Snehal Khatavkar
User Research. Service Design
Service design | User research | UX prototyping
Re-designing the Healthcare Power of Attorney process
A patient-centered approach to design a scalable and adaptable process to increase patient engagement.
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CONTEXT + PROBLEM
Dealing with Covid-19 taught us that most people are unprepared for unexpected situations like sickness, accidents, and surgeries
A Healthcare Power of Attorney is a legal document allowing individuals to appoint a trusted person to make medical decisions on their behalf in critical situations. It serves as a crucial preventative tool, allowing you to maintain control even when you can't speak for yourself.
UChicago Medicines existing HPOA form
Brief
The University of Chicago Medicine and ID partnered to address a critical patient care need: the low percentage of patients with Healthcare Power of Attorneys on file. We undertook a patient-centered approach design the
end-to-end experience. The solution focuses on promoting the use of HPOAs, clarifying the submission process and integrating forms into patient Electronic Health Records (EHR).
Impact
Presented the entire re-designed experience along with actionable recommendations to UChicago Medicine, resulting in a 6 week pilot program to implement recommendations from the report
Role
Collaborated with a team of six, leading research planning and execution. Co-led as a service designer, translating insights into experience maps and service blueprints to build a shared understanding of the end-to-end experience.
Methods
Generative research , evaluative research, service blueprint,
experience mapping, rapid prototyping
CHALLENGE
UCM Health System faces significant challenges in effectively communicating the importance of healthcare power of attorney documents and managing them efficiently.
Despite playing a crucial role in ensuring patient
autonomy and delivering relevant care, currently only 6% of patient population has appointed a Healthcare Power of Attorney (HPOA).
Encourage healthy and critical care patients both to appoint a Healthcare Power of Attorney.
Design a digital first process from a paper based process to integrate completed forms into the patients electronic health records.
Design a replicable workflow to scale across UCM clinics.
10+
Reviewed secondary research articles and resources looking for barriers and good practices.
90+
responses to a survey to understand the perceptions, and knowledge of the general public about HPOA.
5
interviews with patients and non-patients to understand their perceptions and experiences with HPOA
2
visits to clinics where we carried out contextual inquiry with doctors and medical assistants (MAs), to understand their perspective.
20
think-aloud tests to understand the problems of the HPOA form itself.
RESEARCH
I developed a research plan along with research tools like interview protocol, survey design to conduct generative and evaluative research to explore patient and staff needs, potential barriers to completing and integrating a HPOA form into the Electronic Health Record.
Research survey with 81 participants revealed
Individuals find it difficult to establish relevance and urgency of having an HPOA in the pink of health
Patient needs
Patients do not understand the process for procuring and filing the form
58% didn’t know the process of filing an HPOA and
54% participants that knew about HPOAs,
didn't know where to get one.
HPOA is considered unimportant
(66%) Sixty-six percent of people aware of healthcare power of attorney (HPOA) do not consider it a priority.
Lack of knowledge
40% of our survey sample had never heard of an HPOA, who is eligible for filling one and when is it used
“ I haven't filled one out because I'm still under the delusion that I'm never going to be incapacitated to the point that someone else will need to make health care decisions for me. I still believe that I'm going to be healthy my whole life and then die peacefully in my sleep after my 110th surprise birthday party, which ended at 2am. I'm half-kidding, but yes, it's mostly out of not wanting to believe that "it" (i.e., a horrible disease or terrible accident) is going to happen to me, despite all of the evidence to the contrary that it happens to lots and lots and lots of people..” - participant
SOLUTION STRATEGIES
Make the process simple and regular so that patients are aware of it, normalize it, and can easily complete it.
01
Simplified workflow for increased clarity and access
02
Communication strategy for
Increased awareness through Repetition and Resonance
03
Scalability for Implementation through monitoring and control
Ideal patient experience with a digital + physical submission process
After finalizing the key strategies, I constructed an experience model of the entire patient journey to demonstrate how our proposal increases awareness, simplifies the process, and identifies critical touchpoints.
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Service blueprint : A guide for implementation
I developed a service blueprint to integrate all the recommendations in one place and guide the implementation process.
What I'd do do different next time!
Healthcare projects involve navigating complex relationships among multiple stakeholders, both internal and external. To better understand these dynamics, I will use stakeholder mapping as an active tool to uncover key influential stakeholders that can impact the overall process. By using stakeholder maps, we could've avoided being blindsided by the (HIM) department earlier in the project and design a full proof submission process.
In rapid research, effectively documenting insights is key to quickly moving from research to action. Without a structured approach, valuable information can become fragmented. Using templates could have streamlined this process by providing a consistent format, ensuring key details were captured, enhancing clarity, and improving collaboration—ultimately accelerating the transition from insights to implementation
RESEARCH SYNTHESIS
The existing process at UCM is underdeveloped with limited protocols which reduces patient engagement and delays
documents from reflecting in the patient's electronic health records
Single point dependency weakens the system
Relying on a single individual’s knowledge for checking and uploading forms to the patient portal creates a bottleneck, causing potential delays.
HPOA is not prioritized in the current workflow
Physicians and MAs must gather patient medical histories quickly to stay on schedule, often deprioritizing enquiring about HPOA submission status.
HPOA is only introduced to 65+ and critical care population
Protocols for introducing the topic are limited to end-of-life situations or elderly patients and does not include younger population.
Refined information architecture to improve information flow for patient understanding and access to patient information.
Created Frankenstein prototypes to improve information flow. Refined prototypes through 2 rounds of A/B testing.
Elements such as thought-provoking questions, humor, and more inclusive imagery are most effective in drawing patients' attention and causing curiosity about the topic.
Worked closely with visual designers to test prototypes for communication messages. I led planning and execution for two rounds of usability testing in UCM clinics to evaluate message effectiveness.
