06 Article Amy Health Service Design Shoes A

Healthcare service design: Five failure modes to avoid

When it comes to designing patient services for health care, we have the best intentions.

But sometimes we get in our own way when it comes to creating good design. Here’s a few failure modes to watch out for…

1. Mapping only the clinical journey. A patient’s health and wellbeing are comprised of so much more than symptoms. Don’t forget the financial burden. It’s different for every patient and can change significantly throughout a patient’s journey – how she starts is not necessarily how she will be at different points throughout or at the end. Treatment costs change throughout the journey and the patient’s income (or the caregiver’s income) changes, too, as work is missed and benefit status changes. To illustrate how much financial toxicity worries Americans, a recent study by Amino and Ipsos found that Americans are just as worried about a medical bill they can’t afford as they are with being diagnosed with a serious illness.

For example, a cancer patient may have great commercial coverage, but may lose it if she needs to file for disability or has to stop working. Or caregivers/family members may have to miss work or stop working to take care of the patient, contributing to more financial stress. Financial assistance foundations can lose funding. After surviving diagnosis and treatment, a third of cancer survivors experience financial hardship that can put their physical and mental health at risk, according to a 2016 study published in CANCER.

In recent years, as treatment costs continue to escalate, financial toxicity is increasingly considered an adverse event of cancer care. The pain extends beyond cancer patients to all consumers of health care. The average family premium has risen nearly 20 percent in the last five years, according to the Kaiser Family Foundation. Between 2005 and 2015, out-of-pocket costs such as deductibles, co-pays and co-insurance, have risen 66 percent, which was more than twice the rate of wage growth during that period, according to Kaiser. When we neglect the financial journey of patients, we ignore a significant factor that could greatly impact quality of life.

2. Neglecting to invite legal to the meeting. Legal always gets a bad rap. We tend to think of them as the department of “no.” I’ve planned plenty of workshops or milestone meetings and when I ask clients who we can invite from legal, I often get a look like I have three heads! There’s an assumption that having legal in the room will stifle innovation. But what I often see is worse than that – a team spends several rounds ideating without legal and then when ideas are presented, they are shot down. Co-creating with legal earlier helps surface some very important design criteria that we can use to inspire rather than stifle innovation.

3. Seeing everything as a nail when you have your hammer. Not too long ago, I worked with a client that had just amped up some of its automation capabilities and wanted to deploy them as part of its patient services with the launch of a new drug. A team spent countless hours thinking about all the ways to apply this technology when user research showed that some of the basic means of communication (like a personal phone call) would be a much better fit based on the patient’s needs at various points in the journey.

4. Missing the forest for the trees – and overplanting the forest. Good service design takes into account not just the touchpoints and services you are designing for your patients, but all of the other touchpoints and interactions that the patient is having with stakeholders in their health care ecosystem. For example, during one project we mapped out the entire ecosystem of partners and people that may be involved in a patient’s therapy and the client was shocked – they had never zoomed out so much to see how this condition could touch so many facets of a patient’s life. I’m fortunate enough to have had the opportunity to be in countless homes of patients, so I hear their stories – and see what it looks like in terms of all the paperwork, mail, prescriptions, phone calls, texts, apps, patient portals – and more.

5. Making the prescriber the bad guy. Too many times, I see frustration with healthcare providers who don’t prescribe the product or don’t prescribe it properly. Just like we get frustrated by patients who don’t take their medications, we must remember that doctors are only human, too. They also wish they could create a better patient experience but are hampered by rules and systems that hold them back and cause burnout. According to the 2018 Medscape National Physician Burnout Report, nearly two-thirds of U.S. physicians feel burned out, depressed or both. Neurologists, critical care and primary care doctors report the highest rates of burnout. A heavy load of bureaucratic tasks like charting and paperwork and long hours are the leading sources of burnout.

While designing patient services, be sure to take into account stakeholders that are interacting with the patient throughout the journey. Then, consider where you can leverage other touchpoints that may be more meaningful than what you can offer. Where can you amp up someone else’s touchpoint rather than create a new one?

If there is something that ties all five of these failure modes together, it’s a lack of empathy and systems thinking – meaning we not only need to be able to put ourselves in others’ shoes, but we need to recognize all the shoes there are in a patient’s journey that matter when designing services. That’s not a knock on those designing health care services, just a reminder that this is complicated work and we need all the help we can get.

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