CLIENT |

National Healthcare Group Polyclinic

 

DURATION |

6 Months,  Completed in August 2014

 

THE BACKGROUND |

National Healthcare Group Polyclinics (NHGP) runs nine polyclinics (one-stop health centres) serving over 800,000 people in the central, northern and western parts of Singapore. With plans to develop a tenth clinic to meet the primary care needs of the burgeoning population in the West Region, NHGP engaged us to help rethink and innovate key products and services to enhance the patient experience for the upcoming clinic.

 

THE CHALLENGE |

Despite the operational efficiency of existing clinics — some which see up to 1500 patients per day — With the new clinic set to be NHGP’s first 7-storey clinic, and the largest to date, there was a pressing need to transform care and service touch-points to address these issues.

 

How can NHGP create a more holistic, patient-centred healthcare experience that builds upon and improves their recognized standards for quality care in the community?

 

Our challenge was to create a clinical experience that was more patient-centric, and to evaluate when, where and how to infuse the patient journey with appropriate technology and human interactions to facilitate the ideal care experience.

 

A second layer to the challenge was to explore how NHGP could better leverage care partners and providers in the broader healthcare landscape both private (independent general practitioners — GPs) and public (institutions within the Regional Health System — RHS) to enhance primary care provision.

 

THE PROCESS |

I was involved as a key designer in the team to lead participants from NHGP through the 6 month Design Thinking project from the process of envisioning,  discovery, ideation, prototyping. The final delivery of design concepts were served as a blueprint for the future of NHGP’s primary care vision.

 

01 Stakeholder Research

In-depth interviews were conducted with key stakeholders and stakeholder groups from different polyclinics in order to better understand the inherent challenges in primary care. The team also conducted on-site observational studies to gather first-hand knowledge and data about the

different practices for delivering care services at various polyclinics. Initial research revealed a number of insights and issues rooted in inconsistencies across different polyclinics:

 

NHGP staff have different interpretations about key aspects of primary care (patient-centred care; family medicine values; teaching & research).

 

NHGP staff are varied in their approaches to the concept of team-based care and how it is applied to the polyclinic context.

 

“… the family medicine values of personal care, providing primary care and preventive care … [are we] able to do it in polyclinics currently? I think the answer is 98% no. We are just clearing the crowd. We are just seeing the patients every 2 to 5 minutes. Do we provide the comprehensiveness? Where is the continuity …? ”

– Physician

 

“… we generally don’t take time to know people [patients] and I think that it’s a huge problem because we have forgotten about it … I have forgotten about it half of the time.”

– Physician

 

The larger question that emerged from these insights was: How can NHGP work together towards conceiving a future generation of polyclinics if they continue with disparate practices, approaches and interpretations of polyclinic goals and patient care?

 

Accordingly, the workshop sessions were planned out to allow some of these issues and challenges to be aired, discussed and reconciled.

 

02 Future Envisioning Workshop

 

The envisioning workshop series was designed to facilitate multidisciplinary participation and collaboration between NHGP staff to explore and dissect key issues through immersive activities, discussions and debates. Participants were encouraged to work together over the

course of three sessions to formulate a shared vision for the future generation of polyclinics.

 

Your Ego In a Jar

A spirit of collaboration and an open state of mind NHGP participants pledged to set aside their egos to work together and think through tough challenges relevant to the present and future of polyclinics and primary care. The ideas, thoughts and opinions of participants summarized in this report represent their spirit of collaboration and open mindedness.

 

The envisioning process helped to uncover key insights and issues relevant to the future of polyclinics and primary care so that they could be contemplated and deliberated over by a broad range of staff from NHGP. While the intention was not to yield answers or solutions to these issues, the true value came in bringing key NHGP representatives from across various polyclinics to work and think through relevant challenges together.

 

Key Insights & Issues

 

  1. Efficiency Is Not Efficacious in Polyclinic Care

 

  1. Roles And Responsibilities Of Polyclinics Must Be More Clearly Delineated

 

  1. Patient-Centred Care Is Definitive But Not Defined

 

  1. The Tenets Of Family Medicine Need More Emphasis

 

  1. Team-Based Care Requires A Shift In Attitudes

 

  1. Multidisciplinary Care Teams Must Be Adaptable

 

  1. Polyclinic Spaces Are Not Designed For Team-Based Care

 

  1. Care Efforts Must Extend Beyond The Clinics Into The Community

 

  1. Pathways For Information And Communication Flow Are Discontinuous

 

  1. Teaching Activities & Residents Need To Be More Patient-Focused To Better Integrate Into The Polyclinic System

 

Session 1:

Discuss & Define – participants arrived at consensus of opinion about key principles of family medicine and primary care as it applies to polyclinics. These were later used to gauge and evaluate envisioned care paths/processes.

