This project by Lina Antolínez, Diana Sánchez, María Andrea Luque & María Ordóñez is a finalist for the Service Design Award 2017 in the Student category.

Communi.care is a set of tangible interventions within the internal patient transportantion service at FSFB Hospital that will facilitate communication and make clear shared responsibilities among nurses and the support team to take care not only for patients but also for co-workers.

In healthcare organizations and hospitals to treat and/or heal hospitalized patients in a successful way is not only a matter of a good diagnosis and the right medical treatment or procedure performed by specialists doctors. Nurses and support teams are caregivers that play a fundamental role in healthcare organizations because they have more frequent and direct interactions with the patients during the most critical moments of their hospitalization.

From the diagnosis and monitoring of any disease or medical condition, to the recovery phase after surgery or medical procedures -and even until the patient discharge-, nurses and support teams are expected to prepare, accompany and transport patients within the hospital facilities. These moments are probably when patients feel more vulnerable, unprotected and exposed and for this very reason, when their perception of the experience during the hospital stay can be affected in a good or a bad way.

With the aim of improving the experience for hospitalized patients and making more efficient the support services, considering its expansion plan from 4 to 12 floors of hospitalization, the Fundación Santafé de Bogotá (FSFB) university hospital, took on the challenge of redesigning and scaling up the internal transfer of patients´ service, in collaboration with the Master in Design students of Los Andes University.

The output of this process is Communi.care , a set of tangible interventions within the service that will facilitate communication and make clear shared responsibilities among nurses and the support team to take care not only for patients but also for co-workers. This output will also help FSFB to deliver a low-cost, more efficient and more caring patient internal transportation to positively impact patients’ experience at the hospital by improving the perception of being vulnerable and unprotected and reducing in 37.5% the amount of time waiting to be transported.

Manifestation

Communi.care considers support staff as the main actor of the service -and backstage as the main environment- since they are totally responsible for the care of the patients when transporting them. Communi.care translates existing tacit knowledge and communication codes of the support team into tangible low-cost tools and technologies (touchpoints) for transmitting significant and accurate information to make evident and ensure that relevant information about the transferred patient is not mistaken.

What stakeholders think of Communi.care

“The project synthesises and discovers new needs of every actor involved in the service. One of the most valuable things is that we could identify and solve communication and interaction issues that exist between the different involved areas. This project responds so well to our organizational issues and now we can scale up without having to hire much more staff and with a low-cost implementation.” said Andrea Osorio, Innovation Director of FSFB.

“The interventions can help us to reduce mistakes and omissions in scheduling medical appointments. They can also help me to know where and when patients are located in the hospital. In my case, I need to replace a process, but this way is much more effective and collaborative.” said Mónica, Floor Coordinator, VIP hospital rooms.

“Now we can give priority to the patient itself than over the patient’s documents. This new system allows each responsible caregiver to do so, in this service, because usually in Ultrasound Images they only ask for the patient transportation and request the transfer documents, without even looking or checking the patient” said Juan Carlos, Support Staff.

Process

For the end-to-end development of Communi.care , master students and advisors followed an innovation process in which different perspectives from doctors, nurses, patients, support staff and experts were considered and involved into the final service design. An extensive qualitative research in real context combined with discussion and ideation sessions, and a fast iterative prototyping process in real context leaded the path to identify valuable insights. The approach of this project embraces Human Centered Design principles and tools and follows the four steps innovation framework proposed by Beckman & Barry (2007): Observations (Contexts), Frameworks (Insights), Imperatives (Ideas) and Solutions (Experiences).

A. Observations (Contexts)
Understanding needs and opportunities through several real context observations accompanying nursing and support staff during their journeys. This approach allowed us to create a direct and empathic interaction with those who were involved in the service and to acknowledge their stories, experiences and motivations. From the above, it was possible to comprehend the complexity of accompanying and transporting patients within the hospital facilities and to visualize the wide spectrum of challenges and opportunities.

B. Frameworks (Insights)

Organizing large amounts of collected data and information to identify patterns and focus on the most essential design needs. We analyzed and defined the main service moments and actors, we identified critical situations using actors and journey maps, blueprints and route maps. After processing all the information we could identify several insights such as: limited flow of information between actors, alterations in the patient experience, unshared responsibilities and unnecessary repetition of tasks. All of the insights were highlighted and correlated to generate systematic and integrated ideas and solutions.

