1. Designing for
the Clinic Experience
Service Design
Patients Family
for UPMC Presbyterian
Neurosurgery Clinic
Carnegie Mellon School of Design
UPMC Center for Quality Improvement & Innovation
Service Design · Fall 2007
Staff Dr. Kassam
Melissa Cliver · Jamin Hegeman · Kip Lee
Leanne Libert · Kara Tennant
2. UPMC Center for Quality
Improvement & Innovation
Our liaison with the clinic
Given Problems
Wayfinding
Wait time
Work flow
11. Service Blueprint of Presby Neuro Clinic
Service of Presby Neuro Clinic
PHYSICAL Front Waiting Front Waiting Front Hallway Exam MRI & Exam MRI & Door Tag Waiting Check-out
EVIDENCE Desk Room Desk Room Desk Room Chart Room Chart Room Room
Check-out,
PATIENT Sign In Wait Check-in Wait Responds Follow to Wait in Answer
Wait
Ask Return
Wait Pay, &
ACTIONS Exam Rm Exam Rm Questions Questions Door Tag Leave
Line of Interaction
ONSTAGE Call Escort to
Check
Meet Dr. Process &
CONTACT Welcome Process Patient Vitals &
Exam Rm Ask Quest Kassam Check-out
PERSON
Line of Visibility
BACKSTAGE Get See Other Grab Check Place in Take See Other
See Other See Other
CONTACT Patient
Patients Patients Door Tag Patients
Patient Kassam Away Patients
PERSON Chart Location Bin Chart
Brings Chart in Grab Kassam
Door Tag To Be Chart Gets Quick
Back Seen Bin from Bin Review
Chart Write Rm Check
Taken by # on Patient Dictation
Staff Schedule Location
Line of Internal Interaction
SUPPORT Records/ Bin Chart Records/
Debbie’s Door Tag Schedule Database
Chart Cart Database System Storage
PROCESSES System System
System System
System
12. Lack of wait time interactions
Service Blueprint of Presby Neuro Clinic
PHYSICAL Front Waiting Front Waiting Front Hallway Exam MRI & Exam MRI & Door Tag Waiting Check-out
EVIDENCE Desk Room Desk Room Desk Room Chart Room Chart Room Room
Check-out,
PATIENT Sign In Wait Check-in Wait Responds
Follow to Wait in Answer
Wait
Ask Return
Wait Pay, &
ACTIONS Exam Rm Exam Rm Questions Questions Door Tag Leave
Line of Interaction
ONSTAGE Check
CONTACT
PERSON
Welcome
? Process
? Call
Patient
Escort to
Exam Rm ? Vitals &
Ask Quest ? Meet Dr.
Kassam ? Process &
Check-out
Line of Visibility
BACKSTAGE Get See Other Grab Check Place in Take See Other
See Other See Other Kassam
CONTACT Patient
Patients Patients Door Tag Patients
Patient Away Patients
PERSON Chart Location Bin Chart
Brings Chart in Grab Kassam
Door Tag To Be Chart Gets Quick
Back Seen Bin from Bin Review
Chart Write Rm Check
Taken by # on Patient Dictation
Staff Schedule Location
Line of Internal Interaction
SUPPORT Records/ Bin Chart Records/
Debbie’s Door Tag Schedule Storage Database
Chart Cart Database System System System
PROCESSES System System System
13. Complex workflow Presby Neuro Clinic
Service Blueprint of
PHYSICAL Front Waiting Front Waiting Front Hallway Exam MRI & Exam MRI & Door Tag Waiting Check-out
EVIDENCE Desk Room Desk Room Desk Room Chart Room Chart Room Room
Check-out,
PATIENT Sign In Wait Check-in Wait Responds
Follow to Wait in Answer
Wait
Ask Return
Wait Pay, &
ACTIONS Exam Rm Exam Rm Questions Questions Door Tag Leave
Line of Interaction
ONSTAGE Call Escort to
Check Meet Dr. Process &
CONTACT Welcome Process Patient Vitals & Kassam
Exam Rm Ask Quest Check-out
PERSON
Line of Visibility
BACKSTAGE Get See Other Grab Check Place in Take See Other
See Other See Other
Kassam
CONTACT Patient
Patients Patients Door Tag Patients
Patient Away Patients
PERSON Chart Location Bin Chart
Brings Chart in Grab Kassam
Door Tag To Be Chart Gets Quick
Back Seen Bin from Bin Review
Chart Write Rm Check
Taken by # on Patient Dictation
Staff Schedule Location
Line of Internal Interaction
SUPPORT Records/ Bin Chart Records/
Debbie’s Door Tag Schedule Storage Database
Chart Cart Database System System System
PROCESSES System System System
14. Flow dependent on Dr. Kassam Clinic
Service Blueprint of Presby Neuro
15. Needs
Patient Staff Dr. Kassam
Feeling welcome Better workflow Spend quality
time with patients
Actual wait time Locating Dr. Kassam
and each other See everyone
Respect
Communication Support Staff
Space and comfort
Making a difference Time
Distractions
16. It’s more than wayfinding,
wait time, and workflow.
