This is the fourth 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, and part 3.

Olive View-UCLA Medical Center recently launched Prospective Action in Care Transitions (ProACT), an initiative that aims to inform patients’ patient-centered medical homes (PCMH) via automatically-triggered emails if a patient visits the emergency department (ED) or urgent care clinic.

The program already is helping to stop unnecessary acute care patient visits. For example, a real-time email recently notified a PCMH care manager that a patient arrived at the ED with a laceration. When the care manager informed the patient’s primary care physician (PCP) that the patient was receiving stiches, he offered an available appointment for suture removal. Before ProACT, the ED would have brought the patient back to the ED for suture removal; instead, the email alert helped connect the patient with his PCP and avert an unnecessary ED visit.

How did we transition from no solution for improving care coordination to this innovation?

The Innovation Cycle

Innovation is the creation of a “sticky” idea or product, versus invention, which is simply the idea or product. “Stickiness” transforms invention into innovation.

Innovation is best achieved through the innovation cycle. Elegant innovations, which appear intuitive, most often emerge from intense due diligence. While it now seems obvious that the best way to coordinate care transitions is through automated email alerts, this was not evident at the start of our journey.

Throughout the process to develop a tool to improve care coordination, we consulted Innovator’s Guidebook (Center for Care Innovations 2013) for techniques, methods, tips, and worksheets.

According to the guidebook, the innovation cycle includes six steps:

  1. Empathize (Understand/Frame)
  2. Explore (Ideate/Prototype)
  3. Experiment (Test/Refine)
  4. Develop and launch
  5. Empathize (Talk with end-users about ease-of-use and effectiveness)
  6. Continue cycle to modify innovation

Empathize and Inquire

At the onset, we sought to understand existing processes around care transitions. Were there any? What were the components? Who did what?

It all begins with a stakeholder assessment. The more people we engaged with, the more our understanding of the process evolved, and the more we learned we needed to involve additional stakeholders. We created a stakeholder diagram that included key players, such as patients, schedulers, case managers, care managers, internal medicine and emergency medicine faculty and house staff, and managed care services staff.

To collect input from these stakeholders, we posted open-ended questions on bulletin boards in the internal medicine clinic:

  • What do you currently like and dislike?
  • What information would be received?
  • How would it be communicated?
  • Describe the ideal care transition process.
  • Who would be contacted?

The questions solicited responses for two weeks and were anonymous to maintain comfort levels and honesty.

Analyzing the Results

Based on the responses gathered, we compiled a word map to help us glean major themes, which we then turned into topics for in-depth focus groups and further inquiry. The largest and most-frequently used words were:

  • Discharge
  • Notification
  • Email
  • PCP
  • Text message
  • ER
  • Discharge summary 

Through stakeholder analysis, we were able to narrow our scope of potential users. From insights gleaned through the bulletin board and word cloud, we began determining user opinions and potential issues.

In the next installment, we’ll describe additional empathy tools, including digital apps.