Navigating the Complexity of Cancer Diagnosis

Peter Jones Co-Creation, Design for Care, Systemic Design

A team from OCAD University’s Health Design Studio [1] designed a series of synthesis maps for the Canadian Partnership Against Cancer, for a project to proposes systemic responses to the clinical and social complexity of cancer pre-diagnosis in Canadian care provision. In the two synthesis maps presented here, we represented clinical diagnostic processes and the patient experiences associated with navigating the complexity of cancer diagnosis for three cancer sites, across three (representing 6) geographical regions. The maps were constructed in an iterative design and research process by the HDS as part of a larger CPAC collaboration to identify evidence-based opportunities for system-level change in cancer diagnosis to improve patient experience and clinical practices. The maps present an integration of current knowledge from clinical practice and patient experiences drawn directly from interviews and workshops with patient advisors, primary care physicians and cancer specialists. Two Maps Tell the Story The clinical process map, A Clinical System Perspective of Pan-Canadian Cancer Diagnosis, represents the complex steps of current pre-diagnosis practices for patients living within three geographic regions. Three cancer sites were chosen to …

Synthesis Maps from CanIMPACT | Mapping the Clinical Cancer System

Peter Jones Design for Care, Service Design, Systemic Design

The CanIMPACT project (Canadian Team to Improve Community-Based Cancer Care Along the Continuum) is a multidisciplinary pan-Canadian program studying how to improve cancer care to patients in the primary care setting. Funded by the Canadian Institutes of Health Research for 5 years (2013–2018, Grant no. 128272) the project was led by Dr. Eva Grunfeld, Director of Research at U Toronto’s Dept of Family and Community Medicine.  For the CanIMPACT synthesis map project, our sLab team (Jones, Smriti Shakdher, Prateeksha Singh).  Two synthesis maps were prepared to reflect the discovered insights from the multi-year investigation, a clinical system map and a patient-centred map informed by the CanIMPACT Patient Advisory Council. The resulting maps were published (a first for a system map method) in Current Oncology and presented at the first Canadian Partnership Against Cancer (CPAC) conference, and MedicineX 2017. Jones, P.H., Shakdher, S. & Singh, P. (2017). Synthesis maps: Visual knowledge translation for the CanIMPACT clinical system and patient cancer journeys. Current Oncology, 24 (2), 129-134. Synthesis mapping produces high-quality representations of insights drawn from research evidence, It presents visual models …

Soft Service Design: Interventions in Complex Social Determinants

Peter Jones Design for Care, Service Design, Social Systems Design

Design for Health (2017) Design for Health – Published by Routledge May 2017,   Edited by Emmanuel Tsekleves and Rachel Cooper (Editorial overview of book and chapters) Chapter 3:  Soft Service Design around the Envelope of Healthcare (Peter Jones) Better alternatives to improving population health have been sought by healthcare policymakers and the front-line clinicians who see patients in everyday care settings. While public health experts and primary care clinicians recognize the significant effects on health from social determinant factors they have limited tools for addressing these causal factors in their patient’s lives. Systemic improvements to a population’s social ecology are considerable challenges from within the “envelope” of a healthcare system. The service design challenge I propose and aim to answer is that of, can we better intervene outside of and around the envelope of the healthcare system? In mental health and primary care contexts, we find that systemic factors and social determinants (such as environment, housing, social lifestyle, food accessibility) account for a significant proportion of presented conditions that are treated as mental illness. The primary care and mental health systems are …

Participation in Healthcare Systems: Patients aren’t Customers

Peter Jones Design for Care, Service Design

My favorite healthcare blog KevinMD posts every so often with an eloquent heartfelt piece on the problem of patients as customers. In This is Why Patients Cannot be Customers Dr. Tanya Feke points out that: A study in the British Journal of General Practice showed how patient satisfaction surveys can be skewed. More than 980,000 patients were surveyed across 7,800 practices. Doctors who prescribed more antibiotics were perceived more favorably than family doctors who doled out fewer antibiotics. When you consider U.K.’s National Institute for Health and Care Excellence estimates more than 10 million antibiotic prescriptions are inappropriately prescribed every year (antibiotics do not treat colds and other viral infections), there is a serious disconnect. We continue to borrow from inappropriate language constructs to make arguments about desired outcomes without thinking through the anticipatory ancillary effects. If we propose that patients are persons, as Tanya does, that’s a start. Individuals have unique needs and when we treat them as patients, we are authorized to treat them within the context of an institutional role.  However, patients are not customers, and if …