroeder,Linderman,e e, oo 2

chroeder,Linderman,e e, oo 2

o Lean SixSigma(2012)

u er y 2Parameswaran,Raijmakers(2010)

o a ns so n- ö er g, o o a , e n a ya 2 1 3c o rn cn e e r 2 1 2

ar n 2 9

erry (2004)e rr y e m an 2ohmer(2009)

rs ensen 2o ne s 2 1 3a m , Z mr n g, u z

u c e r 2 1a n s, o e a , e av ey ,T o ma s, y on , 2 1 1 .

Types of interactions that impact change

Outsideof ResearchSpace

HealthCareInnovation

DecisionMakers/

Managers

HospitalAdmins

GraphicDesigners

Arch &Interior

Designers

UX/IxD

HealthCare

ConsumerSector

HealthCareClinical

PracticeSector



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Consent Forms

Research ProjectExplanation

The followinginformation providesan introduction to the “Health De signer:A strategy to supportchangresearch projectto be conducted in St.Louis,MissourifromJanuary 20 15 to April 2015.

ResearcherBioEnrique Von RohrisaDesign Managementgraduate studentatthe Savannah College of Artand Designresearch constitutesthe final projecttoward amaster’sdegree.Von Rohrcurrently teachescommunicatdesign and ispartof the administration atthe SamFox School of Design and Visual ArtsatWashingtonUniversity in St.Louis.The projectisbeingconducted outside of hisrolesatWashington University.

Purpose of the StudyThe purpose of thisstudy isto understand how mightthe application of design managementmethodolosupporttransformational change within the institutional healthcare sector?

Sub-QuestionsThe research will be guided by the followingsub-questions:Whatare successesof the institutional healthcare sector? (1IH)Whatare challengesforthe institutional healthcare sector? (2IH)Whatisthe definition of transformational change in the contextof institutional healthcare? (1TC)Whatare the techniquesused to fostertransformational change? (2TC)How istransformational change sustained in institutional healthcare? (3TC)Whatare managementmethodsused in healthcare? (1DM)Whatisthe definition of design managementin the contextof institutional healthcare? (2DM)Who are leadersof design managementactivity in healthcare? (3DM)

DataCollection MethodologyDatawill be collected primarily through interviewsand secondary sources.These will include designprofessionalsattraditional firms,designerswithin healthcare settings,aswell asinstitutional healthcaprofessionals.Additional secondary research in literature reviewswill be conducted to evaluate bestprand trendsof how design and design managementisbeingused in non-traditional ways.

DataManagementAll datawill be anonymized duringfinal production of the research results.Individual interview datawistored on two external hard drives,all of which will be erased afterone yearof the interview date.

ContactInformationThisprojectisbeingconducted through the Design ManagementProgramatthe Savannah College of ADesign.Foradditional information please contactProfessorReginaRowland,Ph.D.at rrowland@scad.

Pre–Interview DiscussionFigures10 and 11 concern the ResearchProject Explanation andInformedConsentForm .

The pre–interview discussion structure isoutlined in Table 13.

Table13. Pre–interviewdiscussion steps.

Step Time Interviewer Subject Supplies

1 3 min >Give subjectthe ResearchProjectExplanation and read each partwithsubject. >Explain thatthey can keep thiscopy.

Listen/Review Envelopewith forms

2 2 min >Give subjectthe InformedConsentForm and read each partwith thesubject. >Requestthatthey sign the formattheend. >Retrieve the formand place inenvelope.

Listen/Review Envelopewith forms

Figure10. Research project explanation. Sampleoftheformused to discussthenatureofthe project with subjectspriorto theinterview. Author’simage.

Research Questions Matrix

S ub -Q ue st io ns W ha t d o we ne ed toknow?

Why dowe need toknowthis?

What kind of datawill answerthequestion?

Where can Ifind thisdata?

What type of datacollection methodswill be used?

Whodowecontact?

When doweneed toknow?

What are welearning?

What might we bemissing?

1.Whatare the successesinthe institutional healthcare sector?

Whatisworking? Whatdoesitlook like? How doesitwork?Actual programsthathaveworked.

To learn fromgood examplesto apply to others.Can itbereplicated? If so,how and howmightDMGT supportit? Setcontextforsuccess.

Listof case studiesorprojectsthatare workingwell.

>Institutional health careprofessionals >Secondary research

>Interview >Unique method >Secondary research

>Subject1 >Subject2 >Subject5 >Subject7 >Subject10

> E nd of un i t3 W ha td oe sr ea l su cc e sslook like forinstitutionalhealth care so thatwemightincorporate itintothe productto market.

Nothavinga largeenough sample size.Whatisreally bigversusjust aspecificdepartment.

2.Whatare the challengesin the institutional healthcare sector?

Whatisnot workingwell? Arethere clear,bigproblemsthatare system-wide? Are theyobservable or understandable?

To know if there is consensuson the typesof challengesthatpeople see in thisspace.

Listof large-scalechallenges.Storiesofdaily problemsthatkeeprecurringthatare partofthe largerchallenge.




> E nd of u n it3 F un da m en tal c h al l en g esin thisspace.

Otherchallengesthatmightnotseemlarge atfirst,butdo contribute tosystemicchallenges.

3.Whatis the definition oftransformational change inthe contextof institutionalhealth care?

