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Experience DesignA Framework for Patient Care
presented by Art FrohwerkClearpath, LLCin collaboration w/ Quantum
at Meeting of the MindsTorontoJune 23, 2010
Useful Tools & Systems
Transformational StrategiesCreating Meaningful Stories
Relevant Processes
Comfortable Places
Engaging People
It’s About Connections!
Appropriate Measures
Challenging Vision
Context …a whole system approach
The Environment of Trends & Opportunities
Roadmap to sequence Implementation
Experience Design Principles
Strategy Management SystemStrategic Purpose & Commitment•Vision, Mission, Values•Strategic Imperatives
Culture Design based on Values
Influencing People Governance & Policies
Experience Design
Framework
Big Picture Framework
StoryboardFundamentals
Master Process
Master Process to orchestrate “The Organization’s Way” to best do business
Desired Outcomes
Core Process
Master Process to orchestrate “The Organization’s Way” to best do business
Info. & Support Processes
Inputs
Opportunitie
s
Opportunitie
s
RolesRoles
“Moments of Truth”
Support Systems
Measures
Measures
Community-scale Master Process
- Gather information - Analyze results - Conduct tests - Generate reports - Bill- Gather information - Analyze results - Conduct tests - Generate reports - Bill
CollectRequirements
Set-up &Conduct Test
DeliverReports
Evaluate & Dictate Report
CollectRequirements
Set-up &Conduct Test
DeliverReports
Evaluate & Dictate Report
OB PATIENT
LABORATORY
PHYSICALTHERAPY
Admit Prep TreatmentEvaluate Recover Evaluate Follow-upCheckout
COMMUNITY &INFORMATION
MEDIA
AMBULATORY PATIENT HOME HEALTH
PHARMACY
Interpret Validate Prep/Dispense Check & InformOCCUPATIONALHEALTH
LONG TERM CARE FACILITY
Information,Education,
Interpretation
Treatment PatientHistory & Medical
Records
BehaviorModification
Compliance Monitor
PRODUCT SUPPLIERS
EMPLOYERS
ALLIED PROVIDERS
AdministrationHuman
ResourcesQuality
ResourcesNursingMaterials
ManagementPlant ServicesMedical StaffExecutive
Leadership
Management Reporting Finance
& AccountingInformation
ManagementOutpatient Clinic
Area Services
GENERAL EDUCATION
Deliver
DIETARY SERVICESER
RADIOLOGY
Put Patient in room - take Vitals, History, Physical Assess.
Make roundsDocument Patient information & Assemble chartConduct selected Patient educationPrep, Dispense/Mix meds., & Monitor Patient needsSupport Physician procedures, effortsCoordinate communications & Access info./materials
Refer to Critical CareSupport Outpatient testing
Support Health programsSupervision of StaffOngoing Staff education
SchedulingManage Database - Cancer RegistryCollect data & reconcile data for BillingCheck charges & delete if Hospital duplicatedLook-up information
Maintain a System plan & maintain & repair/upgradeMaintain the System & on-going improvementsStandardize & purchase all PC’s, most software, etc.
Receive requests & identify needsAssign staff & scheduleDevelop & coordinate plans & put into databaseDo process design as necessaryCommunicate with users & managementDo projects, install, test & documentSurvey Departments after work done
Conduct on-going Staff education
Supervision of Staff:- Maintenance, Security
Facility Management ( 4 properties):- Write Policies - Safety, Security, Plant Operations- Monitor HVAC, Test Fire systems- Manage Phone system (#’s, line expansion), Cable TV- Maintain generator/emergency power, logs- Materials (finishes, etc.)- Hazardous Waste- Track Vendor service reports, Track Construction documents
(rehab, new buildings)- Generate Reports, Track incident variance reports- Preventative Maintenance program (equipment, Systems)- Attend numerous meetings
Material Distribution:- Create “Pick-list”- Fill Order- Remove from Inventory Control
Receiving:- Buy standard commodities- Receive & Inspect- Print & Apply Stickers (Patient billable only)
Forms (>1000 different) & Matl. Mgmt. Standards:Request-Design-Review-Define use,#,etc.-Approve-Print-Distrib.
