Redesign of public health system navigation

Healthcare navigation has evolved over time from limited provider-focused options to service options where patients can navigate healthcare themselves. This has been carried out with a lens on empowering patients and giving them more control and options in managing their care.

The growing number of options creates a complex landscape. We designed a program to gain a deeper understanding of patient and caregiver experiences and inform the development of a new public digital service for citizens.

We discovered that navigation itself wasn’t a problem but a solution to the fragmentation of information and touch points.

To discover how to deeply address fragmentation, we had to reframe our mindset from experts asking ‘How do patients Navigate the Health Care System so we can create a service for them?’ to learners asking ‘ Patients are experts navigators, how do currently fix a fragmented health system and how we can support them in their journey?’

What we did
> User and Secondary Research
> Personas through Semantic Analysis
> 6 Journey Mapping
> Solution Probe

We generated 28 hours of data, which was transcribed into our research management software and clustered in 4,000 tags that were organized into 11 themes and 56 sub-themes to form our insight:

• The complexity of mapping care means that journeys can last a matter of hours or last for a better part of a lifetime.
• Patients are constantly learning within their treatment, and for some, all of this is happening within a wider discourse of continuous care. While a journey is often seen as a series of linear steps, navigating healthcare is often an interplay of continuous learning interactions.
• Within this interplay patients are constantly “Locating” to understand where to go next; “Informing” in order to guide their decisions and gain knowledge; and “Reorienting” when they recognize they are not getting the right care or need to consider a new diagnosis or treatment options.
• Reorienting means that healthcare experiences going from diagnosis to cure can turn into multi-year journeys of trial and error, bringing them further or closer to their ‘direct path’ across multiple specialists, trying to access the right information.

This Locating, Informing, Reorienting loop is a constant part of navigating health care. As a patient locates where to go, they discover more information, which reorients them to a new location. It is an invisible compass that guides patients across single visits to a clinic, or to multiple-year journeys for patients with chronic illnesses. Some patients are forced to step forward and backward in a dance between their health and the health system.

Amongst 34 patients attributes, we selected two attributes that formed the basis of our archetypes:

1. Their proactivity vs passivity as it relates to taking care of their health
   or the health of others
2. Their tendency towards being self-directed vs guided by others, as it
   relates to seeking out advice and information.

These attributes were deemed the most relevant to understand fundamental behaviours that could affect the use of healthcare navigation systems.
The personas were then cross-referenced with previous research that
had been done within the client’s organization.

By mapping journeys, across the Knowing & Accessing stage 4 questions constantly appear in the lives of patients, that they aim to answer to try to get to the next part of their journey and access health care:

1. Where do I go/search?
2. How do I get there?
3. How do I get the information?
4. What do I have/know?

Within this winding journey, we experience four macro phases and 13 sub-steps. Some are experienced as part of a linear journey. Some are skipped altogether.

To bridge the various gaps in citizen journeys, we prototyped and tested digital touchpoints offering a range of options on how to ask questions and get information. We represented the possible digital interactions through illustrations to present them back to stakeholders and validate them.

In the next phases of the project, this solution would indicate what channels are the most used, and what are the areas where citizens go back and forth the most in their Locating, informing, Reorienting loop.