Design Thinking in Eye Care

[Former Member]

Sankara Eye Care Institutions is a group of 13 eye hospitals across India, tirelessly working with one single vision  - “To work towards freedom from preventable and curable blindness”. With the help of 125 Doctors, 600 paramedical professionals and 275 support staff they have touched the lives of over 40 million people since their genesis in 1970s. It started as an Immunization Program by Dr. R.V.Ramani and his wife, Dr. Radha Ramani. In time it transformed into an Eye Care Initiative. Sankara Eye Care works on self-sustainable model of 80/20. 80% of the medical capacity works towards free eye care for poor, which is sustained by the 20% medical capacity working for paid patient.

Sometime in the first week of July 2014, Sankara Eye Care approached lakshman.pachineelaseshadri (Lucky) from SAP, Bangalore to help them improve their “end-to-end patient experience” using Design Thinking Approach. I volunteered in the project as both a participant and a Design Thinking Coach. Lucky was leading the facilitation of the whole workshop. This is a brief glimpse of what we did during the workshop and how we negotiated through the challenges faced in this workshop.

We conducted an approximately 10-day workshop spread across 8 weeks with 25 plus participants from both Sankara Eye Hospital (SEH) and SAP, Bangalore. The structure of workshops was broadly broken in two basic sections

• Introductory Workshop (0.5 Day)
• Overall Workshop (9.5 Days)

With two main objectives, we started with the Design Thinking introductory 1/2 Day workshop, firstly to introduce SEH participants to the method of Design Thinking and second, to understand the problem better and find out what SEH meant by “end-to-end patient experience”. This early identification of the initial problem space helped all stakeholders involved in the project, to be on the same page. It was handy in setting the expectations for the SEH Team apart from helping us plan the workshop much better.

Initial Problem Space

As with most of the projects, the design challenge in the beginning was too vague. It was kept vague so that there is some leeway for us to identify a set of pressing needs as opportunities. And in turn it helped us explore solutions for the most relevant opportunities.

With the help of a focus group from SEH, this is what initial problem statement looked like…

How might we design an efficient end-to-end experience for our out-patients and hospital staff that reduces waiting time, delay and frustration to create out-patients’ delight (becoming SEH marketing ambassadors) and higher level of motivation (attitudinal shift) for the hospital staff?

With this broad HMW statement, we started our overall Workshop. It went through a typical Design Thinking Approach of first identifying a “Problem Space” and then find a most relevant “Solution Space” for the same. During the "Define" (synthesis) phase we used Journey Map as the framework. The insights from the "Observe" (research) phase were pegged to the different stages of the Journey Map. This helped the team come-up with more holistic solutions.

The outcome was a presentation made to the SEH management team with a set of probable solutions ranging from policy, organization & process level changes to new technology solutions to help them being more efficient. The Key Insights, which guided us to the appropriate solutions, were broadly clustered into 3 themes.

Management Theme

HMW

How can SEH Management motivate Sankara staff to take pride and ownership in their responsibilities, out perform out-patient management, retain and grow sponsors/donors and increase its visibility.

Key Solutions

• Motivate and build competition by introducing grading by management KPIs and patient feedback.
• Co-Innovation Lab to build an ecosystem and foster innovation in Eye Care.

Doctor Theme

HMW

Enable Dr. Roshani to do justice to her vocation without compromising on quality with proper planning of work allocation & distribution with better technical & competent support systems & can get personal time to relax.

Key Solutions

• An application to help doctors and the hospital staff to keep track of the appointments real time.
• Proper Triage at the camps will reduce load on doctors and in-turn help reduce stress.
• Camp Pert: Management of patient flow on the community side to reduce confusion

Patient Theme

HMW

Enable Staff-Patient transparency and staff communication, so that the patient is clear about the next steps by getting right information and spends minimum time possible in the hospital.

Key Solutions

• Systemic solution to enable remote appointment booking and floor management of patient flow without actual files.
• Online Appointment booking
• Tablet solution for Floor Manager

Navigating from a broad HMW statement to a set of probable solutions had some interesting challenges.