Quality Assurance facilitator:- Assess- Plan- Implement- Evaluate
Staff & Community Education (annual & routine):- Identify Needs- Identify Solutions- Make Available- Deliver- Measure success
Corporate Compliance & Quality Reports
Evaluate Patient indicationsIdentify & Order testsAccess information Develop diagnosisFormulate treatmentDocument patient data
Conduct selected Patient education
Conduct procedures
Ongoing medical & quality systems education
Provide Administrative support to CEO functionOverview Operational PerformanceAnalyze & Interpret DataRecommend ActionsInteract with Industry & Allied groups, organizationsWork with Physicians & Departments to resolve
questions, issuesAssure response to Patient complaintsOversee capital projects
- e.g. new building, dining area, ER waiting areaConduct/Participate in meetings - e.g. Budget, Board,
Medical Staff, Patient Services, Dept. heads, etc.Oversee Community Relations & Educational activities
Recruit new employeesInterviewHireOrient
Assure Compliance Review timesheets for payrollLiaison for Employees to Administration & InsuranceAnswer questions of Employees
EnrollmentBadgesBenefits ( vacation, sickness, insurance, etc.)Interpersonal issues
Catalyze Strategy Stimulate movement to meet challenges of MissionProvide for Education, Growth, & ContinuityFacilitate setting Standards for performance & outcomesBe the senior communicator to:
CommunityBoardMedical StaffEmployers
Provide senior oversight to Payor, clinical, & businessprocesses through championing of Teams
Develop & maintain the plan for key measuresDevelop reportsProduce reportsDistribute when & as needed
Data Processing & Patient Accounting(see above)
Accounting:Pay BillsMaintain Capital Assets log
(Health & Wellness to Employers & Employees)- Schedule Patients & be chain-of-custody to
Drug screens- Collect Patient data, dictate/document - Track-down chart, deficiencies,
& FAX needs list- Deliver Results & Reenter Patient Regist.- Billing info. to system for Employer, TPA,
Managed Care, Patient
Get Order
Initiate &Schedule
GatherData
CheckoutEvaluation& Diagnosis
FormulateTreatment
PatientArrival
ProviderFollow-up
PatientCompliance
Correspondence / ROIAssemble Transcription CodingAnalysis Deficiency Analysis Chart Completion
Audit / Second Bill Bill Patient Close AccountInitiate CollectionsGather Billing Data Enter Data Inquiry of EligibilitySubmit Bill Remittance PostEdit BillGenerate Bill / EditPATIENT ACCOUNTING
MEDICAL RECORDS
Medical StaffCoordination
Liaison between Medical Staff & HospitalMaintain Physician information & credentialing dataInform Departments of new PhysiciansRemind Physicians - insurance, reappointment, etc.Track procedures per PhysicianCoordinate reappointment of Physicians every 2 yrs.Maintain minutes of Medical Staff meeting
Conduct literature searches
Manage Library
Operate internal Newsletter
HospitalInformationClinic NameLocation AddressLocation Phone #Service/SpecialtiesMissionCapacityAmenitiesPhysicians’ NamesFeesQualifications/TrainingInsurance Participation
PatientDemographics
NameAddressSexAge, DOBPhones - Home, WorkResponsible Party
Parent, Guardian“Next of Kin”, Emergency
ContactEmployer, OccupationDays/Week of WorkMarital StatusSocial History
PatientMedical History
Previous Medications/Drug History
Previous Medical ProblemsPrevious Treatments/TestsPrevious Physicians/
AdmissionsPrevious SurgeriesFamily History InformationAllergiesCurrent Meds, Former MedsClinical InformationOther
InsuranceInformationInsurer NameType of InsuranceCopaymentCard Number
(policy #, phone #, etc.)Supplements/Attachments
(e.g. Medicare)Contract RequirementsContractual AdjustmentsEligibilityMultiple Insurers
PrimarySecondary
Current ProblemsSymptomsChief ComplaintReferralVital SignsWeight - HeightPulse - B/P
Physical ExamProblem ListPatient SatisfactionSelf Care - Dress, FeedLife Quality Indicator
SchedulingInformationRoom/EquipmentPatient PhysicianAttending Physician Admitting PhysicianSupport PersonnelEquipmentAppointment InformationInsurer Information
Billing/InsuranceInformationPatient Name Patient Type (In., Out., ER, etc.) Advance Beneficiary Notice
(“ABN”)Advance DirectivePayor NameEmployerPayment HistoryCurrent BalanceProvider Number Diagnosis/Billing CodesComplaintsAccountingFace SheetBill Type (Phys., Hosp., etc.)
PharmacistInformationNameAddressPhone/Fax NumberCredentials
Protocols &ProceduresPhysician Practice ProtocolsFlow Sheets-Care PathsRegulationsHMO, Other Insurance
GuidelinesTest/Treatment ProceduresCode of ConductValue StatementsPolicies
DiagnosisInformationPhysician HandwritingPhysician DictationICD-9 CodesTreatment Protocols/
ProceduresPharmacopoeia (e.g.)
PharmaceuticalInformationPrescription PadsAllergiesPhysician Name, Address,
Phone #, License #, DEA#sPatient NameDateMedication List, Names
Quantities, Doses,Interactions
SignatureDrug InteractionsPatient Information Sheet
Test InformationTest OrderedMRIs, CTs, ENGs,
MCDs, etc.Lab Data, X-Ray DataResults ReportsAdvance Beneficiary Notice
Therapy SitesNameAddressPhone Number
Test SiteInformationNameAddressPhone NumberOrdering PhysicianInsurer Approved Site for
Laboratory TestingRadiology TestingAncillary Testing
TreatmentInformationResultsPhysical TherapyOccupational TherapyConsultantsApproved by Third Party
PayorsFollow-upTime in System
Employee/StaffInformation
NameAddressPhone, Fax, Pager, E-mailCredentialsAvailability/Schedule
PhysicianInformation
NameAddressPhone, Fax, Pager, E-mailSocial Security #DependentsResumeAvailability/Schedule
Materials & SuppliersDescription, Part #’s, CostSuppliers NameSupplier Info.
- Contact Phone, AddressAuthorizationContracts
RegulationsMedicalClinicalEmploymentBusiness & FinanceFacility & Property
Sym
ptom D
iagn
ostic
Info
rmat
ion
App
oint
men
t
Adm
issi
ons
Gui
delin
es
Tre
atm
ent
Opt
ions
Pre
Cer
tific
atio
nof
Insu
ranc
e
Med
ical
His
tory
Cas
eM
anag
emen
t
Pro
cess
Exp
ecta
tions
Orie
ntat
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to F
acili
ties
Sat
isfa
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urve
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Pai
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s
Dis
ease
Info
.
