top of page
Snehal Khatavkar
Design researcher. Design strategist

Click to see the full report including research, artifacts, touchpoints and reccomendations to UChicago Medicine 

We analysed the existing patient journey at UCM via a Mixed methods approach and learnt 

METHODS 

10+

Reviewed secondary research articles and resources to understand barriers to HPOA completion and best practices in the field.

5

semi structured interviews with patients and non-patients to understand their motivations, needs and experiences with HPOA.

20

think-aloud tests to understand the problems of the HPOA form itself

90+

Responses to digital survey to get an understanding about the perceptions, and knowledge of the general public about HPOA.

2

visits to clinics where we carried out contextual inquiry with doctors and medical assistants (MAs), to understand patient medical staff interaction and in clinic patient journey 

60+

think aloud tests and intercepts to test messaging strategies and understand perceptions of HPOA in different age groups.

CONTEXT

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 that allows individuals to appoint a specific person they trust as their medical decision-maker in unexpected situations to act on their behalf

It acts as a preventative tool for individuals to ensure their healthcare wishes are reflected in the treatments they receive if individuals are unable to voice them in unexpected circumstances like surgeries, accidents, 

or critical illness.

CHALLENGE

Despite playing a crucial role in ensuring patient autonomy and delivering relevant care, currently only 6% of patient population has a Healthcare Power of Attorney (HPOA) on file.

UCM Health System faces significant challenges in effectively communicating the importance of healthcare power of attorney documents and managing them efficiently.

The ideal patient journey consists of 4 distinct phases

Signing a medical decision-maker is not a one-time decision it’s an ongoing process. Patients require appropriate support throughout the process. We designed an ideal patient journey taking into account the users needs and devised a three pronged approach to establish relevance, enable patients to fill the forms with confidence and  make sure the forms are reflected in the EHRs

Undeveloped process and limited protocols in the health system excludes younger population, and introduces delays the process

BARRIERS

PATIENTS

“I need to take the weight, temperature, pain scale, blood pressure, review patient history... All in 5 minutes to keep the doctor on time.” - MA

STAFF

“I need to take the weight, temperature, pain scale, blood pressure, review patient history... All in 5 minutes to keep the doctor on time.” - MA

Single point dependency 

Dependency on a sole individual's knowledge for checking and uploading forms to the patient portal creates a bottleneck, leading to potential delays in the process.

HPOA is not prioritized 

Physicians and MAs are tasked with inquiring about the patient’s medical history in a limited amount of time to keep their appointments on schedule. Asking about the HPOA is not prioritized

Communication is limited to 65+ population 

The established protocols to introduce the topic are only for end-of-life situations or for elderly patients which are not widely disseminated among the staff.

Uncertainty is too abstract to act on it
Lorem ipsums Lorem ipsums Lorem ipsums Lorem ipsums Lorem ipsums Lorem ipsums Lorem ipsums Lorem ipsums Lorem ipsums Lorem ipsums Lorem ipsums Lorem ipsums

Lack of knowledge, eligibility and use 

44% Lack of process clarity

Unclear and long process
59% Don't know what an HPOA is

DISCOVER: COMMUNICATION STRATEGY 

Patients value the conversation about their future health decisions with their decision maker and were motivated to sign an HPOA to be assured of their loved one’s presence

Communication is limited to 65+ population 

The established protocols to introduce the topic are only for end-of-life situations or for elderly patients which are not widely disseminated among the staff.

"I do ask elderly patients about HPOA" - MA

HPOA is not prioritized

Physicians and MAs are tasked with inquiring about the patient’s medical history in a limited amount of time to keep their appointments on schedule. Asking about the HPOA is not prioritized

“I need to take the weight, temperature, pain scale, blood pressure, review patient history... All in 5 minutes to keep the doctor on time.” - MA

Single point dependency


Dependency on a sole individual's knowledge for checking and uploading forms to the patient portal creates a bottleneck, leading to potential delays in the process.

"I'm the only one who knows how to scan the forms" - MA

BARRIER

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 


Unclear and long process

58% didn’t know the process of filing an HPOA and
54% participants that knew about HPOAs, 
didn't know where to get one.

"Did not know I needed it" - Survey participant 

It is not important 

Even amongst those who know about HPOA’s, many (66%) don’t see it as a priority.

'm in my twenties and haven't thought much about end of life care” - Interview participant

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.

This is information overload, it is difficult to understand and even when reading it I am still confused.” -Think aloud participant

Research survey with 81 participants revealed

“ 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

USER NEEDS 

Individuals find it difficult to establish relevance and urgency of having an HPOA in the pink of health

De-prioritized as its not seen important

Individuals do not act on the information and appoint a medical decision-maker because they do not see the urgency

Deciding a medical decision maker requires vulnerable conversations 

They need a guidance support on who should be the agent and to have that conversation

FILL: REDESIGNED FROM FOR BETTER COMPREHESION AND IDENTIFICATION 

Patients require  specific context to comprehend the significance of HPOA, while medical staff must have swift access to agent details.

Monitoring for consistency and effective results 

Repeat exposure to normalise having an HPOA for all age groups 

Streamlined process with digital and physical touchpoints to boost engagement by minimizing obstacles

A simplified patient-centered process that normalizes having an HPOA for all ages,  seamlessly integrating them into patients' medical records for easy tracking 

GOALS

We aimed to increase patient awareness regarding the significance of maintaining an HPOA on record. Additionally, our goal was to streamline the process, making it more accessible and routine for completion. Lastly, we sought to facilitate the implementation of these strategies to guarantee the efficacy of the proposed modifications.

SERVICE BLUEPRINT 
integrating all the recommendations in one place and guide the implementation process