How isthe termunderstoodand whatare some examples?Isthissomethingthat hindersbroaderhealth care progress?

To understand if the subjectsview transformational changeasan actual function of theinstitution.

Descriptionsofsignificantchangesthathave occurred in theorganization.

>Institutional health careprofessionals >Designersin health carepractices



> E nd of u n it3 U nd e rstan di n g of“transformationalchange” by designersandhealth care managers.

Examplesin the healthcare space thatareof asufficiently largescale to be deemedtransformational.

4.Whattechniquesare usedto foster transformationalchange?

Whattacticsare used to startand sustain change? Are therespecifictypesof tools?

To gain a deeperunderstandingof the toolsand stepsthatleadto transformational change.Who leadsthis?

The exacttype oftechniquesorsystemsused,such asLean orSixSigma.




> E nd o f u ni t 3 T ec hn iq ue s fo rtransformational change.

Transformational changemay be acommonmethod acrossallorganizations.

5.How istransformational

change sustained ininstitutional health care?

Effective activitiesoractions

to sustain change.Whatarethe barriersto change?

To know how sustainable long-

termchange is.Whatneedstobe overcome?

Tacticsthatsupported

the long-termchange.

>Institutional health care

professionals >Secondary research

>Interview

>Unique method >Secondary research

>Subject1

>Subject2 >Subject5 >Subject6 >Subject4

> E nd of un i t3 I f th er e a r e a n y

barriersto enactingtransformational changeprograms.

Insightfromthose

atthe very top of theorganization.

6.Whatmanagementmethodsare used in healthcare?

Isanythingunique abouthealth care and theapplication of designmanagement?

To compare againstwhatmightbe deemed as “traditional”managementprocesses.

Specificexamplesorprojectsthatmighthave used adesignmanagementprocess.




> E nd of un i t3 A p ossib l e d ee pe rconnection betweendesign managementandhealth care.

There may be no uniquemethod forhealth care.

7.Whatis the definition ofdesign managementin thecontextof institutionalhealth care?

Whatdoesadesign processreally look like foraffectingchange in institutional healthcare?

To know if people are alreadydoingsimilarthings.To knowwhatthe differentsubjectsconsiderto be adesign process.

Specificdefinitionsandexamplesof designprocesses.



>Subject3 >Subject4 >Subject11 >Subject12

> E nd of un it3 T h e p er c ep tion of th erole orneed fordesign ininstitutional health care.

Subjectsmay notknowDMGT,asitisayoungfield.

8.Who are leadersof designmanagementactivity inhealth care?

Who are the leadinginstitutionsorgroupsusingdesign to drive bigchange inhealth care?

Are there unique leadershipskillsthatcould be supportedby aDMGT process? Who outthere isdoinga greatjob?

Published informationand articlescitingthesuccessof the groups.

>Designersin health carepractices >Online datamining >Contactfromliteraturereviews



> E nd of u n it3 W ho a re c on sid er e dleaders? Whattoolsare they usingto affectchange?

Smallergroupsthatarenotwell published due toproprietary information,which isacommonchallenge in health care.

Table12. Sub-question matrix.

PrimaryResearchQuestion:

Howmightthe applicationofdesignmanagementmethodologiessupporttransformationalchangewithintheinstitutionalhealthcaresector?



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Research Protocol: Interview Card Sorting Exercise

DesignProcess

TransformationalChange

ManagProc

B ui ld E va lu at e

C on ne ct Fo st er

D et er mi n e M ob il iz e

Encourage

R e co g ni z e T r an s la t e

Weave

U nd er st an d

Communicate

M on ito r

Clarify

B al an ce

Discover

Define

Develop

Explore

Iterate

Play

Visualize

Synthesize

Draw

Implement

Card Sorting Unique Method

Thisunique method wasadapted froma 2013study by MillerandMoultrie.They called ita “card sorting” method and theirstudy

focused on understandingthe skills of UKfashion industry leadersthathad “design” in theirjob titles.This card sortingadaptationevaluated subjects’understandingof design,management,and

transformational change by providinga collection of words(Figure 14)identified fromliterature reviewsrelated to these three

areas.The intentwas to capture subjects’personal associationswith activitiesin the contextsof their jobsand how they rated

theirstrengths in each (Figure 15).

The card sortingstructure is outlined in Table 15.

Table15. Card sort steps.


1 2 min >Place materialsin frontof subject. >Place page in frontof subjectwithwordsrandomly arranged to the left. >Ask subjectto arrange wordsnextt o

the word “Me” based on how oftenthey do thattype of activity. >State thatthey have 5 minutestocomplete thiswork. >Additional “blank” cardsare providedin case there are otherwordstheywould like to add.

>Watch andlisten

Envelopewith 11x17paperandwords

2 5 min >Watch and documentany type ofcommentsubjectshave in the process

>Arrangewords

NA

3 2 min >Once done,tape all wordsin place. >Then ask subjectsto rate on ascaleof 0–10 how well they think theyperformeach one of the activities. >State thatthey have 5 minutestocomplete thistask.

>Watch andlisten

Tape andpen

5 5 min >Watch >Label wordson ascale of0–10

Figure14. Card sort words. Ten wordsareidentified in eachcategory. Only ten minutesarealloted forthisactivity. Twoblank cardsareprovided in theevent asubject would liketoadd to thecollection. Author’simage.

