Solution Ideation Research Exploration Introduction 1 TEAMTEAM Jason Howell Catarina Pereira Alankrita Prasad Steven Selzer Zhen Zeng UPMC Presbyterian Hospital | Cardiac Catheterization Lab Project Documentation Designing For Service Fall 2007 Shelley Evenson School of Design Carnegie Mellon University
A 12-week project with UPMC where a 5-person design team developed an internal service resource of best practices to help the hospital manage innovation and transform the design culture.
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A representative from the Center for Quality Improvement and Innovation introduced our team to the primary
goal of this project: to create a patient-centered experience in the cardiovascular diagnostic center by taking the
patient’s perspective into account at every stage of the patient journey.
Create a safe and reliable atmosphere;
Create a comfortable, family-friendly environment;
Promote the ideals of a welcoming and caring staff;
Consistently achieve high-quality outcomes;
In particular, they encouraged us to improve or create services that would promote the following core values:
Our Response
We used this as our starting point for research and ideation, but soon found that the scope of the project would
be much greater than we initially expected. The rest of this document will explore our findings, our process of
ideation, and the resulting service design solutions we believe respond to some of the more significant issues.
Avoid unnecessary delays;
Eliminate the redundancy with providing personal health information;
Facilitate flow throughout the patient journey.
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Exploration2
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12 Territory Map
comfort
Hospital Personnel
Please make it better.
Patients
Is my loved one being cared for?
Famliy + Friends
integrity
perception of hospital
brand identity
e�ciency
hospital e�ciency
centralized records
UPMC environment
security privacy
navigation
ambiance
care
personal attention
empathy
accommodations
communication
patient status
family awareness
internal communication
guidance
I want to help patients feel better.
Our territory map illustrates the patient-centered experience, with a focus on comfort as it is derived from the
many facets (i.e. care, integrity, environment, communication, and efficiency) of the UPMC health care system.
Size indicates how much each facet relates to comfort.
Overlap indicates the degree of focus for our project.
We began by developing an affinity diagram of our varying preconceptions of the health care experience. In
order to calibrate the team’s collective eye, we developed a territory map that established “comfort” as the
appropriate lens through which we could focus on the patient experience and the resources by which the
experience is guided.
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Finally, we looked at the people and their roles within the CHA, where a nurse also acted as coordinator and receptionist in addition to the medical responsibilities prescribed by her job description.
We observed various processes in action: patients checking-in, answering questions, and preparing for the procedure; and nurses documenting patient status, verbally handing off responsibilities, and responding to bedside alarms.
After a sufficient self-imposed wait time, we navigated to the Catheterization Holding Area (CHA) where we first encountered patients donning gowns, nurses tending to those in need, and our own visceral response to the familiar hospital environment.
We spent time in the waiting room soaking in the emotional ambiance and evaluating our own experiences in terms of physical comfort and the resources with which we could help pass the time.
Observation
Our journey began by navigating to the Cardiac Catheterization Lab using hospital signage, an exercise that suggested potential problems with wayfinding.
To research the experience, we had to experience the experience.
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14 Directed Storytelling
“Participants tell stories as a way for researchers to
understand and document participants’ experiences.”
Evenson
With a general impression of the patient journey and corresponding levels of comfort, we set out to
develop a better understanding of the processes and personal sentiments that comprise the experience
for both patients and staff. We explored the potential of directed storytelling, a form of narrative inquiry
in which “participants tell stories as a way for researchers to understand and document participants’
experiences” (Evenson).
In order to better understand the experience, we conducted several interviews with both patients and
nurses in which they were asked to describe either the patient journey (if the participant was a patient)
or a typical work day in the CHA (if the participant was a nurse).
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15Core Competency
At the heart of the UPMC Cath Lab are its people. The nurses and technicians
combine their treatment expertise with a willingness to accommodate patients’
needs in a personal, adaptable way. The Cath Lab staff show their commitment to
providing quality care with compassion.
Based on the data we collected from our observational and
research methods, we were able to identify the distinctive
areas of expertise of the Cath Lab and its people. In an effort
to consolidate our collective understanding, we articulated
these unique qualities in a statement of core competency.
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16 Patient Typology
Our research provided a wide range of qualitative data on the patient experience. We created
two distinct patient typologies and identified their characteristic qualities in an effort to
consolidate our collective understanding of the patient experience.
First time patients and their families are often overwhelmed by the big city experience and the
negative stigma attached to large hospitals. In addition to the challenges posed by way finding, first
time patients and families frequently ask questions and generally require more information. Often, they
arrive with misconceptions of the procedure and its results, elevating levels of anxiety and prompting
additional attention from staff.
