Ideas by Bridgeable

Looking forward: Decentralized healthcare delivery

Looking forward is a series of trends we’ve observed in the healthcare and pharmaceutical sectors. For each trend, we detail what signals are driving it and explore how we could respond with service design and highlight similar case studies.

Care is being delivered in multiple locations

Care is moving from out of the hospital and into many other locations. As a result, healthcare systems are becoming increasingly decentralized, mobile, and multi-sited. Meeting the patient where they are is the essence of this trend.

Some of the locations that will see an increased delivery of care include: in the home and into the hands of the patient via home care or telemedicine, to the neighbourhood, such as the local pharmacy, and to community-based clinics offering outpatient care as alternatives to the hospital as a main location of care. 

What are we seeing that is suggestive of this multi-sited move? 

First, there is a growing emphasis on the home as a key location for care, allowing patient comfort and quality of life. Where the care cannot be within the home, there is pressure to have it be closer to the patient, in their local neighbourhood and community. For example, new retail and convenience clinics are emerging, effectively responding to primary care needs in a more on-demand model–an example here are MinuteClinics by CVS in the U.S. Other clinics, whether outpatient, ambulatory, or offering urgent care, are also moving to neighbourhoods, separate from hospitals, where they may have been traditionally housed in the past, offering greater access to patients near their home. 

Another example of attempts to meet the patient where they are is the use of mobile trailers as clinics. These mobile clinics can move more quickly to where the need is, often deployed to underserved neighbourhoods. Mobile trailers have been a part of vaccination and testing efforts during the COVID-19 pandemic, and in some cases hospitals have been transforming them into more general care. Whether they are a temporary stopgap or a mainstay is yet to be seen, but they are an evident demonstration of the shift to decentralized healthcare.

What’s driving this decentralization and mobilization of healthcare?

The move of care out from the hospital into the community and home is driven by a number of large-scale systemic pressures–or change drivers. An important driver is the pressure of the cost of healthcare. This cost is entangled with an aging population which has–and will continue to have–greater healthcare needs, with complex and often chronic health issues that pose an increasing burden to the system. 

Not only is the home a potentially better site for care, it can offer better outcomes and a better quality of life. Bringing care to the home and neighbourhood aligns with valuing access to care. Since quality over quantity and patient outcomes are already being driven by the move to value-based care, this may be borne out. Finally, moving care to multiple locations is facilitated by technological disruptions in healthcare, that is, the digital and virtual delivery that can connect a patient to the hospital from their home.

How might we respond to the move of healthcare to multiple locations?

Taking a human-centered service design approach, we might inquire into what is needed in the new location, such as the home, for the best patient experience. At Bridgeable, we often begin by asking patients and those involved in care first. Let’s take a look at an example:

Case Study: Prototyping high-value, personalized in-home care services in a changing health care market 

The Challenge: Facing an uncertain policy landscape and increased competition, Saint Elizabeth Health (SE Health) partnered with Bridgeable to map out the older adult (60+) home care experience in suburban Ontario. We worked closely with SE Health’s internal innovation team to research, co-create, and test high-fidelity service prototypes that focused on the softer side of care to enable better in-home experiences for older adults and their caregivers.

Our Approach: We undertook a rigorous research and service design process aimed at connecting the back office to in-home. The project team learned that the pace and tone of home care is often set within the first three days that a client is approved for care. Decisions made in these crucial moments often script how care is managed and delivered at the in-home. Bridgeable co-designed and tested prototypes that re-scripted the home care experience in order to connect the back office to in-home care. This ensured client needs and preferences were made a priority throughout the end-to-end home care experience. 

Impact: Bridgeable designed an enhanced home care experience that prioritized scheduling (to better manage client expectations), enhanced information sharing (to improve continuity of care between visits), and improved client onboarding. This experience was brought to life with six high-fidelity service prototypes, including a new scheduling interface, onboarding toolkit, and a new job to dedicate to client onboarding. Bridgeable also created a detailed implementation guide and prototype video to support SE Health in their future work.

This focus on key moments is just one way we might work together to improve the move of healthcare to multiple locations while also ensuring the best patient experience.

Taking a human-centered service design approach

While increasing access, multiple locations might result in fragmentation and disconnection in a patient’s experience as they move through care. At Bridgeable, we are often thinking about these through the lens of service design and human-centered design. 

For example, we may consider what care patients need and desire in what locations for the best patient experience. Patients might desire a diagnostic test to be delivered by a nurse as a part of home care, emphasizing their comfort. Patients might prefer to go to a pharmacy clinic in their neighbourhood because they can do this visit immediately, driving the process themselves and being able to consult with their trusted pharmacist. 

We might also consider that, though the delivery at home or in the pharmacy diverts care from the patient’s primary care physician, this key stakeholder can be brought in to support the patient in their access to care. 

Finally, we might take a broader approach by thinking of care as a continuous journey through all these locations that bring together all those involved. In the example, delivery at home or in a pharmacy becomes part of an omnichannel approach that brings together all locations and key stakeholders. All these elements–the people and key locations and moments–are a part of great service design. 

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