As part of the Waterloo Wellington Local Health Integration Network’s (WWLHIN) patient and family advisory committee (PFAC), I had the opportunity to define what patient values mean through a community co-design effort. Taking this initiative further, I imagined how one could understand their patient values from a digital standpoint. As part of my academic senior design project with my supervisor Dr. Paul Stolee,  I conceptualized a strategic vision that leveraged a patient-first approach in measuring the healthcare experience through continuous feedback. 

view updated values →
Problem diagnosis   

The inception of this project began when one of our committee members saw a poster about patient values while visiting the hospital and inquired about its source because it certainly wasn’t from a patient's perspective. 

Our whole group agreed that these sentiments didn't capture what was important to us as patients and caregivers. When we learned that the Patient Declaration of Values (PDV) is a legislated requirement under the Excellent care for all Act and is meant to ensure accountability and evaluation of a positive patient experience, our committee found it imperative to take on a redesign effort to define patient values by actual patients. We dedicated a sub-committee to manage this effort and set out to define the objective and scope.

Primary Objective:  To update the Waterloo Wellington LHIN Patient Declaration of Values by working with the PFACs of Waterloo Wellington LHIN hospitals and other health service providers to create an improved PDV that is shared across health service providers in the LHIN.  

The scope of our project was outlined as:

💊 Joint meetings of PFACs or PFAC representatives

💊 Engagement with identified health service providers

💊 Engagement with patients and caregivers.

💊 The development of a set of measurable values for an updated Patient Declaration of Values

💊 Public posting of an updated Patient Declaration of Values.

Although it was out of our sub-committees scope, I wanted to dedicate a part of my senior design project to explore how patient experience can be measured, recorded and inform accountability with the updated PDV.
charting the Journey  

The overall project workflow looked like this: 

PFAC Committee
Dr. Stolee (Academic supervisor)

6 months over the school year
My role

Committee member and independent research designer
Codesign appointment  

We acknowledged that engaging users about their healthcare experience required a safe space and strong facilitation that empower patients to co-design. Being patients and caregivers ourselves, we understood how valuable it is to share our own experiences and have time to  empathize with those that could relate. It frames the mental model in which we can begin assessing and strategizing areas of improvement. We brainstormed generative questions that would help our patients and caregivers articulate what matters to them using IDEO’s human-centered design thinking techniques. As part of the ‘inspiration’ phase, we wanted to capture our users' feelings, ambitions, motivations and interactions with Waterloo-Wellington healthcare services and how they would want it to change.  

Screenshot of the co-design event invite

The codesign event had 64 patients and caregivers from 20 different health service providers and organizations across Waterloo Wellington. I had the opportunity to lead facilitation with 7 people. Over dinner, we learned each other's names and a bit of our personal health care background and what motivated us to codesign in defining patient values.  This helped to break the ice and create a comforting atmosphere in which I led the facilitation to answer our three questions. After each question, we all spent five minutes silently writing down our own ideas and then sharing them with the group. Any new ideas were also added to our growing document and after no new ideas were shared, I asked to prioritize which three ideas our participants liked the best through dot voting.  

Top dot-voted answers to our facilitation questions

These dot-voted ideas helped to form the basis of the values that matter most to patients and caregivers. Based on what I heard from my group, I created representative user personas.
Assessing it all together  

After the main codesign event, my subcommittee began to look at all the dot-voted ideas and started to cluster them into themes.  Through affinity mapping, we started to understand and capture high-level values patients and caregivers expected from their healthcare experience.  Working with our communication and content designers, we started to draft phrases that articulated patient values. We also scanned declaration of values from other health regions and assessed visual features that worked and didn't work when presenting patient values.  

Scanning other jurisdictions’ patient value charters

Our main aims were to keep the values succinct, easy to understand and informed by health experiences. We sent out our first draft of the PDV to our users to solicit further feedback through a survey. 