SEH being keen to learn more about Design Thinking, wanted to experience it first hand. Our agreement with SEH to work on their premise and also have SEH Employees as participants, in the workshop, resulted in some interesting challenges.

Avoiding biased perspective

The user segment itself being a part of the team made it challenging to maintain a neutral outlook. And we realized that balanced composition as well as healthy team dynamics plays a key role in identifying the most relevant problem space.

In the early phase, some of the SEH team members were unable to detach themselves from their day-to-day work environment. Since they also represented a section of end users, they tried to justify why things are done in a certain way. But then they were quick to adapt. At the same time a few SAP team members also had preconceived assumptions, which were quickly broken. Basic questions from SAP team members and eye care specific domain expertise within SEH team members rubbed against each other and slowly, the difference blurred and everyone started looking at things as a team. By the beginning of synthesis phase we were able to attain a balanced perspective. The assumptions were thrown out, and genuine curiosity crawled in the teams. This was possible because we made sure each of the 3 teams had a healthy representation of SAP and SEH team members.

Hospital premise not equipped to run Design Thinking

The activity hall given for the workshop was a typical lecture hall. There was a projector wall and the other 3 sides had blank walls with no writing space. Being on a bootstrap budget, didn’t help much. Some quick pragmatic thinking helped us to come-up with ways to create a Guerilla DT Space.

• Vertical working areas: we covered all wall on the 3 sides with cheap brown paper. This was used for writing as well as clustering with post-it.
• White chart paper for doodling: Instead of expensive whiteboards we used white chart papers, to have some portable white doodling areas
• White thermocoal sheets were used as platforms to depict floor plans.
• Cuttings from old newspaper and magazines were used to create personas

Everyone wanted to focus on patients as the obvious target user
Since everyone wanted to focus on patients, proper planning to intervene at the right moment was instrumental in maneuvering the teams from the obvious problem space to a wider and more relevant set of solution spaces.

There were 3 main roles – Paramedical/Administrative Staff, Optometrist and Doctors. We consciously made an effort to have most of the roles represented in each of the teams. Luckily as expected, while deep in the process we realized each team had a dominant member from SEH representing a different user segment At the same time we also noticed that all the 3 teams were concentrating on the patient as their target user. Since as an outcome we wanted to cover a set of solutions covering bigger segment of the hospital experience, we decided to intervene just after story telling & clustering of insights was over, at the cusp of Research and Synthesis.

The intervention was in the form of a constraint given to the teams. We observed that the insights identified by each of the team had some generic patterns. Each team had an insight from each of these three main themes – Patient, Doctor & Management. Therefore we asked each of the teams to concentrate on a specific theme. The user segment represented by the dominant SEH Team member in each team governed this theme allocation. Hence…

• Team with a dominant Staff Member got “Patient” Theme
• Team with an dominant Administrator got “Management” Theme
• Team with a dominant Doctor got “Doctor” Theme

As a result of this intervention, by the end of the synthesis, we had three different sets of insights specifically for three different personas derived from three different Journey maps for one problem space “end-to-end patient experience”.

Conclusion

The main objective, problem space, participating members and the practicalities on the ground level govern the shape of any Design Thinking workshop. This malleability in Design Thinking Process is the key tool in the hands of people facilitating a Design Thinking Workshop, since each Design Thinking workshop is unique in it own sense.

Note of thanks

The outcome of the project could not have been possible without the contribution of each one of the team members and support from SEH Management team. Special thanks to Lucky for giving me an opportunity to participate in this initiative; apart from helping me in this blog with his valuable inputs.

Team iCare:Veena(SEH), Monika(SAP), Pallavi(SEH), Sumitra(SAP), Richa(SAP), Nanditha(SAP), Srikant(SEH), Sandeep(SAP)

Team Sangathan: Dhaneesh(SEH), Priya(SEH), Arun(SAP), Aparna(SAP), Arti(SAP), Monika(ex-SAP), Raman(SAP), Geetha(SEH), Jagdish(SEH)

Team Nayantara: Keerthi(SAP), Varun(SAP), Usha(SEH), Rakesh(SAP), Saurabh(SAP), Barathi(Ex-SAP), Shalini(SEH), Kumari(SEH)