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Zaintzeko-I: metodología de diseño centrado en las personas para el desarrollo de nuevos productos y servicios centrados en la experiencia de paciente
Abstract
Investigaciones recientes resaltan la importancia de introducir la eXperiencia de Pacientes (PX) a la hora de proponer productos y servicios en entornos sanitarios y sociales 1–3. Tradicionalmente el desarrollo de estos está liderado por equipos con un perfil experto en la tecnología a desarrollar, sin embargo, carecen de información real sobre el contexto de uso 4. El diseño centrado en las personas o human-centred design (HCD) 5 es un enfoque que ayuda a integrar la PX en las organizaciones y guía en el abordaje de problemas habilitando a profesionales y pacientes a co-diseñar los servicios y/o productos en colaboración 6. En este contexto nace Zaintzeko, una metodología HCD específica para su uso en entornos socio-sanitarios con el objetivo de guiar a las empresas y organizaciones a proponer nuevos productos y servicios para mejorar la PX. La primera experimentación de la metodología (Zaintzeko-I, 2018-2019) tuvo lugar en el ámbito académico con el apoyo de la DFG y UGGASA. Zaintzeko-I fue realizada por 23 personas graduadas en ingeniería de diseño industrial con conocimientos en HCD. Los 5 equipos de trabajo fueron capaces de identificar y definir la problemática y necesidades reales de las personas que son parte del ecosistema de cuidados, y de traducir estas necesidades en nuevos productos y servicios. Los 5 prototipos digitales presentados estaban en un nivel de desarrollo semi-funcional, lo que ayudó a la comprensión de las propuestas por parte de las empresas interesadas en el sector. Los equipos ejecutaron la metodología Zaintzeko de forma satisfactoria, a pesar de ser necesarios más estudios empíricos sobre su uso, la metodología asiste a los equipos a comprender la PX para después, definir y detallar las necesidades de las diferentes personas que forman parte del equipo de cuidados y traducirlas en requisitos de los nuevos productos y servicios.
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Healthcare is a service setting where meeting the needs of customers (patients and their families) is uniquely challenging. But the necessity, complexity, cost, and high-emotion nature of the service, as well as technological advances and competitive dynamics in the industry, make the imperative for service innovation in healthcare especially urgent. Forward-thinking healthcare institutions around the United States are succeeding in establishing a value-creating innovation culture and in implementing operational and strategic service innovations that benefit them and their stakeholders. They view continuous innovation as a non-negotiable goal, prize institutional self-confidence, and include patients and families on the innovation team. Cancer care, in particular, faces a pressing need for service innovation, and some progressive oncology centers are demonstrating what is possible to improve the patient and family service experience. The imperatives, now, are for service innovation to become part of the fabric of how all healthcare institutions, not just the groundbreakers discussed in this article, operate—and for academics in the field of marketing to play a crucial role in that effort.
Health and wellbeing are determined by a number of complex, interrelated factors. The application of design thinking to questions around health may prove valuable and complement existing approaches. A number of public health projects utilizing human centered design (HCD), or design thinking, have recently emerged, but no synthesis of the literature around these exists. The results of a scoping review of current research on human centered design for health outcomes are presented. The review aimed to understand why and how HCD can be valuable in the contexts of health related research. Results identified pertinent literature as well as gaps in information on the use of HCD for public health research, design, implementation and evaluation. A variety of contexts were identified in which design has been used for health. Global health and design thinking have different underlying conceptual models and terminology, creating some inherent tensions, which could be overcome through clear communication and documentation in collaborative projects. The review concludes with lessons learned from the review on how future projects can better integrate design thinking with global health research.
Healthcare industry continues to evolve under conditions of intense competition in approaching health prevention, protection, and promotion. Therefore, healthcare providers are challenged to always ensure better patient experience, winning patients’ satisfaction, and loyalty and remain competitive on today’s healthcare market. Healthcare markets bring together professionals and their patients into real collaborative relationships, which empower patients to contribute to the healthcare improvement. Within this competitive landscape, which is also characterized by digital health tools boosting patients’ awareness and controlling their own health, medical providers need to be perceived as skilled and trustworthy in relying on patients’ needs, expectations, and sacrifices are required in order to obtain the promised benefits. Moreover, while constantly providing a holistic assessment of the healthcare services’ and experience attributes, acting on feedback and reaching healthcare service excellence, providing a better understanding of all the touch points with their patients and improving the quality and consistency of all these touch points, all these are achieved by employees, who are truly connected to the healthcare business.
Today, patients are systematically becoming aware of the diversity of their choices, being increasingly involved in making better healthcare choices, and, so, more and more innovative products are introduced, targeting new patient segments. Findings from the last three years have shown that patients may achieve better outcomes due to the stakeholders’ commitment to innovation within the context of the big-data revolution, by building new values.
It is necessary to rethink the different experiences of patients in health care area. Feelings such as anxiety and fear, for example, are common in the interactions between caregivers and patients, which reflects the disparity between the offered and the necessary to meet the patients’ demands. In this article, there will be analyzed two cases of successful application of the Design Thinking in the Health Care area, the “Mayo Clinic” – elected the best hospital in the USA in 2014 - and the “Humanization of the perioperative experience of the elective patient ” – a Master's thesis developed by the author at Fluminense Federal University (UFF) in 2015. It’s demonstrated the potential of using the Design Thinking for the systematic planning and re-planning of the health service, seeking to meet and transpose the human beings expectations, generating values for the clients, market spread and leveraging a competitive advantage.
