Transforming the Hospital Discharge Journey
Transforming the Hospital Discharge Journey
Role
Lead Product Designer (UX)
Timeframe
Q4 2017 (12 Weeks)
As a Lead Designer on athenahealth's inpatient clinical electronic heath records (EHR) product I worked to identify key areas of impact for both the business and our users. After working with the Hospital Documentation team it became clear that one of the greatest areas of the product we could impact was Hospital Discharge.
In this case study I will outline the process I took to build top-down buy-in and the work that went into better understanding and re-designing the inpatient discharge process.
User Impact
100% of patients admitted to the hospital are discharged via the inpatient discharge workflow.
Financial Impact
Contributes to over $10mm in Discharge Not Final Billed (DNFB) due to outstanding discharge tasks.
Building the Case
Building a strong case for prioritizing specific projects often requires more than qualitative data alone—this project was no exception.
We received frequent complaints about our discharge workflows, yet the process had remained largely unchanged and under-resourced since its initial development years ago. As a data-driven organization, Athenahealth prioritized user impact, but quantifying that impact was crucial to driving change. For this initiative, I identified and leveraged key metrics to demonstrate the importance of redesigning the discharge process and the potential ROI it could deliver.
Legal / Compliance
The discharge workflow is disjointed, clunky, and noncompliant - to the point of formal grievances.
The Team & Process Overview
As the Lead Designer I worked closely with the Hospital Documentation team (later known as the Hospital Discharge team) as well as two other strategic designers/researchers.
We used a rapid, iterative prototyping-feedback loop to identify must-have components and to define the overall framework for how those components would ultimately fit together. We prioritized modules that created external value in the short term and enabled us to learn how to increase that value over time.
Discovery.
Before the official project kickoff, I had already conducted extensive research but wanted to deepen our understanding by engaging with users and involving stakeholders who had not previously been part of the process. To achieve this, we organized a series of research sessions with customers, focusing primarily on two key user groups: nurses and doctors. These sessions were followed by multiple site visits across the country, allowing us to observe firsthand the pain points in the existing discharge process.
*Map of locations visited for in-person research.
"A patient could have a great experience at the hospital, and the last thing they remember is the delays in discharge.”
- Shift Nurse
"We just hope nobody gets discharged over the weekend, because Shirley doesn’t work on weekends.”
- Head of Nursing
*User research being conducted at a Detroit area surgical and rehabilitation hospital.
The initial research I conducted also enabled me to create artifacts that could be shared with stakeholders to clarify the inherent complexities of our current workflow. These artifacts not only facilitated better understanding but also supported a proposal for future improvements. Each proposed improvement was strategically aligned with two of the business's core OKRs for the year, ensuring the design recommendations directly contributed to key organizational goals.
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Synthesizing Findings.
After completing multiple rounds of research calls and site visits, we dedicated time to synthesizing our findings. It’s incredible how a few gator boards, sharpies, and hundreds of sticky notes can transform weeks of research into actionable insights! Through this synthesis process, we uncovered several key findings that shaped the direction of our work:
Finding the info I need is like searching for a needle in a haystack.
It’s unclear what happens to my data.
Discharge documents aren’t meaningful or useful to recipients.
I’m not sure what I need to do next.
Complexity isn’t the problem, coordination is!
Features don’t match the clinical mental model or complexity of needs.
*The "War Room" where all of our research synthesis and design concepts were created.
These key insights were distilled into three strategic themes, which served as the foundation for formulating a guiding design principle. This principle became the cornerstone for our concepts and ultimately shaped the direction of our designs.
Theme 1
Facilitate clear and efficient communication of care provided.
Theme 2
Improve date-of discharge efficiency by surfacing what needs to be finished.
Theme 3
Enable collaboration to ensure appropriate care continues beyond the stay.
Guiding Principle
"Create a place where the entire care team can coordinate & complete discharge work efficiently, starting when the patient is admitted and continuing until their care continues beyond the hospital."
Concept Generation & Validation.
After synthesizing our research down to key themes and formulating our guiding principle we were ready to start generating concepts to validate with our users. For this project we decided to conduct two phases of concept testing. Each concept would look to answer specific questions that could help guide us closer to our final design.
Phase One consisted of 3 different concepts with 5 different users.
Concept A - "Guided"
Key questions to answer:
-
What is the value of a more step-by-step workflow?
-
What is the value of a dedicated space to do discharge work?
Concept B - "Workspaces"
Key questions to answer:
-
What is the value of a more collaborative workflow?
-
What is the value of a dedicated space to do discharge work?
Concept C - "Consolidated"
Key questions to answer:
-
What is the value of an “all-in-one” screen/workspace?
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What is the value of embedding discharge work in existing areas of the product?
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What is the value of making a literal connection between input (documentation) and output (documents)
We used the initial three concepts to identify the most intuitive mental model for organizing discharge workflows, validate essential components and functionality, and determine which elements delivered the greatest perceived value to our users. These insights informed the development of the second round of concepts we tested.
Phase Two consisted of 2 different concepts with 5 different users.
Concept A - "Impactful"
Key questions to answer:
What works or doesn't work for inpatient?
What features are “must-have” vs “nice-to-have”?
What works or doesn't work for ED/surgery?
Concept B - "Visionary"
Key questions to answer:
-
What is the value of evolving each of the features?
-
How might it make sense to incorporate care planning in the future?
The second round of concepts enabled us to gain valuable insights into the features and flows that would become the new discharge experience and position Athenahealth's discharge process for future expansion into other areas of the hospital outside of the inpatient care setting.
In the end the design work done around Athenahealth's discharge experience had an impressive impact on our users. We were able to drive adoption, save time, and impact the bottom line of every single hospital on Athenahealth's network all while at the same time improving inpatient care and post discharge outcomes for tens of thousands of patients.
Measuring Success.
77%
Provide Patients with Discharge Education
Increase of 14%
(Pre-GA 63.2%
84%
Utilize Discharge Planning workflow
Increase of 44.4%
(Pre-GA 39.6%)
1 hr
Reduction in Time to Discharge
Out performed
OKR by 20%
In addition to the quantitative data that supported the impact this project had, our users loved it too!
"Amazing, Awesome, Super, Great! Love how easy it is to get to them and don’t have to add a new document every time!"
- Shift nurse
"Everyone is thrilled about it. All in one area, everyone can see what everyone is doing."
- IT Support Specialist
Final Directional Designs.
I delivered the Hospital Documentation team an initial set of designs for the entire discharge workflow, making it the first project to leverage Athenahealth's in-progress design system, Forge.
This reimagined experience introduced a scalable navigational framework that emphasized key aspects of inpatient discharge, ensuring compliance, optimizing patient care, and accommodating the diverse mental models of our users.
We introduced a dedicated planning section to the discharge process, a new concept prioritized on our roadmap. This workflow directly addressed one of the key research themes: facilitating clear and efficient communication of care.
A clear checklist of tasks required for patient discharge ensured compliance and minimized oversights. This feature improved day-of-discharge efficiency by highlighting outstanding actions.
Improved documentation simplified the process of generating key discharge documents at the end of a patient’s stay. These enhancements reduced hospital readmission rates and supported collaboration to ensure continuity of care.