Inst
ruct
ions
Com
preh
ensi
on&
Com
plia
nce
Sig
ns &
S
ympt
oms
Opt
ions
Mea
ning
of
Con
ditio
ns
Whe
re
do I
go? E
xpla
nat
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of Is
sues
Tre
atm
ent
Opt
ions
Abi
lity
for
Com
plia
nce
Adv
anc
e D
irect
ives
& P
atie
ntR
ight
s
Dia
gnos
ticIn
form
atio
n
Pre
scrip
tions
& o
ther
Fol
low
-up
Pre
scrip
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& o
ther
Fol
low
-up
Sat
isfa
ctio
nS
urve
y
Pai
nS
tatu
s
Inst
ruct
ions
Com
preh
ensi
on&
Com
plia
nce
Sig
ns &
S
ympt
oms
Pre
scrip
tion
& o
ther
Fol
low
-up
Rec
over
y &
Bac
k to
Wor
k
Bac
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k
Bac
k to
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Sat
isfa
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urve
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ss
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Insu
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Dia
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Exp
lan
atio
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Issu
es
Edu
catio
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Ass
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Edu
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Ass
essm
ent
Sat
isfa
ctio
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urve
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Sat
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Sat
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CARDIO PULMONARY
OB PATIENT
Sat
isfa
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urve
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19
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. Fro
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RMAT
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Community Health System PARTS OF THE MASTERSOCIAL SERVICES
Keep abreast of Community resources & available servicesRespond to Patient callsCoordinate with Agencies & Insurance- help discover how to pay- provide support systems
Provide after-care planningContact FamilySupport ER Patient needs
Ser
vice
s
PATIENT SELF-CARE
Insurance
IN-PATIENT Dis
ease
Inf
o.T
reat
men
t P
lan
Com
preh
ensi
on(a
bilit
y to
und
erst
and)
Pre
para
tion
for
Hom
e
Clinical:- Identify Patient needs, conditions- Collect, Screen per protocols, Combine papers - Generate an Order for the Kitchen- Revise Orders per paper slips
Management:- Gather Patient satisfaction data- Develop reports
Production:- Work with Kitchen to develop recipes & menus- Spot check food (temperature, quality, etc.)
Clinical:- Identify Patient needs, conditions- Collect, Screen per protocols, Combine papers - Generate an Order for the Kitchen- Revise Orders per paper slips
Management:- Gather Patient satisfaction data- Develop reports
Production:- Work with Kitchen to develop recipes & menus- Spot check food (temperature, quality, etc.)
•Assisted Living•Nursing Home•Convalescent•Senior Centers
Coordinate & Visit SchoolsEvaluate Athletes & Doc.Treat as possible (70%)Refer to Physician (20%, !0%)Follow-up calls to ParentsMonitor Physical Therapy Pats.Work with Orthopedic. PhysiciansAccess records as needed
Coordinate & Visit SchoolsEvaluate Athletes & Doc.Treat as possible (70%)Refer to Physician (20%, !0%)Follow-up calls to ParentsMonitor Physical Therapy Pats.Work with Orthopedic. PhysiciansAccess records as needed
SwitchboardPatientsInsurance companies
SwitchboardPatientsInsurance companies
CashieringBill Medicare, Medicaid, Insurance,
PatientsRecord PaymentsPurge AccountsStudy manualsCorrect Billing problemsSearch for information
MailAccounts Receivable & CollectionsManage processesDevelop reports
Register- Collect Patient data- Check eligibility
Develop impressionTreat critical problems
Get recordsReview chartDocument diagnosis, meds., etc.
Order tests
Register- Collect Patient data- Check eligibility
Develop impressionTreat critical problems
Get recordsReview chartDocument diagnosis, meds., etc.
Order tests
Conduct TestsGive EducationProvide Prep MaterialsTake History, Needs
Conduct TestsGive EducationProvide Prep MaterialsTake History, Needs
SPORTSMEDICINE
CALLCENTER
BUSINESSOFFICE
Communicate & Coordinate
Gather Patient Data & Assure
RegulatoryCompliance
BillConduct Patient Care
Document & Distribute Info.
Manage Logistics & Schedule
of Care
Communicate & Coordinate
Gather Patient Data & Assure
RegulatoryCompliance
BillConduct Patient Care
Document & Distribute Info.
Manage Logistics & Schedule
of Care
Communicate & Coordinate
Gather Patient Data & Assure
RegulatoryCompliance
BillConduct Patient Care
Document & Distribute Info.
Manage Logistics & Schedule
of Care
Collect Transport AnalysisProcessReportResults
DistributeResults
Collect Transport AnalysisProcessReportResults
DistributeResults
REGISTRATION
In-Patient, Out-Patient, Home Health:- Physician referrals- Gather new info. & Access info. in system- Conduct tests & assessments- Analyze results- Provide Care - Assure compliance & report CQI info.- Fill-out forms & Generate reports- Bill
In-Patient, Out-Patient, Home Health:- Physician referrals- Gather new info. & Access info. in system- Conduct tests & assessments- Analyze results- Provide Care - Assure compliance & report CQI info.- Fill-out forms & Generate reports- Bill
AMBULATORY SURGERY
8
9
10
7
5
4
3
6
Find Learn Buy
STORESGovernmentManufacturingServicePrivateSmaller Companies
Safety TreatmentsDiseasesFirst Aid FitnessSafety TreatmentsDiseasesFirst Aid Fitness
2 Pharmaceuticals
Instruments & SuppliesBioTech
Medical Devices
Publications
Insurance Broker
Managed Care & TPA
Reinsurer
Submit Interpret Explanationof Benefits
Coverage Inform Submit Interpret Explanationof Benefits
Coverage Inform
Insurance Provider1
REGULATION - Administration
DES
IRED
OU
TCO
MES
Optimum PatientQuality of Life
Optimum PatientQuality of Life
Minimal CostMinimal Cost
Maximum Patient Security
Maximum Patient Security
Maximum Medical Knowledge
Maximum Medical Knowledge
Easy AccessEasy Access
CommunityInfluencingProcesses:
Schools Radio Churches TelevisionAssociations Internet Businesses Paper - Periodicals, Mailers
Key Support Processes:
REGULATION - Clinical
Critical Information:
Momentsof Truth:Issues for Informed
Decision Making &
Defining Points of Quality
CO
RE
PRO
CES
S
RN CALL LINE
RN HOME VISITS
CHARITIES & AGENCIESRed Cross
Nutritional SupplementInformation Management, Communications, & ComputerEquipment, Durable Medical, & Instrument Materials Services
Others
TherapiesTherapies
HospiceHospice
Fitness CentersFitness Centers
ClinicsClinics
Specialty PhysiciansSpecialty Physicians
INSURANCE
GeneticsGenetic Risks …
EnvironmentWeather: Air, Water, PollutionRadiation Sources
Social Values: Life Worth Religious Beliefs Artificial Life Support Distribution of Resources
Population Demographics, Psychographics:Access to Care, Handicaps AgeFinancial
Special Interest
Industry Associations
Knowledge Sources
Point-of -Care TestingStat TestingLocal, Regional TestingReference LabClinical StudiesApplied ResearchAcademic ResearchDisease Center -Regional, InternationalCollegesUniversities
Government Agencies - Administrative (OSHA, EPA, NBS, etc.)Legislative PolicyTaxes, Fines, and other Incentives
Government Agencies - Clinical, Medical (FDA, NIH, CDC, etc.)Industry Standards (AMA, CLMA, etc.)
