The aim of this project is to apply design approaches for creating innovative, effective, and sustainable solutions for social impact and change in the topic of health care.

The goal was to increase the participation rate of colon cancer screening in Estonia
project general info
PROJECT : social innovation DESIGN PROJECT WITH riina raudne, josina vink and Tanel Kärp

CHALLENGE : Very few members of the target group ever reach the colon cancer screening. The overall service, once they get there, is in need of analysing and designing: how does the procedure day look like, how are the patients communicated with, counselled, and so on.

client: PERH (North Estonia Medical Centre)

Starting point
End result
starting point
Since the problem and its context is a complex topic we decided to start with the primarily research on what is colon cancer screening, what kind of procedure it is and why it is necessary to go for a check up. We looked into various scientific papers, from Estonia and abroad, as well as gathered data from statistics engines on how many people (and other demographic data) visit the colon cancer screening procedure, how many people get notified about the diagnosis annually and other important information that will give us a broad understanding of the subject matter.

We found out that colon cancer is one of the main causes of death in western countries. It affects mostly adults over 55 and, unfortunately, the symptoms show up late. To give the patient a higher chance of survival and better quality of life after the treatment, it is common practice to invite selected demographics to a screening, meaning looking for an illness in people who do not show any symptoms yet. cc screening is a test on a stool sample, collected at home by the person and sent to the lab for a check-up. An important detail is that in Estonia this service appeared only 4 years ago.

From the research we understood that the service system in Estonia is shared (and not always in a clear way) between different actors, which provide and take care of different segments of the process. If for the patient the experience looks almost linear, there are actually several institutions involved. We pointed out that haigekassa (Estonian health insurance fund) is taking responsibility for the participation rates and manages the overall process, our main problem owner.
We proceeded with the interviews and spoke with the people on the provider side and receiver side, to see the service, its problems and qualities rom a human perspective.
Perh surgeons
family doctors
We interviewed:
Some insights and patterns in the stories have been particularly useful for us:

the whole service is individual based, it is intensified by a sensitive and uninviting task (stool sample), and scary topic (cancer);

when there is a positive relationship between a proactive family nurse and the patients, where the trust is, the participation rate is great;

family nurses communicate to couples simultaneously , when there is a coincidence of the same test for two partners the number of the participants increases strongly. unfortunately coincidental cases are happening rare;

when talking about good habits, the relationship with doctors, health-care and so on, most people connect it with childhood memories, or the present need \ responsibilities \ experiences with families and friends.
To condense the scope of the plausible solution for the challenge we have come up with the following design principles that will guide us in the process:

1) short and sweet (possible to pilot in one year)
2) cost effective
keep in mind the age
4) service based
5) don't force it
6) use existing relationships
7) consider privacy and data protection

Through the research, we uncovered a strong connection between relationships (in particular partners and family) and self-care. the bigger change we are pointing toward is to bring the patient's network into his healthcare experiences, acknowledging the importance of his/her support system.

We envision a c.c. screening process that "exploits" the user's relationships to raise the participation rate in the screening, by supporting and responsibilizing him/her.

Based on the research we defined our mission: use interpersonal relationships of patients to increase the participation rate in the cc screening. We want to promote the idea of "interdependence" between people part of the same network. We envisioned a future where the importance of family and network in the relationship with health-care system is more visible and useful.
interdependence: the state of being dependent upon one another, mutually dependent
We started from personal page: the citizen's access to public services, and to one's personal information shared with the government (one of the reasons why Estonia is called a digital nation (or e-estonia)).

On Toomas' personal page, we added the family section, where he can visualise, edit or add people from his network or family, and their mutual access to personal information. Here, Toomas, who already has his wife and daughter connected, can add his old friend Hendrik and decide which level of confidentiality he want to grant. Once they both accept this mutual access, the are part of each other's e-family!
end result
The change is simple, but this new piece of information on Toomas's life can be used in several ways:
To go further with design and implementation of the idea, there would need to be a wider user research and co-design approach, involving policy makers, users and providers from different areas and demographics.

Some mistakes would need to be avoided, in particular:

drop a new load of responsibility on the "mom" of the network, without a dynamic of mutual support;

avoid to create confusion and useless bureaucracy for doctors and nurses;

caution with privacy and treatment of sensitive data, giving full control to the users.
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