Finalist 2022

Heart Helper Pilot

Department of Premier and Cabinet / Safer Care Victoria / Peta Fawcett / Sophie Jennings / Katerina Yakimov / Joanna Szczepanska

Heart Helper Pilot is an in-home care service for heart failure patients to reduce hospital readmission and improve their wellbeing.

The Heart Helper Pilot is a new service designed to support Victorians living with heart failure. Funded by the Commonwealth, a Victorian Government partnership was formed between Safer Care Victoria (SCV) and the Department of Premier and Cabinet’s Service Design Team to respond to a complex public health challenge; One in four patients who are sent home from hospital after a heart failure admission need to return to hospital within 30 days. Human-centred design and co-design approaches were employed to design the new service, which was developed collaboratively with heart failure patients, carers, family members and healthcare workers.

Design Brief:

Safer Care Victoria identified heart failure as a significant contributor to hospital capacity issues in Victoria’s public hospital system and scoped an opportunity to develop an in-home alternative model of care. The brief responds to the two challenges; how can we deliver more effective care whilst also decreasing hospital presentations for heart failure patients?  Heart failure is a condition that poses a significant burden for patients, carers and the health system. Heart failure patients have a prognosis worse than most cancers, and many endure frequent and prolonged hospitalisations.  To do this, we worked closely with heart failure patients, carers and family members about what is important and how their experiences and wellbeing could be improved. This new service is designed to increase patient self-care and management, improve patient education and trial a combined workforce model that is supportive and effective.

This project was developed by:

Design Process

The project approach was crafted to respond to the unique needs of the public sector and is based on the Victorian Government’s Human-centred Design playbook and Safer Care Victoria’s Partnering in Healthcare Framework. The design process placed the healthcare system stakeholders at the centre in a process that brought together aspects from both human-centred and co-design approaches.  The design process responded to the complexities of Victoria’s healthcare system by employing a range of design methods to comprehensively engage with all stakeholders in the system, including lived experience consumers, heart failure patients, carers, family members, clinicians and healthcare workers.

This ensured that the outputs designed had considered the needs and experiences of the patients within the current assets, challenges and realities of the hospital system and health service delivery for those needing heart failure care.  We did this by involving system actors throughout the design process:

  • Listening to and observing patients: 1-1 interviews with heart failure patients with different lived experiences (e.g. Newly diagnosed, multiple diagnoses, with and without external support); Observation study with patients enrolled in at-home care.
  • Hearing from carers and family members: 1-1 interviews.
  • Shadowing and prototyping with healthcare workers: Focus groups with staff from healthcare services in regional and metropolitan Victoria; Shadowing healthcare workers in hospital; Prototyping sessions to develop and test concepts with healthcare workers.
  • Employing a lived experience consumer as a design team member

Design Excellence

The Victorian Government’s human-centred design approach considers user experience from the perspective of internal and external users or stakeholders. In this project, user experience has been factored into the design from the views of clinicians, patients and their carers to design user experiences that re-imagine the relationship between patient and healthcare professional to be more effective, engaging and efficient.

The human-centred and co-design processes used to develop the service model are set up for sustainability as the Heart Helper Pilot model has been informed by the likely beneficiaries and the system.  The link between patient experience and health outcomes Safer Care Victoria’s Partnering in Healthcare framework sets out the connection between patient participation and quality and safety in healthcare delivery which the Heart Helper Pilot supports in two ways:

  • Facilitating participation in the design process at the ‘service level’. Our team engaged with users from the outset by crafting various design methods and tools that facilitated safe and meaningful participation by vulnerable and often hard-to-reach cohorts.
  • Patient experience design as a lever for quality and safety outcomes at the ‘individual level’. SCV sets out consumer (patient) participation in their own treatment as a key indicator of healthcare performance and quality. Increasing participation levels between patient and healthcare professionals is directly linked to quality and safety performance criteria.

Our solution supports patients to take an active role in their own care through the design of self-management, education and awareness resources embedded into the service delivery model. “We know good design can help us gain different perspectives, understand our community needs more clearly, identify new solutions, and improve patient outcomes. For this project, it helped frame the challenge from the eyes of the consumer and their carers rather than from the system delivering the care.” Sophie Jennings – SCV

Design Innovation

The future of healthcare is at-home care. Whilst we often see medical technologies proposed as the solution to shift healthcare from the hospital to the home, we rarely see holistic solutions that rethink the entire service delivery model. This project is innovative because it seeks to holistically transform how healthcare is delivered. Rather than designing a new service model from the expertise and capability of the health system, this collaboration focused on the real-life needs of the community-dwelling patient and carer managing heart failure. This perspective promotes innovation and challenges inertia. The Heart Helper Pilot does this by:

  • Integration with existing outreach programs: Designed to work alongside existing outreach programs.
  • Placed-based approach: The model has been designed to be customisable to where the healthcare service and individuals are located.
  • Patient and carer education and engagement: Educational resources are introduced into the patient experience to support and build greater health awareness and self-management

More than 1/3rd of heart failure patients admitted have a Charlson Comorbidity index score of 6 to 9 (VAED), which means that heart failure patients have some of the most complex needs as assessed by high co-morbidity rates and high resource use. The HHP is designed around the complex and unique circumstances of heart failure patients by:

  • Targeted and tailored: Consideration of individual patient needs rather than a one-size-fits-all solution. For example, CALD communities' language needs have been considered through the use of interpreters and customising resources.
  • Focus on the patient's emotional state: This is achieved through phone calls and home visits
  • Education and resources: Healthcare workers will adapt, revise and revamp existing content (e.g. Heart Foundation booklet)
  • Engagement: Home visits and calls with healthcare workers
  • Heart Care Package' resource: This resource is a 'live' document. The information provided is local and targeted to heart failure patients.

Design Impact

The business case has now been approved, and resources have been hired to implement the 10-12-month pilot from July 2022. Our future state service blueprint was a key input into the business case and recruitment plan. We see the impact of our design through many lenses:

  • Responding to urgent issues of Victorian hospital and ambulance system capacity amplified by Coronavirus (COVID-19).
  • Increasing patient engagement, leading to increased quality and safety of care.
  • Breaking down the silos between government departments to bring healthcare and design professionals together in a genuine collaborative partnership model.
  • Building staff confidence and ability to advocate for design-led healthcare transformation.  Sustainable management of public hospital real estate and resources Coronavirus (COVID-19), an ageing population, and the increasing complexity of care needs will continue to place pressure on our healthcare system. HHP demonstrates the potential for hospitals to increase system capacity without increasing property footprint. For heart failure patients, in which 25% return to hospital, offering the hospital as a service - rather than a fixed place - introduces flexibility in hospital facility planning.

Improving quality of care in public hospitals

  • SCV’s Partnering in Healthcare framework sets out a vision for all Victorians to access high-quality, safe and effective healthcare.
  • Socioeconomic status and region of birth are leading indicators of heart failure in Australia. Those from low socioeconomic areas are 2.5 times higher to present to a hospital for heart failure. Our process directly targets these areas by embedding the design team in hospitals to develop a care model accessible to CALD communities and low socioeconomic backgrounds.
  • In 2019-20 there were 33,400 Australian public hospital ED presentations with principal diagnosis of heart failure. Physical bed and staff shortages are contributing to Victorian hospital capacity issues, and the HHP has the potential to significantly decrease readmission and free-up valuable ED resources.

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