PreAdm TESTING
Any complex system is best optimized by first recognizing all the parts and influencing forces. Then, we determine how they connect, or need to connect, in order to deliver the desired outcomes. From here, we assure the roles, skills, and relationships; the tools and systems; the behaved beliefs; and the measures and incentives needed are available to predictably operate and deliver the intended performance. This way, the various paths of designing a solution can be sequenced to manage interdependencies, monitored, and implemented in a meaningful order and adapt based on actual context.
- Gather information - Analyze results - Conduct tests - Generate reports - Bill- Gather information - Analyze results - Conduct tests - Generate reports - Bill
CollectRequirements
Set-up &Conduct Test
DeliverReports
Evaluate & Dictate Report
CollectRequirements
Set-up &Conduct Test
DeliverReports
Evaluate & Dictate Report
OB PATIENT
LABORATORY
PHYSICALTHERAPY
Admit Prep TreatmentEvaluate Recover Evaluate Follow-upCheckout
COMMUNITY &INFORMATION
MEDIA
AMBULATORY PATIENT HOME HEALTH
PHARMACY
Interpret Validate Prep/Dispense Check & InformOCCUPATIONALHEALTH
LONG TERM CARE FACILITY
Information,Education,
Interpretation
Treatment PatientHistory & Medical
Records
BehaviorModification
Compliance Monitor
PRODUCT SUPPLIERS
EMPLOYERS
ALLIED PROVIDERS
AdministrationHuman
ResourcesQuality
ResourcesNursingMaterials
ManagementPlant ServicesMedical StaffExecutive
Leadership
Management Reporting Finance
& AccountingInformation
ManagementOutpatient Clinic
Area Services
GENERAL EDUCATION
Deliver
DIETARY SERVICESER
RADIOLOGY
Put Patient in room - take Vitals, History, Physical Assess.
Make roundsDocument Patient information & Assemble chartConduct selected Patient educationPrep, Dispense/Mix meds., & Monitor Patient needsSupport Physician procedures, effortsCoordinate communications & Access info./materials
Refer to Critical CareSupport Outpatient testing
Support Health programsSupervision of StaffOngoing Staff education
SchedulingManage Database - Cancer RegistryCollect data & reconcile data for BillingCheck charges & delete if Hospital duplicatedLook-up information
Maintain a System plan & maintain & repair/upgradeMaintain the System & on-going improvementsStandardize & purchase all PC’s, most software, etc.
Receive requests & identify needsAssign staff & scheduleDevelop & coordinate plans & put into databaseDo process design as necessaryCommunicate with users & managementDo projects, install, test & documentSurvey Departments after work done
Conduct on-going Staff education
Supervision of Staff:- Maintenance, Security
Facility Management ( 4 properties):- Write Policies - Safety, Security, Plant Operations- Monitor HVAC, Test Fire systems- Manage Phone system (#’s, line expansion), Cable TV- Maintain generator/emergency power, logs- Materials (finishes, etc.)- Hazardous Waste- Track Vendor service reports, Track Construction documents
(rehab, new buildings)- Generate Reports, Track incident variance reports- Preventative Maintenance program (equipment, Systems)- Attend numerous meetings
Material Distribution:- Create “Pick-list”- Fill Order- Remove from Inventory Control
Receiving:- Buy standard commodities- Receive & Inspect- Print & Apply Stickers (Patient billable only)
Forms (>1000 different) & Matl. Mgmt. Standards:Request-Design-Review-Define use,#,etc.-Approve-Print-Distrib.
