Radiology, Service Design, Servicescapes, and Scenography: The Workflow of Patient and Family-Centered Care

I’m delighted to see @Jim_Rawson_MD on the Healthcare Leadership tweetchat this week, having met him this spring at the Healthcare Systems Process Improvement Conference. He tweeted something very nice about me, which I cannot resist embedding here! :)

I reviewed materials supplied by @Colin_Hung at the end of his blog post Radiology + Patient & Family-Centered Care and I was struck by the relevance of, guess what … wait for it… workflow! No, really, let me make my case.
Take, for example, In the Patient’s Shoes. Radiologists Question and Evolve the Patient Experience With Input Straight From the Source.

I could quote at length, about waiting rooms, waiting for results, complete patient experience from appointment to followup, turnaround times, and especially “Rawson helped adjust the department’s entire workflow.” But you get the idea.

In fact, other aspects described, such as wall colors, anxiety, calm, and recovery rooms are also about workflow, if you think of workflow in terms of my personal and favorite definition:

  • “A series of activities, consuming resources and achieving goals.”

Sometimes I talk about tasks or steps instead of activities, but activities works best here, because we more naturally think of patients as involved in activities than tasks or steps. Consuming resources, that’s costs, including, perhaps especially, costs to the patient, from financial to physical to mental and emotional. Goals, those are self-evidently patient goals, from a patient-centered perspective.

However, I wish to discuss workflow from a slightly different perspective, from that of the fascinating disciplines of service design, servicescapes, and scenography.

  • Service design is a form of conceptual design which involves the activity of planning and organizing people, infrastructure, communication and material components of a service in order to improve its quality and the interaction between service provider and customers”
  • A servicescape is “the environment in which the service is assembled and in which the seller and customer interact, combined with tangible commodities that facilitate performance or communication of the service”
  • Scenography is the seamless synthesis of space, text, research, art, actors, directors and spectators that contributes to an original creation.” (Also see Scenography: A Ritz-Carlton Secret For Creating A Magical Customer Experience)

All and any of these three Ss (alliteratively reminding us of “Service”) are relevant to Patient and Family-Centered Radiology. A major contributor to imaging patient experience is their visit to the radiology department or imaging center and their interaction with staff there.

But here is the thing. If you read about service design, servicescapes, and scenography, you’ll see workflow ideas popping up over and over!

Let’s start with service design. You’ll see the phrases, “sequences of actions and actors’ roles”, “temporal sequences” and “time sequences” in a service encounter over and over. One of the roles of service design professional is to literally, visually, draw out current and alternative workflows. One of the important tools of service design is “specification and construction of processes.” AKA workflows. Then there is the “service blueprint”: “to map the sequence of events in a service and its essential functions in an objective and explicit manner.” AKA workflow diagrams and process maps. Now consider “service drivers”: functions make work “fluent” and clarity requires each step to be assigned a simple understandable role. The “customer journey” is often literally drawn as a workflow diagram or process map.

How about servicecapes? One of its most important ideas it to essentially use the physical environment to direct sequences of activities of staff and customers. This can range from painting arrows on walls and floors to much more subtle clues, such as using aesthetic signals (people tend to move toward more attractive locations than less attractive locations). The physical environment can be literally used as a workflow engine to propel and funnel human activity.

Scenography (applied to non-theatrical venues) is about using the theater arts to turn service environments into “stages” on which “actors” “play” “roles.” Used mostly in the hotel industry, it’s about making you a star in your favorite movie (Bogart and Becall in the hotel in Key Largo, Sponge Bob in your undersea neighborhood). Just like in servicescape, props are not random, we expect them to be used — that fancy pen on the desk expects to be used, and that computer kiosk expects to be used. And the order of use is a workflow just as a play’s script has stage directions that turn into three-dimensional tableaus facing an audience.

Practically speaking, what does all this mean? Folks who understand the above ideas need to meet and observe and understand the patient. And one person who is a natural, who deals with workflows all the time is what used to be called the hospital “management engineer.” In the old days these were trained as industrial engineers (my MSIE). Today they sometimes called health systems engineers, though increasingly many non-industrial engineering professionals think in terms of workflows.

I could stop here. We need people trying to improve radiology patient and family imaging experience to think in terms of “workflow.”

But I won’t stop here. Just as data without date technology is foolish, workflow without workflow technology is foolish. In fact, radiologists were early adopters of workflow technology. They use it to collect images, to customize imaging workflow, to intelligently distribute images to remote viewers for reading and so on. In fact, the speech (and increasingly, natural language) technology radiologists use to transcribe and create value from transcriptions also has some of the most sophisticated workflow technology in the heath IT industry.

Radiologists need to use their knowledge of workflow technology to include patients in the workflows they design, manage, and participate it.

So, to summarize this post I say this: Look at radiology patient and family imaging experience not just through the lens of physician, staff, and patient workflow, in all its senses, including physical environments. Also think about how to use workflow technology in build workflows that include patients, systematically collect data, and continually improve patient and family imaging experience.

I am looking forward to tonight’s #HCLDR twitter chat!

P.S. I encourage you to read all of @Colin_Hung’s Healthcare Leadership tweetchat tee-up blog post Radiology + Patient & Family-Centered Care including @Jim_Rawson_MD’s content and questions.

@wareFLO On Periscope!


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