My first feeling after entering a hospital is anxiety. If I am not worried about my own procedure or a family member’s test, I am thinking about all the germs in hospitals. I’ve never had a panic attack, but if I did, it would be in a hospital.
Worrying about myself is bad enough but thinking about my kids being in the hospital magnifies that concern by a factor of 100.
The Center for Health Systems Excellence at Cincinnati Children’s is using a design strategy to erase those feelings in parents and children. The idea is to give people a sense of control and calm. This means way-finding signs that are easy to understand, a clinical experience that provides frequent touchpoints and just enough information, and physical spaces that allow for an escape from illness.
Julie Elkus is the Director of Innovation at The James M. Anderson Center for Health Systems Excellence at Cincinnati Children’s Hospital Medical Center. She is helping to create these experiences and change the way care is delivered.
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Elkus worked at General Mills and Proctor and Gamble as a product manager and then as a qualitative research director at Ipsos. She joined Cincinnati Children’s about two years ago as a member of the Center for Health Systems Excellence. The Center focuses on quality and process improvement.
She said that for hospital administrators, it’s easy to overlook the feelings evoked by a visit to the hospital.
“People come in and they are anxious and nervous, and things feel a little out of control,” she said. “There are things we can do all along the journey to make parents feel that they have made the right decision and are figuring things out.”
Elkus joined the hospital around the time this center opened. A more recent project of hers involved the white boards in every hospital room. She brought together a big group of stakeholders – nurses, doctors, parents – to figure out what was working and what could be improved upon. The group used foam core and painters tape to redesign this familiar element of a hospital room.
The result was a standard board that will be used across the hospital that incorporates the informational needs of all members of the care team from specialists to nurse assistants.
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One of the most interesting elements of the new design was the glass plate that covered the board and an empty space in one corner. Parents and patients could slip photos behind the glass to remind themselves and caregivers of a child’s life outside the hospital.
Elkus is in the middle of another project that is more complicated than the white board redesign. She is working with the hospital’s population health team to improve outpatient clinics and the related patient experiences. They are focusing on pre-term births in particular.
“We have been trying to reduce those rates for 20 plus years,” she said.
To get started, the team did 17 in-home interviews that lasted more than two hours. The team visited women in the Avondale neighborhood of Cincinnati where the hospital is located. Elkus showed me a complex chart with multiple rows and columns that illustrated the many elements of a primary care experience. The project is at a midway point with lots of work still to be done.
Cincinnati Children’s is obviously a special place with lots of resources and experts. I asked Elkus how a small hospital with less money and no specialists could use design thinking techniques to improve the patient experience. Here is her advice.
Start with the user in mind
She said the first step is to get patients and families involved in this improvement work.
“Only people who are having the experience know how it feels to them, and how they define it,” she said. “We must work to understand how they feel, and then co-create solutions with them.”
She suggests asking questions such as, “What do you like? What would you change? What would you do if you were in charge?”
Experience the hospital yourself
As part of the out patient redesign process, she had members of the project team visit other places where people wait – Nordstrom, a children’s museum, and the Apple Store. The idea was to think about the experience of waiting and see how it works in other settings.
She suggested that simply sitting in waiting rooms and looking at it as a patient or family member would can be very eye-opening for staff.
Build something people can hold
Elkus said that a physical object will generate much more feedback from people than a written description alone. Even if the prototype is crude or made of cardboard, having one will speed up the design process significantly.