Intake to
Incision
Service Design for Surgical Conversion
01.
Overview
My Role
Service Designer
TEAM
1 Service Designer
1 Physician
2 Clinical Researcher
SCOPE
UX Research
Service Design
Patient Journey Mapping
UX Proposal
Duration
Feb - Jul 2017
Shipped
Columbia University Medical Center’s orthopedic department was experiencing a surge in Korean patients—many presenting with severe, long-term pain. However, despite the growing volume, conversion rates from consultation to surgery remained low. This posed both a patient care concern and a significant financial loss for the hospital.
The leadership team wanted to better understand why these patients were dropping off before reaching surgical consideration and identify points of friction in the patient journey.
Shipped
In compliance with my confidentiality agreement, I have omitted and altered any confidential details.
02.Problem
Korean patient visit up,
surgical conversions down—why?
CUMC’s orthopedic department was experiencing a growing number of Korean patients—but very few completed the surgical journey. This resulted in poor patient outcomes and lost hospital revenue.
03.
Listening to users
The numbers told us something was off—but to understand why, I turned to the patients themselves. I spoke with 20 Korean individuals who had dropped out of the surgical funnel,
These conversations uncovered a key pattern: patients weren’t opting out of surgery because they didn’t want it—they were falling out of the system due to confusion, communication gaps, and lack of support.
04.
User Insight: Persona
Goals
Find relief from chronic pain after exhausting conservative treatment
Get clear, efficient care without excessive administrative burden
Feel respected and understood in her care journey
Pain Point
Language Barrier: calling the hospital and navigating the system in English was intimidating
Emotional Impact: Felt embarrassed after being turned away at the visit.
System Complexity: Unfamiliar with how to deliver all the requests.
“I didn’t know I needed to bring anything. I waited so long for this appointment. They said I had to go get the CD myself, but I don’t even know how. Maybe it’s just easier to go back to Korea for surgery—at least I’d understand what’s going on.”
Mrs. Park
A 70-year-old Korean woman living in Queens. After months of conservative treatment for chronic back pain, she finally booked an appointment—only to be turned away because she didn’t bring her imaging CD. No one had told her to.
Her story wasn’t unique—it reflected a broader pattern of breakdowns in care navigation, especially for non-English-speaking patients.
05.
Journey Mapping
mapped the full patient journey—from the initial call to post-operative follow-up—and identified multiple critical drop-off points:
🔻 Key Breakdowns:
Call Center Scheduling
No triage process. Patients without proper insurance prerequisites were scheduled with surgeons, only to be told later they weren't eligible.
Lack of Visit Preparation
Patients weren’t told to bring their radiology CDs or reports, leading to canceled visits and loss of trust.
Hospital Check-In Confusion
After checking in, patients—especially those with limited English—were unsure of where to go or what to expect.
No Guidance on Next Steps
Even when seen, patients didn’t understand how to move forward. Many didn't return simply because they lacked the information and confidence to do so.
06.
Designing the Solution
To address the root causes, I led the creation of a new service blueprint grounded in patient behavior and operational needs.
