Design Care Delivery Transformation

Congratulations! Your team is ready to design the care delivery transformation. That is a big accomplishment. Before you get started, take a moment to reflect on how much your team has accomplished:

• Creating a culture of equity
• Identifying a health equity focus
• Diagnosing root causes
• Prioritizing root causes

There are multiple moving parts in the care delivery transformation design process. The Recommendations for Designing Equity-Focused Care Delivery Transformations document will take you through the process step-by-step. In part, it explains how simple and logical questions can become quite complex and nuanced when answered using the detailed and rich data gathered from your root cause analysis. It provides detailed guidance for how to break down those complex questions into smaller ones that are easier to answer, as well as best practices and common errors to avoid. The following information describes important aspects of design process to consider as you plan.

Think Sequentially

It is likely that your intervention design will take some unexpected twists and turns along the way. This is normal. The decisions made during the design process will raise new questions, perspectives, and challenges. One way to stay on track when encountering an unforeseen challenge is to have a strong plan that articulates the ideal path the intervention will follow. Think of it like an outline for a paper. Like an outline, you can start by asking several key questions:

• How will the care transformation be tailored to specifically address the needs of your priority population(s)?  (Your root cause analysis will help you answer this question.)
• How will the care transformation address the prioritized root causes identified during the root cause analysis?  (If you completed a priority matrix now is the time to use it as a guide.)
• At what levels of the health system will the care transformations occur? (Examples of healthcare system levels include patients, healthcare providers and care teams, organizations [e.g., health plans, municipal or governmental agencies, community-based social service organizations], community, and regulatory/policy.)

These questions are a springboard to help you in the design process and help lay the foundation for a successful intervention. The image below illustrates the various level of the health system.

Now is an ideal time to review the Essential Elements of the Roadmap, including Anticipating Data Challenges, Obtaining and Maintaining Stakeholder Buy-in, and Partnering with Patients and Community Organizations. Use the information and insights provided therein to improve the process of designing your care transformation.

Make Room for Multiple Voices

Take a moment to list all of the possible individuals who will be involved in the care transformation, including members of the priority population. Once you’ve created your list of stakeholders, take a look at it again. Think about people who may have a role to play but are less obvious choices such as:

• The call center, intake, or front desk staff who often are the first care team members patients encounter
• Pharmacy staff and technicians who play an important role in patient education and health promotion
• Nurses, community health workers, social workers, or patient navigators
• Health plan teams such as the Diversity, Equity, and Inclusion (DEI) team, benefits coordination, or utilization management
• Governmental or regulatory agencies that could play a role in long-term changes to the healthcare system that will support and enhance the care delivery transformation, such as legislative or contract-based requirements.

Finally, consider whether there are community-based organizations that serve your priority population. They might have key information to inform the design of your care transformation.

When you’ve finished your list of stakeholders, lay out a plan for how you’ll get their input. Perhaps you’ll create town hall events, or work with your human resources or Diversity, Equity, and Inclusion teams to create an anonymous survey or poll. It will be important to keep stakeholders informed over time and to go back to them with progress updates and requests for additional feedback regarding decisions you’ve made. Even better, partner with them throughout the entire design process, from beginning to end.

Identify the Changes That Are Necessary for Success

Now that you have a process for collecting stakeholder feedback, ask them to identify potential barriers that might hamper the initiative’s success. Is there anything your stakeholders can spot that is missing in your initial plans for transforming care? It’s not just stakeholders who can help you identify blind spots and barriers. Considering making space to create ongoing moments of engagement for: individuals living with the health inequities you are trying to address; staff members of all partnering organizations; and community members. You might also consider implementing patient care process maps to help the team plan the care transformation and anticipate roadblocks.

A process map is a flowchart that illustrates how patients proceed through the care system from the broadest (macro) to the smallest (micro) perspective. It also details the front-line and behind-the-scenes patient care and processes that the care team utilizes from beginning to end. A process map can help the care intervention team identify where there is opportunity to improve care delivery. It’s concerned less with job titles and hierarchy than the work that needs to be completed or improved. Your team could also create a logic model whereby they imagine the causes and effects that would lead to a certain outcome. Think of a logic model like a visual “if-then” chart that illustrates to the team the relationships among resources, activities, outputs, and outcomes as well as the places where transformation may be possible.

There are many ways to create a process map or logic model. Talk with your team to determine whether different maps or models are needed for each team function or if one can adequately serve all departments, teams, and staff members at each partner organization that will be involved in the care transformation.

Think About Leverage and Consider Roadblocks

Consider whether there are existing patient care pathways or programs that can be leveraged by utilizing or transforming them in some way for the desired care transformation as well as what work would need to be done to tailor it to your intervention. Also, consider how and in what ways your proposed care transformation may conflict with existing care processes and how to adjust the new or existing processes to remove the conflict. Taking time to anticipate and plan for conflicting programs will help your team’s intervention succeed.