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Category Archives: Design Education

Oh Capital Metro App… mapping the pain

In our first assignment for Q2 in the Rapid Ideation and Creative Problem Solving class, we were tasked to deconstruct and analyze the current state of the Austin Capital Metro mobile app. The goal of this project is to find the obvious inefficiencies in the system structure, and map them out in a visual “Concept Map” of touch point, or areas of interaction with the app that we personally deemed important to the end goal the user is attempting to create. After mapping our version of the current state of the app’s system design, we then created a new, first iteration, of what we thought would be a good starting point for the optimal system flow for completing the task of 1. planning a trip, and 2. purchasing a ticket to be able to take the trip you need.

Below is my Concept Map of the current system flow of the Capital Metro app on a relatively high level. ConceptMapAsIs-01

The main issues I found with the current app was not only the general confusion in the interface, but the redundancy of information, when things could easily be consolidated for ease of use.

Below is my first iteration of the basic system flow for a re-design of the app. The first screen being an actual geo-located map of where you are in the Austin, and what bus stops are surrounding you visually represented by clickable icons that give you more info about the bus, the schedule, and the route.

ConceptMapIdeal-01

I also believed it was important to be able to store information about your most valued routes, and easily purchase tickets within the app both in the constant navigation bar as well as during the establishment of your route choice.

Posted in Classes, Creativity, Design Education, Design Research, Interaction Design, Strategy | Leave a comment

Ux for Good: Hidden Patterns In Rwanda’s Reconciliation

This post is my fourth post in a series on the UX for Good design challenge. Check out the first post: UX for Good Introduction to get a better understanding of what the UX for Good design challenge is about.

Writing throughout the challenge posed to be a bigger challenge than I thought; given the time spent traveling and doing actual work.  But I plan on continuing these posts as this project progresses.

 

 

“Simplicity is reached on the other side of complexity.”

My former manager Frank Lyman often uses this metaphor to describe a pattern he’s observed when people work through complex problems. After reciting the pull quote, he often states something to the effect of:

“Imagine a bell curve.  At the left side of the curve is a blissful state of unaware.  As you move from left to right, the level of complexity (and often anxiety) goes up and up and up.  Just before the pinnacle of this curve, we often find ourselves in the most chaotic state. Everything is conflicted, none of the parts make any sense, and it’s really unclear as to where everything is going. Then you realize what needs to be done and you arrive at a state of simplicity; a state that could only have been achieved by going through the complexity.”

 

I’d like to think that the point at the top of the curve is a moment of ephiphany.  Sometimes it’s your own doing, but more often than not it comes from a rigorous process or a casual observer; who simply notices the right thread to start pulling on. Not to say that our team in Rwanda wouldn’t have discovered the “right path” if left to work through it – but we would have lost a significant amount of time (needed to do good research) if left to our own devices. Three days on the ground in a place that takes 12 hours to access leaves little time for error.

The three days of research conducted in Rwanda fell into this pattern, but with the steepest logical and emotional upswing toward complexity I’ve ever experienced. Our entry into the curve started with the Kigali Genocide Memorial.

The Kigali Genocide Memorial (KGM), crafted in partnership by local Rwandans and Aegis Trust, was built to commemorate victims of the 1994 genocide; giving Rwandans a place to bury and remember their loved ones and document their history. The center itself is a museum that sits next to a series of mass graves, where over 250,000 are buried.

 

Walking past the graves, it’s extremely hard to comprehend the number of people that lie within arms reach.  Each one, a person, with a family, a story.  Each person with hopes and aspriations just like any one of us. But no longer. One of the Aegis employees tried to give us a sense of scale.

He said, “picture a stadium.  A large one – say the Dallas Cowboys stadium – holds 50,000 at best?  Now multiply that amount of people until you get to around 250,000.  That is how many rest here.”

 

So I stood there thinking about the sheer mass of 250,000 people – and how they managed to fit all of them into a space that really isn’t much larger than a 1 acre backyard.  “How big are these graves if they hold that many people?”, I asked.

“Most of the bodies aren’t completely whole..  We know they are different people because of the size, shapes and placement of the bones, but each coffin is filled by the bones of multiple different people. We don’t have most of the names either, because there are no written records – and anyone who would have been alive to note a missing person was also wiped out.”

 

As hard as it is to summarize the feelings you have while standing there – it’s even harder to capture them in a manner that can be conveyed to others. You feel sick – yet emotionally detached.  You know what you are hearing is awful…  Yet you are unable to truly understand it. It wasn’t until our first Contextual Inquiry that the feeling really sank in, and the team moved up the curve of complexity.

 

Prior to going into the museum, I had the chance to do an interview with a survivor. He must have noticed my “absence of self” expression that lingered for about an hour as I sat on a bench just outside the main entrance.  A face I noticed on almost every one of my fellow designers during the first day of research. The man sat down and began to talk to me about the memorial gardens and the city of Kigali. After some brief back and fourth, he gave me an entirely different perspective on what this place meant to him.

