Challenge

Our challenge was to map out the patient experience of Chronic obstructive pulmonary disease (COPD) at the system level to uncover space for innovation.

Outcome

In mapping the systems around the experience of care for COPD, we discovered areas of potential intervention within the stigma created by the surrounding systems. The project is ongoing…

Method(s):

• Literature Review

• Systemic Design

My Role

As a team, we researched COPD and iterated on the different mapping tools. I was specifically responsible for all the graphics and visual representations of the maps we came up with. We presented the tools to our class together.

Project Team

• Kowoon Jang

• Ruslan Hétu

• Victoria Weng

Using the information we gathered from our initial research, we began to work through the system beginning with the Iterative Inquiry. Then we pulled out the key actors from the Iterative Inquiry to map on the Actors Map to understand their influences. Using our better understanding of the relationships we created our Causal Loops diagram. This revealed the power that stigma held which we then, with reference to the other maps, developed our Systemigram, mapping COPD.

Iterative Inquiry

This iterative inquiry for chronic obstructive pulmonary disease (COPD) was created to examine each element that is part of the system for a patient with COPD and its respective structures, functions, and processes. To begin with, we start with a need for the initial diagnosis of COPD, who we need a primary care clinic for, and what they need for this is a set of diagnostic procedures such as spirometry, chest x rays, CT scans, etc., which happens in the context of primary care. This is then followed with the need for treatment, which we also need a primary care clinic for and is again conducted within the context of primary care. There is a varied process for treatment, which ranges from flu vaccines to various medications. This is then followed by the need for advanced treatment, which is where we then advanced into the context of secondary care and require specialists who may order different combinations of medications or special treatments. This further goes into the need for surgery, which brings us into the context of tertiary care and is done through tertiary care facilities like the hospital, surgeons, ICUs, etc. The type of surgery needed depends on the patient. Following surgery, there is a need for recovery which can occur in the ICU and/or at home. This function is carried out by varied processes such as pain relief medication, rest, exercise, and more. This then follows into the need for therapy which occurs in the context of secondary care, and is done through specialists like psychologists, therapists, and psychiatrists. The process this is done through can include therapy, antidepressants, and support groups.

Actors Map

To frame the system of COPD, we identified who is actively involved in the system and mapped them according to their level of interest and power. We placed the stakeholders in 4 different rings, which (in order of internal ring to external ring) are: patient network, primary healthcare, healthcare system, and society. The patient network consists of those immediately close to the patient, such as family, caregivers, friends, and coworkers. Primary health care involves all the players who play a role in primary care and whom a patient with COPD would initially interact with and continue to follow-up with to manage and treat their disease. This includes primary care physicians, nurse practitioners, community health centres, telehealth, and medical imaging and laboratories. Moving into the healthcare system, we have included the stakeholders involved in COPD who are not part of primary care and not necessarily healthcare professionals. This includes secondary care specialists, tertiary care specialists, personal support workers, home oxygen therapy vendors, smoking cessation programs, etc. Through mapping all the relevant actors in the system, we are able to view the level of impact, engagement, and influence actors have in the system.

Causal Loops

Individuals diagnosed with COPD risk being stigmatized, shamed, and blamed by healthcare providers and themselves. COPD is often labeled as the “smoker’s disease” as tobacco smoking is the most common cause of COPD, although factors such as air pollution and genetics can also cause COPD. Most cases of COPD are also known to be preventable by reducing an individual’s exposure to risk factors like smoking. As a result, COPD is largely associated with tobacco smoking which is already stigmatized by the anti-tobacco movement. This knowledge of COPD further encourages the stigma of COPD, and can lead to blame and guilt from healthcare providers. Individuals with COPD can also experience self-guilt, and the combination of these can lead to depression and self-loathing. Such feelings can make it difficult to quit smoking, the source of the disease. This often does not help the case of patients or their treatment, and some healthcare professionals may be further frustrated by their behaviour. The healthcare system becomes continually strained as a result.

Systemigram

To give a visual representation of the overall architecture of the COPD system, we looked at the system from the perspective of a patient with COPD. Based on this perspective, we were able to focus on the specific parts of Ontario’s system the patient interacts with. The areas we focused on are: causes for COPD, parts of the society that influences and is influenced by COPD, parts of the healthcare system the patient interacts with, the impact of COPD on the patient’s life and the parts of Ontario’s system the patient needs for long term care since COPD is not curable, but its symptoms manageable.