Welcome to the Amusement Park!

Reframe your approach to patient experience design

As healthcare organizations embrace consumerism for their customer/member/patients/users, hereinafter referred to as patients, there has been an explosion of design thinking techniques to improve patient experience and ultimately health outcomes.  Nearly every organization, new and incumbent, has attempted to map a patient journey – the somewhat branching, linear approach to describing a typical, idealized experience in care used to define performance standards, allow for continuous improvement and scaling of services. 

The creation of these maps typically involves the creation of personas, homogenized identities stemming from market research that represent patient archetypes that may go on said journey.  While this approach is directionally correct, if you have ever been involved in these exercises, they often feel like a frustrating amount of abstraction combined with wild, unverified assumption creation, while ignoring daunting complexity, all in the name of “getting something done.” The clinical people in the room keep spouting exceptions.  The non-clinical folks accuse clinicians of navigating rabbit holes, while the design facilitators just throw up their hands. Worse, the rituals of corporate hierarchy dictate these maps usually end up constrained to powerpoint slides to be force fed to an executive, further trimming the branches while forcing the illusion of linearity, and an annoying tendency to compare them to manufacturing lines.  Therein lies the fatal flaw.  

You see, as many of you have learned, probably the hard way, patient journeys are rarely linear.  Although some elements are predictable, like needing to get blood drawn at some point, the actual paths are chaotic and seemingly random. They are not a quest, road, race or vacation.  Forcing ourselves to predict, even branching linear movement, becomes quickly overwhelming because it is far too complex to actually capture. It is very likely impossible to do so in any meaningful way.  So instead, let’s reframe patient experience from a linear journey to something much more fun and useful: A trip to an amusement park. 

Enter the Amusement park  

Think back to your last trip to an amusement park. Growing up, we had Six Flags Great Adventure, which, for the price of a Coke can, you could surround yourself with DC characters, the now defunct Great American Scream Machine, later outdone by Superman. Picture, if you can, your most recent memories – the colors, lights and crowds, whipsawing around the attractions.  Also, remember the greasy, sugary food, delicious at first but dangerous at high g-forces.  And don’t forget the long, boring lines, the thrill of getting the front car, or the disappointment of finding out your favorite ride was down for maintenance. 

While awash in these fond memories, now readjust your expectation of an ideal patient journey.  First, there is no ideal, because every trip is unpredictably different. Like your trip through amusement parks, care is not linear.  Where you went that day was a function of crowds, weather, mood, your companions and the state of the park.  Maybe you rode the same rollercoaster three times in a row because the line was short.  Maybe you spent 2 hours trying to find your friend in the water park.  The randomness makes it fun, which is the point of an amusement park in the first place.  Patients, whether in a virtual, office, or hospital-based set of interactions will have similar variability based on symptoms, provider availability, knowledge and bias, seasonal surges, time of day, equipment and supply availability, maintenance status, and on and on.  

However, despite all of the apparent amusement park chaos, there is quite a bit of order underneath. The look and feel of the park journey, experienced as colors, smells, sounds, characters are all designed and chosen with intent and purpose.  There are distinct areas within a park, big rides, water rides, the kids area, with the pathing between designed to keep guests flowing and avoid bottlenecks.  And even while paths are less predictable, the set of possible stops on the journey, the rides, attractions and concessions, are very predictable.  Each ride is an incredibly well engineered and (hopefully) meticulously maintained experience.  Ride operators generally have a bored, vacant look as the actual ride itself is so damn predictable.  No one (outside of Action Park) is supposed to be injured. Thoroughly rehearsed shows happen at scheduled times and the games are perfectly designed to be frustratingly unwinable.  It is the focus on these precision elements, serving as the foundation for the overall experience that reveals a better pattern for understanding and designing patient journeys: Focus on perfecting the rides first.

Within any healthcare service, there are standardized, repeatable elements hiding within the chaos, in this case the rides.  A doctor visit may go one of one hundred different ways, but the taking of your blood pressure ought to be predictable and repeatable.  Similarly, every order for blood work is a little bit different, but the techniques of phlebotomy and specimen processing should be very, very predictable (or else).  We should find comfort from the same bored, dispassionate ride operator faces from x-ray techs when getting imaging of your foot.  And the comparison scales up to more complex services.  Operating rooms are masterpieces of chaotic coordination, amusement parks within themselves, but when systematically managed, they can improve throughput, while achieving the intended outcome, with a reduction in complications.  

Now, if you’ve experienced healthcare at any point in your life, you are unlikely to have experienced either the whimsy nor robotic precision of an amusement park, despite continuous attempts to improve these elements of care.  Unfortunately, due to volume-based business models, combined with technical silos, most organizations attempt improvements in throughput by service, organized and measured by department (the lab department, radiology department, doctor work, nurse work, etc.) rather than looking through the lens of a patient experience, which we’ve just determined is challenging to capture. This is the equivalent of making every rollercoaster as short as possible. 

So, Aspiring Improver of health care, what are you to do?  First, dump personas in favor of Clay Christensen’s Jobs to Be Done.  We are not an average collection of our traits, rather we are multitude-containing humans trying to get better.  You do not engage in a healthcare journey because you are a middle-aged suburban woman.  To use the language in the Jobs to Be Done framework, you hire healthcare to solve your health problems, like screening for breast cancer.  

The shift from personas to jobs may seem subtle, but focusing on problems to be solved rather than demographic traits allows you to design potential paths through the amusement park.  Remembering that unlike every other consumer-focused business, no one wants to consume health care, they want to be healthy, and, if lucky enough, are forced to consume healthcare to maybe get there. Therefore, understanding the problem a patient is trying to solve will help you organize your services (rides) to solve those problems, rather than organizing to maximize throughput of each part.  While the “Jiffy Boob” article laments the loss of humanity within a clinical service, it also describes an incredibly well-functioning, job-focused clinical service that needs very concrete and achievable improvements.  Design each service carefully, maintain and improve it, and ensure that it is designed to solve relevant patient problems, not optimize volume.  

The amusement park analogy keeps on giving.  Fancy parks (looking at you Disney), offer concierges or guides to plan your trip through the park, skip lines, and maximize fun.  Not only does this improve customer experience (for those willing to spend for it), it actually allows for some predictability and influence over everyone’s path through the park.  It turns out we have a similar function in health care that we’ve marginalized, neglected and flooded with paperwork: Primary care.  We should deploy them based on complexity rather than discretionary income, and you can further enhance the operations of your park. 

So if you currently operate or dare to design a novel healthcare experience, remember that you are building an amusement park, not a factory.  Each “trip to the park” is a collection of healthcare jobs, the resolution of each leading to the next step in the journey. Apply the tools of rigorous engineering to the rides, individual services.  Apply the tools of hospitality/experience design to the park, the overall feel of the services, knowing that they will span unpredictable paths.  Design your marketing/sales/patient engagement (perhaps the only linear part of the whole journey), to elicit recognition that each of us has health care jobs to be done, and that your system/product/service/insurance can solve those problems in the least painful way possible.  

If we get this right, we can usher in a new era of health care, where we align experience, expertise and payment to truly improve the health of humanity…. so we can all spend our time doing anything else but consuming health care…and maybe spend more time at amusement parks!