Humanizing Healthcare for Aging Adults in Rural Illinois
As the only level 1 trauma center in central Illinois, the Carle Foundation Hospital provides vital healthcare for many rural Illinois residents. Carle’s Rural Health Alliance asked my team to investigate the needs of elderly rural patients and provide inspiration for innovative and implementable care solutions. Conducting research with 30+ physicians, caretakers, service providers, and patients, we developed several design recommendations for new programs focused on building and maintaining trust with aging patients in rural areas.
Topic Area
Healthcare
Project Type
Research & Strategy
Role
Design Researcher
Our Process
In the first phase of research, we met with Carle stakeholders and subject-matter experts to understand their existing work with rural aging adults. We conducted semi-structured interviews with hospital leadership, physicians and other clinical specialists, rural transit coordinators, and community leaders.
Recruiting participants required putting in significant time to build trust in each town. We attended several events at local community centers to recruit participants. This had the added benefit of introducing us to individuals who offered support services to older adults (e.g. senior center employees and meal delivery volunteers). In-depth interviews, often performed in participants’ homes, were the primary means of gathering data. Several participants also completed a Circle of Care Activity to map out the individuals who played an active role in managing their health. In addition to interviews, I conducted a shadowing ride-along with a meal delivery service, meeting residents who depended on this vital service for nutritional meals and wellness visits. Co-creation sessions with Carle stakeholders and Carle Illinois College of Medicine students informed our concept development.
At the time of our research, there were 51 Critical Access Hospitals and 234 Rural Health Clinics in Illinois. Critical access hospitals are indicated with bright red pins – darker red denotes a Carle affiliation. Circles around each pin indicate a 25-mile radius. This map showed many towns with residents facing significant travel barriers preventing travel to the nearest hospital for care. With the guidance of Carle stakeholders, we focused on two towns, Hoopeston and Olney, both parts of Carle’s Rural Health Alliance. We also included Lexington for its smaller size and location outside of Carle’s then-current region of care.
Insights
Key insights from our research focused on the cultural fabric woven into rural life in central Illinois. We highlighted the elements of this culture that can often get lost as an organization grows and scales to serve a broader population. With Carle’s recent expansion, it was important to tap back into the core of the communities they aimed to serve.
Rural community is deeply personal & selfless.
People do things for the sake of “it’s the right thing to do” rather than for recognition. There is an expectation that neighbors will support each other, and individuals don’t want to be seen as a burden.
“Many times we would be closing up for the day and see patients still waiting for a ride… so we’d take them home.” -Rural Primary Care Provider
Trust is the social currency of rural towns.
While initial skepticism of change is often present in rural communities, trust is not a limited resource. With a community-focused mindset and a deliberate touch, trust can be earned.
“We think of trust as precious, and yet it’s the basis for almost everything we do as civilized people…We rely on laws and contracts as safety nets, but even they are ultimately built on trust in the institutions that enforce them.” - “Begin with Trust,” by Frances Fei and Anne Morriss, Harvard Business Review, May-June 2020
The choice of rural is intentional.
People chose rural towns for the sense of community and the slower pace of life, even knowing they’re relinquishing ease of access to certain services. Challenges such as limited transit options and limited access to hospitals are accepted realities of life.
“We've traveled, we’ve lived all over, we’re not just rural bumpkins.” -Olney Resident
People crave honesty, through good and bad.
Word of mouth and face-to-face communication is the bedrock of community connection in these rural communities. People want to know they’re getting the whole story.
“If people see you owning up to your mistakes...that’s where we’ll see folks buy into anything.” -Rural Primary Care Provider
Design Principles
Based on our insights, we formulated 4 design principles defining the foundational and experiential elements of any role, product, or service Carle creates for patients.
2. Encourage Conversation
Word of mouth is a powerful force of information dissemination in rural towns. Therefore, a culture of open and upfront communication, which sets realistic expectations between providers and patients, is essential. Celebrate successes, acknowledge failures, and most of all remember to ask the important questions.
“[Patients] don’t care how much [doctors] know until they know how much you care.” -Olney resident
1. Grow with the Community
Loyalty is important in small, rural communities. Many small communities are very intertwined and have an “it takes a village” mentality, which extends into their perceptions of healthcare. People want to feel the organizations in their community will grow and adapt to support them through changes.