Over the last decade, growing attention has been paid to the potential value of design theory and practice in improving public services. Experience-based Co-design (EBCD) is a participatory research approach that draws upon design tools and ways of thinking in order to bring healthcare staff and patients together to improve the quality of care. The co-design process that is integral to EBCD is powerful but also challenging, as it requires both staff and patients to renegotiate their roles and expectations as part of a reconfiguration of the relationships of power between citizens and public services. In this paper, we reflect upon the implementation and adaptation of EBCD in a variety of projects and on the challenges of co-design work within healthcare settings. Our discussion aims to contribute to the growing field of service design and to encourage further research into how co-design processes shape – and are shaped by – the power relations that characterize contemporary public services.
The NHS has been collecting data on patients’ experience of care for over 10 years but few providers are systematically using the information to improve services. Angela Coulter and colleagues argue that a national institute of “user” experience should be set up to draw the data together, determine how to interpret the results, and put them into practice
Increasing pressure to improve health outcomes of populations with limited resources has prompted an emphasis on innovation. Design thinking has been proposed as a systematic approach to innovation in health, owing to its human-centred methodology that prioritises deep empathy for the end-users' desires, needs and challenges, which results in a better understanding of the problem in order to develop more comprehensive and effective solutions. A key feature of design thinking is stakeholder participation. If design thinking is going to be used as an approach to design and implement effective, equitable and sustainable health solutions, assessing stakeholder participation should be integrated into the process. Therefore, the purpose of this review is to i) provide an analysis of the literature on assessing stakeholder participation in health and ii) propose a framework based on the literature analysis that can be used to assess stakeholder participation during the design thinking process in health innovation. Drawing from participatory research in health, where stakeholder participation is recognised as a core principle that facilitates the implementation of solutions, we integrate stakeholder evaluation tools into the design thinking approach. We draw on an assessment framework that describes levels of stakeholder participation by their involvement in making decisions about their health. Using a 5-point continuum where the lower end represents the medical approach (professionals make all the decisions) and the upper end represents the community development approach (all stakeholders are key decision makers), we propose a modified assessment framework to evaluate stakeholder participation during the design thinking process. The modified framework provides a simple and practical tool to evaluate stakeholder participation. Stakeholders can rate their perceived level of participation, as well as that of the other stakeholders. Evaluation of participation in a design thinking project may be used to improve participation, and therefore the uptake and sustainability of innovations. The framework may also be used in design thinking beyond health applications.
Using a human-centered design method, our team sought to envision a new model of care for women experiencing low-risk pregnancy. This model, called OB Nest, aimed to demedicalize the experience of pregnancy by providing a supportive and empowering experience that fits within patients’ daily lives. To explore this topic, we invited women to use self-monitoring tools, a text-based smartphone application to communicate with their care team, and moderated online communities to connect with other pregnant women. Through observations of tool use and patient- and care team–provided feedback, we found that self-measurement and access to a fetal heart monitor provided women with confidence and joy in the progress of their pregnancies while shifting their position to being an active participant in their care. The smartphone application gave women direct access to their care team, provided continuity, and removed hurdles in establishing communication. The online community platform was a space where women in the same obstetric clinic could share nonmedical questions and advice with one another. This created a sense of community, leveraged the knowledge of women, and provided a venue beyond the clinic visit for information exchange. These findings were integrated into the design of the Mayo Clinic OB Nest model. This model redistributes care based on the individual needs of patients by providing self-measurement tools and continuous flexible access to their care team. By enabling women to meaningfully participate in their care, there is potential for cost savings and improved patient satisfaction.
Background:
Increasing use of emergency departments among older patients with palliative needs has led to the development of several service-level interventions intended to improve care quality. There is little evidence of patient and family involvement in developmental processes, and little is known about the experiences of - and preferences for - palliative care delivery in this setting. Participatory action research seeking to enable collaborative working between patients and staff should enhance the impact of local quality improvement work but has not been widely implemented in such a complex setting.
Objectives:
To critique the feasibility of this methodology as a quality improvement intervention in complex healthcare settings, laying a foundation for future work.
Setting:
an Emergency Department in a large teaching hospital in the United Kingdom.
Methods:
Experience-based Co-design incorporating: 150h of nonparticipant observation; semi-structured interviews with 15 staff members about their experiences of palliative care delivery; 5 focus groups with 64 staff members to explore challenges in delivering palliative care; 10 filmed semi-structured interviews with palliative care patients or their family members; a co-design event involving staff, patients and family members.
Findings:
the study successfully identified quality improvement priorities leading to changes in Emergency Department-palliative care processes. Further outputs were the creation of a patient-family-staff experience training DVD to encourage reflective discussion and the identification and application of generic design principles for improving palliative care in the Emergency Department. There were benefits and challenges associated with using Experience-based Co-design in this setting. Benefits included the flexibility of the approach, the high levels of engagement and responsiveness of patients, families and staff, and the impact of using filmed narrative interviews to enhance the 'voice' of seldom heard patients and families. Challenges included high levels of staff turnover during the 19 month project, significant time constraints in the Emergency Department and the ability of older patients and their families to fully participate in the co-design process.
Conclusion:
Experience-based Co-design is a useful approach for encouraging collaborative working between vulnerable patients, family and staff in complex healthcare environments. The flexibility of the approach allows the specific needs of participants to be accounted for, enabling fuller engagement with those who typically may not be invited to contribute to quality improvement work. Recommendations for future studies in this and similar settings include testing the 'accelerated' form of the approach and experimenting with alternative ways of increasing involvement of patients/families in the co-design phase.