C. Imperatives (Ideas)

Prioritizing the ideas to define and select design imperatives. We understood the blank spaces of the current experience and proposed intangible and tangible benefits that the nursing and support team will get from the service redesign. We created opportunity areas based on the most relevant, urgent or interesting findings. All of them were intended to strengthen existing tacit codes, simplify information flows, reduce the tension between actors, make visible times, places and conditions of patients and recognizing mutual work and shared responsibilities.

D. Solutions (Experiences)

Generating, selecting and testing alternative solutions taking into account the process and decisions made before to solve the support team needs. There were proposed four (4) integrated interventions that were prototyped in real context. The prototyping process was made in six (6) iterations along with chief nurses, nursing assistant, support teams and other stakeholders, with the aim to understand the way that the prototypes improved tasks and times through their feedback and adjusting details in real time when needed.

Output

Communi.care intervenes the internal transfer service of patients in the FSFB, taking into account shared responsibilities of different actors to breed a positive experience towards the patient, based on the understanding of the different roles and an effective internal communication. In order to do this, four articulated design interventions were created to build a strategic and systemic design solution:

1.Notification System: Is a tangible intervention in the floor space that visualizes information of programming, enlistment and execution of transfers. It indicates when and what type of transfer should be performed, and whether a patient is being prepared or transferred. It works hand to hand with the transfer card.

2. Transfer Card: It is a communication tool that not only contains medical information of the patient to be transferred but also can account for their origin, destination and transfer status. It shows the shared responsibilities of the actors involved in the process, linking the information directly to the corporeality of the patient being transferred.

3. Notification Board: It is a visualization tool that allows the support team and exams assistants prioritize and organize the patient's pick up and transportation, reducing the waiting time after finishing an examination. It also delimits responsibilities at the moment of transmitting the information and activating a notification. This tool returns the autonomy to the support team and works simultaneously with the support network.

4. Support Network: It is the support team’s solidarity network, which reduces the accumulation of patients on the examination areas, through collaborative work and mutual appreciation. it seeks to reduce the accumulation of tasks of particular members of the support team and the several minute patient waiting.

IMPACT

Communi.care can strengthen empathy, solidarity and cooperation among support staff and other stakeholders. We strongly belief that healthcare organizations that create fluid and caring environments for their work teams can redefine the way of caring about patients and positively impact their experience at the hospital.

Impact for Organization (FSFB)
● Improves the logistic and coordination functions of the patient's transportation
● Reduces accumulation of patients to be transferred
● Reduces mistakes in patient information and condition
● Generate empathy bonds between the nursing, support team and the patients
● Positively affects the patient's experience, being attended in a more efficient and
careful way.

Impact for Support Team and Nurses
Communi.care recognize, use and potentiate communication codes, that already circulate between support team, which makes easier for them to recognize and appropriate the new system.
● Generates autonomy for the support staff, reducing stressful communication with other actors involved in service.
● Balance the workload of the support staff who transport patients
● Delimits support team responsibilities, optimizing times and avoiding delegating them tasks that do not fit them
● Creates a network of solidarity and mutual appreciation of work among the support team members.
● Generates easy and fluid transfer notifications between support team and other stakeholders
● Replaces and improves existing communication channels.

Impact for the Patient
● Reduces waiting time, from 30 minutes to 15 minutes as maximum.
● Reduces stress levels by means of the reduction of the waiting time and caring treat.
● Previously the documents had more priority that the patient itself, Communi.care interventions make the patient the first priority, without neglecting the other needed processes and reducing mistakes in procedures and misplaced information.

Project Credits

  • Project Name: Communi.care
  • Team: Lina Antolínez, Diana Sánchez, María Andrea Luque & María Ordóñez
  • Category: Student
  • Service Design Award 2017, nominated project for Student Award
  • University: Universidad de Los Andes
  • Course: Master Studio: Service Design
  • Client/external stakeholder: Juan Manuel Gonzalez (Student Advisor), Christiaan Job Nieman (Student Advisor)

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