“This place is home to me.  It has the bones of my mother and my father… I’m still looking for the bones of my brothers, my sisters, my cousins, aunts and uncles… Someone out there knows where they are, but they just aren’t saying anything… But my parents rest here. Here, they are no longer in the bush.”

 

As a design researcher, you are rarely caught off guard during an interview.  Your job as a facilitator is to feel out potential avenues of exploration in real time – responding to the participant’s statements, actions, and reactions – such that you might uncover their perspective in a particular context. The interviews that we did over the course of 3 days in Kigali were exceptionally difficult – not necessarily because of responses like the one above, but because of the way a person’s demeanor would change throughout the interview. Each person we talked to would drift away at some moment while they were telling us stories, or politely answering our questions.

Their eyes would shift in such a way that you would swear they were watching something horrible happen just over your shoulder.  They didn’t frown.  They didn’t smile.  They just watched. Watched something you could feel but never come to understanding yourself. Watched something they have probably replayed over and over for the past 20 years since the genocide, and all the while, attempting to do their part to make us feel as comfortable as possible. This was heart wrenching.

These experiences moved the team further up the complexity curve.  In addition to not having a direction to start aiming our research, we were now emotionally invested with the people who were kind enough to share their stories.

 

While some members of the team spoke with locals and visitors, others moved through the museum portion of the memorial.  The museum itself is 4 – 5 stages of audio and visual walkthrough of the historical markers that led to the genocide, personal accounts of the 100 day event, a brief overview of the international response, subsequent actions of recovery, and finally remembrance and dedication to lost loved ones.

While the memorial seeks to serve as a point of education for the Rwandan people, the customer journey has quite the opposite effect. Many visitors, both local and foreign, described their emotional state as “broken” upon leaving the exhibit.

 

“What did I expect?  I just totally got smacked. [crying] I just got hit…. I watched readings, I watched tapes [of the genocide] but it was so distant. They were not useful… I could not understand [until I came here]. I came for someone who lost about 34 members of their family.  I couldn’t understand how 34 people can be killed.. It was people cutting and hacking.. It was your next door neighbors, people you grew up with, people you lived with…”

 

Our own design team even struggled to come to terms with the profound sense of loss that immediately follows a visit to the KGM. At some point during our second day of research, while gathered to plan our few remaining hours on the ground, we reached the pinnacle of complexity.

In recapping the days activites, doing a mental inventory of the research opportunities we had left, and feeling the pressure of the ticking clock, one of our team members opened up with frustration. He said, “How are we supposed to research this if we can’t get over it ourselves.”  We are supposed to document as much of this experience as we can, yet we are paralyzed by the immense amount of pain and loss.

 

What happened next was our moment of epiphany.  Jeff from insight labs connected the dots we were unable to see.

“Maybe this is the point..  If you all are so conflicted as a result of being here, that you can’t get anything done, how do we expect someone who isn’t going to be here for this many days to be able to reconcile the feelings into some form of sustainable action?”

 

The design brief suddenly made sense – “The problem we’re trying to solve isn’t just genocide and isn’t just museums.  Rather, it’s the gap between the way we remember the genocides of the past and how we act to prevent the genocides of the future.”

We’d been so focused on the types of actions someone can do to identify and prevent future atrocities that we missed the real problem. Experiences like the KGM leave you so broken that you are unable to act in any capacity, much less one that requires empathy and some form of critical thinking.

Aegis Trust partially recognized this deficiency when they created a traveling education exhibit, based off of the original narrative in KGM. On our 3rd day of research, the team drove out into rural Rwanda to see this exhibit and speak to the community educators. The tone and narrative of the education exhibit was almost the opposite of its predecessor at KGM. While it told the same initial story, this exhibit ended with stories of people working together as a means to emulate model behavior.

 

“Have you seen the exhibit at KGM? Yes?  Then you can see the difference.  At KGM, you get to the end and just go ‘poof’; but with this one [educational exhibit] that happens very quickly.  Users go through the hard part, but then also the uplifting part; realizing some of the possibilities that are there.”

- Morley Hanson, Aegis Trust

 

The groups of school children who arrived from nearby villages left with renewed compassion toward their fellow countrymen and a motivation to correct wrongdoing in their own lives.  The traveling exhibit not only transferred the values of critical thinking and empathy, but it was able to contextualize examples of supportive behavior that rural villagers could emulate every day.

After seeing this, it became obvious to the design team that one key to generating action was to provide examples that locals and visitors could see in their daily lives.  We would need actions that ranged from easily achievable to aspirational. This would provide “humanitourists” the ability to gain confidence that they can affect change and the realization that there is more that can be done.

 

Our final 24 hours of research in Kigali was focused on interviewing visitors of the museum and observing education workshops conducted by Aegis Trust.  One of our first participants, a youth leader on his 4th return to Rwanda, gave us another clue into the recipe for creating sustained action. He described an interaction with his grandmother upon returning from his first visit to Africa.

