Fostering Continuity and Equity of Care for Patients at the Primary Care Clinic
Time Frame: May - August 2022
Education
Product Development
Overview
This project addresses the ongoing challenge of improving continuity in Cincinnati Children's Hospital Medical Center's primary care clinics (PPCC), including the Burnet, Hopple, and Fairfield primary clinic locations. Despite previous efforts, a desire for enhanced care continuity persists among providers and families.
The team addressed continuity challenges within the community by creating a physical guide for parents and patients to advocate for themselves, along with handouts/flyers that remind healthcare providers to prioritize continuity. This resulted in providers at PPCC keeping continuity in mind when scheduling the patient's next visit and parents advocating for continuity.
“We get to know parents and children so that we can understand priorities, perspectives, personalities, so that we can see growth and progress over time where we can see variations from that.” - Provider
My Role: UX Research Lead Lead interviews Created Research Plan
Skills: Interviews & observations Thematic analysis Prototyping User testing
My Team: 1 UX Research Fellow 1 Communication Co-op 1 Masters of planning GA
What is Care Continuity?
Continuity of care refers to the consistent and seamless provision of healthcare services to a patient over time. It ensures that the patient receives coordinated and comprehensive care across different healthcare settings and providers.
What are the Challenges in Ensuring Continuity?
Provider Turnover
Ongoing education requirements drive provider turnover in the PPC, causing frequent changes in the healthcare team and inconsistent care plans.
Health Equity Factors
Families face health equity challenges like limited medical literacy, technology access, and transportation issues, which hinder their understanding of the importance of continuity.
Information Gaps
Families lack knowledge of their doctors and previous care plans. Lost data complicates provider hand-offs, requiring a "collective memory" for smooth transitions.
Project Outcome: Currently Being Tested
As of January 2024, the concepts have been printed and are awaiting approval for testing at the clinics.
CCHMC's metrics include vaccination rates and continuity. Passports will be distributed every other week to compare data against families who did not receive them.
Health and Well-Being Passport Enhancing comfort at PPC clinics involves providing patients and caregivers a comprehensive introduction and autonomy over medical information. This includes a physical record for tracking medical history, ensuring they know what to expect and empowering them to seek continuity with the same doctor.
Back of Door Signage
This sign hopes to empower patients and caregivers with resources for self-advocacy, ensuring they understand and have the option to maintain continuity. Provide clarity on how they can effectively advocate for themselves in seeking and securing continuity.
PHASE 1: DISCOVERY
Discovery Phase Goals:
Analyze the facilitators and barriers to care continuity within families and the Primary Pediatric Care (PPC) system.
Map patient and provider journey to identify areas for improvement.
Develop tools to help providers better understand the diverse situations of patient families.
Discovery Phase Outcome:
Research Findings: challenges, successes, and opportunity areas
Patient and Provider Journey: areas of improvement in the journey
Persona Tools: represent different patient families and their unique needs
Phase 1: Discovery Process
We defined our goals for each phase of the project and identified the need to understand the primary hurdles to continuity from both the provider and patient perspectives.
Field Study: Interviews + Observations
To understand patient and provider journeys, the team collected information through interviews and observations at the Pediatric Primary Care Clinic (PPCC). I created interview guides to understand the people
Thematic Analysis: Challenges & Successes
The team collected interview transcripts and analyzed them using thematic analysis to identify emerging themes from stakeholder responses. From there, we were able to analyze challenges and successes in the system.
Journey Mapping: Providers + Patient Families
To identify the journey map, we analyzed interview transcripts and observations to map out each pain point and successes.
Personas: Representation
Leveraging data from our interviews, the team crafted seven distinct personas representing various types of families attending the PPC. Subsequently, the team mapped out the two most significant determinants on an axis.
Current State: High Access & Low Continuity
Cincinnati Children’s Primary Care Clinic should increase patient trust and find the right balance of access of care and care continuity.
Increasing patient and provider value in continuity by leveraging the PPC’s strengths (Education + Familiarity) may lead to increased continuity.
PHASE 2: IDEATION
Ideation Phase Goals:
Focused opportunity areas
Ideate concepts based on the chosen opportunity areas
Narrow down concepts to refine and test
Ideation Phase Outcome:
Focused opportunity areas: 6 themes to further ideate
Focused areas: 4 ideas to refine and test with Primary Care Clinic providers.
Ideate Process
From the identified opportunity areas, we initiated team ideation and collaborated with healthcare providers to prioritize concepts that best aligned with their needs.
Ideation: Brain Writing Exercise
The team utilized a brain writing exercise to generate opportunity areas focused on enhancing continuity while maintaining access. Over eight rounds of ideation, the team generated 180 ideas.
Focused Opportunities: Affinity Mapping
From the 180+ ideas, the team refined and narrowed the ideas to 26 ideas, identifying key themes for focused development. We then established cross connections with dotted lines to signify instances where solutions intersect or influence each other.
Prioritized Ideas: 6 Themes Emerged
From the initial concepts, we consolidated the ideas down to 26 ideas to be presented. From there, the client prioritized these ideas based on ease of implementation and the time required. This process allowed us to further narrow it down to 6 themes.
Persona Activation: Scenarios
We used personas to demonstrate how these concepts could improve continuity rates. Collaborating with the CCHMC team, we identified four key themes to focus on for quick onboarding and alignment with capabilities.
PHASE 3: REFINEMENT
Refinement Process
Prototypes were created and validated with healthcare providers to ensure clarity and accuracy. Feedback was used to refine the content before releasing it to the Cincinnati Children's Hospital Medical Center (CCHMC) team to further test.
Prototype Refinement: Content Validation
The team created prototypes and presented to 10 healthcare workers at the primary care clinic to validate the content and ensure it effectively supports both them and their patients.
Implemented Concepts
After discussing with the Principal Investigators, the team decided to focus on short-term solutions that can be tested without disrupting the current clinic flow.
Health and Well-Being Passport Enhancing comfort at PPC clinics involves providing patients and caregivers a comprehensive introduction and autonomy over medical information. This includes a physical record for tracking medical history, ensuring they know what to expect and empowering them to seek continuity with the same doctor.
This sign hopes to empower patients and caregivers with resources for self-advocacy, ensuring they understand and have the option to maintain continuity. Provide clarity on how they can effectively advocate for themselves in seeking and securing continuity.
Reflection
Project Learnings
I learned the importance of balancing stakeholder needs while aligning with client capabilities to find the optimal solution.
Consideration of Health Equity Factors: Taking into account the health equity challenges families may face in providing care, ensuring the project addresses these disparities effectively. Resourceful Interview Strategies: When interview participants are unavailable, pivot by leveraging client resources to conduct interviews, utilizing transcripts to gather necessary insights.
Clear Communication of Project Intent: Clearly communicate the project's intent and how information will be used during interviews, fostering openness and trust among patient families.
Effectiveness of Simple Solutions: Recognizing that sometimes a simple physical solution can be more effective than systemic changes in addressing specific challenges.
