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Five steps to successful service design in healthcare

Tuesday, 23 June 2015   (0 Comments)
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Why: Ikhwezi Clinic in Nomzamo, one of Cape Town’s busiest clinics, needed to address some critical issues to improve the patient experience and make it a more comfortable and efficient health-care environment.

What: One of the City of Cape Town’s WDC2014 projects was to use service design principles to re-engineer the systems and processes.

How: The project used service design processes to identify certain key challenges at the Clinic, including flow and waiting time, cleanliness and privacy. Once the main issues had been identified, various initiatives were activated to help address each challenge. Some of these pilots will be rolled out to other clinics across the province.

Ikhwezi Clinic Initiative

Many clinics today face the same problems: growing patient needs in resource-constrained environments; inefficient systems that lead to long queues and long waiting times; minimal comfort for patients; eroded patient privacy and dignity; frustration for staff and patients alike. At Ikhwezi Clinic, the problems are particularly acute.

As one of their World Design Capital projects, the City of Cape Town introduced a service design intervention at the clinic. The project had various goals:

  • to address the clinic’s complex challenges by encouraging user-centric collaboration and creativity

  • to identify opportunities to introduce design-led thinking as a way to solve problems, and encourage the practice to be adopted more widely

  • enhance the current services at the clinic for the benefit of its community and users

Working with service design consultants Robert Bloom from Creo Consulting and Candice Pelser of Further, the project began with five steps that helped to shape the project outcomes. These steps were applied to the main issues of cleanliness; flow and wayfinding; greening and aesthetics and privacy at the clinic.

1. Holistic approach to the clinic ecosystem, and stakeholder review: The service design team engaged with multiple stakeholders. These included representatives from the municipality, service providers, not-for-profit companies who support the clinic and community representatives.

2. Ethnography and empathy: Extensive first-hand observations provided an insight into the daily experience of staff and patients, and helped to direct the project’s focus.

3. Co-creating: Despite intense pressures on their time, clinic staff worked with the project team in constrained environments to define the main challenges around patient experiences. This two-way interaction helped to co-create the project outcomes.

4. Staff engagement: By engaging staff and patients in the research process the project team could fully understand what the main challenges were. These challenges were categorised and allocated to different staff members who were mandated to focus on potential solutions.

5. Empowering staff: A strong focus of the project was to empower staff to co-design and pilot solutions to improve both waiting time and conditions in specific areas. Important training elements in this process included continuous improvement and the Plan Do Study Act cycle. Staff were given autonomy to try new things, which helped to develop an environment based on trust.

Project outcomes

1. Improved immunisation stream

After the consultation process, it emerged that waiting time in the immunisation stream was an area that needed improvement. Dr Heather Tuffin, a service optimisation expert from the provincial government, spent considerable time in training and enabling staff to look at ways to shorten waiting time.

It also became evident that there were too many touchpoints, or waiting areas, along the immunisation stream and that these could be consolidated. A more streamlined administrative service was implemented to help process patients more efficiently. An important solution was to encourage patients to respect appointment times. In addition, staff would collect patient folders the evening before, which enabled clients to bypass long queues each morning while waiting to be issued with their folder. This was a seemingly simple solution that radically cut waiting times and improved customer experience.

2. Continuous improvement

With the project complete, staff are now following a continuous improvement cycle and are encouraged to meet each morning to discuss what is going well, identify new challenges and agree on how they can be resolved.

3. Securing funding to get the basics right

Candice Pelser secured additional funding from the Dutch Embassy’s #CoCreateSA Fund. This provided some budget to provide some basic comforts, which included procuring blinds and installing a new sink. The fund also allowed the team to redesign the patient flow process.

4. Cleanliness and greening

Daniel Sullivan, from the City’s World Design Capital team, helped to link the clinic staff to services within the City to help the clinic manage their recycling, and also to support the overall project outcomes.

5. Engagement with academia

Students from Cape Peninsula University of Technology have begun to work with the clinic in their final year undergraduate research projects across all of the focus areas. They have presented a number of ideas that could be further developed. In particular, the challenge of developing new wayfinding solutions has been taken up by a Masters student who will be working on a new system for Ikhwezi, which can be used more widely at other clinics. This work is due to start in July.

Are you a designer interested in learning more about service design, or a business owner wanting to know how to use service design to improve your company?

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