The experience is the relationship between
patients, staff, and Dr. Kassam within the
given space.
17. Opportunities
Embrace Wait Time
Inform, engage, and comfort patients?
Improve Workflow
Fewer tasks, less distraction,
and better communication?
Balance Kassam
Support his efforts to help patients,
but also find time for himself and
support his staff.
22. But decided to focus more
on the patient experience.
Why?
Opportunity for the greatest impact
Client focusing on workflow
More physicians in the future
will reduce strain on Dr. Kassam
Client nudging us that way
23. We moved and removed chairs
to affect the patient experience.
Before After
24. Because we involved
the staff in our process,
they really helped us
gain access to patients.
26. Eleven Exam Room Interviews
“We’ll talk about anything to anyone.
Entertain us.”
“The first time I came, my mom and cousin
were in the waiting room for three hours.
My mom finished a book. That was really
hard for me.”
“Our town has one traffic light.”
“I come by myself now. I don’t bring
my family anymore. I’m my own woman.”
“I’m about to get brain surgery.
I don’t want to play checkers!”
27. Patient Journey
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28. Emotions patient emotions
family emotions
Support Needs
patient support needs
family support needs
Waiting Needs family waiting needs
patient waiting needs
Information Needs family info needs
patient info needs
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D P Di Pr Su Po Fo Fo
29. New Pre-op Post-op Returning
Patient Patient Patient Patient
Curious Can’t think Dazed Thankful
Emotions Hopeful Overwhelmed Feels bad about Understanding
family waiting
Feels bad about Self-concerned Bored
family waiting Mixed feelings:
Confusion laughing crying Blessed
Confusion
Shock and relief
Emotional Support Transportation Transportation Transportation
Support Someone to collect info Someone to collect info Physical care
Needs Someone to make Physical care
arrangements
Distractions Special treatment Distractions More engaging
Waiting distractions
Needs Interactions
Schedule Testing info Possible symptoms Wait time
Information Valet Surgery info/procedure Medical education Schedule/other appt.
Needs Place to stay Reality: good/bad Medical translation Don’t want to repeat
personal info
Wait time Wait time Schedule/other appt.
Sign-in process Sign-in process Wait time
31. low cost
Cost/Value Stages of Care
wheelchair with
regular seating areas suite of cards
coat rack clinic graduation
certificate Kassam fact sheet
note-taking kit
ambient music Neurosurgery
Wall of Hope common terms
glossary
patient-use
phone
partitioned
food & drink cart waiting area
low value high value
no front desk
video testimonials
rotating museum USB memory stick
artwork exhibits for patient records
waiting room TVs
calming closed-circuit TV
Kassam TV real-time
water fountain to watch surgery
wait tracker
patient
transportation
LCD screens patient information
for dynamic art for visually impaired
computer kiosks
wait room wait room
food servers librarian mentor patient advocate
high cost
32. low cost
Cost/Value Stages of Care
wheelchair with
regular seating areas suite of cards
coat rack clinic graduation
certificate Kassam fact sheet
note-taking kit
ambient music Neurosurgery
Wall of Hope common terms
glossary
patient-use
phone
partitioned
food & drink cart waiting area
low value high value
no front desk
video testimonials
rotating museum USB memory stick
artwork exhibits for patient records
waiting room TVs
calming closed-circuit TV
Kassam TV real-time
water fountain to watch surgery
wait tracker
patient
transportation
LCD screens patient information
for dynamic art for visually impaired
computer kiosks
wait room wait room
food servers librarian mentor patient advocate
high cost
33. Concept Validation Soothing Music
Glossary of Neurosurgery Terms
Patient Information Card
Mary arrives at the clinic for her pre-op visit. She’s The waiting room is filled with soothing music,
exhausted from all the testing and feels very stressed. which helps to calm her, reducing some of her anxiety
a
and stress.