Research Protocols: Interview Questions Field Notes Form

Interview Questions: Field Notes

TargetSubject: Designer

Record the followinginformation fromeach interviewee.

Inter vi ewer __________________________

Interviewee __________________________

Date/Time __________________________

Company Name __________________________

A ddr es s __________________________

UnderstandingRoles1. Tell me alittle aboutyourrole and how longhave youbeen doingthistype of work?

2. Tell me aboutyourbackground thatled to an interestand work inhealthcare?

Institutional Health care Sector(IH)3. Whatkindsof thingsdo youthink are workingwell in healthcare? (1IH1)

4. Are there particulartypesof healthcare challengesthatyouhave found difficultto solve? (2IH1)

5. Whatprocessesdo yousee people usingto solve complexoperational functionsin healthcare? (2IH2)

Transformational Change (TC)6. How would youdescribe some large changesthathave occurred forsome of yourclients? (1TC1)

7. How do yousee large change projectsidentified and started foryourclients? (2TC1)

8. Are there specificmetricsorreasonsthatmustbe metto initiate large changes? (2TC2)

9. How are projectsfacilitated? (2TC1)

10.Are there communicationsortoolsyou observe to be effective insupportinglarge change? (3TC1)

11.Whatkindsof barriersto sustaining change overtime have youobserved? (3TC2)

Design ManagementMethodologies(DM)12.Whattypesof processor managementtoolsare used in yourwork? (1DM1)

13.Are there toolsyouthink work betterthen others? (1DM2)

14.How would youdescribe the design process? (2DM1)

15.In whatwaysdo youthink yourwork followsthat design process? (2DM2)

16.How are innovative or“outof the box” type projectsstarted in healthcare and who leads them? (3DM1)

Interview

Figures12–13 representthe Interview Questions Guides.Theguidesincluded space forsubject name,date,time, and location

where the interview occurred.

The interview discussion structure isoutlined in Table 14.

Table14. Interviewdiscussion steps.


1 35min

>Turn on recorder >Settimer >Begin to ask questions

R es po nd E nv el op ewithInterviewQuestionsguide

2 1 >Instructsubjectthatthe interview partisdone and we will now do aquickexercise. >Place Interview Questions notesintoenvelope.

NA Envelope

Figures12–13 . Interviewquestionsfield guide. Pageswithquestionsused duringsubject interviews. Author’simage.



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Data: Card Sort by Subject TypeS ub j ec t T yp e H D H D H D H D H D H D

Subject # 3 4 6 9 11 12

Code Word Total Av

DP P lay 4 5 4 2 8 6 29 4.8

DP Draw 4 1 8 10 6 6 35 5.8

DP Discover 2 5 3 9 8 8 35 5.8

DP Define 2 5 10 8 6 6 37 6.1

DP Iterate 2 8 7 8 7 8 40 6.6

DP Explore 9 5 3 6 9 10 42 7.0

DP Develop 9 10 6 9 4 6 44 7.3

DP Implement 7 10 6 9 5 8 45 7.5

DP Visualize 7 8 7 7 9 8 46 7.6

DP Synthesize 9 5 8 9 10 8 49 8.1

S ub -To ta l 5 5 6 2 6 2 7 7 7 2 7 4 4 02

MP Structure 2 5 2 6 4 8 27 4.5

MP Balance 9 1 2 8 4 4 28 4.6

MP Budget 4 10 1 5 4 4 28 4.6

MP Ensure 7 5 6 8 3 4 33 5.5

MP Monitor 7 5 5 9 4 6 36 6.0

MP Negotiate 4 10 5 5 6 8 38 6.3

MP P lan 4 10 2 9 7 6 38 6.3

MP Understand 2 8 9 9 8 6 42 7.0

MP Communicate 7 10 9 10 10 6 52 8.6

MP Clarify 9 10 9 8 10 8 54 9.0S ub -To ta l 5 5 7 4 5 0 7 7 6 0 6 0 3 76

TC Determine 2 5 8 5 1 2 23 3.8

TC Foster 2 5 1 7 3 8 26 4.3

TC Mobilize 4 10 2 9 3 6 34 5.6

TC Build 4 10 6 4 7 6 37 6.1

TC Encourage 2 8 2 7 8 10 37 6.1

TC Weave 7 8 7 7 4 6 39 6.5

TC Connect 2 5 8 9 10 6 40 6.6

TC Recognize 9 5 8 7 8 6 43 7.1

TC Evaluate 9 8 4 8 7 8 44 7.3

TC Translate 9 5 9 8 6 8 45 7.5

Su b-To ta l 5 0 6 9 5 5 7 1 5 7 6 6 3 68

Table16. Card sortingresearch datafor health caredesigners.

Overview

Table 16 representsall datafrom the “health care designer”subjects.Datais sorted accordingto design process(DP),

managementprocess(MP),or transformational change (TC).Table 17 representsdatafrom the “health care manager” subjects

and all datawassorted in the same way asTable 16.

Insights

Sortingthe datarevealed that health care designersandmanagershad the conceptof synthesizein common when looking

atthe top 2 words. Thisword wasassociated with the “designprocess.” Forthe “managementprocess,” the common words

between the two subjecttypes were communicateand clarify .For“transformational change,” the common word was translate.

