BREAKING CLINICAL SILOS AND ORCHESTRATING A UNIFIED STRATEGY FOR SEAMLESS ADOLESCENT CARE CONTINUITY.

Role: Service Design Manager

Focus: Clinical Operations, Population Health, Care Pathway Design

Recognition: Finalist, Service Design Network Award (2024) and Don Norman Design Awards (DNDA) (2024)

Service Blueprint

THE CHALLENGE

How might we prevent fragmented care as patients age out of the pediatric system?

Transitioning from pediatric to adult healthcare creates a significant operational gap. Patients move from a high-touch, parent-managed environment to an adult system requiring high autonomy. At Intermountain Health, this discontinuity resulted in confusion, missed appointments, and a lack of medical adherence—particularly for patients with complex chronic conditions.

The initial scope focused only on high-risk patients. However, our investigation revealed a systemic failure: the lack of a standardized transition framework affected every adolescent patient, creating anxiety and operational friction across the network. We needed to redesign the journey not just for the sickest, but for the entire population of 250,000+ youth.

"THERE IS NO COLLECTIVE OR COHESIVE WAY TO DO TRANSITIONS; MULTIPLE CLINICS DO IT THEIR OWN WAY. BUT THERE NEEDS TO BE A MORE FORMAL STRUCTURE, DEPENDING ON THE CLINIC."

- Dr.KW, Primary care, Adult Provider

User research- Collecting feedback

THE STRATEGY & RESEARCH

We moved beyond a "one-size-fits-all" approach to design a Stratified Service Model. I led a mixed-methods research initiative to map the friction points and segment the population for targeted interventions.

Ecosystem Audit: We engaged 80+ stakeholders (pediatricians, adult providers, school officials, parents) through surveys and deep-dive interviews to understand the operational silos between departments.
Risk Stratification & Segmentation: We recognized that a healthy 18-year-old needs a different transition path than a medically complex one. We segmented the 250,000+ patient population by Medical Severity (Low, Medium, High Complexity) and Developmental Stage (Early Adolescence 11-14 vs. Late Adolescence 15-18). This allowed us to design tailored care pathways that allocate high-touch resources only where necessary.

Research, Synthesis and User Segmentation

THE SOLUTION

We launched The You & I Health Club, a patient-facing service brand that transforms the transition process from an administrative burden into an empowering milestone.

The "4 Moments" Framework: We structured the longitudinal journey around four distinct operational phases: Education/Coaching, Transition Kick-off, Warm Handoffs, and Establishing Adult Care.
The You & I Toolkit: We deployed a suite of tangible tools, including a patient-facing digital portal, age-specific transition checklists, and provider conversation guides. These tools facilitate "warm handoffs" and ensure that transition discussions happen proactively at every well-child visit.
Population Health Intelligence: In partnership with the Enterprise Analytics team, we developed a real-time operational dashboard. This tool gives leadership visibility into transition volumes and tracks exactly which "stage" of the journey every patient is in, enabling data-driven resource allocation.
Live Implementation: The solution is now active and live, serving patients across the Intermountain Health network (View the live site here).

THE OUTCOME & REFLECTION

CROSS-DISCIPLINARY IMPACT

The project successfully transformed a fragmented process into a scalable clinical product, gaining recognition in both medical and design communities.

Clinical Validity & Design Excellence: We bridged the gap between two worlds. The work was selected for presentation at the Baylor College of Medicine Quality Improvement Conference (demonstrating clinical efficacy) and the Service Design Global Conference (demonstrating innovation excellence).
Scale & Reach: The initiative is designed to scale systematically across the Intermountain network, spanning 7 states and establishing a universal standard of care that directly impacts over 250,000+ patients aged 11–18.
Operational Standardization: We delivered a unified roadmap that eliminated ambiguity for providers, replacing ad-hoc transfers with a structured "Warm Handoff" protocol.

REFLECTION: SYSTEMS OVER SILOS

Designing for Autonomy: As a physician, I was trained to treat disease. This project taught me to design for capability. The success of the transition wasn't about the medical record; it was about the patient's confidence to navigate the system alone.
The Universal Pivot: The decision to expand from "chronic only" to "all patients" was a strategic risk, but it proved that inclusive design often yields better systemic efficiency than targeted fixes.
Silos are Safety Risks: This work highlighted that the most dangerous place in a hospital isn't the ER—it's the empty space between departments. Strategy is the only discipline that effectively bridges that gap.

“FROM MY PERSPECTIVE, NIRALI HAS LED THE EFFORTS ADMIRABLY. SHE WAS ALWAYS HELPING US MEET THE TIMELINE... [AND] HAS BEEN AMAZING AT FINDING SOLUTIONS/IDEAS TO MEET THE IDENTIFIED NEEDS FROM OUR PATIENTS‘ AND STAKEHOLDERS‘ SESSIONS... I AM PLEASED WITH THE PROPOSAL THAT HAS BEEN PUT FORTH. THANK YOU FOR THE PROFESSIONALISM, EXPERTISE, AND FRIENDSHIP/TEAMING...”

- Executive Clinical Program Director of Childerns Health

TEEN-TO-ADULT HEALTHCARE TRANSITION