Draft patient values sent for user feedback via survey

Using our users’ feedback we went through follow-up iterations and worked with a visual designer to finish our final draft. Resulting from this process I was able to start a design sprint on measuring the success of patient values in WWLHIN mandated settings.
Deliverable diagnosis  

Through the new PDV rollout, I learned that all major hospitals in the WWLHIN will be adopting our PDV. I wanted to focus on these high-traffic patients settings and understand what opportunities exist that could be used to gauge how well patient values are being incorporated in the healthcare experience.  Using testimonies from the PDV codesign forum, I was able to capture the journey of a patient’s hospital visit.  

Click to see patient journey
From this patient journey, I noted that there were opportunities to ask patients and caregivers to reflect on their healthcare experience using patient values as baseline metrics. I started to brainstorm how patient values could be transformed into quantitative metrics through a simple digital experience. I conducted a generative interview with 5 patients and caregivers on their thoughts on giving feedback on their healthcare experience. In the interviews, I presented a scenario to the users where a patient waiting for their hospital visit saw the following poster:

Finished patient value poster with feedback mockup
I asked users what they made of the poster messaging and what they would do next. Users expressed that they would want to go to the feedback link and read about the patient values and what other users have said. After completing their healthcare visit they would go back to the feedback site and provide input as long as they remember.
The main takeaways that I used to create a PDV feedback mechanism were: 

📌 Understand the patient values and comment whether those values were present in their care experience

📌 Wanting to see what other users have expressed for transparency and accountability to the hospitals

📌 Understand the patient values and comment whether those values were present in their care experience

I worked to create a low-fidelity experience of the online feedback site, deliberating mainly on the user flow and content design. I started with a mobile-first design and brainstormed multiple IA pathways that would engage users and generate a high response rate. 

Sketches of potential feedback pathways and photo of participant testing user flow

In my first round of test with 4 users, I got the following feedback to inform my iterations

“I’m not sure if I would know if there was a continuous improvement to my health care unless I was asked a specific question about it”

📍Main takeaway: Rather than asking if the presence of the patient value existed directly, contextualize the value in a health experience that patients can relate to and frame it as a question.

“Great! But what will they do with this feedback and how will I know?"

📍Main takeaway: Patients want to know that their feedback is being acted on rather than being dismissed. Having a way to see the hospital's response to feedback could address this. 

“I would want to see which values are positive and negative for hospitals”

📍Main takeaway: Users were interested in seeing an averaged view of patient values for hospital settings to see what hospitals did well  what still needed to be improved.      
I iterated the user flow before committing to the high-fidelity version. I formed a design guide and complementary graphics that matched the WWLHIN visual language. 
Through another round of testing with 4 more users, I was able to test the end-to-end experience of the user reading the PDV poster,  submitting patient feedback and seeing other users’ ratings. I was also able to use user feedback to update the PDV site which includes email signup for patients interested in participating in PFAC activities. 

An additional consideration that I had was users who lacked digital access but wanted to give feedback. Through environmental scans and secondary research, I ideated and prototyped what an iPad feedback mechanism could look like stationed in hospital settings. 

Users can quickly submit their feedback, see additional details and automatically reset for the next user.
Prescribing a better experience  

Through this unique experience with the WWLHIN PFAC I was able to use my perspective as a patient to inform my role as a designer. Participating in collaborative co-design with other patients and caregivers to create a patient-centric value framework helped me recognize the diverse needs of those navigating and operating in the healthcare space. I also witnessed the importance of continuous participatory involvement from users to evaluate iterations and inform what still needs to be done. Developing a PDV was the first step and designing a feedback mechanism was a natural response. Moving forward as a member of the PFAC and as a designer, I want to collaborate on implementing this patient value feedback mechanism and test with more diverse user groups. Due to my project timeline, I was limited in scope with all that I wanted to accomplish but I’m incredibly thankful for my academic supports and the WWLHIN community in letting me shape patient values for the future.