Bold steps to envision the future of health care coordination

  • Business Model Innovation
  • Design Doing
  • Strategic Visioning

Working in the health care field is always rewarding, as you are truly making a difference in people’s lives. Recently, I took on a project to better understand care coordination for children with medical complexities (CMC) and design potential improvements for these children and their families.

Let’s start off by explaining who children with medical complexities are: they are characterized by having multiple chronic conditions, a high level of health care need (both medical and community-based), and high family need for support and services. Simply put, they are the most complex of the complex medical, behavioral or socially challenged child population. Children with medical complexities comprise of about 1% of the children in the US and consume about 27% of the medical dollars in the US. These numbers are largely due to the fragmentation and lack of effectiveness of the care system as a whole. Most providers understand that there is a need to re-design the way we care for this population, but where can we start?

Take a design thinking (or as we at BMI like to call it, design doing), empathy and consumer-based approach that enables us to co-create new services by understanding, iterating, and validating, to delivering a system that is beneficial to all stakeholders.

Using design thinking/doing, we started by understanding and mapping the ecosystem of care for CMC’s and their family.

Understanding the CMC’s and family – customer safari

Starting with the child and their caregivers we were able to understand their needs both large and small, including what the current care system is doing to meet these needs, what needs are not being met and which services are inadequately being delivered.

We drew our research from going out and talking to CMC families, clinical providers, health care administrators, and social or community-based organizations. We conducted a series of focus groups and interviews with these groups. Our goal was to better understand the complex ecosystem of CMC’s current state and alternative models, as well as future visions for care coordination.

What we found was a fragmented system that left CMC and families with a variety of unmet needs. Some of these needs identified were a lack of communication between and among providers, lack of self-management resources, and lack support for families that address social factors impacting health. We also found that the existing medical literature on care coordination did not adequately deliver actionable steps for a provider to adapt into their system of care to help guide them to improvements.

Designing the health care ecosystem

Rising medical costs, coupled with consumer’s increased expectations and pressure to do more with less budget, leads to more healthcare leaders finding themselves with more questions than answers. How can they bring the team together to co-create products, services, and strategies to solve this wicked problem?

The design thinking/doing approach enabled us to map the care ecosystem from both the CMC’s and family’s perspective and the provider’s perspective. We gained an understanding of the context and needs of CMC’s, families and providers. To design a new system of care coordination, we engaged stakeholders through the design process – iterating, pretotyping and validation of the new designed solutions.

The end result was the first step towards delivering on all stakeholder needs’, a set of adaptable frameworks that guides leadership and implementing teams through understanding their current ecosystem to executable steps moving towards integrated care.

Whatever the problem is that you’re trying to solve – and in this case care coordination for CMC’s – there’s no such thing as a silver bullet solution. In other words, thinking there is a single right solution or intervention to any problem, especially complex ones, will likely lead to more issues. Adaptable frameworks work as a way to customize the solutions to each individual provider and community based on their needs and resources additionally, they are able to evolve over time.

By taking a design thinking/doing approach (akin to the scientific method), we can uncover hidden needs, ideate possible solutions, and rapidly validate those solutions until we come up with the optimal mix (for now). And, it should be noted, this is not about one-time solution creation either. The health care landscape should be thought of as in a liquid state more than a solid. When an organization decides to truly embrace design thinking/doing methodologies as a systematic approach to continually create, deliver, and exchange value with its customer, it enables systematic and sustainable change.

Final thought

The patients’ care experiences can be designed and improved through the use of design thinking/doing which offers the holistic process needed to solve the complex problems in care coordination.

What complex problems do you face in your industry and organization? We would love to hear from you at BMI!

 

The white paper is the first of two papers to be published on the Lucile Packard Foundation for Children’s Health website. The published white paper – Achieving Care Integration for Children with Medical Complexity: The Human-Centered Design Approach to Care Coordination – lays out the first couple of frameworks for the care system’s leaders to gain a top-level understanding of the issues at hand. The second paper will be published later this year.

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