Background: Hospitalization can be overwhelming for patients. Diagnostic uncertainty is common, and patients interact with many professionals who present information that may seem confusing. We bring a design thinking perspective to creating more patient-responsive hospital care, allowing their stories to drive the creation of a human-centered experience. Design thinking is about understanding needs and generating multiple ideas to create innovative, far reaching solutions. It focuses on how the system is experienced by the user. By using a rapid-cycle approach of obtaining input followed by ideation, prototyping, and testing, we offer a unique approach to improving experience and outcomes.
Methods: We sought to explore patients’ experiences of hospitalization from a design thinking perspective. As part of an ongoing collaborative care implementation, we interviewed patients, asking about their needs, communication, family involvement, and understanding of the care plan. Patients were identified by a case manager based on cognitive function, acuity of illness, and English fluency. Interviews were audio-recorded and transcribed. We adopted the design thinking method from IDEO, an international design firm, and coded interviews for unmet expectations, workarounds, tensions, problems, and needs. We aggregated responses with similar content into themes that allow us to identify opportunities for innovation.
Results: We utilized interviews of 45 patients conducted over 3 months. Transcripts were coded by two members of the research teams, who had 74% agreement. Disagreements were resolved by consensus. Unmet expectations included patients’ perception that information was not explained, or their expectation that physicians have answers to all of their questions, not recognizing that there might be diagnostic or treatment uncertainties. Patients felt that their hospitalization was disrespectful of personal priorities. An example includes a patient whose discharge timing was disruptive to her responsibilities outside of the hospital. Patients used workarounds to better understand the care plan. An example includes self-checking consistency across team members to ensure accuracy in their care. Patients also reported difficulty with health literacy, coordinating communication among specialties, and maintaining continuity of care.
Conclusions: Design thinking offers a novel approach that focuses on understanding patients’ experience of care as the basis for improving care delivery. Using patients’ perspectives enables us to identify opportunities for improvement and ways to approach those opportunities that we would not otherwise discover by learning not just what patients say and do, but how they think and feel. In turn, we can understand their motivation for health in terms of personal priorities rather than their disease. These insights will allow us to better address their actual needs. Our work demonstrates the feasibility and utility of applying this framework to understanding hospital care from patients’ perspectives.
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