The wordsthatscored highestwere synthesize , communicate ,clarify ,and translate.The wordsthat scored the lowestwere the

same within each group: play , draw , balance , structure , determine ,and foster .

Research Activity

Overview

The research wasconducted overa two-week period fromJanuary 19 to 30,2015.A total of 6 designersand 6 managerswere

interviewed attwo St. Louishealth care companies.The designersand managersranged in role type and level,butall had either a

creative or managerial role supportingtransformational change,innovation and large scale projects.All subjectswere responsible

forsupportingchange initiativesin theirorganizationsatvariouslevels.The interviewswere conducted within aone-hourtime frame.All interviews were recorded and transcribed upon

completion.Photographswere taken of the subjectsduringthesigningof the consentforms and duringthe card sortingactivity.



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S u bj e ct T yp e H M H M H D H D H M H D H M H M H D H M

Subject # 1 2 3 4 5 6 7 8 9 10

Code Word

MP Balance 5 2 9 1 6 2 2 8 8 2

MP Structure 6 2 2 5 0 2 5 8 6 5

MP Budget 6 2 4 10 3 1 5 5 5 5

DP Play 1 8 4 5 6 4 8 4 2 2

TC Determine 3 3 2 5 10 8 9 7 5 6

DP Draw 2 4 4 1 9 8 2 8 10 2

DP Define 5 5 2 5 7 10 2 7 8 2

TC Foster 7 5 2 5 8 1 7 5 7 7

MP Ensure 7 1 7 5 9 6 7 5 8 5

MP Monitor 4 3 7 5 7 5 9 6 9 3

TC Build 8 7 4 10 8 6 4 6 4 6

DP Discover 4 8 2 5 8 3 9 5 9 8

TC Weave 6 8 7 8 8 7 3 5 7 8

DP Develop 6 9 9 10 0 6 9 5 9 5

TC Mobilize 8 5 4 10 9 2 8 8 9 7

MP Negotiate 7 2 4 10 8 5 10 10 5 5

TC Recognize 4 8 9 5 5 8 7 6 7 7

TC Evaluate 5 6 9 8 8 4 8 8 8 3

MP Understand 5 6 2 8 7 9 7 8 9 8

DP Explore 3 8 9 5 9 3 7 8 6 7DP Visualize 3 8 7 8 10 7 8 5 7 4

MP Plan 7 7 4 10 1 0 2 8 9 9 7

TC Encourage 6 8 2 8 10 2 10 6 7 10

TC Translate 3 7 9 5 7 9 8 10 8 7

DP Iterate 7 9 2 8 10 7 10 5 8 10

TC Connect 8 9 2 5 10 8 10 8 9 9

DP Synthesize 5 8 9 5 7 8 9 7 9 10

MP Clarify 2 5 9 10 10 9 10 9 8 6

MP Communicate 5 6 7 10 10 9 10 10 10 6

DP Implement 9 7 7 10 10 6 10 10 9 10

HD Totals 160 205 167 225

HM Total s 157 176 229 221 211 18

Data: Card Sort all Data

Table18. Card sortingresearch data.

Overview

Table 18 showsall dataentered, based on how the subjectsnumbered each word duringinterviews.Subjects were firstasked

to place the wordsin proximity to the word “Me” based on howoften they did thatwork in theirjobs. Subjectswere then asked to

rate on ascale of 0–10 how they thoughtthey supported changethrough the wordslisted on each circle.The datais sorted based

on the average totalsfromlow to high.

“HM” indicateshealth care managersand “HD” noteshealth care

designers,all workingwithin two large health care systems inSt.Louis, Missouri.A total of 6 designersand 6managerswere

interviewed.The codeswere “MP” formanagementprocess,“DP”fordesign process,and “TC” for transformational change.

Insights

A review of the datarevealed thatthe most common activities

forall subjectswere visualize , plan , encourage , translate , iterate ,connect , synthesize , clarify , communicate ,and implement.This

suggeststhat,on average,these wordssupport change in thesubjects’activities.

Health care professionalsscored atotal of 30 pointshigheroverallthan designers.Thissuggeststhathealth care managerswere

more engaged in change within theirjobsthan designers.

Analysis: Synthesis by Subject Type

– +How welldoyou thinkyou support changethroughtheseactivities?

VisualizeSynthesize ImplementPlayDraw DesignProcess

C om mu n ic a te C la r if yBalance Structure

E va lu ate C on ne ctTranslateFosterDetermine

UniquetoHealthCareDesigners

UniquetoHealthCareManagers

Overview

Figure 16visualized 6 wordsin common between health caredesignersand managersthatranked low on how well the subjects

believed they do these thingsin supportof transformationalchange.Fourwords representingwhatsubjectsbelieved they do

well in supportof change rose to the top of the scale.However,2unique wordsranked high for designerscompared to managers.

Insights

Figure 16clarifiescommon challengesfor both health care

designersand managers.It wasrevealingthat the same wordsexisted forboth subjecttypes. Thisinsightmay informstrategies

to help designersand managersachieve these activitieswhenleadingchange type activities.

The visualization also helped identify the top common strengthsfordesignersand managerswhen supportingchange.In addition,

there were unique wordsforeach subjectt ype – visualizeandevaluatefordesignersand implementand connect formanagers.