 

(Or you can say: A guide for understanding NHGP’s approach for delivering quality care in the polyclinic and primary care settings (ideal principles of care).)

 

Defining The Model Of Care: Ideal Principles

What constitutes the model of care for patients in polyclinics and primary care contexts? How

should care be planned and structured?

 

The following key principles of polyclinic care were highlighted through interviews and emerged

during discussions with key NHGP staff from various polyclinics. When asked, however, many

individuals relayed varied definitions or approaches of their own. In the broader context

of the organization, such variation can lead to inconsistencies in the planning and delivery of

care and service processes.

 

In an effort to create shared goals and envision the next generation of polyclinics, it was

important to bring together participants to think through and arrive at a common understanding of these key principles upon which the foundation of family medicine and polyclinic rest. These

principles, in turn, help define the ideal model of care for polyclinics of the future.

 

Patient-Centred Care

– Care that engages patients and their family in decisions to create a

holistic, customized care plan

– Services wrap around patient to support care plan

 

Personalized Care

– The foundation of patient-centred care

– Respect patients through building trusting relationships; engage both

patients and their families – “know” them

– Customized / tailored care plan to meet patient’s needs

– A base to listen and understand patient needs to provide

patient-centred care

 

Team-Based Care

– One team of multi-disciplinary professionals working in synergy with the

patient & family to achieve a common shared goal

– Consistent familiarity by patients with the people of their care team

– Building a relationship and rapport with the team

– Achieving best care, working towards common goals together

 

Comprehensive Care

– All-in healthcare services for everyone

– Holistic care (looking at issues related to patients) across all age groups

– All “under one roof”, one-stop shop

 

Coordinated Care

– Communication, shared information & records

– Key enablers for integration

– Visibility of information

– Seamless, planned integrated care across different healthcare settings

that is catered towards patients’ needs

– Collaboration & partnership between patient, healthcare team, caregivers

& communities

 

Continuous Care

– Ownership of care – to know what care is given

– Continued care from different / various aspects of care

– Assurance of quality of care and familiarity of services

– Built on relationships

– Connected as a whole (oversee patients even though they have been

handed over to another carer)

– Not the same as continuity of care

 

Preventive Care

– Promote wellness to achieve wellbeing through:

Early detection, Education, Empowerment and Engagement (4Es)

 

Session 1:

Charting an Ideal Care Path – groups explored how a team-based approach would work and what it would look like schematically – taking into account key stakeholders involved in the entire care process.

 

Stakeholders & Contexts of Care

Workshop participants were tasked to consider these stakeholders and contexts of care and

map out their positions, roles and relationships to one another with respect to providing primary

care that adhered to the key principles previously defined.

 

When necessary, workshop participants were encouraged to imagine or create new

stakeholders and to define their roles, responsibilities and relationships in the context of

the ideal care paths they envisioned.

 

The new roles created reflect, in some respects, the current gaps in the system and point towards the need and direction for change in building a new framework for polyclinics and primary healthcare in Singapore.

 

Defining The Process Of Care: Ideal Care Paths

What is the process of care delivery for patients in polyclinics and primary care settings? What are the relationships between key stakeholders and how do these relationships in turn formulate and direct patients along specified paths of care?

 

Workshop participants were tasked to evaluate the roles and relationships of key stakeholders

and relevant healthcare contexts in order to chart ideal care paths for patients navigating polyclinics and primary care. In particular, participants were asked to articulate the ideal anatomy and framework for a team-based care approach.

 

Because research revealed a variety of opinions and approaches to team-based care amongst

NHGP staff, this exercise was an opportunity to bring together key individuals to work together in defining and mapping out the specific elements of an ideal team-based process of care.

 

The following is a summary of the ideal care paths envisioned by participants for the future of

polyclinics and primary care.

 

Session 2:

Break & Fix It – groups scrutinized and modified their ideal care paths after having reflected on its inherent weaknesses / threats and considered how well it adhered to the key principles of family medicine and primary care previously discussed and defined during Day 1. The resulting visualizations served to illuminate the difference in participants’ interpretation while also highlighting the many commonalities in their approach to team-based care (similarities in roles, contexts and stakeholder relationships).

 

Recognizing Shared Goals

What were the common threads and shared goals with respect to the ideal care paths envisioned for the future of polyclinics and primary care?

