A hospital was set to expand,
yet distrust was high in the community
Leveraging mixed method research for rapid insights into missed opportunities
Healthcare / service design
5 WEEKS, 70 HOURS
Interviews
Planning
Exploratory
Secondary
Data Storytelling
CEDAR AVENUE HOSPITAL, SOUTHWEST PHILADELPHIA, OCT - DEC 2022
Gaining a Foothold
Building from stakeholder and secondary knowledge
Our first step was to learn as much as possible about:
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Business goals, needs, constraints
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Current state - what was already attempted and results
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Contextual knowledge - have others experienced this? any possible solutions?
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Users - examining possible targets for research and understanding the community
To carry this out, I personally took action on:
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Secondary research - two rounds (pre and post stakeholder interviews), historical and white paper research
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Stakeholder kickoff meeting - Penn Medicine, PHMC provided knowledge, answered prepared questions
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Stakeholder interviews - I wrote scripts and facilitated interviews with experts from PHMC and Penn Medicine
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Initial Field Study - Toured hospital and community
1
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Finding Answers
Mapping objectives & interviewing users
With firm foundational knowledge, we set out to:
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Prioritize objectives based on impact and feasibility
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Define values and methods for each objective
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Evaluate target users vs participants
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Find and recruit participants
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Ask the right questions
To carry this out, I personally took action on:
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Affinity Mapping Objectives - utilizing gained knowledge to pinpoint areas of impact
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Research Planning - defined methods and value for each objective, set timelines
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Screener Surveys - quick survey that focused on value, user alignment
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Recruitment Strategy - originally focused on patients, hit a snag and instead I canvased the neighborhood
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User Interviews - I wrote scripts and facilitated interviews with former and current patients in the community
Can you walk me through that last time you were at the hospital?
Can you tell me about your most recent experience with the hospital?
“The last time I was there it seemed pretty rundown and disorganized, but that was before COVID. Last I heard it was closing down.”
2
/ 4
Originally, we had planned to gain access to patients through Cedar Avenue Hospital, however, management became concerned about HIPAA protections. Crunched for time we hit the streets of the Southwest Philadelphia neighborhood, canvasing the residential areas, parks, and business surrounding the hospital at different times of day. We spoke to over 40 community members and had formal, 30-45 minute interview sessions with 12. By drilling deep on their experiences, we captured patterns in perspectives, needs, behaviors, and values.
Methods Chosen:
User Interviews with recent patients and community members
Why?
Understand distrust, perspective, recent experiences, behavioral clues, goals, obstacles.
Surveys with community members (3 block radius)
Why?
Understand how big and varied the mistrust is, understand valuation for brands past and present.
Field Study of hospital, in-patient, ER, outside, nearby blocks
Why?
Understand the hospital and its physical relationship to the surrounding community.
Secondary (desk) research of related issues with trust, healthcare business changing hands, etc.
Why?
Learn from already completed, better funded, larger sample research that relates to the problem.
What's Going on Here?
Analysis & synthesis on the path to insight
With firm foundational knowledge for the context, business, and users, we set out to:
Synthesis artifacts, pieced together from data, tap into the core of human understanding- narrative. That narrative helps the entire team make sense of what was uncovered.
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Find clusters and outliers that spoke to patterns of relationships
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Identify unique user segments
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Identify key stages in user journeys
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Compiling insights, evidence, artifacts
To carry this out, I personally took action on:
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Analyzed data for patterns - going over notes, debriefs, recordings, and stats to spot clusters, outliers
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Building data-based personas - patterns of users and their behaviors, needs, goals, and pain points
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Mapping user journeys - what are user groups going through? how does that tie-back to our objectives?
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Highlighting insightful data - Creating visualizations that focus on important takeaways
Quick feedback from a key stakeholder helped us realize that the quotes were creating the most impact for their directness and authenticity, while created personas were a distraction. We tweaked our personas into user profiles, leveraging the impact of real community members that fit the patterns of user groups uncovered.
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/ 4
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Newer resident (past 3 years)
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20 - 30 age bracket
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Regularly walks through neighborhood to her job
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Goes to another hospital further away
Insight to Impact
Transferring deep understanding to stakeholders through narrative
Understanding our uncovered insight was as only as good as how we presented it, we:
To carry this out, I personally took action on:
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Used narrative structures like arcs, timing, and repetition to make the data more meaningful and easier to understand
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Leveraged 'characters' throughout the story that reflected the groups of users we met and challenges they faced
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Combined numbers with quotes, stories, and simple visualizations
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Relayed the urgency of why making changes was so important
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Delivering Presentation - leveraging data storytelling and delivering with the dedication our users deserved
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Revealing Insights - utilizing contextual surveys, cards sorts, interviews, revealed the bigger issues and why
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Connecting Stakeholders - to the knowledge and empathy gained, took questions and feedback
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Map Next Steps - Mapped out possible actions that could be taken to address insights
Insights revealed:
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Building doesn't speak the current state - Poor signage, closed gates, same look and identity
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Outreach is the right idea, comes up short - Outreach is proven to build trust, more resources, channels needed
Questions that warrant a closer look:
?
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Staff - Most are employees from old hospital, lots of change, how are they coping, do they feel like it's a different place?
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Customer Feedback - Current systems yield poor returns, may fail to capture problems and allow for adaptation
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/ 4
Every person that understood the new brands and services in the works for the hospital, were positive and hopeful. Unfortunately...
