This is the sixth blog in a series highlighting how the Los Angeles County Department of Health Services is helping patients better navigate their care. Read part 1, part 2, part 3, part 4, and part 5.
Safety-net organizations face numerous problems, each with many potential solutions. When thinking about solutions, it is helpful to have a framework of innovation. This installment of the blog discusses how to choose between solutions and how to operationalize them.
Some principles to keep in mind when experimenting with solutions are:
- Focus on your interests, not your positions. There are many means (read: positions) to meet the same interest. For example, if the interest is increasing access to care, that can be achieved through:
- Hiring more providers
- Involving non-provider staff in more of the visit, such as patient education or medication adjustments by protocol
- Telephone visits
- Group visits
Getting too attached to any one solution may impede seeing other valuable solutions.
- Be solution agnostic. Approach the problem with no preconceived ideas about the best solution. Take an inquisitive, interrogative mindset, not a pre-prescribed mindset.
- Involve many stakeholders to generate ideas.
- Go broad before going deep. Think of many possible solutions before delving in detail into any one of them.
- Create quick prototypes as a “reality check.”
Relying on these principles, Olive View-UCLA Medical Center launched an initiative called ProACT (Prospective Action in Care Transitions), designed to improve care transitions by using automatically-triggered emails when a patient-centered medical home (PCMH) patient visits the emergency department (ED) or urgent care clinic.
But how exactly did Olive View-UCLA Medical Center brainstorm and prototype solutions to the problem of poor communication between the ED/inpatient settings and the PCMHs?
Our bulletin board/word cloud, dScout, and individual and group interview sessions led us to the conclusion that PCMH care managers were to be the end-users, and they wanted automated email notification of patients’ presentation to the ED.
We mocked up for them four options of how that might look and played the innovators version of the 1960’s television game show, “The Dating Game.” We showed the various prototypes to the care managers and had them choose between various prototypes:
- Behind Curtain #1 – email with link to single patient’s information
- Behind Curtain #2 – email with single patient’s information embedded
- Behind Curtain #3 – email with links to multiple patients’ information
- Behind Curtain #4 – text message with single patient’s information
We included a text message option, even though care managers did not select that as their preferred method. We opted to include that among the prototypes because:
- It was quick and easy to mock-up, and
- Sometimes people feel differently about items or issues when they are made tangible, as in a realistic mock-up.
It may have been difficult for the care managers to imagine what the text message information would look like. Seeing an example might make them feel differently about that option. As it turned out, they still preferred the email option.
A prototype does not need to be expensive. Examples of “quick-and-easy” prototypes are:
- Dioramas or cardboard construction scenes
- Mock-up drawings
- Photo collages
- Short videos
Innovations such as ProACT often require staff training. In the next issue, we’ll describe how our care managers prepared for integrating ProACT into their routines.