Redesigning hospital and community clinic treatment pathways

How a multi-disciplinary, empathy-based approach transformed patient experience and outcomes for a high usage patient segment, while reducing spend


Insight Generation

Strategic Option Development


St. Michael’s, a community hospital in downtown Toronto, faced significant challenges with a large homeless population with chronic and advanced stage liver disease. These patients had no primary physician and were engaging the highest cost, highest burden elements of the healthcare system, using the hospital ER as their daily healthcare service provider for inpatient and critical care during more severe incidents. There were minimal community-based programs to provide preventative care for this population, and those that did exist were disconnected from the hospital, leading to poor continuity of care for these patients. The hospital prioritized improving the patient experience, while reducing the burden from this population as a top area for innovation, and engaged Coactuate to support its exploration of innovative solutions.


Empathetic Understanding

The first step on the journey involved deeply understanding what was happening with the patient population and all the treaters they engaged with. We trained internal hospital staff and patient-facing personnel on ethnographic research techniques and had them engage with patients in a variety of settings in the hospital and community to better understand their lived experiences. We supplemented this with explorative qualitative interviews with healthcare system employees to understand behind-the-scenes challenges and implications to the healthcare delivery ecosystem.

Treatment Journey Mapping

We constructed the first visual mapping of different touchpoints and routes that patients were taking through the healthcare and community-based services ecosystem. We prioritized the touchpoints based on time and resource intensity, and informed the relevant root challenges and needs at each touchpoint using the lived experience insights that were collected in the qualitative research phase. All stakeholders and major pathways through the healthcare system were represented.

Focused Ideation

Pulling together a cross-section of hospital employees, including physicians, nurses, administrators, and representatives from community-based services (e.g., homeless shelters), we explored the journeys collectively and co-created a range of potential solutions to reduce burden on the system. Tactical ideas were critically assessed and prioritized, with a recommendation to pursue four discrete solutions.

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Cross-Stakeholder Understanding

The common factbase and journey map created a shared understanding among the diverse hospital and community-based services stakeholders around their roles in the system. This led to many behavioral changes and new forms of interaction between the hospital ER, other hospital departments, and community outreach clinics and services.

Focused Intervention

Following ideation of 35+ ideas with critical assessment and prioritization, the hospital system moved forward with a solution set that delivered an estimated $2 million in annual cost avoidance, while improving patient outcomes and experience.

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