 

Examining the ideal care paths envisioned by workshop participants revealed a number of

similarities and common threads. Although participants envisioned varied care paths, they

demonstrated shared goals through the care processes they defined – particularly with respect

to the relationships they articulated between key stakeholders.

 

Session 2:

Test It – groups evaluated their care paths using a specific, assigned patient profile to trace and chart the path and process of care. Gaps in the care path were identified and discussed, and new provider roles and services were imagined and created to mend the gaps in the envisioned

care path/process.

 

This is apparent when examining the new roles created by participants in the process of

envisioning their ideal care path. Each group created a number of stakeholders (new roles) that

closely mirrored one another. These reflect, in some respects, the current gaps in the system

and point towards the shared need and shared direction for change in building a new framework

for polyclinics and primary healthcare in Singapore.

 

Session 3:

Zooming In – groups tackled a specific challenge involving their patient profile in the context of their envisioned care path/process model. Scenarios were imagined and visualized to illustrate the relationship between key stakeholders, patients and potential services encountered along the juncture of the polyclinic care experience.

 

Articulated care paths that describe the care process for patients seeking care in primary health contexts Scenario-based visualizations that illustrate and consider how care providers intend patients to navigate various care paths

 

As a result of the envisioning workshop, a summary of the outcomes from the envisioning exercise informed and inspired the beginning of a design exploration to enhance the polyclinic healthcare experience for patients and their families.

 

03 Ethnographic Research with Patients, Their Families and Caregivers

After examining and considering the opinions and views of key NHGP polyclinic staff, the design team investigated and uncovered the needs of patients and their families and caregivers with respect to their polyclinic care experiences.  The team interviewed total of 30 patients, families and their caregivers. Our research quickly uncovered many issues relating to their satisfaction and their overall care experience.

4 Personas & User Journey pics + processes of analyzing data

 

We used the research results to create patient experience maps for 4 of the key patient groups we identified. We charted the patient journeys to map the physical and emotional pain points at critical care/service touch points throughout a typical clinic visit. This helped to highlight key opportunity areas for transforming the care experience — information critical to both the creative team and the client to help drive design direction.

 

The patient experience maps fuelled several co-creation workshop sessions involving NHGP’s CEO, COO and a host of their clinical heads of staff, support teams, and patients from each of NHGP’s 9 polyclinics.

 

04 Co-Creation Workshop

The team then combined key learnings from the envisioning exercise and the ethnographic patient study to formulate a holistic view of the landscape and needs of polyclinic and primary care. The design team work collaboratively with NHGP to co-create concepts and solutions to improve the patient experience in future polyclinics, divided in 4 experience phases; Arrival, Waiting, Consultation, Post-Consultation. I was in charge of facilitating the Arrival Phase team consist of 9 participants during the 4 day co-creation workshop.

 

Pictures of 4 Day ws sessions, Preparations, step by step pictures, me facilitating, etc. ideation, presentation, trends sharing, mapping design challenge, etc.

 

05 Concept Refinement & Final Delivery

The design team further explored and refined key concepts generated collaboratively from the co-creation workshop. Through a process of iteration and testing, the design team evaluated the validity and viability of the key concepts from the co-creation workshop and consolidated into 26 concepts representing four key strategies for enhancing polyclinic care for patients and their families, helping all visitors to feel like they matter:

 

Adding a Personal Touch

  • Humanize the care experience with people-oriented and technology-mediated interactions
  • Eliminate the notion of patients as numbers
  • Reorganize care services to revolve around the patient to simplify their journey
  • Customize point of care interactions to truly reflect a patient-first approach

 

Connecting People

  • Integrate technology in meaningful ways to enhance interaction between patients, their families, and the clinical care teams
  • Form new lines of communication necessary to implement a collaborative and integrated care model

 

Developing Identity

  • Foster meaningful relationships between clinical staff and the patients / families they care for
  • Create a sense of ownership and belonging to the clinic to better engage and empower patients as partners in their own care journey

 

Blurring Boundaries

  • Develop platforms for sharing of knowledge and experiences between clinic staff and the patient populations they serve
  • Create community-oriented spaces and incorporate elements of nature into the clinical environment to promote a sense of healing and calm

 

THE OUTCOME |

The final delivery of the project served as a contextualized guideline which the subsequent architectural and interior design team and NHGP used as a basis to further explore and detail out the polyclinic spaces and products.

The new clinic opened its doors in 2017 as NHGP’s 10th health centre. The clinic have employ a number of solutions from each of the design strategies previously discussed. Most notable will be the adoption of a team-based model of care supported by a host of service, technology and spatial innovations conceptually developed through this project. Patient-centred care will have a new face, and the patient-first care model will be a real service priority.