qualitative research @geisinger health

Redesigning triage pathways to reduce the neurology wait times for obstetrics patients through service design

My Role

UX Researcher
Service Designer

Team

3 Neurologists
4 OB/GYN physicians
2 Nurse Practitioners
2 MTDM Pharmacists
2 UX Researchers

Methods

Stakeholder mapping

Survey design

Semi structured interviews

Affinity mapping

Insight Synthesis

Service Blueprinting

Workflow Mapping

Tools

Microsoft Excel

Miro

Mural

Figma

Timeline

Jun 2025 - Aug 2025

CONTEXT

Headache disorders are a widespread yet under-treated health issue, with women disproportionately impacted. At Geisinger Health, the Gynecology department serve as the first point of contact for pregnant or postpartum patients experiencing headaches

40%

of the global population affected by headache, ~3.1 billion people

1 in 3

pregnant women experience headaches or migraines

847

headache cases annually at Geisinger Health

40%

of the global population affected by headaches ~3.1 billion people

1 in 3

pregnant women experience headaches or migraines

847

headache cases annually at Geisinger Health

40%

of the global population affected by headaches ~3.1 billion people

1 in 3

pregnant women experience headaches or migraines

847

headache cases annually at Geisinger Health

THE PROBLEM

At Geisinger Health, we identified a critical gap in care delivery. OB/GYN providers directly referred patients with headache to neurology, by default, despite the level of severity. This created a cascading effect -

primary user

Pregnant patients

with untreated headache symptoms, cannot wait for specialist appointment

frontline provider

Gynecologists

encountering patients exhibiting headache symptoms but lacking clear pathways for safe treatment

specialists

Neurologists

overwhelmed by referrals and experiencing 6+ months of wait time

How might we?

Ensure that OB/GYN patients receive specialist-level care while empowering OB/GYN doctors to confidently identify, triage, and treat appropriate headache cases themselves?

THE SOLUTION

The Virtual Headache Hospital initiative redesigned the care pathway between OB/GYN and neurology. Instead of defaulting to specialist referrals, we aimed to create decision-support tools and triage protocols that would enable OB/GYN providers to confidently treat appropriate headache cases while ensuring complex patients receive timely specialist care when needed. We presented the solution in the form of a service design blueprint.

RESEARCH PROCESS

DISCOVERY PHASE

Quantitative Survey (n=21)

Working with the Neurology department, I helped design and analyze a survey sent to the Gynecology department to uncover the root causes of over-referral. The questions focussed on how frequently OB/GYN patients experienced headaches, how comfortable the Gynecology doctors felt dealing with headaches in pregnant women and how it differs in high risk pregnancies vs. normal pregnancies. The survey revealed significant gaps in systematic screening and treatment confidence.

Respondent Breakdown:

13 physicians

7 physician assistants/nurse practitioners (mid-level care providers)

13 physicians

7 physician assistants

7 physician assistants/nurse practitioners (mid-level care providers)

1 nurse supervisor

Survey Key Findings

Interesting Pattern

All providers who used the "ask-a-doc" internal consultation feature were Physician Assistants or Nurse Practitioners. No physicians reported using this resource, suggesting a hierarchical or workflow barrier.

EMPATHY PHASE

Qualitative Empathy Sessions

Following the survey, I helped facilitate three empathy sessions bringing together neurology and OB/GYN providers to deeply understand current practices, pain points, and needs across the patient care journey.

Interesting Pattern

All providers who used the "ask-a-doc" internal consultation feature were Physician Assistants or Nurse Practitioners. No physicians reported using this resource, suggesting a hierarchical or workflow barrier.

Interesting Pattern

All providers who used the "ask-a-doc" internal consultation feature were Physician Assistants or Nurse Practitioners. No physicians reported using this resource, suggesting a hierarchical or workflow barrier.

Affinity Mapping

I conducted affinity mapping with findings from both the survey and three empathy sessions, organizing hundreds of data points into meaningful themes and patterns.

