Designing for an Ever-Changing Present: Clinic 20XX Refresh Study Amidst (and Beyond) COVID-19
- Deborah Wingler, PhD
- Upali Nanda, PhD
The Challenge
Health care has been long due for systemic and system-wide reform, bringing an urgency for health care organizations, patient advocates, and policy makers to lead this effort. The U.S., compared to 10 other developed countries, is rated the highest in health care spending, yet lowest in quality of care (Commonwealth report: 2014 and 2021). The lived experiment of the COVID-19 pandemic, including challenges from the rise in health worker burnout, and fundamental issues with public health has once again reinforced the need for change-ready facilities. With plans to refresh the 2015 Clinic 20XX report, the Center for Advanced Design Research and Evaluation (CADRE) and HKS team examined the changes in primary care, in large part due to the pandemic, with a focus on:
- Key drivers and trends
- Patient’s primary care expectations and preferences (across three generations), including telehealth and in-person clinic visits
- Physician’s perspective on primary care
- Changes in patient and provider perspectives over the last 6 years
What We Found in our Research
The research team commissioned a third-party independent vendor to survey both U.S. patients and physicians to capture their experiences:
- 330 patient respondents (110 Millennials, 110 Gen X, 100 Baby Boomers) who had a telehealth visit in the last nine months for primary care needs (January 2021)
- 103 physician respondents (60 Family Practice, 43 Internal Medicine) who transitioned to or expanded telehealth services during the COVID-19 crisis (May 2020)
Here are some key findings from the survey and report:
New drivers of change reflect what we need to live a quality life.
In addition to the drivers from 2015 (system reform, technology, the new patient, the provider, and the field), Climate Change (respiratory diseases, catastrophic events), Infectious Diseases (global outbreaks), Health Equity (access to care, treatment availability, outcome), and Burnout (staff burnout and retention, mental health) emerged in 2021. New players in the market, wellness, and home health are new trends identified in response to the drivers of change.
Process, patient-provider relationship, and place are the trifecta in creating the ideal in-person primary care clinic experience.
Streamlined process (44%), empathetic and knowledgeable providers (27%), and amenity-rich, safe, and clean environment (21%) were the top three components of the patient’s ideal experience. Physicians identified streamlined patient check-in and registration process (4.58 out of 5) and availability of exam room when needed (4.56 rating out of 5) as top facility features to run a successful practice, with patient relationships (4.57 out of 5) being key.
Experience vs. Service
Physical and digital preferences differ by generation.
Baby boomers (70%) and Gen Xers (55%) preferred in-person visits over virtual visits, whereas Millennials preferred virtual (58%) over in-person.
Primary Care Experience
The smartphone has increasingly become the lifeline for patients to access health care services, with a 17-percentage point shift from 2015. While excited about telehealth, especially in terms of access and convenience, physicians are still skeptical about the regulatory reform needed to make it successful.
Phone vs. Portal
Convenience is still key, but now with a digital layer.
Closely following cleanliness and hygiene in the perception of clinic appeal, convenience had typically been manifested through same day appointments and walk-in appointments (with less than 30-min. wait time) in 2015 and are still at the top for Baby Boomers in 2021; however, online registration and mobile apps to track health entered the top three for Millennials in 2021.
Physicians want workspaces that allow privacy, efficiency, convenience, and flexibility.
Closely following cleanliness and hygiene in the perception of clinic appeal, convenience had typically been manifested through same day appointments and walk-in appointments (with less than 30-min. wait time) in 2015 and are still at the top for Baby Boomers in 2021; however, online registration and mobile apps to track health entered the top three for Millennials in 2021.
What the Findings Mean
Patient and provider perspectives, layered on the key drivers and emerging trends, suggest key principles to design primary care clinics that are change-ready. For example,
- Anchor – Connectivity should happen at multiple levels but needs a central point. Position the primary care clinic as an anchor of health and wellness in the community.
- Experience – Just as care is a continuum, the clinic is, too. Double down on experience which includes service and care quality, care team expertise and attitude, and overall sense of place.
- Flexibility – The only certainty is change. Invest in flexibility that can allow clinics to adapt to both future care models and unforeseen circumstances.
Seven Key Principles:
Here are some key takeaways from the report findings:
Humanize the Experience.
- Patients are people first.
- Begin with the basics: cleanliness, convenience, and cost.
- Reach patients where they are, not where it’s convenient for health providers.
The Clinic Is More Than a Building.
- Clinics are now digital/physical ecosystems – create a seamless, branded experience.
- Approach with a concierge mindset: How can the building help? How can digital access help? Where do people need in-person support, both remotely and at the clinic, from the entrance through the treatment journey, and after?
Build Relationship and Trust.
- Relationship is key to success in a practice and to the ideal clinic experience.
- Build clinics that can be portals for authentic relationships between patient, provider, system, and community. This is the foundation underlying all other considerations.
What’s Next
With increasing primary care provider shortages and health care worker burnout at peak levels, it is essential to consider how these drivers will collectively impact emerging care models and care team members, preferences and expectations moving forward.
This study concluded what has been a six-year exploration of how to design for change in the face of an ever-changing present. It is our hope that others will take the insights from this report (and others in the series), continue to ask questions, and use it as a starting point for meaningful innovation.