Figure16. Visualization by subject type. Thisfigureidentifiesboth common strengthsaswell assomeuniquequalitiesfordesignerscompared with managers. Author’simage.


Management Process

DesignProcess

ManagementProcess


LEGEND


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C d S t D t D i & MC d S t D t M


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48

Card Sort Data: Designers & Managers

n s r u c i on s pr ovi e o s u j e c s :Step 1: Arrange wordsin proximity to “Me”

a se on ow o e n you o a yp e o a c v yin yourjob.The closerto “Me” the more youdo

a y pe o a c v y n y ou r o . 5 m nStep 2: On ascale of 0–10 how well do youthinkyou su p por c a n g e r ou g e se a c v e s.(5 min)There are two blank cardsif there area o na n gs y ou o a yo u e e a reimportantto include.

Insights

Figure 22 isa composite of all subjects’card sortingactivities.Lookingat the placementof the wordsin Figure 20 and Figure 21

revealed some differencesbetween health care designers andmanagersin institutional health care environments.

Designersappearto do lessactivity in theirjobs compared to

whatthey believe contributesto change in theirwork.Thisreflectsa disconnectbetween theirability to supportchange andthe amountof time they spend doingthatactivity in theirjobs.

Managersappearto do more activity in theirjobsthat isequally

reflective of supportingchange.The similarity in amountoftime and ability suggeststhey may be more invested in change

activitiesfor theircompany.

Figure22. Compositeofall subjects’card sort results. Thevisualization layesubjects’card sort exercisesonto oneimageand identified thetop wordsfrowith thecorrespondingcolor. Author’simage.

Card Sort Data: Managers



a y pe o a c v y n y ou r o . 5 m nStep 2: On ascale of 0–10 how well do youthinkyou su p por c a n g e r ou g e se a c v e s.(5min)There are two blank cardsif there area o na n gs y ou o a yo u e e a reimportantto include.

Overview

Figure 21layersthe 6 managersubjects’card sortexercises ontoeach other.A filterwas applied to each in orderto see asmany of

the wordsas possible,aswell as to identify density and proximityto “Me.” In addition,the top 3 words identified in Figure 16 were

layered in to help explore any related trends.To build thismap,subjectswere asked to place each word in proximity to “Me”

based on how often they did thattype of work in their jobs.Indoingso, abaseline of common job activitieswere identified foreach of the subjecttypes.

Figure21. Compositeof6 managers’card sort results. Thevisualization layers6 healthcaremanagers’card sort exercisesonto oneimageand identified thetop wordsfromFigure16 with thecorrespondingcolor. Author’simage.

DesignProcess

ManagementProcess


LEGEND


Card Sort Synthesis: Amount vs AbilityCard Sort Data: Synthesis


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Card Sort Synthesis: Amount vs. Ability

Iterate

Translate

Budget

Play Draw

UnderstandPlan Communicate

Amount:Averagelocation ofactivity relativeto “Me.”

Farther = Less activity Closer = Mote Activity

A

Insights

Figure 24 illustratesacoupleof interestingrelationships

between amountof activityand ability. Communicateand

translateare activitiesthat bothdesignersand managersdo

more often in theirjobs.Thesewordsalso gethigh marksforsupportingchange.

Atthe opposite end, play and

draw are done the least and donotsupport change well. Iterate

wasthe only word designersandmanagersboth do more often;however,it wasnot an activity

they believed supported change.

On average,subjectsillustratedthatthese activitieswere done

the leastamountin theirjobs.

On average,subjectsillustratedthatthese activitieswere done

the mostamountin theirjobs.

Onbe

lea

Figure24. Synthesisof card sort relationship ofamount and ability. Theillustrationrepresentstheamount oftimesubjectsspend on an activity in their jobsand theirabilityto makea connection between activities. Author’simage.

Card Sort Data: Synthesis

Understand

Plan

Play

Foster

Build

Translate

Iterate

Draw

Me

–

+



a y pe o a c v y n y ou r o . 5 m nStep 2: On ascale of 0–10 how well do youthinkyou su p por c a n g e r ou g e se a c v e s.(5min)There are two blank cardsif there area o na n gs y ou o a yo u e e a reimportantto include.

Insights

Figure 23illustratessubjects’average placementof wordsinthe card sortingexercise.The placementrepresented how often

subjectsdid an activity in theirjobs. Wordsplaced closerto “Me”reflected thatsubjectsdid thatactivity more;conversely,words

placed fartheraway represented less.

More subjectsplaced the words communicate , understand ,andplan closerto the center. These 3 wordswere in the top 15 wordsthatrepresented subjects’ability to supportchange.It suggests

astrong connection between ability and amountof time spentdoingthat activity,potentially identifyinga good setof attributes

to support. When lookingatthe second setof top 3 closestwords,we see 2unique words, translateand iterate ,which are associated

with design and transformation.All other wordsare associatedwith management.

More subjectsplaced the words budget , draw ,and play fartherfromthe center. These were also in the bottom15 words,thus

suggestingacorrelation between lower ability and lessamount

of time spentdoing these activities.However,it doespresentanopportunity to evaluate if these representactivities thatmightsupportchange in otherways.