Wall of Hope
On Adam’s first visit to the clinic, the In the exam room, the doctor and nurse Adam thumbs through the glossary the
check-in nurse gives him a glossary of list off a number of procedures and nurse gave him earlier and learns what
common terms used in neurosurgery. medical terms that Adam does not know. all of those terms mean. He feels less
He feels confused and overwhelmed. anxious about the process.
Dr. Kassam Fact Sheet Debbie hands the nurse her patient The nurse swipes the card in the reader, Her medical history and information
information card to begin her clinic then Debbie enters a pin number. prints out for her to verify. Debbie’s
appointment. glad she doesn’t have to recite any
information or fill out paperwork.
During their wait time, they
y
notice a wall with testimonials
from previous patients.
vious
Bonnie and her husband arrive at
the clinic for the first time, anxious
and tired.
Bonnie sees comments of those
t
before and after surgery an finds
nd
and
some comfort and assuranc ce.
assurance.
She is not the only one.
University of Pittsburgh
Medical Center
Center for Quality Improvement & Innovation
Helen is concerned with her surgery. She is given a sheet providing facts Helen is reassured that she is in
and information on Dr. Kassam. good hands. She is able to focus on
other things.
36. Design Implications
Provide patients with access to resources
so they feel in control of their experience.
Embody the comfort Dr. Kassam provides.
Increase interaction between patients
and Dr. Kassam and his staff.
37. Concept and Process Book
Holistic view of the clinic
Sharing what we learned
Providing concept ideas
to further explore and
continue the work that Design for
the Clinic
we started Experience
Concepts for
UPMC Presbyterian
Neurosurgery Clinic
Carnegie Mellon School of Design
Service Design Fall 2007
Melissa Cliver
Jamin Hegeman
Kipum Lee
Leanne Libert
Kara Tennant
38. Current State
CURIOUS
Lack of interaction at different points
throughout the journey creates a barrier PERSONABLE
between patients and their families and
the positive experience of being with
ANXIOUS
CLEAR
Dr. Kassam and his staff. CONFUSED
EXPERIENCED
UNDERSTANDING
ACCOMODATING OVERWHELMED
AT EASE UPSET
ANSWERS
CARING
DR. KASSAM PATIENT
COMFORTING
CONFIDENT
A TEAM
REASSURING FAMILY
STAFF
DIRECT
TRUST-WORTHY FRUSTRATED
WARM
SCARED
GOOD HUMORED
UNCERTAIN
39. Ideal State
CURIOUS
Continual interaction extends the
positive experience of being with PERSONABLE CLEAR
Dr. Kassam and his staff to the
patients and their families, putting ANXIOUS
them at ease and giving them EXPERIENCED CONFUSED
control of their experience.
