Designing a wellness-based Healthcare Power of Attorney (HPOA) system
Project Overview
​
The University of Chicago Medicine approached us with a big problem, the low percentage of patients with a Healthcare Power of Attorney (HPOA) on file. This project aims to address the challenges surrounding the integration of HPOA documents into the health records of patients. We focused on understanding the patient experience around HPOAs and developing a scalable, replicable patient-centered process for promoting, collecting, and integrating HPOAs into patients' health records.​
​
Client
UChicago Medicine
​
Duration
February – May 2023
Methods
Desk research, user interviews, ethnographic observation, user journey mapping, prototyping,
user testing
My Role
Service Designer and Design Researcher
Team
Nishanth Srikanth - Design Researcher
Snehal Khatavkar - Design Researcher
Dennis Siegert - Graphic Designer
Shirin Navgire - Graphic Designer
Covid taught us most people are unprepared for sickness, accidents, and surgeries.
A Healthcare Power of Attorney (HPOA) designates a specific person as the medical decision-maker for individuals who are unable to make their own medical decisions due to various circumstances such as accidents, surgeries, or critical illness. While HPOAs are crucial for ensuring patient autonomy and appropriate medical care, health systems often struggle to efficiently collect and store these documents.
Today approximately only 6% of the UChicago Medicine patient population has an HPOA
For patients between the ages of 18 and 40, this is as low as 0.7%
How can we help people understand the importance of being prepared and having an HPOA on file?
We use a mixed methods approach to understand possible barriers for patients to have an HPOA on file.
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.
To synthesize the research, I created a journey map that summarized our learnings, documenting the end-to-end HPOA process.
Process and stakeholders maps helped me better understand the current experience
Me leading a discussion to identify barriers and pain points in the patient journey, using one iteration of the journey map as a tool for conversation
Discoveries
Main barriers of the HPOA process
Patient side
Lack of knowledge
Half of the survey participants did not know what an HPOA is or have ever heard of it.
“Did not know I needed it” -Survey participant
It's not important
​Appointing a medical decision maker is not seen as an urgent matter since it is related to end-of-life situations, and not daily life.
“I'm in my twenties and haven't thought much about end of life care” - Interview participant
Lack of clarity
It is perceived as a complicated process. The form is confusing and long, and the submission process is unclear.
“This is information overload, it is difficult to understand and even when reading it I am still confused.” -Think aloud participant
Staff side
Lack of time
Physicians and MAs don't have time to talk about it during the patient consultation. The issue is not a priority for them either.
“I need to take weight, temperature, pain scale, blood pressure, review patient history... All in 5 minutes to keep the doctor on time.” - MA
Fragile process
The knowledge about the procedures to upload the forms to the system falls on a single person, which makes the process fragile.
"I'm the only one who knows how to scan the forms" - MA
"I do ask elderly patients about HPOA" - MA
Limited protocols
The established protocols to introduce the topic are only for end-of-life situations or for elderly patients and are not widely disseminated among the staff.
Talking about having a healthcare power of attorney shouldn't be difficult and yet it is. From here, we started formulating a hypothesis for ironing out the friction points.
Solving the mystery of HPOA
The goal is to make the process simple and regular so that patients are aware of it, normalize it, and can easily complete it.
We wanted to raise awareness among patients so that they know the importance of having an HPOA on file. Second, we wanted to simplify the process and make it routine so that it's easier to complete. Finally, we wanted to support the implementation of these strategies to ensure the effectiveness of the proposed changes.
Awareness through Repetition and Resonance
Simplification through Clarity and Access
Implementation through Monitoring and control
Putting together an ideal experience
Having decided on the main strategies, I built an experience model of the entire journey to illustrate how our proposal raises awareness and eases the process for patients and which touch-points will exist.
The new patient journey
Click on the image to see the details
We developed prototypes of the artifacts present in the experience: communication and orientation materials (posters, banners, and brochures), redesigned HPOA form, and text messages. I was in charge of planning and carrying out two rounds of usability tests in the clinic to identify the effectiveness of the different messages and the clarity of the new form.
.jpg)
More than 20 iterations of awareness posters that evolved based on user testing (left)
The team and I doing tests at the UCM clinic, evaluating the effectiveness of different messages and the attractiveness of the images (right)
Learnings from testing
Communication and awareness materials
Elements such as thought-provoking questions, humor, and more inclusive imagery are most effective in drawing patients' attention and causing curiosity about the topic.
Form
Medical staff needs easy access to the Medical Record Number of patient and Medical Decision Maker information. We added a space for the MRN tag and highlighted the MDM information with a box.
Service Blueprint
Guide for implementation
As a result, I developed a service blueprint to integrate all the recommendations in one place and guide the implementation process.
Click on the image to see the details
See the full report with all artifacts, touch points and recommendations
The first version of the service strategy will be launched during the spring of 2024 with a 6-week pilot program.
What I’d do differently next time…
🧬 Understanding relationships and influences is key when working in healthcare.Work in healthcare is quite complex as it involves many hierarchies and relationships between different stakeholders internal and external to the healthcare organization. To start with a clearer understanding of all the areas and stakeholders relevant to the project, next time I am going to lead a collaborative stakeholder mapping session with the project sponsors, to see who has the most influence on the HPOA process and to be able to reach them earlier in the process.
🤸 Adopt a flexible process when designing for complexity. At first, my team struggled to identify the touch points of the patient journey as we found that it had multiple paths that incorporated both physical and digital versions of the process. To gain more clarity, I proposed to conduct patient interviews and contextual inquiries with medical staff in the clinic. I focused on uncovering user gaps to complete the process. By having both an internal and external perspective, it was much easier to map out the current experience.