Figure23. Synthesisofcard sort map. Displaysthe 6 wordsmost frequently placed closeto “Me” and the6wordsmost frequently placed fartherfrom “Me” by subjects. Author’simage.

DesignProcess

ManagementProcess


LEGEND

Communicate

Budget

Structure

Clarify

H o w o f t e n d o y o u d o t h a t t y p e o f a c t i v i t y i n y o u r j o b ?


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Interview Synthesis: Challenges

“It’salwaysplayingthestandardsagainst theindividual needs.”

“Anythingthat comesdto individual behaviojust really hard.”

“Thosethingswith crossoverboundariesarethe hard onesto solve.”

“Thepayment modelsand structuresare nottotally aligned yet withthebehaviorsthat youwould want to seethatwould eventually result

in theoutcomesthat youwould want to happen.”

“When you’reinbetween spacesorthey need to bringmultiplethingsto bearon aparticularpatient’sissue, that’swheretheydon’t work so well.”

“All ththattowresp

Insights

Insightsaboutchallengesreflected a very large spread in theissues.Comparingcommentsto the card sortingexercise showed

thatcommunication isan underlyingchallenge acrossall areas.There seemed to be aconstantneed to better understand what

all the differentareasare doingand how to better coordinatetheiractivities. The complexity of problemsbeing solved seemed

to constantly pointto the need forbetter communication andcoordination.Examplesof thisincluded electronic medical recordsystemsand simply makingdecisionsaboutpatients. There wasa

sense thatmuch of the knowledge isthere, butgettingit all in oneplace isachallenge.

In addition,the health care sectorseemed to be lookingoutward

forsolutions. Subjectsare notonly willingto use new ideas,butthey are actively goingout and lookingat otherdisciplinesforknowledge.Thisinsight wasalso reflected in the earliermarket

analysisand the breadth of organizationsin health care thatareusinginnovation toolsto re-engineer how they are operating. Chall

Interview Synthesis: Working

“I think very old paradigmsarebeing challenged.”

“Transparency is anothergood thing.”

“I think aswe’removingmoretowardsafocusonpopulation healthmanagement.”

“Health careworkersdo an amazingjob atworkarounds.”

“Lookingat patientcenteredoutcomesishugenotjust patient

reportedoutcomes.”

“Slowly but aremovingfrom areactivemedicalapproachinto moreof a

preventativepublichealthapproach.”

“I think what isworkingisthat we’realwaystrying toimprovetheforms to supportthefunction, so wespendalot oftimeaskingpeoplehowthey do theirworkand learningtheprocesses,and engagingthe coreunderstanding.”

“I think that outcomescertainly havegotten much betterover theyearsand I think thevoice ofthe customerfocus, we’vehad alot of that asatrendy term about fiveyearsago, andI think we’restill seeingthat maybeinfamily centered care. ”

“I think that health careisbecomingmore nimbleinapplicationsofnew ideasand new treatments.”

“Fundamentally, whathappensin theinpatientroom and theinpatientunit isreasonably goodexperienceformost folks. ”

“We’rereally good at treatingdisease.”

Figure25. Quotationsfrom subject interviews. A selection ofquotesaboutworkingactivity in institutional health care. Author’simage.

Insights

Insightsfrominterviews reflected thatsubjectsbelieved thepeople who are in health care are committed to their jobsand

wantto do well. Patient-centered outcomestopped the mindsformany in partbecause of federal regulations.In addition,there

wasa focuson preventive care asopposed to reactive medicine.The scrutiny hasalso led to more transparency in many of the

organizations’operations.

Subjectsalso expressed agreaterwillingnesson the partof their

organization to adoptnew ideasin orderto solve some of thechallengingissuesfacinginstitutional health care systems.There

wasa culture of constantprocessimprovement.


Health CareManagers

LEGEND

Working


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Interview Synthesis: Design Process

“Design pourorgaseemsadisjointin silos.”

“I think theprocessimprovement pieceand havingthoseworkshopswith theright peopleis important.”

“I think that thedesignprocessisfinding thewayto best utilizetheresourceavailableto support theneedsand theworkflowthat needsto happen.”

“Youare readingbetweenthemassdata and thenbeingable to takethatproblem that younowidentified so clearly.”

“Itthwp

“So I would start by figuringout, definingtheproblem -I’velearned howimportantthat is.”

Insights

Mostsubjects identified the design processas aproblem-solvingprocess.Each had aunique way of describingitor adifferent

application to it,but overall,they all defined itas aproblem-solvingtool. Some equated itwith aprocessimprovementtool

and some used itfor more open-ended exploration of possibilities.

Des

Pro

Interview Synthesis: Barriers

“So thebarriersthat exist alot of timesisalot around theacceptance, so feelingownership orclear understandingof thechangeor thepotential impact ofthechange.”

“Asit relatesto the built environment, thebiggestbarrieris that thepeople that areinvolved inthebeginningare not thepeople that ultimatelyareusing thespaceso there’sno continuity orunderstandingon thepart ofthe peoplethat arecurrently livingin thespacehow thespacewasdesigned to function.”

“Adoption isahugething,yeah.”

“Thebarriersquestionisalwaystoughestbecausethere’ssomany levelsand they’reso strong.”

“Weseealotofturnoveri nthestaff.”

