Challenge and selection

I work at a large, private ambulatory healthcare provider. Our aim is to provide accessible, high- quality and cost-effective care, appropriately addressing patients’ needs. In order to make sure, that  our patients get help from the right clinician we routinely analyze reasons for patients’ specialist  visits. We identify medical problems that could be solved faster and better by medical personnel with  lower - but still appropriate to the problem - level of competence, and with increased patient  engagement.

Warts’ treatment is one of such simple medical problems, that needs care path redesign. It consumes  more than 10% of dermatologists visit in our system, despite the fact, that warts can be treated with  OTC products at home with self-care. Dermatologist often use cryotherapy for treatment, and this  procedure is usually painful during and after the procedure, and sometimes cause difficulty in  functioning for several days.

Before searching for a new, better care path, it was important to understand “what is”:

  why patients choose dermatologist for warts treatment,

  what is their service booking process and what information they receive,

  what they like and what dislike in the current solution,

  what they know about the treatment and its alternatives,

  if and how they self-diagnose warts,

  and what would be the new design criteria.

I planned to use visualization tools Journey Mapping to describe current solution.

Application

I organized two focus groups with eight participants each – one group with parents of children age 4  to 12 and the other one with adult patients. Having 2 groups was necessary to differentiate needs of  adult patients and parents of pediatric patients. All participants declared, that they’ve already had  experience with warts’ treatment.

I started with telling a real story of my child treated for recurring warts. The story was personal and  relevant to the topic of the focus group and as such it helped to bring back participants own  experiences of wart diagnosis and treatment before we moved into Journey Mapping.   There are 2 possible ways of booking the service -  phone booking via Contact Centre or online  booking (internet and mobile application). I divided participants into 2 groups, depending on the way  they use for booking services, and asked them to draw their path as a process, with main steps  starting with identifying a problem (wart), searching internet or asking friends for information on  what to do, through booking, first visit, follow up visit (if any) and end of treatment. Each group was  asked then to use green and red post its to write down strengths – using  green post-its – and  weaknesses – using red post-its –  of the current process. While filling in post-its participants were  also asked to note, what could help them to move to self-care as the primary solution.

Visualization of the care path allowed to identify steps in the process that require change, and to  collect detailed information on what should be changed. Red and green colors of post-its helped to  visualize priorities – what to focus on first. The session gave us an insight into real patient

perspective – what helps, and what makes the treatment difficult or delayed, and what patients need  to know about self-care to treat it as an alternative to repeated visits with specialist. It gave very  detailed and practical foundation for defining design criteria for the new solution.

Insight and Approach

Journey mapping appeared to be very effective in discovering patients’ perspective. Using colors  simplified prioritization of the nest steps. Each focus group took only 2 hours and within such short  time we were able to gather information that allowed better understanding of experience, emotions,  information challenges and unmet needs of our patients.

The information collected during the session helped to define basic criteria for the new solution:

  Fast access to the first visit and initiation of the treatment at the visit,

  No demand for dermatologist visit if other medical personnel can help,

  At the first visit agreement on a treatment plan, especially what to do if initial treatment is  ineffective,

  Recommendation on choice of treatment, with preference for self-care, but with clear  instructions on the duration, effects and possible complications of the treatment,

  Demonstration of application of the topical use agent at the first visit, so the patients would  feel safe when applying the agent at home,

  Good communication skills of the clinician (primary physician or nurse) delivering treatment,  and in case of children – someone, who has an "approach to children",

  Materials about warts’ treatment to take home or to access from recommended website.

Organizational innovation in healthcare must focus on patient experience. Customer journey  mapping is an effective tool to define “as is” processes with practical information necessary to create  new design prototyped.

Alternative tools that could be used to work out design criteria with patients include:

1. Asking patients to tell their individual stories of warts treatment and, based on several

interviews, create personas with different clinical and emotional needs. The personas would  help to design new solution addressing specific needs of different patients. This approach  will, similarly as 2 focus groups described above, allow to address needs of both adult  patients and parents of pediatric patients.

2. Organizing brainstorming session on weaknesses and strengths of the current solution

followed by defining ideal solution,

3. Drawing a mind map with key criteria of ideal solution.