OVERWHELMED
ACCOMODATING UNDERSTANDING
AT EASE
ANSWERS UPSET
DR. KASSAM
PATIENT CARING
COMFORTING
A TEAM FAMILY
STAFF
REASSURING
DIRECT TRUST-WORTHY CONFIDENT
WARM FRUSTRATED
SCARED
GOOD HUMORED UNCERTAIN
40. Patients Family Patients Family
Staff Dr. Kassam Staff Dr. Kassam
Clinic Staff Meetings Clinic Staff Locator
Needs met Needs met
• Forum for discussion • Finding each other
and reflecting and Dr. Kassam
• Team-building • Reduction in tasks
41. Patients Family Patients Family
Staff Dr. Kassam Staff Dr. Kassam
PCP Direct Link Wait-time Indicator
Needs met Needs met
• Support his staff • Desire to see everyone
• Time for himself • Time for himself
• Better communication
42. Patients Family Patients Family
Staff Dr. Kassam Staff Dr. Kassam
Gift from the Clinic Wall of Hope
Needs met Needs met
• Comfort • Reassurance
• Feeling of good will • Information
from staff • Distraction
43. Welcome Booklet
Embodying Dr. Kassam and the clinic
Comfort
Confidence
Warmth
Humor
Bringing Dr. Kassam to the waiting room
Increasing staff service delivery role
44. Layout of the Book
front cover back cover page 1 page 2
If you want to learn more about me or
the clinic, visit the clinic’s website. It has
a lot of good information and videos.
neurosurgery.pitt.edu/minc
I know you don’t want to be here.
I know you don’t want to know me.
But the best thing that could happen
is to know me.
I’ve performed more than 3,000 neurosurgical procedures. More than
800 are what’s called minimally invasive endoscopic procedures.
And I’m a person first. I’ll be direct and treat you like a friend.
Occasionally, I may even make you laugh.
page 3 page 4 page 5 page 6
It’s minimally invasive brain surgery I work with a great team, and could My staff and I see a lot of patients,
through the nose. This requires no not do my job without them. They can and provide attention and care to
incisions and patients can often be answer a lot of your questions. Trust all. We know this sometimes leads to
discharged within two days. them as you trust me. We’re here for backups. But I hope you’ll understand
you the whole way through. and trust I’ll see you as soon as I can.
Under my direction, the center has pioneered and developed much om rse
Ro o m r Nu
of the technology and instrumentation used during these surgeries. it ing Ro
it vis m to
vis rst isit isit ait xa en
With continued research and experience, I now use this surgery for are /fi isit vis
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2 days - 2 weeks
2 days - 4 weeks
1 month - 1 year
6 months - 1 year
45. When they meet him in the exam room, they
see that he is indeed personable, and funny,
too, just like in the booklet.
Annette is a new patient.
After she and her husband check in,
a front-desk staff member gives them
a welcome booklet, indicating it’s
a message from Dr. Kassam.
In the waiting room, they read Dr. Kassam’s
welcome. They like that he seems personable
and experienced, and are glad to find out
a bit about him.
Welcome Booklet
The Welcome Booklet gives new patients an overview of Needs met Patients Family
the overall patient journey, one clinic visit, the staff and • Information
Dr. Kassam in Kassam’s own words.
• Interaction with Kassam
Since a staff member hands the booklet directly to the
Staff Dr. Kassam
new patient, it also serves as a new line of interaction
between the staff and patient where there was none before.
46. Clinic Chat
A Vision for the UPMC Neurosurgery Clinic
Creating a system of interaction,
information, distraction, and support
Extending the comfort of Dr. Kassam and the clinic
47. Waiting
Room
Patient
Waiting
Room
Patient
Messages from patients, staff and Dr. Kassam appear on a large
Clinic Chat display in the waiting room.
Common phrases from the Clinic Chat appear in a tag cloud on adjacent
display to give viewers a general idea of what’s been discussed.
Clinic Chat
Patients, Dr. Kassam, and staff contribute to an organically Needs met Patients Family
formed system that provides information, distraction, and • Front-stage/back-stage
a connection with Dr. Kassam and his staff during periods interaction
when they cannot be physically present with the patient.
• Information
Staff Dr. Kassam
• Distraction
• Support
48. Staff have access via hall displays.
Patients can send messages to Clinic Chat
from their phone, personal computer or kiosk
in the waiting room, exam room or at home.
Dr. Kassam can reply from the office computer.
49. Part of a Larger
Information System
Includes information about:
Dr. Kassam
Surgery and Side Effects
Clinic Staff
Prescriptions
51. Designing the Experience Together
Patients, staff, and Dr. Kassam contribute to
designing the experience
Wait time is an opportunity to interact with other
patients, staff, and Dr. Kassam
The service extends the comfort of Dr. Kassam and his
clinic and provides information, distraction, and an
experience that is created together with the patients,
which increases patient control