The Yellow Notes - Quotes from the Empathy Sessions. Each row represents findings from one session
The Orange Notes - Insights and connecting ideas corresponding to the quotes
The Blue Notes - Actionable items / building blocks for the next session

The details of the notes have been blurred to protect PHI [Protected Health Information]

IDEATE PHASE

Ideation Session

From this synthesis, I created a Framework for Collaboration that structured our findings into actionable categories. This framework was used to work on develop the solution with our stakeholders.

THE SOLUTION

Iteration 1: Service Design Blueprint

We synthesized all ideation workshop outputs into a comprehensive service design blueprint that mapped the entire patient journey across multiple layers.

Blueprint Components:

Documents/Forms/Questionnaires - All patient-facing and provider-facing tools
Patient Actions - What patients do at each step (Line of Interaction)
Frontstage Actions - Visible provider activities (Line of Visibility)
Backstage Processes - Behind-the-scenes clinical and administrative work
Support Processes - Enabling systems (EHR, pharmacy, education programs)

We synthesized all ideation workshop outputs into a comprehensive service design blueprint that mapped the entire patient journey across multiple layers.

Blueprint Components:

Documents/Forms/Questionnaires - All patient-facing and provider-facing tools
Patient Actions - What patients do at each step (Line of Interaction)
Frontstage Actions - Visible provider activities (Line of Visibility)
Backstage Processes - Behind-the-scenes clinical and administrative work
Support Processes - Enabling systems (EHR, pharmacy, education programs)

What didn't work?
We presented this as a proposed solution to Neurology and gathered their feedback. The team found it overwhelming to comprehend the different stages in the design. The blueprint attempted to capture every possible scenario, touchpoint, and handoff across seven stages of care. While comprehensive, it included:

Multiple decision trees at each stage
Detailed role definitions for 6+ different provider types (OB doctors, roomers, pharmacists, MFM specialists, neurologists, case managers)
Numerous parallel pathways for different patient scenarios
Extensive backstage coordination requirements
Multiple support systems that needed integration

Interesting Pattern

In healthcare settings with limited time and resources, the most implementable solution isn't always the most comprehensive one. Providers need workflows that integrate into existing routines with minimal cognitive load.

Iteration 2: Streamlined Clinical Workflow

Based on stakeholder feedback, I distilled the most critical, high-impact elements into a practical workflow with clear decision points and four defined care pathways. These weren't new findings. They were simply easier pathways that could be integrated into the clinicians current workflows to enhance them

IMPACT & NEXT STEPS

Outcome

The OB/GYN headache care pathway was accepted by Neurology leadership and formally proposed to the OB/GYN department. The workflow is currently in the implementation phase. With the new workflow, we expect to have:

Before vs After
How the solution addresses specific use cases:

MY ROLE

When this project started, there was no playbook. Both departments came to us with challenges, but how we'd uncover the root problem and what methods we'd use was entirely open. We started with a survey to understand prevalence and patterns, then diving deeper with structured empathy sessions across three care stages, an idea from the Neurology three step care. I designed the research instruments, helped facilitate the sessions, and chose affinity mapping to make sense of the data. Beyond research design, I managed complex stakeholder dynamics. Neurology wanted fewer referrals, OB/GYN wanted more support, and both needed to feel heard and involved in the solution. I suggested co-design workshops to build solutions collaboratively rather than presenting finished recommendations. When the comprehensive blueprint overwhelmed stakeholders, I took their feedback seriously, pivoted the approach, and simplified it into an implementable workflow. Everything, from the research methods to synthesis techniques to solution frameworks had to be designed from scratch, and it was incredibly rewarding!

REFLECTION & LEARNING

What worked?
The combination of quantitative survey data and qualitative empathy sessions gave us both the scale of the problem and the nuanced human factors driving it. Co-designing solutions with stakeholders—rather than presenting finished concepts—ensured buy-in and surfaced implementation concerns early.

What I'd do differently?
I would have involved operational stakeholders (department managers, IT teams) earlier in the process, especially before creating the detailed service blueprint. Their perspective on implementation feasibility would have flagged complexity concerns upfront, saving us an iteration cycle and getting to the simplified workflow faster.