“So one bigoneisourturnoverrate. It seemslikewe can just get

peopletrained on an interventionand then wehavenewmanagement and newstaff. ”

“Turnover. It’sahugefactor.”

“Peoplejust beingset in theirwaysand not wantingtochange.”

“Whilewe’retrying to learn frommanufacturingindustry, we’renot great yetat learninghowto use daily improvementboards. ”

“Ifit’s somethingthey don’tthink about every day, it’sreally not goingto stick.”

“I think turf. Youknow,peopletryingto protecttheirturf, youknow. ”

“No onehasmoretimetodo newstuff.”

Figure27. Quotationsfrom subject interviews. A selection ofquotesaboutbarrierto sustainingchangein institutional health care. Author’simage.

Insights

Barriersto change for the organization were many.Turnoverwasa constantchallenge and wasa significantdisruptor.In

one case,asubject noted thatover40% of the participantthatinitiated aprojectwould no longerbe there when the projectwas

implemented.Many timesformulti-yearprojects the same peoplethatdesigned aspace would no longerbe there to move in.

A second large barrierto change wasadoptingthe idea.Whilemany identified teammeetingsas agood processto gain

alignment,there wasstill an acknowledgmentthatadoption wasdifficult.Otherc hallengesincluded available time to do work or

people beingset in theirwaysof doingthings.

Barriers


Health CareManagers

LEGEND


Persona: Sally

“Ourvision iscoming“It wasgreat to seethose financial numbersInterview Synthesis: Management Process


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y

Sally F.

Directorof Activation Management

Age: 31Hight: 5’– 6”

Race: CaucasianEducation: MBA, MPH

s s ginto focus.”

Figure31. Sally personaactivities. Anoverviewofthekindsof activitiesSally hasto do in herday-to-day job aspart ofherlarge-scalechangesupportfunctions. Author’simage.

Figure30. Sally persona. “Youngnurseorfemaledoctor” [Photograph], by P.Marcinski, n.d., Fotolia. Retrieved July7, 2014, from: http://us.fotolia.com/id/21540802

asg ea see se a a be sand knowwe areall on thesamepageabout howto proceed.”

E va lu at e D et er mi ne

BudgetBalance

PlayDraw

Needs Improvement

Overview

Sally isa recentaddition to alarge health care systemin the St.

Louisregion. She hasjustarrived fromCaliforniawhere she wasinthe health care businessmanagingoperationsfor athree-hospital

system.With an MBA and MPH and five yearsat herprior job,where she managed ateamof five people, she will now manage

atwenty-person teamfacilitatingthe openingof a200-milliondollarfacility forpediatrics.This will require all heracumen inunderstandinghow hospitalsof the future will need to run and

manage ateamcharged with documentingthe processandensuringall move into the new spaces.

Environment

Sally isworkingout of atemporary facility thatisoutfitted to

change once the projectis complete,so ithas alarge loft-likequality to it.While she overseesateam of twenty,there are over

one hundred people in thisspace, all very busy on variouspartsofthe project,so itis hard to focusat times.

Skills

Sally isago-getter. She isdirect and professional in her

interactions.She alwayshas to translate information froleadership meetingsto her teammembers.She connects

and isable to implementaroad map addressingaparticHerteam appreciatesherencouragementand ability to

iterate ateach step of the way.

Frustrations

Given the large scale of the new organization, it hasbeedifficultfor Sally to know how to prioritize.Her ability tocompetingopinionsof the variousstakeholdersis hard,

when there are strong-willed doctorsthatdo not wanttono foran answerand are stuck in theirways. She feelssh

really use some help with structuringhow bestto convinherideas will work.If she could only draw the ideas!

DesignPro

TransformaChang

ManagemProces

“Weusein ourdepartmentPlan-Do-Study-Act.” “SixSigma and DMAICis

definitely necessary onsomeprojects.”

“Makesurethat all oftheright peoplearetalkingto each otherI think isone.”

“Thelean and six-sigmablackbelt culturecameinto healthcare, so in essencethey arejust learningfrom otherdisciplines.”

“Nowthat alot ofthatperformanceengineeringisstandard in health care,everyoneislookingforthenext tools, so that iswhy wearelookingforothertoolsfrom otherdisciplines.”

“What wedo haveisstandard operatingprocedurein many ofthethingsthat wedo.”

“... peopleare nevergoingto becogsnor would weeverwant to treat themthat way.”

“Wehaverigidly defined protocolsthat arefollowednot just forscanning, but foreven just the treatmentofpatient information and treatment ofsubjectinformation, treatment of peopleensuringthat theyaregiving theirinformed consent.”

“Weareusingallthesethingsthatwehaveused inhealth careforavery longtimeand wearejustrunningin circlesit seemslike usingthesamestuff.”

“Becausewhat happensisthat person thenleavesand thenthere’sno, youknow,consistency. Thenextperson comesin. Well,

I want it to belike this.Well, that’snot what it’sabout. It’sabout tryingto setup theflowso thateverybody workswell.”

“...likesto haveevents,whetherit’san eventora2P, orsomekind ofLean orSix Sigmaevent,whereyou’reactuallyputtingtwo orthreeusergroupstogetherthat aresharingapatient.”

