Patient engagement can be tricky. Despite good intentions, many do it wrong, as evidenced by the wealth of examples in the #HowNotToDoPtEngagement thread. At ConsultLoop, the wellbeing of the patient is at the core of every decision we make even though they are not our customers. However, patients are what motivated us to start this company, and make the measuring stick by which we look at our accomplishments. We wanted to experiment with a type of patient engagement that works for startups, where we struggled to find examples of any kind. In this article, we will share our experience with a type of design sprint. We sincerely welcome any criticism of our approach, and any inquiries from other startups or health organizations who want to experiment with this model (email me here).
Patient Engagement and Startups
There are three main things that set startups apart from typical health organizations. First, they have to make decisions, act on them and iterate at a very high speed. Second, they have to create opportunities to spark ideas, explore new lines of business and new ways to create value to stakeholders. Third, startups are under the most direct pressure to align the interests of the business and better patient care. How could we engage with patients in a way that moves quickly, is sensitive to new opportunities, and supports audacious thinking? Could we do it cheaply? And can we do it in a way that respects the time, insight and experience of the patients who participate?
We decided to look at a key part of the patient journey in healthcare that is central to our e-referral platform – the time before a patient’s first appointment with a specialist. Typically, a patient may get some instructions about bringing a health card and some cancellation policies. Was this a lost opportunity? We strongly felt that we could transform this experience, if only we could get some insightful patient input. We also wanted to test a model of patient engagement. We read through many of the resources sent to us by patients we follow and admire on social media (a special thank you to @couragesings, @patient_commando, @solidfooting, @annetto, @aliesmaybe, @jenhoronjeff among many others), and tried to understand elements of good patient engagement in patients’ terms.
Let’s get going – but where?
We first needed to clearly identify what patients want before their appointment. So we drew up a first survey (email us if you are interested in the survey questions). We gave scant info for context, preferring patients draw from their own experiences, and asked “what could have been done differently so you would be more satisfied with this experience”? We then asked what would be important aspects of any instruction materials sent to the patient, listed several items for patients to choose from, and asked why the most important one was chosen. Through a twitter posting and listserv at our workspace, we got 27 responses in 2 hours. We offered $5 to Amazon and it took an average of 3 minutes to fill the survey.
We learnt a TON. First, we looked at the short answer responses and found key themes for patients. They wanted information to be clear and easy to understand. They wanted to have a good sense of what will happen in the appointment, and how they should best prepare for it. They also identified that this was an opportunity to reduce anxiety and feel positive about the care they will receive. This gave us a clear idea of what our designs must accomplish for patients. Patients also indicated what elements of pre-appointment materials would be desired. Ranking them by popularity, we could validate that they are consistent with the answers to the previous question, and we now knew what our design should have. It was time to get to the drawing board.
Creating and Iterating
We set out to make two raw, independent prototypes of pre-appointment mailouts. We internally compared them and refined them, checking them against the patient responses from our first survey.
Our next step was to get patient feedback on these two prototypes, as comparison is powerful in extracting feedback. Which did patients prefer, and why? Did they help accomplish what patients wanted them to accomplish? We sent out the survey to the patients who had replied to our first survey because they already had expectations of what “good” is. We showed both prototypes and asked for each one how much they agree with the following:
- The presentation overall is clear and inviting
- I am confident I can prepare for my appointment
- It is easy to find key info like appointment time, location, contact information
- Seeing this makes me more confident in the care this clinic provides
A dozen replies and a dozen $5 certificates to Amazon later, we had the info we needed. Though both scored well, there was a clear winner. In their comments, patients gave some great insight into why. This meant we were well-positioned to take the best aspects of each prototype and create a hybrid design and move towards a finished product.
The Finished Product
Thanks to all this input, we created a type of instruction sheet for patients that is almost a new type of document – rather than instructions of what a patient must follow, it is a guide to help the patient prepare for and understand their appointment (you can see the online version here). This change in positioning is important. We also created a companion app so that patients could see if the clinic was running behind by texting “WAIT” to our app’s number or visiting the clinic’s page.
We then took our design work back to patients one more time. Have we improved on the last examples? The answer was yes (15/15 respondents gave it a smiley face), but we had to find out for sure. We succeeded in improving on this key part of the patient journey.
Patient Engagement and Us
We know that we got tons of insight from this process, and that we could not have imagined anything like this without patient input. It was fast, allowed us to catch new creative sparks and ideas, and was guided yet open in its inquiry. It was pretty cheap – a couple hundred dollars is palatable for any startup. And it was certainly agile – we began without knowing exactly what we would do next and had a finished product within a few days. But did patients feel they had an impact? Was the length of the surveys and the compensation for them appropriate? Was their participation valued and were they respected as patients? And most importantly, how likely are they to recommend or endorse this design process to another clinic or institution? Well, we asked them:
We are very pleased with this result, and propose every patient initiative be evaluated with these questions.
The Way Forward
Patients are an active, essential part of healthcare. We believe that startups are the sector within health that will bring in new, creative ways of doing things, and that patients’ voices must be heard as they are the “north star” we should be aiming towards. This is just one kind of engagement – asynchronous, temporary, and superficial. But we feel it is something that creates value for the system and can have an impact. As evidence, we look at the quality of this design and the positive experience patients report about this engagement process. We look forward to doing this again and iterating on this process, improving little by little each time.