What I learnt?
The most elegant research solution isn't always the most implementable one. In healthcare settings where provider time and cognitive load are at a premium, simplicity beats comprehensiveness. Sometimes "good enough to launch and test" beats "perfect on paper." My job as a researcher isn't just finding the right answer, it's prioritizing the right problem to solve for and finding the right answer that the organization can actually use. Stakeholder management isn't just about buy-in; it's about understanding organizational capacity and designing within those constraints from the start.

Redesigning triage pathways to reduce the neurology wait times for obstetrics patients through service design

Headache disorders are a widespread yet under-treated health issue, with women disproportionately impacted. At Geisinger Health, the Gynecology department serve as the first point of contact for pregnant or postpartum patients experiencing headaches

At Geisinger Health, we identified a critical gap in care delivery. OB/GYN providers directly referred patients with headache to neurology, by default, despite the level of severity. This created a cascading effect -

Ensure that OB/GYN patients receive specialist-level care while empowering OB/GYN doctors to confidently identify, triage, and treat appropriate headache cases themselves?

All providers who used the "ask-a-doc" internal consultation feature were Physician Assistants or Nurse Practitioners. No physicians reported using this resource, suggesting a hierarchical or workflow barrier.

Following the survey, I helped facilitate three empathy sessions bringing together neurology and OB/GYN providers to deeply understand current practices, pain points, and needs across the patient care journey.

All providers who used the "ask-a-doc" internal consultation feature were Physician Assistants or Nurse Practitioners. No physicians reported using this resource, suggesting a hierarchical or workflow barrier.

All providers who used the "ask-a-doc" internal consultation feature were Physician Assistants or Nurse Practitioners. No physicians reported using this resource, suggesting a hierarchical or workflow barrier.

The details of the notes have been blurred to protect PHI [Protected Health Information]

From this synthesis, I created a Framework for Collaboration that structured our findings into actionable categories. This framework was used to work on develop the solution with our stakeholders.

We synthesized all ideation workshop outputs into a comprehensive service design blueprint that mapped the entire patient journey across multiple layers. Blueprint Components:

Documents/Forms/Questionnaires - All patient-facing and provider-facing tools

Patient Actions - What patients do at each step (Line of Interaction)

Frontstage Actions - Visible provider activities (Line of Visibility)

Backstage Processes - Behind-the-scenes clinical and administrative work

Support Processes - Enabling systems (EHR, pharmacy, education programs)

We synthesized all ideation workshop outputs into a comprehensive service design blueprint that mapped the entire patient journey across multiple layers. Blueprint Components:

Documents/Forms/Questionnaires - All patient-facing and provider-facing tools

Patient Actions - What patients do at each step (Line of Interaction)

Frontstage Actions - Visible provider activities (Line of Visibility)

Backstage Processes - Behind-the-scenes clinical and administrative work

Support Processes - Enabling systems (EHR, pharmacy, education programs)

Multiple decision trees at each stage

Detailed role definitions for 6+ different provider types (OB doctors, roomers, pharmacists, MFM specialists, neurologists, case managers)

Numerous parallel pathways for different patient scenarios

Extensive backstage coordination requirements

Multiple support systems that needed integration

In healthcare settings with limited time and resources, the most implementable solution isn't always the most comprehensive one. Providers need workflows that integrate into existing routines with minimal cognitive load.

The OB/GYN headache care pathway was accepted by Neurology leadership and formally proposed to the OB/GYN department. The workflow is currently in the implementation phase. With the new workflow, we expect to have:

Before vs AfterHow the solution addresses specific use cases:

We synthesized all ideation workshop outputs into a comprehensive service design blueprint that mapped the entire patient journey across multiple layers.

Blueprint Components:

We synthesized all ideation workshop outputs into a comprehensive service design blueprint that mapped the entire patient journey across multiple layers.

Blueprint Components:

Before vs After
How the solution addresses specific use cases: