As an innovation hotbed with ample resources, the San Francisco Bay Area offers abundant opportunities for creative problem-solving to address complex social challenges, such as those seen in healthcare. Many believe that a key to unlocking solutions to these challenges is to leverage design thinking and experimentation. Recently, Minerva partnered with Zuckerberg San Francisco General Hospital (ZSFG) and the San Francisco Department of Public Health (SFDPH) Innovation Hub to explore the problem of a fragmented patient experience for those receiving prenatal care at the Women’s Health Center at ZSFG.
The Women’s Health Center at ZSFG is a large, full-service, multidisciplinary obstetrics and gynecology practice. Specialized personnel, including physicians, nurse midwives, nurse practitioners, and counselors provide a broad array of prenatal care services to a diverse, underserved, and vulnerable patient population. After learning about Minerva from City Experience Manager Capri LaRocca, ZSFG and SFDPH Innovation Hub collaborated with eight students from the Class of 2021 on a project that used design-thinking strategies to improve the care experience and patient perception of prenatal care for both patients and care providers.
“ZSFG is a thriving healthcare delivery environment that facilitates lifelong learning for its providers, staff, and patients, particularly for the care of low-income individuals,” says Dr. Tuot, Associate Professor in Medicine at the University of California San Francisco (UCSF.) “Engaging with curious, enthusiastic undergraduate students is one way to foster this learning, and develop and nurture a commitment to the underserved. Dr. Su and I were also looking forward to working with creative young minds, who can provide a fresh perspective and outlook.”
One challenge identified at the Women’s Health Center was a reported inconsistency in patient care given by their doctors versus their midwives. Findings from a previous survey indicated variation in how patients engaged with and felt supported by their midwife and physician providers. In order to understand this variation and to improve and equalize patient care, Minerva students and ZSFG and SFDPH Innovation Hub staff members, Patricia Price, Project Manager at Innovation Hub, Dr. George Su, Associate Professor in Medicine at UCSF, and Dr. Delphine Tuot worked together to investigate the reported differences and propose improvements to equalize the hospital experience for all parties.
This project was an interesting opportunity for students because it offered a door into the healthcare community in the Bay Area and exposure to care for the underserved. “I was drawn to this project because I was extremely interested in learning more about design thinking and applying it to solve real-life problems, like those faced by the prenatal unit at the hospital. After being exposed to design thinking during high school, as well as interacting with IDEO during a co-curricular in the fall semester, I wanted to go beyond just understanding design thinking in theory,” says Anya Chen, a student from Singapore.
With the goal to improve patient and provider care in mind, the Minerva team started by looking at reported patient satisfaction data. This showed that patients who engaged less reported a lack of communication and comfort with their providers. Poor engagement negatively affects the accuracy of patient assessments as well as the quality of care. For example, patients who do not feel comfortable with their provider are, consciously or not, less likely to disclose complete health history, which can lead to future complications.
Recognizing that further information was needed, the team interviewed clinic patients to better understand the care experience. Guided by Ms. Price, Dr. Tuot, and Dr. Su, and pulling from the principles they were studying in their Multimodal Communications Cornerstone course, the students conducted ethnographic interviews, studied the patients’ journey, and organized structured brainstorming sessions to better understand the problem from a human-centered perspective. Because the patients came from diverse social and economic backgrounds, an empathic approach to understanding their varied points of view was critical. “The clinic serves many women in marginalized groups, so honing in on issues in a sensitive way was vital,” says Isabella Buchanan from South Africa, emphasizing the importance of emotional intelligence as well. “We had to identify which questions were appropriate for which patients to be sensitive and respectful.”
Then, using problem-solving concepts from their Empirical Analysis Cornerstone, the student team developed parameters to help them quantitatively and qualitatively measure the data collected during the interviews, and subsequently reviewed the data to address any potential collection biases. To gain a deeper understanding of the patient care provided by the prenatal clinic at ZSFG, the students also shadowed patients and their respective clinicians, and led focus groups of patients.
The team reported their findings to the Women’s Health Clinic, and offered a framework for three key opportunity areas. These included an opportunity to intentionally empower patients and staff through enhanced partnerships, to leverage or redesign a process aimed to cultivate trusting relations, and to adjust the clinic space to model great care.
The team’s work also revealed an interesting and pervasive dichotomy around the patient’s experience of care. Some providers’ interactions were perceived as more holistic and addressed multiple aspects of expecting mothers’ experiences. Exchanges with these providers were characterized as more personal and conversational, with attention to topics such as how their pregnancy was affecting their psychological health. Other providers’ interactions were more technical and physically-focused. These providers approached care encounters with a problem-solving perspective, such as, “What is wrong, and how can we fix it?”
Moreover, the team reported that provider body language played a large role in framing how an encounter was perceived. For example, some providers would inadvertently block the computer screen while reviewing the patient’s medical information, which caused some patients to feel anxious. Proposed countermeasures included letting the expectant mother listen to the ultrasound for a few minutes longer and maintaining more eye contact during evaluations.
“Design thinking requires creativity and often benefits from perspectives outside of the given field of interest,” shares Dr. Tuot. “Minerva students are smart, young problem-solvers and keen observers, who were able to bring a fresh set of eyes to the problem at hand. Additionally, their enthusiasm, hard work, and dedication to the project was key to helping the team complete the first phase of the project.”
This project was extremely valuable for Minerva, ZSFG, and the SFDPH Innovation Hub. Minerva students were connected with incredible professional mentors at ZSFG, introduced to numerous career fields within the healthcare sector, and were able to help address a large-scale, systemic challenge using their creative thinking and innovation techniques.
The SFDPH Innovation Hub was able to synthesize the student team’s findings and identify key opportunity areas in which ZSFG can focus for later ideation and prototype development. In the next phase of the collaboration, the SFDPH Innovation Hub and ZSFG will continue to improve patient and provider interactions by refining clinic processes to cultivate trusting relationships and whole-person care. Additionally, the SFDPH Innovation Hub was introduced to a remarkably talented and dynamic partner, and will seek future opportunities to collaborate.
“This project was an extremely valuable experience on so many levels. It pushed us to utilize design-thinking principles and methodologies in real-life, which made what we had learned in class relevant and understandable, and deepened our knowledge,” shares Chen. “Seeing how design thinking can be used to tackle issues in healthcare opened my eyes to how diverse the social impact field is, inspiring and challenging me to continuously search for new opportunities to learn.”