If the hospital fails to even communicate that it's open and under new ownership, how could it communicate something more subtle, like new services? How will it attract customers?
90% of the community is unaware or misinformed about the hospital's ownership & services.
90% travel further to other hospitals, urgent care, or avoid care altogether.
The result is a loss of revenue for the hospital and a lowered network of customers as the hospital sets to expand to new services (ie, primary care).
Tracking ROI
Charting goals and measuring investment to impact
Core Issues Uncovered:
90% of community unaware or misinformed about the hospital's ownership and services.
90% travel further to other hospitals, outpatient centers, urgent care or avoid care.
Both result in revenue lost for hospital, lowers hospitals network of customers as they set to expand to new services (ie, primary care)
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Outdated visual signals (signage, architecture, sculpture) reinforce prior branding or closure.
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Ineffective community outreach, under-resourced staff, and limited channels of communication.
Benchmarks:
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Percentage of community members that correctly identify hospital status, new brands, services (currently 10%)
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Disparity between key demographics of community members that can correctly identify current state of hospital
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Event attendance, social media reach, newsletter open rates.
Investment:
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Signage and architectural communications - $1.4 million (one time investment)
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Additional community outreach staff and materials to cover events, social media, networking - $200,000 (+ $100,000 year 2)
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Research services to measure benchmarks through recruitment, surveys, interviews - $50000 (+50,000 year 2)
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Increased patient volume by 5% → increase in revenue (projected $1.3 million)
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Increase in patient referrals to new services by 8% → increase in revenue (projected estimate $300,000)
ROI
Outcomes
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PHMC and Penn Medicine validated $1.4 million investments into signage and architecture that communicated a future of the highest quality brands, range of care, and new identity- a hospital not just open, but bringing a new future.
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Cedar Avenue validated the value-to-investment in outreach, including additional staff, increased presence at block meetings, regular presence at community events, and further developed connection through social media.
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Patient feedback through mail-in surveys warranted additional research, as these methods have a high failure rate.
1 Year
$1,600,000 - $1,650,000
$1,650,000
)
x100 = 3.03%
(
ROI =
near breakeven on initial investment,
after 2 years, for every $1 spent, a return of $1.80
2 Years
$2,320,000 - $1,850,000
$1,850,000
)
x100 = 79.5%
(
ROI =
Goals:
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Increase correct awareness of hospital status from 10% → 51% in 12 months
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Identify and reduce disparity in awareness between the highest and lowest-informed key demographics by 30%, 12 months
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Increase event engagement (attendance per event, new attendees, demographics, intakes/leads)
Reflection
What I loved about this project was the way I was able to connect with both the business and the people in the community. By leveraging desk research, stakeholder interviews, and user interviews I was able to capture a picture of each of the perspectives. With this understanding I was able to gain insight into the disconnect in the community and how that could impact business goals. The people that I worked with from PHMC, Penn Medicine, and the community of Southwest Philadelphia were amazing and I loved the sense of purpose.
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The level of passion and intrinsic motivation I feel in working with users in a high impact space like healthcare made this one of the most rewarding experiences in my life.
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The team I worked with was amazing, each of us bringing something to the table, coming together and supporting each other in the moments we needed it most.
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The absolute highlights for me, were writing scripts, interviewing, and presenting the narrative of the data. This just seems to be an uncanny strength for me.
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I'm still (and forever) learning. Between the unique skills from teammates and the avenues of research vs constraints, I know I would not do this project the same way again. I learned a lot about making the most of data visualizations and continuing to dig deeper at root causes, values, and differences.
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If I could ask one more question, I would love to gain more perspective from the employees. The hard thing about a short time frame is you sometimes have to cut things out or save them for later, and that was the case here.
Quantitative gives us the "what" and "how big"- a target that hones in on a problem. Interacting with users and digging into their lived experience lets us understand the "why"- the behaviors, goals, and values that build strategic solutions.
Outcomes
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PHMC and Penn Medicine validated $1.4 million investments into signage and architecture that communicated a future of the highest quality brands, range of care, and new identity- a hospital not just open, but bringing a new future.
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Cedar Avenue validated the value-to-investment in outreach, including additional staff, increased presence at block meetings, regular presence at community events, and further developed connection through social media.
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Patient feedback through mail-in surveys warranted additional research, with failure rates over 70%.
Urban community hospitals have been closing down...
Urban community hospitals have been closing down, leaving large gaps in essential care for whole neighborhoods. The same was true for Mercy Hospital in Southwest Philadelphia until an unprecedented partnership between Independence Blue Cross, Penn Medicine, PHMC, and Children's Hospital of Pennsylvania stepped in to save it.
The new ownership prided themselves on never allowing the emergency room to close but, with plans for expansion already in the works, the hospital faced a legacy of mistrust by the very people they served.
For this project, I worked on a team of five. My responsibilities including organizing stakeholder interviews, performing secondary research, planning research objectives, writing interview scripts, facilitating user and stakeholder interviews, analyzing research, crafting synthesis artifacts (user profiles, journey maps), and leveraging data storytelling to create impact among stakeholders.
Research Process:
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Gaining a Foothold - Building from stakeholder & secondary knowledge ......
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Finding Answers - Mapping objectives & interviewing users ..........................
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Looking for Patterns - Analysis & synthesis on the path to insight .................
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Insight to Impact - Transferring knowledge to stakeholders with storytelling ..
Index