Returning patients and their families are more familiar with the procedure and arrive with
expectations. While their expectations are being met, returning patients and families are generally
content; there is a tendency, however, to get impatient when they experience delays or provide their
personal health information several times throughout the process.
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17Patient Journey
Doctor
Admit into hospital
DischargeCath Lab Journey
The patient journey begins when a patient is either referred to the Cath Lab by his primary care physician or
brought in by ambulance in the event of an emergency. Patients flow through several stages of the journey,
culminating in one of two possible post-procedural pathways: the patient gets admitted to the hospital as an
inpatient, or the patient gets discharged and goes home. Sometime thereafter, patients return to their primary
care physicians for follow-up care.
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18 Patient JourneyScheduling Arrival Registration CHA Pre-Procedure Procedure Post-Procedure
We identified seven stages of the patient journey: Scheduling and Getting Informed, Arrival,
Registration, Encountering the CHA, Pre-Procedure, Procedure, and Post-Procedure.
Scheduling and Getting Informed
Patients are contacted by phone to schedule an appointment, at which point they are provided general
information about the procedure and how to prepare. A formal letter is mailed to patients, though our
research suggests that they often have to come in for the procedure before the letter even arrives. In
addition, a link to an informational video is provided to patients, but again it seems this video often goes
unwatched.
Arrival
Since many patients and families are traveling to Pittsburgh from rural parts of Pennsylvania, the big
city experience can be overwhelming. They often experience problems with finding parking, orienting
themselves in the matrix of buildings, and finally navigating their way to the Cath Lab by following
inconsistent and often vague signage.
Registration
Once patients arrive at the ambiguously-named Medical Procedure Unit (MPU), which is essentially a
waiting room where patients check-in, this stage of the journey involves verifying one’s medical record
and signing a consent form. The physical space is shared with another unit of the hospital, confounding
processes and generally adding to the level of discomfort in this typical hospital waiting room.
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Pre-Procedure
Patients are assigned a room, at which point they may don the patient gown, use the restroom, and
settle in before the pre-procedural questioning and physical preparation. Patients are then required to
verify one’s medical record a second time, while simultaneously getting shaved and medicated for the
procedure. Family members are then allowed to enter the CHA and accompany patients until they are
escorted in for the procedure.
Procedure
During the procedure, family members are given a pager and encouraged to visit the café or return to
the MPU. The pagers are reportedly nonfunctional in the café and the MPU provides little in the way of
relief affordance.
Post-Procedure
In this final stage of the journey, family members are reunited with patients as they return from the
procedure. Patients are monitored for excessive bleeding and provided a meal after several hours of
recovery. At this point the nurses determine whether the patient needs to be admitted into the hospital
or may be discharged.
Encountering the CHA
Wayfinding from the MPU to the Cath Holding Area (CHA) seems easy enough considering it is located
just around the corner, but patients often walk right past the CHA to Radiology. The CHA has no obvious
reception area and the clutter of medical equipment floating around the walkways, the constant beeping
of bedside alarms, and general ambiance can be a bit overwhelming.
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20 Service Blueprint
Due in part to the complexity of interactions during the pre-procedure stage, we developed a service blueprint
to understand in even greater detail all of the front- and back-end interactions that take place. We highlighted
several points in orange where patients typically experience heightened levels of anxiety.
line of interaction
line of visibility
line of internal Interaction
Physical Evidence
Patient Actions
Onstage Contact
Backstage Contact
Support Process
check inundress & bathroom
break
verify medical history
verify medical history
prepare physically
wait waitfamilyjoins
patient
admit patient
draw bloodmedicate
shave
enterpatient
info
order lab work
schedulesheet & eRecord
signconsent
form
review risks& consent
form
explain procedure
set patient status to “ready”
notifyattendant
let family in
eRecord whiteboard
nurse’s stationeRecord
schedule sheet
patient roompatient gown
bathroom
computer cart status monitor & equipment
consent form television television
wait
televisionchairscafe
pagernursepractitioner’s
clipboard
review medical history
review medical history
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Research3
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Focus Areas
Communication Inefficiency
Way Finding to CHA
Waiting RoomRegistration Process
Nurse’s Station
Patient Rooms
Nurse-to-Nurse Communication
Linen Service Check-in
Overflow Room Bloodwork Process
AmbianceFood quality Entertainment
Patient Status
Family Accommodations
Due in part to the complexity of interactions during the pre-procedure stage,
we developed a service blueprint to understand in even greater detail all of the
front- and back-end interactions that take place. We highlighted several points
in orange where patients typically experience heightened levels of anxiety.