Co-Design: A Path to Improve Patient & Team Experience

1. A9 These presenters have nothing to disclose March 2019 Co-Design: A Path to Improve Patient & Team Experience Barbara Balik, EdD, MS, RN Senior Faculty, IHI Aefina Partners Barbara@AefinaPartners.com Mr. Nasser Al Naimi HMC Deputy Chief of Quality Center for Patient Experience and Staff Engagement Director – Hamad Healthcare Quality Institute

2. Session Objectives • Define patient-centered co-designed care • Identify the benefits of co-designed care in quality, safety, empathy, and partnerships outcomes • Use “what matters to you” conversations and other effective strategies to engage others in the co-design of care

3. Co-Design • What is your definition? • Why move to co-design?

4. Co-Design: Definitions • A range of actions • A way of thinking • Brings people’s lived experience to the heart of the design process • NHS – participation is a right • Beyond patient or staff experience • not just how feel about a service or process, but how they can actively change it • Applies to patients, families, and caregivers

5. Co-Production of Healthcare Services The interdependent work of users and professionals to design, create, develop, deliver, assess and improve the relationships and actions that contribute to the health of individuals and populations through mutual respect and partnership that notices and invites each participant’s unique strengths and expertise. P. Batalden

6. Co-Design • A mindset and group of methods that bring together patients and families, staff and clinicians, performance improvement experts, subject matter experts, and other important stakeholders to design new care and service offerings or improve existing ones. • Based in deep empathy and creative problem solving combined with a focus on outcomes that matter to customers • All are full partners throughout the entire co-design process • Can be applied to all processes Kaiser Permanente CoDesign Recipe: https://share.kaiserpermanente.org/wp-content/uploads/2018/04/CoDesign-Recipe.pdf

7. HMC Definition of Co-Design

8. HMC Definition of Co-Design • Combined effort of all stakeholders • For a common purpose of designing / re-designing and delivering care / processes / systems • Which benefits all

9. Why – Benefits of Co-Design • Improved process design by those most involved • Usually better, faster, cheaper – for everyone • Seeing with new eyes – innovative solutions • Better adoption of changes • Energized team members • Respectful designs

10. “We are really good about caring what you think about us. We are not good about caring what you think.” – Catherine Lee, VP Service Excellence, McLeod Regional Medical Center A Dilemma Barbara Balik. Barbara@AefinaPartners.com

11. Hamad’s Journey with Co-Design Mr. Nasser Al Naimi

12. Beginning… • More than 40 patient and family members • Across 5 facilities • 22 meetings so far • Average - 3 concerns discussed per facility • All this in just 6 months

13. PFAC Members

14. PFAC Members

15. Improvement Ideas • Way Finding • Token machine – Facility Rounds • Flyers and posters design • Doctors schedule to be mentioned on the door • Religious lectures provision • Recreational equipment

16. Experiential Training

17. Involving Patients and Family • Recruitment • Orientation • Prize Distribution • Trainings

18. Brainstorming

19. Where are you on the journey? Barbara Balik. Barbara@AefinaPartners.com

20. Is your assessment – Or This? This? Barbara Balik. Barbara@AefinaPartners.com

21. Doing To – Similar to Prisons Barbara Balik. Barbara@AefinaPartners.com

22. Doing To – When: • We say – you do: schedules; visiting hours • We waste your time – come to the clinic and wait • We assume we know what the community needs • Information is not shared or understandable • Professionals often lack partnership skills • We determine if you are compliant • There is helplessness – when the patient/family say: • I don’t know what is the plan of care or what happens next • I don’t know who is in charge of my care • I don’t feel like you know me Barbara Balik. Barbara@AefinaPartners.com

23. Doing For – Choosing a home for someone, without asking Barbara Balik. Barbara@AefinaPartners.com

24. Doing For – When: • We keep the patient or community member in mind when designing or improving programs – then ask • We design the teams to help you – without you • We manage your expectations about waiting, what healthcare can do, or what the community needs • Early but limited use of health literacy • We teach you – lots & lots & lots – without asking what you need • We are beginning to get it about cross-continuum but don’t know much about the white spaces • We assume we know everything about health and healthcare Barbara Balik. Barbara@AefinaPartners.com

25. Doing With – In this Together: Barbara Balik. Barbara@AefinaPartners.com

26. Doing With – When: • “Nothing About Me Without Me” • “At the table” – Patient/family/community are essential team members to design and improve programs that follow the patient journey • We deeply understand ‘What Matters to You’ • Full transparency – “If you know – I know” • All key decisions are mutual – including who is on my team • All staff are caregivers and are skilled in respectful communication and teamwork • Health Literacy is everywhere in patient care • Senior leaders model that patient’s safety and community well-being guide all decisions • Staff, providers, leaders are recruited for values first, then talent • Systems work well – for everyone Barbara Balik. Barbara@AefinaPartners.com