Service Blueprint
Patient Journey
Patient Action
Frontstage
Backstage System
Support Process
Pain Point
Call to Schedule
Initial Visit
Surgical Eligibility Review
Pre-Op Prep
Surgery
Post-Op Follow Up
Service Blueprint (As-Is)
Calls main line; struggles in English
Checks in; waits
Meets surgeon if seen
Told to complete conservative care (sometimes unclear)
Rarely returns
Call center books any open slot (no triage)
Front desk check-in only; no prep reminder
Surgeon discovers missing imaging / incomplete conservative care
Verbal instructions only
Patient must call to schedule post-op
Surgery scheduled weeks/months later
No screening logic; EHR doesn’t flag conservative history
Imaging not pre-validated
Insurance rules require documented conservative treatment
No centralized checklist
No automated post-op appointments
OR scheduling separate
No language routing
No pre-visit packet
No eligibility script
No patient tracking for pre-op tasks
Manual reschedule burden on patient
Standard clinical workflow (OK)
Wrong provider; language stress
Missing CDs → visit canceled
Surgeon time wasted
Patients confused; drop-off
Low follow-through, lost revenue
Patient Journey
Patient Action
Frontstage
Backstage System
Support Process
Metrics
Interventions
Call to Schedule
Initial Visit
Surgical Eligibility Review
Pre-Op Prep
Surgery
Post-Op Follow Up
Service Blueprint (NEW)
Calls; routed to Korean language line (or interpreter)
Arrives with required imaging & records
Correctly routed: surgeon vs. pain mgmt
Receives written + translated checklist
Undergoes surgery
Auto-scheduled post-op visit; receives reminders
Call center uses triage questions; selects correct provider
Staff verifies imaging checklist during confirmation
If no conservative care: routed to pain mgmt (not surgeon)
Nurse/coord shares “What to Expect” packet
Post-op appt scheduled before discharge
Standard surgical flow
EHR intake form captures conservative history flag
Appointment type tags imaging required
Insurance rule logic added to scheduling notes
Pre-op task tracker (checkboxes)
Automated reminder texts / interpreter note
OR booking linked to task completion
Triage script (EN/KR)
Confirmation call checklist
Routing rule sheet (eligibility matrix)
Printable + SMS checklist links
Follow-up schedule template
Shared surgical calendar
✅ Linked scheduling
% correctly triaged
% visits with complete imaging
% eligible at first surgeon visit
Pre-op task completion rate
Post-op visit adherence
Metrics
✅ Triage protocol
✅ Radiology prep comms
✅ Eligibility routing
✅ Pre-op checklist & packet
✅ Post-op pre-booking + reminders
Surgery conversion
Goal of creating this protocol was to prevent ineligible patients from landing on surgeon calendars; get them to the right conservative care first; reduce frustration + wasted slots.
Call Center Triage Protocol
Prefer speaking
in Korean?
Reason for visit?
(Back/Neck?, leg pain?)
Has patient had images (MRI/CT) in last 6 months?
Completed conservative treatment for 6 + weeks?
(PT, injections)
Offer
Korean-Speaking staff
Send Confirmation
Send Confirmation
Send Confirmation
Schedule with appropriate
orthopedic doctor
(hip & knee, sports med)
Schedule with PMNR/Non-Surgical physician
Schedule with a surgeon
Yes
Yes
Yes
Yes
Yes
No
No
No
Yes
Confirmation Call Checklist
Short Reminder (24 hours Prior- SMS)
Missing Image at Confirmation & Escalation Logic
Call Goals: Confirm visit, prep patient, reduce day-of cancellations.
Quick Script:
“I see your MRI was done at an outside facility. You’ll need to bring the CD and report with you. If you need help getting it, I can give you the number to call or we can request it for you—would you like help?”
Confirm appointment date + time + location.
Confirm preferred language; interpreter requested if needed.
Remind: Bring radiology imaging CD/DVD + written report (MRI/CT/X-ray).
If imaging done at CUMC? (If yes, no CD needed; confirm in system.)
Confirm insurance card + photo ID.
Confirm referral authorization if required.
Ask: “Have you completed physical therapy or injections?” Record response.
Provide arrival time instruction (arrive 20 min early for paperwork).
Provide callback number if patient has questions.
Reminder: Your orthopedic visit is tomorrow at [time]. Please bring your imaging CD and report if done outside Columbia. Reply 1 if confirmed, 2 if you need to reschedule.
Escalation Logic
Situation
Patient cannot obtain CD in time
Offer to reschedule or assist with record transfer
Avoid same-day turnaways
Patient unsure what imaging was done
Contact originating facility
Document
No conservative treatment but booked with surgeon
Re-route and notify patient ASAP
Reduce wasted slot
Action
Note
Increased Surgical Conversion Rate
After implementation, surgical booking rates among Korean patients increased by 28% over the following quarter. Fewer patients dropped off after their initial visit, and more progressed to pre-operative planning.
Improved Patient Confidence and Satisfaction
Post-visit surveys showed a 22% improvement in satisfaction scores among Korean-speaking patients. Interviews indicated higher trust in the care process due to clearer communication and expectations.
Protocol Adoption Across Departments
The triage process and confirmation call checklist were adopted by the entire spine surgery division, not just for Korean patients. This created a more standardized intake experience for all surgical candidates.
07.
Impact
OTHER PROJECTS