Quality Assurance facilitator:- Assess- Plan- Implement- Evaluate
Staff & Community Education (annual & routine):- Identify Needs- Identify Solutions- Make Available- Deliver- Measure success
Corporate Compliance & Quality Reports
Evaluate Patient indicationsIdentify & Order testsAccess information Develop diagnosisFormulate treatmentDocument patient data
Conduct selected Patient education
Conduct procedures
Ongoing medical & quality systems education
Provide Administrative support to CEO functionOverview Operational PerformanceAnalyze & Interpret DataRecommend ActionsInteract with Industry & Allied groups, organizationsWork with Physicians & Departments to resolve
questions, issuesAssure response to Patient complaintsOversee capital projects
- e.g. new building, dining area, ER waiting areaConduct/Participate in meetings - e.g. Budget, Board,
Medical Staff, Patient Services, Dept. heads, etc.Oversee Community Relations & Educational activities
Recruit new employeesInterviewHireOrient
Assure Compliance Review timesheets for payrollLiaison for Employees to Administration & InsuranceAnswer questions of Employees
EnrollmentBadgesBenefits ( vacation, sickness, insurance, etc.)Interpersonal issues
Catalyze Strategy Stimulate movement to meet challenges of MissionProvide for Education, Growth, & ContinuityFacilitate setting Standards for performance & outcomesBe the senior communicator to:
CommunityBoardMedical StaffEmployers
Provide senior oversight to Payor, clinical, & businessprocesses through championing of Teams
Develop & maintain the plan for key measuresDevelop reportsProduce reportsDistribute when & as needed
Data Processing & Patient Accounting(see above)
Accounting:Pay BillsMaintain Capital Assets log
(Health & Wellness to Employers & Employees)- Schedule Patients & be chain-of-custody to
Drug screens- Collect Patient data, dictate/document - Track-down chart, deficiencies,
& FAX needs list- Deliver Results & Reenter Patient Regist.- Billing info. to system for Employer, TPA,
Managed Care, Patient
Get Order
Initiate &Schedule
GatherData
CheckoutEvaluation& Diagnosis
FormulateTreatment
PatientArrival
ProviderFollow-up
PatientCompliance
Correspondence / ROIAssemble Transcription CodingAnalysis Deficiency Analysis Chart Completion
Audit / Second Bill Bill Patient Close AccountInitiate CollectionsGather Billing Data Enter Data Inquiry of EligibilitySubmit Bill Remittance PostEdit BillGenerate Bill / EditPATIENT ACCOUNTING
MEDICAL RECORDS
Medical StaffCoordination
Liaison between Medical Staff & HospitalMaintain Physician information & credentialing dataInform Departments of new PhysiciansRemind Physicians - insurance, reappointment, etc.Track procedures per PhysicianCoordinate reappointment of Physicians every 2 yrs.Maintain minutes of Medical Staff meeting
Conduct literature searches
Manage Library
Operate internal Newsletter
HospitalInformationClinic NameLocation AddressLocation Phone #Service/SpecialtiesMissionCapacityAmenitiesPhysicians’ NamesFeesQualifications/TrainingInsurance Participation
PatientDemographics
NameAddressSexAge, DOBPhones - Home, WorkResponsible Party
Parent, Guardian“Next of Kin”, Emergency
ContactEmployer, OccupationDays/Week of WorkMarital StatusSocial History
PatientMedical History
Previous Medications/Drug History
Previous Medical ProblemsPrevious Treatments/TestsPrevious Physicians/
AdmissionsPrevious SurgeriesFamily History InformationAllergiesCurrent Meds, Former MedsClinical InformationOther
InsuranceInformationInsurer NameType of InsuranceCopaymentCard Number
(policy #, phone #, etc.)Supplements/Attachments
(e.g. Medicare)Contract RequirementsContractual AdjustmentsEligibilityMultiple Insurers
PrimarySecondary
Current ProblemsSymptomsChief ComplaintReferralVital SignsWeight - HeightPulse - B/P
Physical ExamProblem ListPatient SatisfactionSelf Care - Dress, FeedLife Quality Indicator
SchedulingInformationRoom/EquipmentPatient PhysicianAttending Physician Admitting PhysicianSupport PersonnelEquipmentAppointment InformationInsurer Information
Billing/InsuranceInformationPatient Name Patient Type (In., Out., ER, etc.) Advance Beneficiary Notice
(“ABN”)Advance DirectivePayor NameEmployerPayment HistoryCurrent BalanceProvider Number Diagnosis/Billing CodesComplaintsAccountingFace SheetBill Type (Phys., Hosp., etc.)
PharmacistInformationNameAddressPhone/Fax NumberCredentials
Protocols &ProceduresPhysician Practice ProtocolsFlow Sheets-Care PathsRegulationsHMO, Other Insurance
GuidelinesTest/Treatment ProceduresCode of ConductValue StatementsPolicies
DiagnosisInformationPhysician HandwritingPhysician DictationICD-9 CodesTreatment Protocols/
ProceduresPharmacopoeia (e.g.)
PharmaceuticalInformationPrescription PadsAllergiesPhysician Name, Address,
Phone #, License #, DEA#sPatient NameDateMedication List, Names
Quantities, Doses,Interactions
SignatureDrug InteractionsPatient Information Sheet
Test InformationTest OrderedMRIs, CTs, ENGs,
MCDs, etc.Lab Data, X-Ray DataResults ReportsAdvance Beneficiary Notice
Therapy SitesNameAddressPhone Number
Test SiteInformationNameAddressPhone NumberOrdering PhysicianInsurer Approved Site for
Laboratory TestingRadiology TestingAncillary Testing
TreatmentInformationResultsPhysical TherapyOccupational TherapyConsultantsApproved by Third Party
PayorsFollow-upTime in System
Employee/StaffInformation
NameAddressPhone, Fax, Pager, E-mailCredentialsAvailability/Schedule
PhysicianInformation
NameAddressPhone, Fax, Pager, E-mailSocial Security #DependentsResumeAvailability/Schedule
Materials & SuppliersDescription, Part #’s, CostSuppliers NameSupplier Info.
- Contact Phone, AddressAuthorizationContracts
RegulationsMedicalClinicalEmploymentBusiness & FinanceFacility & Property
Sym
ptom D
iagn
ostic
Info
rmat
ion
App
oint
men
t
Adm
issi
ons
Gui
delin
es
Tre
atm
ent
Opt
ions
Pre
Cer
tific
atio
nof
Insu
ranc
e
Med
ical
His
tory
Cas
eM
anag
emen
t
Pro
cess
Exp
ecta
tions
Orie
ntat
ion
to F
acili
ties
Sat
isfa
ctio
nS
urve
y
Pai
nS
tatu
s
Dis
ease
Info
.
