Design process helps identify opportunity for improvements to Toronto Academic Pain Management Institute (TAPMI) patient experience

Case Study by Brenda Little RGD, Senior Designer, Pivot


Pivot was approached by the Toronto Academic Pain Management Institute (TAPMI) to research their existing system of patient care, in particular the referral process, and discover opportunities for improvement. The project would include two phases: the first focused on service design, the second creating a website to support the findings from the service design phase.


TAPMI, a new virtual network of five Toronto-based pain management clinics, was formed to address the fundamental disconnect between patients and providers and provide seamless care to Ontario’s chronic pain patients.


Beyond general improvement of the system, the TAPMI team was specifically looking to reduce wait times for patients in chronic pain and avoid redundancies in the referral process. Inefficiencies in the system often result in patients being referred to the wrong clinics and backlogging the system. Seeing this as a problem that could be improved with adequate online services for patients and their primary healthcare providers, such as educational modules and self-management resources, TAPMI is hoping to streamline the flow of patients not only into the TAPMI hub, but also back out to their primary care provider.


The 'Service Design' Approach:

Service design involves applying a designer’s skill set to solving problems with services to improve systems and organizational inefficiencies. It is the ultimate interaction design, applying the design thinking process we are familiar with to re-imagining a user’s interaction with a service and all its touch points. There are many different methods and approaches to service design, but most are focused on the user or customer “journey” through a service and the front-stage and backstage components that interact to provide that service. Mapping out the journey visually provides a bird’s eye view of the service that often reveals insights into where problems begin and how they might be improved.



We as designers have the luxury at the outset of a project of being unencumbered by the bureaucracy of an organization or the knowledge of why something has always been done in a certain way to get to a messy place that needs rethinking. We can come in as curious newcomers and see things with a fresh perspective the client cannot. On top of that, we are trained to apply a design thinking process to research and iterate through ideas. It’s also really gratifying to have the opportunity to apply our design skills to solving problems that have real, positive impact on people’s lives!


Research and Analysis: 

After our initial kickoff meeting where we determined the user personas of the chronic pain system, we conducted interviews with patients and health care providers to view the current programs and referral process through their eyes. By gathering qualitative feedback we were able to better understand their experiences with the existing referral process. We then compiled our interview findings with our research into other successful referral processes internationally, both in and out of the chronic pain sphere, and began sketching out a patient experience map, which brings together the most common experiences we heard in our interviews into one experience. Visualizing the patient journey in this way allowed the client to see more clearly where they needed to focus their efforts as they began developing their programs.


Design Process: 

Once we had completed the interviews, we began to extract key statements and organize them into themes. At the same time, we began forming our experience map using the information gathered in the interviews to piece together the existing patient experience, taking into consideration both the contextual and emotional elements of their journey, to establish touch points with the system and areas of opportunity.


Creating one patient experience for the diagram was very difficult. Every patient we spoke with had such a unique story to tell and every health care provider also had a unique perspective and clinic setting. It was a huge challenge to take all of that information and filter out the common experiences in order to create one journey that encompassed a broad experience. Accomplishing this task was an iterative process that also included client input, as they are themselves the experts on the system side of the story.


The Role of the Client: 

Client input was critical to the success of this project. We had a lengthy meeting at the outset of the project with the entire TAPMI team to hear them articulate the project goals, needs and challenges as well as walk us through the users of their system. This gave us a much deeper understanding of the project and our target audience than a document brief. The client had already conducted a lot of their own research, which they shared with us into other successful chronic pain programs and referral processes around the world. They also validated and provided information for the backstage interactions on the experience map, drawing from their own first hand. Once we began the website portion of the project, we worked collaboratively with the client to create the site content.



Solution and Deliverables: 

We compiled all of our findings, research and the experience map into a final presentation for the Service Design phase. The experience map revealed to them a critical discovery: during the patient’s longest wait period, the pain clinics were doing nothing to help them. This has become an important area of focus as TAPMI moves forward with the development of their program. The experience map is helping them contextualize their work as the programs they are developing fit into one or more of the sections along the patient journey, as well as helping them identify future areas for program growth.


Upon completion of the Service Design phase, we created a website to establish their brand and give them an online presence as they work on developing their programs.


Next Steps: 

Creating the experience map was the ultimate deep dive that now informs our work with TAPMI as we move on to designing their expanded website. It will be a larger, more comprehensive site that addresses the original project goals, including patient self-management tools, customizable care pathways and educational modules. In a perfect world it would be wonderful to iterate on the experience map a few years down the road to see if the patient experience through the system improves; we will have to wait and see if budgets will allow for this!