First research trip to Denmark: Preliminary insights and future challenges
It’s been a week since we return from our first trip to Denmark, and after many hours of debriefing, making transcripts and desk research we are beginning to find where our research opportunity is.
Research & Approach
As briefly mentioned in our first post, the purpose of our research is to develop a vision of distributed healthcare experiences for the New North Zealand Hospital, by exploring the role that technology might play in future experiences of COPD patients. This vision will put the needs of patients and medical practitioners first, by integrating people, technology and processes in pursuit of a shared goal and sustainable business model. We hope that the outcome of this vision will offer a sense of purpose for those planning the new hospital and have an impact in the future services implementation.
Our approach is based in the Design Council ‘Double Diamond’ which is divided into four distinct phases — Discover, Define, Develop and Deliver. Traditionally when people re-design services, they start with what they believe to be a problem, to develop solutions and then deliver them. The difficulty with this is that it often means that people end up solving the wrong problem. What service design does is to start with ‘discover’. This involves explore the context by going out to listen to people working in, and using the service to understand what is going well, and what it is that could be even better. Then, once the challenges and opportunities are defined, it is then possible to start co-developing design concepts to finally deliver or implement a design intervention.
This understanding of the state of the art was the purpose of our first trip, so currently we are beginning to make sense of all the information we have gathered in order to narrow down the scope.
Our way to Hillerød
Our research was done at the current North Zealand Hospital (Nordsjællands hospital) in a danish town named Hillerød, which has approximately 30.000 citizens and is located around 30km to the north of Copenhagen. As seen on the map, three hospitals will be merged into one, once the new hospital is open to public in late 2020.
The Innovation Unit of the new hospital is located at Hillerød hospital. Thanks to the kind help of Rie Maktabi (our project partner and member of the unit), we had access to clinicians and relevant stakeholders during our four-day research.
We are currently organising our insights into four key areas:
1. User experience (doctors, staff, patients, relatives, etc.). This is particularly important for COPD that are being constantly rehospitalized.
2. Understanding of the danish healthcare system.
3. The use of technology: current and future use, and the overall state of the art within healthcare
4. The business case for our intervention (economical, organisational and policy perspectives)
During our trip, we had in depth conversations with over 15 clinicians, experts and practitioners from different departments, and one COPD patient (more patients, nurses, GPs and other stakeholders are considered for our second trip). These are some of our preliminary insights:
1. User Experience
- There is a positive cultural shift regarding illness and the role of the hospital amongst practitioners.
“The concept of the hospital has to change. I believe the name should not be NHN Hospital but New Zealand Centre for health”
- Our COPD target group is an extreme user within our overall project scope: Patients need to feel safe and are hard to reach. Many of those being rehospitalized are isolated and experience hard home/hospital transitions.
“I remember I had a patient who said “I would never phone you, because I don’t want to be a burden. There is a lot of shame involved in this problem.”
“(COPD patients) are group of people who are invisible for the rest of society”
2. Danish healthcare system
- Home treatment is a national target: Tele-care systems seems to be the answer with a 1.25 billion € investment (TeleCare Nord)
- The primary care sector will need to expand its role
“We are dependent on the primary sector. It needs to be ready to meet the patients. There is a bigger need for incorporation of these sectors so there are no shifts but maybe one process. If we don’t have those fixed, the nice patient journey will abruptly end and patients will be re hospitalised”
“The primary care sector, the municipalities and GPs haven’t been quite ready for the change…the municipality has not been ready to take over, so we have had a great deal of readmissions”
- Lack of efficient Communication channels in healthcare is a transversal issue: Hospital/home transitions are not smooth. However, there are many interventions trying to improve this.
“We need to automate communication between hospitals and GPs, Our system isn’t integrated with the GP systems”.
- There is no clear understanding of how technology might fit in a new future. Also, monitoring for the patients is a new job function with no clear ownership:
“We don’t know how technology will be in 10 years and we don’t know yet regarding the responsibility of monitoring”
- Experts don’t know exactly how it will change the landscape, frontline staff don’t know many times where to find inspiration/what is going on.
“We also need the information about modern technology…what is actually possible. I don’t know what we’re missing and I’m sure we’re not the only one”
- Some current patients experience barriers to access/understand/use technology.
“TeleCare Nord shows, how telemedicine contributes to increased comfort and disease mastering, but there is still a demand for targeting of the offer to patients with severe COPD, in order to achieve benefits for both patients and short term economic gains.” *
- The new VR Lab at the hospital is a very exciting initiative. There, technology is being used to prototype and co-create as a more immersive experiences for future users, staff and potentially patients.
4. Business case
- Home treatment is a national target initiative. In this context there is a big investment and telecare
- The are national drivers for integration of primary and secondary care
- Readmission rates are a big issue, which reinforces the need to improve distributed healthcare services. In the case of patients with COPD, the rehospitalization percentage within 30 days is remarkably high ca. 30%
In summary, health care is such a complex system that the only way we can start envisioning change is by using an abstract lens, considering data, channels, functions and experience in an orchestrated vision. What we observed in Hillerød is no different of other health care systems: A complex constellation of technologies and big data systems -that are about being more complex- rarely connect, resulting in low productivity, excessive costs and risks of decreasing patient safety, quality, and value.
From the insights described, it is clear that we need to develop new business models and new organizational structures for the new hospital focusing on future opportunities of telecare, not as a technology itself but as a interconnected service. As mentioned by members of CIMT during a research meeting, patients don't have control of their devices today (only healthcare professional can access an overview of the data), but they hope this will happen somehow in the future. Additionally, TeleCare Nord have not worked with video and video conferences between personnel and patients which might be an interesting application to explore with COPD patients.
We see there are big opportunities finding ways of telecare that engage patients and practitioners proactively, giving citizens the option to manage their own care. This will require a fundamental redesign of the patient’s role from that of a passive recipient of care to an active participant. Now the question is how.
As a final note, we would like thank everyone we met for making us feel so welcome and we hope that we can touch base with you on our next trip.