Inst
ruct
ions
Com
preh
ensi
on&
Com
plia
nce
Sig
ns &
S
ympt
oms
Opt
ions
Mea
ning
of
Con
ditio
ns
Whe
re
do I
go? E
xpla
nat
ion
of Is
sues
Tre
atm
ent
Opt
ions
Abi
lity
for
Com
plia
nce
Adv
anc
e D
irect
ives
& P
atie
ntR
ight
s
Dia
gnos
ticIn
form
atio
n
Pre
scrip
tions
& o
ther
Fol
low
-up
Pre
scrip
tions
& o
ther
Fol
low
-up
Sat
isfa
ctio
nS
urve
y
Pai
nS
tatu
s
Inst
ruct
ions
Com
preh
ensi
on&
Com
plia
nce
Sig
ns &
S
ympt
oms
Pre
scrip
tion
& o
ther
Fol
low
-up
Rec
over
y &
Bac
k to
Wor
k
Bac
k to
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k
Bac
k to
Wor
k
Sat
isfa
ctio
nS
urve
y
Wha
t do
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ed?
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I do
ing
enou
gh? Dia
gnos
ticP
roce
ss
Pre
Cer
tific
atio
nof
Insu
ranc
e
Dia
gnos
ticP
roce
ss
Exp
lan
atio
nof
Issu
es
Edu
catio
n &
Ass
essm
ent
Edu
catio
n &
Ass
essm
ent
Sat
isfa
ctio
nS
urve
y
Sat
isfa
ctio
nS
urve
y
Sat
isfa
ctio
nS
urve
y
CARDIO PULMONARY
OB PATIENT
Sat
isfa
ctio
nS
urve
y
19
99, 2
003,
200
7, A
. Fro
hwer
kCo
mm
unity
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Community Health System PARTS OF THE MASTERSOCIAL SERVICES
Keep abreast of Community resources & available servicesRespond to Patient callsCoordinate with Agencies & Insurance- help discover how to pay- provide support systems
Provide after-care planningContact FamilySupport ER Patient needs
Ser
vice
s
PATIENT SELF-CARE
Insurance
IN-PATIENT Dis
ease
Inf
o.T
reat
men
t P
lan
Com
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ensi
on(a
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y to
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Pre
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Clinical:- Identify Patient needs, conditions- Collect, Screen per protocols, Combine papers - Generate an Order for the Kitchen- Revise Orders per paper slips
Management:- Gather Patient satisfaction data- Develop reports
Production:- Work with Kitchen to develop recipes & menus- Spot check food (temperature, quality, etc.)
Clinical:- Identify Patient needs, conditions- Collect, Screen per protocols, Combine papers - Generate an Order for the Kitchen- Revise Orders per paper slips
Management:- Gather Patient satisfaction data- Develop reports
Production:- Work with Kitchen to develop recipes & menus- Spot check food (temperature, quality, etc.)
•Assisted Living•Nursing Home•Convalescent•Senior Centers
Coordinate & Visit SchoolsEvaluate Athletes & Doc.Treat as possible (70%)Refer to Physician (20%, !0%)Follow-up calls to ParentsMonitor Physical Therapy Pats.Work with Orthopedic. PhysiciansAccess records as needed
Coordinate & Visit SchoolsEvaluate Athletes & Doc.Treat as possible (70%)Refer to Physician (20%, !0%)Follow-up calls to ParentsMonitor Physical Therapy Pats.Work with Orthopedic. PhysiciansAccess records as needed
SwitchboardPatientsInsurance companies
SwitchboardPatientsInsurance companies
CashieringBill Medicare, Medicaid, Insurance,
PatientsRecord PaymentsPurge AccountsStudy manualsCorrect Billing problemsSearch for information
MailAccounts Receivable & CollectionsManage processesDevelop reports
Register- Collect Patient data- Check eligibility
Develop impressionTreat critical problems
Get recordsReview chartDocument diagnosis, meds., etc.
Order tests
Register- Collect Patient data- Check eligibility
Develop impressionTreat critical problems
Get recordsReview chartDocument diagnosis, meds., etc.
Order tests
Conduct TestsGive EducationProvide Prep MaterialsTake History, Needs
Conduct TestsGive EducationProvide Prep MaterialsTake History, Needs
SPORTSMEDICINE
CALLCENTER
BUSINESSOFFICE
Communicate & Coordinate
Gather Patient Data & Assure
RegulatoryCompliance
BillConduct Patient Care
Document & Distribute Info.
Manage Logistics & Schedule
of Care
Communicate & Coordinate
Gather Patient Data & Assure
RegulatoryCompliance
BillConduct Patient Care
Document & Distribute Info.
Manage Logistics & Schedule
of Care
Communicate & Coordinate
Gather Patient Data & Assure
RegulatoryCompliance
BillConduct Patient Care
Document & Distribute Info.
Manage Logistics & Schedule
of Care
Collect Transport AnalysisProcessReportResults
DistributeResults
Collect Transport AnalysisProcessReportResults
DistributeResults
REGISTRATION
In-Patient, Out-Patient, Home Health:- Physician referrals- Gather new info. & Access info. in system- Conduct tests & assessments- Analyze results- Provide Care - Assure compliance & report CQI info.- Fill-out forms & Generate reports- Bill
In-Patient, Out-Patient, Home Health:- Physician referrals- Gather new info. & Access info. in system- Conduct tests & assessments- Analyze results- Provide Care - Assure compliance & report CQI info.- Fill-out forms & Generate reports- Bill
AMBULATORY SURGERY
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Find Learn Buy
STORESGovernmentManufacturingServicePrivateSmaller Companies
Safety TreatmentsDiseasesFirst Aid FitnessSafety TreatmentsDiseasesFirst Aid Fitness
2 Pharmaceuticals
Instruments & SuppliesBioTech
Medical Devices
Publications
Insurance Broker
Managed Care & TPA
Reinsurer
Submit Interpret Explanationof Benefits
Coverage Inform Submit Interpret Explanationof Benefits
Coverage Inform
Insurance Provider1
REGULATION - Administration
DES
IRED
OU
TCO
MES
Optimum PatientQuality of Life
Optimum PatientQuality of Life
Minimal CostMinimal Cost
Maximum Patient Security
Maximum Patient Security
Maximum Medical Knowledge
Maximum Medical Knowledge
Easy AccessEasy Access
CommunityInfluencingProcesses:
Schools Radio Churches TelevisionAssociations Internet Businesses Paper - Periodicals, Mailers
Key Support Processes:
REGULATION - Clinical
Critical Information:
Momentsof Truth:Issues for Informed
Decision Making &
Defining Points of Quality
CO
RE
PRO
CES
S
RN CALL LINE
RN HOME VISITS
CHARITIES & AGENCIESRed Cross
Nutritional SupplementInformation Management, Communications, & ComputerEquipment, Durable Medical, & Instrument Materials Services
Others
TherapiesTherapies
HospiceHospice
Fitness CentersFitness Centers
ClinicsClinics
Specialty PhysiciansSpecialty Physicians
INSURANCE
GeneticsGenetic Risks …
EnvironmentWeather: Air, Water, PollutionRadiation Sources
Social Values: Life Worth Religious Beliefs Artificial Life Support Distribution of Resources
Population Demographics, Psychographics:Access to Care, Handicaps AgeFinancial
Special Interest
Industry Associations
Knowledge Sources
Point-of -Care TestingStat TestingLocal, Regional TestingReference LabClinical StudiesApplied ResearchAcademic ResearchDisease Center -Regional, InternationalCollegesUniversities
Government Agencies - Administrative (OSHA, EPA, NBS, etc.)Legislative PolicyTaxes, Fines, and other Incentives
Government Agencies - Clinical, Medical (FDA, NIH, CDC, etc.)Industry Standards (AMA, CLMA, etc.)
PreAdm TESTING
Any complex system is best optimized by first recognizing all the parts and influencing forces. Then, we determine how they connect, or need to connect, in order to deliver the desired outcomes. From here, we assure the roles, skills, and relationships; the tools and systems; the behaved beliefs; and the measures and incentives needed are available to predictably operate and deliver the intended performance. This way, the various paths of designing a solution can be sequenced to manage interdependencies, monitored, and implemented in a meaningful order and adapt based on actual context.
Storyboard to understand & design the Stories
Introduction Registration Service Encounter Discharge Post-DischargeArrive Register TreatLab DispositionCheck-out
Storyboard to understand & design the Stories
Chapter / Scene
Stage
Patient Needs
Our IntentImpressions
Physical Elements
Behaviors
Mechanisms
Check-in EducateRoomTherapy Follow-upPlan
Experience Design STORYBOARDO
N-S
TA
GE
ME
CH
AN
ISM
SC
HA
PT
ER
SC
EN
E
Plan. & Coord.Home, Work, Hospital
(They call us or we call them.)
Check-inPre-op Holding
RegistrationIntroduction B
ehav
ior
Ph
ysic
al C
ues
I
nte
nt
Pro
cess
Peo
ple
T
oo
ls
Pla
ce
Know who I am, have my info: Know & contact my key contacts, my Physician, the plan.
Information/ logistics needed to prepare: Learn date, time, when/where, parking, arrival. Pre-admission testing? What to bring. Length of stay. Know where Family goes. Impact on Family. What should I do with my usual medication routine?
Confirm schedule, timing, what to bring. Answer last-minute questions.
What I should bring: How much to pay, when. Insurance coverage. Pre-register info.
Define team: Select Physician. Team coordinated? Role of Family?
Comfort of Interaction: Easy of access. Empathy. Save time.
Find way easily: Get to ER when ER needed. Travel, find, park.
Physically able to get inside. Surface parking close to the entrance for high-priority Patients – wound care, handicapped, D&T
Know where my Family, friends go and how to contact them.
Security of hospital.
Know who I am. Treated as an individual.
Don’t get lost, delayed.
Aleve worries. No unexpected waits, distractions, embarrassment.
Sense that people, info. is well-coordinated.
ArriveEntrance: Parking or Curb
Check-in, RegisterDesk: Main, Women’s, ED,
Patient floor (after Main)
EDER
Out PatientTransitions / Hand-offs
Hallways
Th
e P
has
eA
ctiv
ity
or
Pu
rpo
seo
n a
giv
en
‘Sta
ge
’ (p
lace
)
Info. ExchangeOutside the Hospital
(Call, Internet, Physician, Media, Friends)
Info. ExchangeIn the Hospital
Experiential Bundles:‘Scene’-specific procedures and behaviors, using predetermined tools, in a given place (‘Stage’), carried-out by specific roles to create an intended experience.
Grounds:• Valet Parking• Golf Cart (Shuttle) • Safety Code Blue Stations In Parking Lot• Covered Entrance• Water Feature• Strategically Placed Benches – Parking Lot, To
Entrance• Inner Courtyard• Labyrinth
Lobby And Public Areas:• Water Feature• Simplistic, Intuitive Layout Of Public Areas• Wayfinding Strategies (Universal Signage, Central
Admitting/Registration)• Chapel And Meditation Room• Learning Center • Use Of Natural Design Elements (Wood Accents, Stonework)• Comfortable And Bariatric Seating• Player Piano And Coffee Bar In Lobby• Wireless Internet Access• Room Service With High Quality Foods (Self Regulated Diet)• Concierge Service
Physician Design Elements:• Covered Parking• Parking Additionally Located Adjacent To ED• Comfortable Physician Lounge With Amenities (Off Courtyard)• Child Care Onsite• MOB With Covered Walkway
Re-transcribe typed prescriptions resulting in disastrous errors.
Didn’t attempt to validate correctness.
Could not alter permissions form to indicate no student Physicians.
Need to know what to eat/not to eat before surgery
…
Connecting not easy- played phone tag ……………………
Place and way to indicate special information.
Overheard concerns.
Discomfort; Wait;
Charging to park; we're the only hospital that does that
Large useful signs.
Helpful person along the way.
Easy parking; Roving volunteers give attention (even at night).
Cluttered spaces. Distracting; Disconnected; Shadows; Glare; Confusing layout
Noise: loud TV, distractions, food channel; Muffled; Cold. Hard; Too Hot; Too Cold; Drafty.
Free-for-all, individualistic; Disconnected: no one sees you sitting; Confusing; Wait; Wonder.Left me to 'chase things down’; Complained about problems; Distracted: Told to 'sit‘ (when it hurt); Waited w/o explanation. Acted bored; No rush in ED – treated as routine.
Too busy; Don't notice; "Never a Triage Nurse.“ No rush – routine, Wonder; Bad measurement
Noise: loud and crowded; Cold room; More blankets
Long wait before surgeryDidn’t pay attention to patient info. provided
No one owning bad behavior.
Cost Estimate
Need:Friendly, understanding, listen & follow-up. Info ready; No financial pressure; Flexible if info not available.Immediately ready (initiation);<5 min. effort; Immediately go to next steps Routine but engaged w/ present person & situation. Responsive.
Fresh air. Live plants.
Seek guidance: Discuss symptoms, potential need, Physician options, second opinion.
Learn: What’s available? What’s the process? How long it takes? Info. needed to provide.
Check on info: My pre-registration, schedule. Directions to hospital & where to park. Physician background.
My financial responsibility: Understand what will be covered by insurance (In? Out?)
Comfort of interaction: Manage fear, grief, denial, anger, depression, acceptance. Courtesy, efficient, competent, empowered.
Welcoming, calming: Treated well. Aleve fears/worries. Courteous prepayment process.
Ready: for my arrival. Know who I am, why I’m here. Coordinate care/info./Physician. Accurate data & verification.
Remember me from previous visits – esp. repetitive lab, therapy, wound care. Avoid long waits, repetition Use what I brought.
Understand: what I’m signing. Remind me where to go. Easy way-finding, understand process & flow. Estimate length of stay (physician at PreAdmit) & cost.
Sense Competence of Staff.
Assess my condition. Verify history. Get ready for treatment. Learn what happens.
Care to listen, show empathy, discuss, explain. Not forgotten. Attentive. Responsive. Courteous.
Comfort & safety. How can I keep from catching something? What do I do if I’m hungry, thirsty, cold, etc.? How do you maintain cleanliness?
Get treated.
Someone is connected to me. They’ve focused on me. Attentive. Responsive.
Learn what it feels like. Know when we will start. Why am I not the priority? What is the system to keep me informed about my wait time (i.e. “Now calling number X…”)? How will I communicate (bilingual, multicultural, hearing impaired)?
Fundamentals of Experience Design
à Be Relevant à Engage à Flow à Adapt
Fundamentals of Design: Be RelevantInclude the “soft” with the “hard”:
– Understand Patient’s needs & expectations vs. Our intent
– Close the gap
q Seek to understand each Patient & Family member as if “standing in their shoes”
q Anticipate & act on the needs & concerns of each Patient & Family member, if possible, before they are voiced.
Pho
to:
Set
on F
amily
of
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ls
Fundamentals of Design: EngageTrigger:
– Impressions • Concepts • Symbols
– Physical elements • The five senses • Memorabilia
– Behaviors • What• Who• Where• When
q Use the 3 key mechanisms to deliver the experience:
-People-Tools-Places
q Address positive & negative cues & the 5 senses that form impressions
q Recognize what should be “on-stage” & when things should be “off-stage.”
Fundamentals of Design: FlowBuild meaningful stories:
– Chapter– Scene– Stage– Transitions
q Connect the Patient & their Care Team to the next:
- Procedure- Service- Time- Place
…so that the Patient never becomes “lost” & we never “drop the ball” in any hand-off.
q Work as a “Healing Team” by sharing & accepting, modeling leadership, & living the 4 C’s:
- Communication- Collaboration- Caring- Cooperation.
Fundamental: AdaptLearn what’s important in the Story:
– Understand– Discuss & Plan– Try– Report
q Experiment
q Be opportunistic
q Pilot
q Share learning
q Innovate
q Constantly improve.
Context …a whole system approach
The Environment of Trends & Opportunities
Roadmap to sequence Implementation
Experience Design Principles
Strategy Management SystemStrategic Purpose & Commitment•Vision, Mission, Values•Strategic Imperatives
Culture Design based on Values
Influencing People Governance & Policies
Fundamentals
Storyboard
Master Process
Principles New Paradigms for implementing Experience Design
1. Bring the Strategy out and alive
2. Get good at Connecting
3. Engage the Soft with the Hard
4. Build meaningful Stories
5. Learn what’s important in the Story
6. Adapt the role of leadership– Bring clarity and focus to vision, values
– Build self-confidence
– Coach and reinforce
– Have faith.
DiscussionExperience Design: A Framework for Patient Care
Pho
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Set
on F
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Experience Design: A Framework for Patient Care
Storyboardq Chapterq Sceneq Stageq Transitions
Master Processq Moments of Truthq Core Processq Support & Information Processesq Systems & Toolsq Desired Outcomes & Inputsq Roles q Measures
Fundamentalsq Be Relevantq Engageq Flow q Adapt