27. Where are you in doing to-for-with? Barbara Balik. Barbara@AefinaPartners.com

28. To-For-With Assessment Patient and Family • Individually – Complete 1-2 examples in each category • Review with 1-2 colleagues • What do your lists tell you? What gets in the way of doing with? Barbara Balik. Barbara@AefinaPartners.com

29. HMC – Getting Started Mr. Nasser Al Naimi

30. Intent

31. Alignment

32. Structures

33. Listen • Lived experiences • Observations • Socially influenced stories • Wish List

34. Share Data

35. Design and Deliver – Working Groups

36. What Matters to You? • What is important to you today? • What brings you joy? What makes you happy? What makes life worth living? • What do you worry about? • What are some goals you hope to achieve in the next six months or before your next birthday? • What would make tomorrow a really great day for you? • What else would you like us to know about you? “What Matters” Older Adults? A toolkit for Health Systems; IHI

37. Joy in Work Steps Leaders Take Outcome: ↑ Patient experience ↑ Organizational performance ↓ Staff burnout 4. Use improvement science to test approaches to improving joy in your organization 3. Commit to making Joy in Work a shared responsibility at all levels 2. Identify unique impediments to Joy in Work in the local context Perlo J, Balik B, Swensen S, Kabcenell A, Landsman J, Feeley D. IHI FrameworkforImproving Joy in Work. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2017. (Available at ihi.org) 1. Ask colleagues “what matters to you?”

38. Caregivers:Adopting and Sustaining New Behaviors • Clarity of Purpose – understand why change • Competence – skilled and comfortable in new behavior – knowing what and how to do it • Contribute – involved in determining the new behavior – what, how, and when • Connected – part of a network, feeling known, cared about and supported in learning the new behavior *Suchman, A, et al Eds. (2011). Leading Change in Healthcare: Transforming Organizations using Complexity, Positive Psychology, and Relationship-Centered Care. London: Radcliffe.

39. Co-Design Steps IDEO: https://www.plusacumen.org/courses/introduction-human-centered-design Kaiser Permanente CoDesign Recipe: https://share.kaiserpermanente.org/wp-content/uploads/2018/04/CoDesign-Recipe.pdf

40. 1. Gather Experiences

41. 1. Gather Experiences • Chose design challenge – Start with needs • What exactly are we working on? • Work on problems that matter to patients, families, team members – ask ‘why is it important?’ • Deeply understand the topic – listen to learn; pool knowledge • What we say, do, and feel in an experience • Share stories - what is working and what is not • Capture needs for improved or new service • How: • Journey map with touchpoints • Direct observation of an experience IDEO: https://www.plusacumen.org/courses/introduction-human-centered-design Kaiser Permanente CoDesign Recipe: https://share.kaiserpermanente.org/wp-content/uploads/2018/04/CoDesign-Recipe.pdf

42. 1. Gather Experiences • People: • Do not always do what they say they do • Do not always do what you think they do • Cannot always tell what they need • Observations lets you find out what people really do and need IDEO 2006

43. 2. Frame Opportunities

44. 2. Frame Opportunities • Problems to solve – the needs and opportunities heard from Step 1 • Are there patterns? • Frame opportunities with partners • “How might we . . .?” • “What if . . .?” IDEO: https://www.plusacumen.org/courses/introduction-human-centered-design Kaiser Permanente CoDesign Recipe: https://share.kaiserpermanente.org/wp-content/uploads/2018/04/CoDesign-Recipe.pdf

45. 3. Generate Ideas

46. 3. Generate Ideas • Generate a range of ideas to address the need • Learn from others • Ask “who else has done this really well? • Is there another organization outside healthcare we can learn from? • How • Brainstorming  post-it notes  cluster ideas IDEO: https://www.plusacumen.org/courses/introduction-human-centered-design Kaiser Permanente CoDesign Recipe: https://share.kaiserpermanente.org/wp-content/uploads/2018/04/CoDesign-Recipe.pdf

47. 4. Select Ideas to Test

48. 4. Select Ideas to Test • Rank ideas – • Important – how well meet the needs? • Doable – how feasible is it to test? • Some ideas to test quickly; others more ambitious but offer great potential • How • Dot voting • 2 x 2 grid IDEO: https://www.plusacumen.org/courses/introduction-human-centered-design Kaiser Permanente CoDesign Recipe: https://share.kaiserpermanente.org/wp-content/uploads/2018/04/CoDesign-Recipe.pdf

49. 5. Measures that Matter

50. 5. Measures that Matter • A brief, combined set • What does successful implementation mean to customers? • What does successful implementation mean to organizational members? IDEO: https://www.plusacumen.org/courses/introduction-human-centered-design Kaiser Permanente CoDesign Recipe: https://share.kaiserpermanente.org/wp-content/uploads/2018/04/CoDesign-Recipe.pdf