Supporting shared decision-making in healthcare with service design
Having a say in your treatment, if you want to, is important if you are a patient. In practice, this often turns out to be quite difficult. For patients and for their significant others and care providers. Sometimes patients and their significant others feel disempowered as the disease progresses. Some find it difficult that they have to deal with so many healthcare providers in their care path. There is a lot of complex information that needs to be obtained and understood quickly. Healthcare professionals find it difficult to find out how to best engage patients in the decisions, taking in consideration all of these different patients. With Metro Mapping, we aim to make it less complex together.
What is Metro Mapping
Metro Mapping is a service design method developed to support shared decision-making in oncology. It literally maps the complexity of a medical care path and shows how shared decision-making is influenced by the interplay of an overview of the care path and its decision-making moments, and a better overview and understanding of the care path (including the unpredictability), the information provision, a clear role- and tasks division and collaboration between the parties involved, and the environment in which the care takes place. The map is the starting point for improving the care path together and ultimately for creating and mapping out a route that best suits each patient.
Metro Mapping is based on scientific research and is currently being developed and tested in three academic hospitals.
In the video below, Ingeborg explains in 15 minutes what service design is, what research was conducted in hospitals that led to the Metro Mapping methodology and how a Metro Map is constructed.
What is Service Design
Service design is a field within design in which not one product but complete services are developed (or existing services are improved). Service designers work in the design process together with customers and the service provider. They use design methods to develop solutions for everything that is involved in service provision: the contacts between customers and service provider, the process and also all kinds of information and products that are used in the service provision. Service design is used to develop a user-friendly and consistent service that contributes to a predetermined goal.
Metro Mapping is a service design method with which care paths are (re)designed. A care path is the service that arises between a care organization and patients. Metro Mapping is being developed to support shared decision-making in a care path.
Metro Mapping contains a plan of action with which service designers, who already have experience in the healthcare sector, can (re)design a care path together with care providers and patients or their representatives. The action plan clarifies, on the basis of four layers, which subjects are important to be reviewed in a service design process. With questions, examples and practical tools, a preparatory phase is first completed. Then iteratively and simultaneously a multidisciplinary team works on the four layers and tests the results.
The methodology is currently being developed and tested in three academic hospitals. If it proves workable, the framework and roadmap will appear on this website. Keep an eye on the blog for updates or subscribe to the newsletter to receive the blog messages automatically in your mailbox.
The four layers
Providing overview of treatment pathway, choices and decision moments
1. Metro line
In the first layer of Metro Mapping, all steps of the care pathway that are important to the patient are mapped. Each phase in the diagnosis and treatment pathway is represented as a metro line. The transition moments from one metro line (e.g. the diagnosis process) to another (e.g. chemotherapy or radiotherapy) become clear, as well as the many choice moments that precede them. This way, it becomes clear which choices there are, what they depend on (for example, the result of a scan or a patient's preference) and the many moments a patient has contact with healthcare providers, for example, at a scan, a blood measurement, the discussion of a result or the outcome of a multidisciplinary consultation of professionals. This chart can also be used to discuss with the patient whether a break in the care path is medically justified and if so, when. Or the available transfer options.
Providing information to the patient and significant other at the right time
Providing insight into who (and in what role) travels with the patient in treatment
Taking account of the care environment at home and in the hospital and devices
The study is based on the experiences of patients, their families, various healthcare professionals, and the experience of Ingeborg Griffioen (see also at 'About us), researcher and partner of a patient with pancreatic cancer.
The study showed that during the diagnosis and treatment process in oncology patients and their significant others experience the following:
- Shared decision-making involves not just one moment in the consulting room, but a series of many small and/or complex decisions, some of which occur expectedly and some unexpectedly. Greater understanding and overview of the diagnosis and treatment process and its potential consequences can help with shared decision making.
- They often search for more and other information.
- The roles, tasks and/or responsibilities of all healthcare professionals involved were not always entirely clear to patients nor what their own tasks entail.
- The environment in which care takes place is not always suitable, and dealing with medical devices, such as pumps, or with medications is also sometimes quite complex.
One of the results of Metro Mapping will be an overview of the different treatment routes for the treatment of a cancer and for each treatment route a detailed mapping with four completed layers. For the Info, Companions and Context layers, accompanying detailed maps have also been developed. These mappings help service designers, care providers, quality assurance staff and patients or their representatives to improve the care pathways together.
It also (literally) maps out the potential for customization and room for adaptability in an individual patient's treatment, or co-production phase. This will allow healthcare providers to work with the patient and loved one to conceive, outline and plan the route that meets their individual capabilities and wishes. In addition to this overview, a series of interventions will be developed and tested. These interventions can be used in practice to support the patient, loved one and caregiver in this co-production.
Metro Mapping was developed as part of a PhD research project by Ingeborg Griffioen conducted at the TU Delft and the LUMC. Partners in the study are the Erasmus MC, the Radboudumc, Living with Hope, the Patients' Association Head Neck and Panton, designers for healthcare. The development of Metro Mapping is made possible with support from the VVCZ and KWF Kankerbestrijding.
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Metro Mapping is currently being developed and evaluated at three academic hospitals.