How to Deliver Patient-Centric Healthcare Solutions
Cardiac rehabilitation programs are typically underutilized and inefficient, calling for a more comprehensive, integrated approach.
Janssen Healthcare Innovation won the Most Valuable HCP Initiative with their Care4Today® Heart Health Solutions program at the eyeforpharma Barcelona Awards. The issue they tackled is hugely important; coronary heart disease places one of the biggest burdens on UK healthcare, creating huge human and financial costs. It is, in fact, the leading cause of mortality, as the cause for around 180,000 deaths annually and it is also estimated to cost the economy around £30 Billion each year.
Although cardiac rehabilitation has well-documented benefits in reducing secondary events and unplanned re-admissions, it is still underutilized as a service with less than 50% of patients starting a cardiac rehabilitation program, and is typically inefficiently delivered. A critical success factor in rehabilitation is for care to begin immediately after the event. However, poor patient management through the healthcare system means that the average program participant has to wait 56 days before commencing cardiac rehabilitation. Moreover, more than half of patients who need this service fail to complete a rehabilitation program.
JHI collaborated with Buckinghamshire Healthcare NHS Trust (BHT) to design a program - Care4Today® Heart Health Solutions - to tackle the systemic causes of these outcomes, which has shown promising results from the pilot phase. Nayan Kalnad, Commercial Lead at JHI and Mirren Mandalia, UK Lead Heart Health Solutions agreed to sit down with us for a Q&A that reveals the key design considerations for innovative healthcare services.
eyeforpharma: Thank you both for joining us, can you talk us through the inspiration for this program?
Nayan: We wanted to research possibilities within secondary or tertiary prevention in cardiology and initially looked into intensive cardiac rehabilitation. Instead, we discovered a shortfall in many countries in cardiac rehabilitation that fitted the profile for a solution that we believed we would be able to scale internationally.
eyeforpharma: How did you select your project partner for the pilot?
Nayan: We assessed a lot of partner sites before we settled on BHT. They were running a pretty good program, but they still wanted to improve and we were lucky to connect with one of their cardiologists, Dr Piers Clifford, who was extremely driven and had collected some of the most comprehensive data on rehabilitation in the country. We started speaking in December 2012 and then in March 2013 we started collaborating on the pilot.
eyeforpharma: How did you refine the role of your partner and communicate your expectations?
Mirren: We expected our partner to provide a strong clinical lead and also a project manager who would be able to make sure we engaged with all relevant internal stakeholders, as well as coordinating the hospital’s deliverables. This project manager role was critical; it helped ensure that we addressed their concerns and stayed relevant to their needs. The hospital remained in complete control of clinical care and delivery of expertise.
Continuous communication was really important, and we put in place several procedures to ensure this. We would have regular 30-minute catch-ups, and every two months have a steering committee meeting with key stakeholders. This would involve their head of facilities, technology representatives, clinical lead for nursing, procurement and research.
When you change something from paper to digital format, you are not just transposing it. You are actually changing the way that the patient is managed.”
eyeforpharma: In terms of implementation, were there false starts?
Nayan: We approached the design process with a co-creation mindset. This started with desk research followed by interviews with clinical and non-clinical stakeholders, but as we started to draw conclusions we would always go back to BHT to validate what we had learned.
Despite this approach, challenges still came up when we put things into practice. Part of the solution is a mobile application that the cardiac rehabilitation team uses when they are out in the community, and although we showed them the wireframes as part of the design process, it did not work well in the field. We had to go back to stage one and redesign.
Mirren: Throughout the first year of the program as the service became embedded, we realized that we needed to make changes to when and where data was captured. When you change something from paper to digital format, you are not just transposing it, you are actually changing the way that the patient is managed.
Nayan: We had a similar experience with the patient activation materials that we developed. We had initially developed separate booklets for patients to support them through the program. As the program developed, we consolidated materials as patients are expected to attend clinics regularly and could not be expected to carry multiple items.
Of course they had concerns, this was a significant change the team would go through, but our principle was to always to do this in a collaborative manner, we always tried to get ahead of the problem.”
eyeforpharma: How did you manage the expectations of the partner through this design process? Did you have issues communicating that this service might not work? Did they have concerns about the potential impact on the patient if it didn’t?
Nayan: Of course they had concerns, this was a significant change the team would go through, but our principle was to always to do this in a collaborative manner, we always tried to get ahead of the problem.
Mirren: When we first implemented the technology, we made sure that there were at least two of us in the hospital over the first couple of months, including the technology implementation lead. We provided intensive support at least in the initial phase so that they felt comfortable and confident with the process. We also acted quickly when any issues arose, communicating openly with the hospital as to when and how they would be resolved.
We had weekly meetings with the clinical lead, but we also had weekly meetings with the nurses to get direct insights into how the implementation was affecting work at an operational level. This is how we got most of the insights into the critical challenges. Having a proper structure to deal with challenges, as well as constant communication, was a key success factor.
eyeforpharma: many thanks for sharing your thoughts on key design considerations Mirren and Nayan!