“I want Carle to be a success, it’s a two-way street. I want them to be loyal to us.” -Olney resident
4. Value Face-to-Face Interactions
Both patients and clinicians emphasized the importance of face-to-face interactions as a meaningful way to build mutual trust. It’s important to get to know community members by showing up to the established spaces where they currently convene: senior centers, diners, and coffee shops.
“Gibson City Hospital had an open house and I talked to my doctor for two hours! Friendliness is really important.” -Hoopeston resident
3. Honor the Patient’s Perspective
Many seniors expressed the importance of feeling heard. From their choices to settle down in rural areas to their own thoughts and opinions about their healthcare, seniors value and appreciate care providers who listen.
“I value you all and Carle coming in here and trying to understand what rural is. It shows they care.” -Lexington resident
Outputs
The design principles were integrated into a rural aging adult’s healthcare experience journey, shown below. In each of the moments that matter along this journey, we illustrated how four concepts – (1) The Welcome Wagon, (2) “Conversations at Carle”, (3) The Welcome Packet, & (4) a Community Health Worker Program – could improve a patient’s experience. We provided an extensive roadmap for how Carle’s Rural Health Alliance could build out these concepts to better serve their community.
Moment 1
Change of Provider
Moment 2
The Waiting Room
Moment 3
The Appointment
Moment 4
Beyond The Appointment
Moment 1: Change of Provider
Healthcare professional turnover in a rural community is inevitable. Aim for retention, while still designing for transition. A proper onboarding experience with a new provider is crucial in developing trust.
Judith has lived in Lexington for 52 years and has seen the same doctor for 40+ years, who just retired. Judith will now be seeing the new doctor in town, Dr. Bernard.
Judith and her son, Mark, notice a flier at the pharmacy. It mentions the Welcome Wagon, a series of events hosted by the hospital.
Being new in town, Dr. Bernard is excited to jump into his new role and feels already at home since the Welcome Wagon has helped him settle in.
Mark decides to attend a potluck that week, which is one of the Welcome Wagon events. This gave him a chance to chat with Dr. Bernard, whom he knows will be his mother’s new doctor.
Moment 2: The Waiting Room
Transportation, or lack thereof, is a reality in many rural towns. We found an opportunity to leverage the extra time patients spend waiting before and after their appointments. Meaningful interactions in this downtime provide a sense of purpose to an otherwise idle time.
Judith has her first appointment with Dr. Bernard. Her son, Mark, had to drop her off for her appointment early before he went to run errands. She’s been nervous about meeting with this new doctor.
Once checked in for her appointment, Judith meets Stephanie, an RN running a new program called “Conversations at Carle”. Having some time to spare, Judith decides to join in.
As they get to chatting, Judith brings up some of her concerns regarding her tremors and how she’s put off seeing a specialist who is further away. Stephanie suggests she mention this to Dr. Bernard.
Moment 3: The Appointment
The initial appointment with a new doctor can be intimidating. Openness from the provider is essential to establishing a trusting relationship with a patient from the start. Seeing providers as holistic individuals can invite patients to open up.
Stephanie walks Judith to her appointment room and introduces her to Dr. Bernard. This simple handoff, and her experience at Conversations at Carle make Judith feel hopeful for her visit with Dr. Bernard.
Once settled, Dr. Bernard pulls out the Welcome Packet. Inside are pages on why he chose Lexington, and even a recommended reading list. All this, especially their shared love of mystery novels, helps Judith feel comfortable to open up about her recent health challenges.
Moment 4: Beyond The Appointment
Many seniors rely on the resources provided by community centers or similar organizations. We were inspired by people who hold multidimensional roles such as that of an ambulatory pharmacist. This helped us identify opportunities to expand the roles of some community volunteers to fit the various needs of rural seniors.
Carle recently reached out to the region asking for volunteers for a new Community Health Worker program. Greg, a meal delivery service volunteer saw this as a great opportunity and signed up for the training.
While delivering Judith’s hot meal, Greg also checks some basic vitals. This helps Judith monitor her health outside of her visits with Dr. Bernard. Greg also has a direct line to a nurse at Carle in case he needs to follow up with Judith about anything.
Greg also does monthly phone check-ins to see if Judith needs any addition medical support. Since Judith lives alone, she’s grateful to know there’s someone trustworthy in the community looking out for her.
All storyboard images were created by Alexis Vasquez.