“...wewrotefourhypothetical patientexperiencesthat startedwith, there’sthephonecall to a woman at worklettingher knowthatherhusband had aheartattack.”

y g

Figure29. Quotationsfrom subject interviews. A selection ofquotesaboutmanagement processesto sustainingchangein institutional health care. Author’simage.

ManagementProcess


Health CareManagers

LEGEND

Insights

Processimprovementmethods were discussed frequently.Theseincluded Lean SixSigma,Plan-Do-Study-Act,and Define Measure

Analyze Improve Control (DMAIC).Variousproject managementtoolswere used,butnone stood outas overarchingbestoptions.

A few noted Human-Centered Design asan emergingtool to solvesome of theircomplexchallenges.Overall,many proceduresare

rigid with setprotocols; thus,there islittle roomfor deviation orinnovation around processorlarge changes.

One overarchingtheme wasthe need forteammeetings –repeatedly,often weekly – in orderto have continuousbuy-in for

processimprovementor fornew initiatives.


Research InsightsPersona: Tomas “Weneed anew“Weneed someways to“I need to figureout howto make“Focusingmoreon peoples’behaviorsand


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Insight 1

Health care turnover is a significant problem,often leading to stalling a project or shelvingit altogether.

Insight 2

Adoption and buy-in is difficult to mitigatehealth care because there are so many expstakeholders involved in one clinical settin

Insight 4

Health care is open to adopting new human-centered design strategies in order understandand improve operations and patient outcomes.

Insight 5

Health care managers and designers havedifferent skill sets and methods for solvingproblems, yet they are often tasked withimplementing large projects in collaborati

Tomas C.

Directorof Design Management

Age: 45Hight: 6’– 1”

Race: LatinoEducation: BFA, MA

processto worktogether.”

get peoplecomfortablewith change.”

betterconnectionsamong mycolleagues.”

habitsisgoing to bea betterway to solvesomeof ourchallenges.”

Clarify

EvaluateEvaluateE nc our a ge R ec ogn i ze

Negotiate

S ynth esi ze I m pl em e ntVisualize

Communicate

Translate

DesignProcess


ManagementProcess

Doing Well

FosterDetermine

BudgetBalanceStructure

Play Draw

Needs Improvement

Overview

Tomasisa native of St.Louis, Missouri.He received his

undergraduate education atPratt Institute in New York City.Upongraduation,he worked forasmall firm with large retail health care

clients,mostly consumerproductsfor Walgreens.Afterfifteenyearsat New York-areafirms,he returned home to work fora local

firm,continuingwith a health care focus.He then moved to theclientside, joiningan innovation teamat amid-size local healthcare system.He washired forhis graphicdesign skillsand because

he isa good visualizerof information.Much of hiswork had beenclarifyingcomplexsystems through information graphics.

Environment

Tomasworksin a corporate environmentcharacterized by typical

rowsof desksin a large open area.However,the company createdanew space called the “Design Tank” to begin exploringnew

processimprovementstrategiesfor theiroperations.

Skills

Tomasisa greatcommunicatorand useshis design skillsto

visualize and clarify complexconceptsor processesthatare partof the firm’soperations.

Frustrations

He isfrustrated with hisrole – he doesnotget to draw orplayasmuch asin priorroles. Thisis mostly due to the corporateenvironment,buthe hopes innovation will be fostered by the

seniorleadership once they see hiswork. He isfeelinga littlestuck in asystemwith people thatdo notwant to change orexplore new ideas.

Attitude

Tomashasa casual,low-key attitude,and nothingseemsto upsethim.When people startgetting emotional,he tellsa joke to createsome levity.He isgood atrecognizingdetailsabout people and

then evaluatingif itis bestto drop ajoke.

Typical Tasks

Atthe moment,Tomasis dealingwith whatmost designersconsider

superficial activities,i.e. justthe visuals.He wasbroughtin tobe partof largert eam,meetingaround strategy and improving

communicationsand operationsof the company,butit hasbeen slowgoing.His bossis achampion of hiswork and skills,but adoption from

otherswill be slow.

Need and Wants

Tomasfeelshe needsto weave hisway into amore robustrolewithin the company,to validate hisskill forlarger rolesthat leadto innovative waysof supportingpatients.He wantsto make a

difference in the livesof the people thatcome to the hospital.Heknowsthere are inefficienciesand people do notlike being there,so

he really wantsto supportchange.

Figure33. Tomaspersonaactivities. An overviewofthekindsof activitiesTomashasto do in hisday-to-day job aspart ofhis design managementsupport functions. Author’sImage.

Figure32. Tomaspersona. “Man on thewall”[Photograph], by Y. Poirier, n.d.,Fotolia. Retrieved July 7, 2014, from:http://us.fotolia.com/id/60940857


Research Findings


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Collective Strengthsfor Change

Synthesize CommunicateTranslate

Makesurethat all oftheright peoplearetalkingto

ach otherI think isone.”

“Try to createthesenseof urgencythat weneed to fixthis, so everybody’son thesamepage.”

Health Care

Designers(MArch, ID, GD)

Health Care

Managers(MBA, MHA)ransparency is another

ood thing.”

Health careworkerso an amazingjob atorkarounds.”

Health care isgood at thesestrategies

Health care isopen to using

Health Care: A Strategy for Supporting Change - DMGT 748 - spreads

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