She asked him, “Did you get that Africa out of your system?”
“No..  In fact, it’s just starting… A missionary had started a school here and they needed someone to run it.  So I came, moved my family, and ended up having my son here.”
 
 

The youth leader had just described his trigger for action. A pattern we noticed in multiple people during our final day of interviews.

Upon hearing moments of “triggered action” from dissimilar participants, the design team began to wonder if it would be possible to manufacture trigger moments within the memorial?  Or at the very least, be in a position to provide resources for action when “primed” individuals reach a moment of potential action after returning home.

The youth leader continued to describe another key to his continued involvement.

“I have a friend here named Erik [his name has been changed to protect his identity].  His entire family was killed in the genocide.  He was called to be a witness against the guy who killed his entire family. So he went and said – this is what happened – but he forgave him. He said, ‘he’s done something horrible to me, but if I do something horrible to him, I’m no better.’”

 

The youth leader was describing a second pattern for sustained action. Motivation that was sustained by a connection with a real person.

“I no longer run the school here in Kigali, but I do bring groups of students to Rwanda.  This is my 4th time back.  We talk about this trip as being a series of contrasts – ups and downs.  We are here this morning, reviewing the history, and then we are going to drive out to a school to see kids that are so full of hope and life.  I think that Rwanda is a story of growing redemption and hope.  If we just have one side of it, we are missing the full picture.”

The youth leader had hit upon another pattern we discovered in multiple western groups who were touring Rwanda.  Each group had modeled a tour that included multiple moments of “ups and downs”.  They had independently discovered that balancing turmoil with hope created opportunities for connection within each of their participants.

 

There seems to be an underground culture of “humanitourism” taking place in Rwanda.

While it’s fair to say that people who make it to Rwanda to visit the genocide memorial are already predisposed to some type of action.  Rwanda itself isn’t a very large tourist destination.  Most visitors have to go out of their way to enter the country to see the gorillas or to go to the genocide memorial.  Very few happen to stop by as part of a day-trip to other sites within Rwanda or it’s bordering countries.

The design team began to wonder if we could amplify this concept of humanitourism.  Is there a market for people who are looking to be inspired by the acts of kindness and reconciliation that are taking place in this small African country?  If so, would we be able to model a series of experiences that activate people to participate?

These were just some of the questions we had upon finishing our research in Kigali.  In my next post, I’ll talk about how we took these data points and synthesized them into design recommendations for Aegis Trust and the Kigali Genocide Memorial.

Posted in Design Education, Design Research, UX For Good | Leave a comment

IDSE 402 Putting Context To Design

After reading the assignments for IDSE 401, I completed a chart to depict the different authors point of view. On one access I thought of showing a linear progression between future design and traditional design. To me this represents how I felt the authors focused on when deciding how they want to make design decisions. 

The authors on the bottom part of the chart used more traditional examples to depict the environment to make informed design decisions. When discussing emotions I feel that they are trying to focus on a more humanities approach to design. This would involve areas such anthropology, philosophy, and sociology to inform the designer on where to discover clues when making decisions.

The authors on the top use more future (not currently existing) design ideas to make decisions. Sanders is the best example of this with her emphasis on the individual that is the ideal user being the center of all decisions.

-Chart depicting the different understandings I interpreted from the reading.

The half of the graph showing Human Focused/Computer Centered is how I feel the authors view interaction. The authors on right side explore the ability to allow technology to function ethnographically. While the authors on the left support methods of human to human ethnography. The authors in this section depicted the human computer interaction relationship and the process of ubiquitous computing. On the the far end of this chart is Mann and his discussion of engaging technology to capture every aspect of his life. I feel it pushes the interaction of computer centered design. Altogether the readings depict important fundamentals when exploring environments for design.

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Designing Meaningful Models for Interaction

Recently our class has been exploring modern design history and its intertwined relationship with computing technology and approaches to human and computer interactions.  Technology is both active and contextual in our lives and as a result any discussion of how humans and technology is characterized by both granular detail and broad societal trends.

Designers are rightfully wary of the effects of amplification that are possible through modern technology.  Industrialization showed us the immense power and terrifying unintended consequences of amplifying design ideas.  And in the computer age we have seen many of the same naive, shortsighted views that characterized industrialization repeated in new mediums.

In one of the articles we recently read, Steve Mann advocates for the use of a video capture device that will record every moment of our lives and act as a filter for our perspective of the world.

Having an on-demand photographic memory can help all of us by offloading, to a wearable computer, the task of memorizing now-mundane details that might only later become important.

I couldn’t help but think of the idealized representations of home life in mid-century advertisements for appliances and how they would free women from the arduous everyday tasks.  And while Mann’s perspective may have seemed extreme not long ago the introduction of google glass clearly demonstrates our willingness to continue to hand off tasks to automation.

In another article, Paul Dourish explores (among other things) how our everyday activities shape our view of the world.  Out of this view we begin to see technology that simply attempts to model and replace human activity more realistically: in severing out connection with the environment around us through our activity, we lose our ability to make meaning of the world.

Practice is first and foremost a process by which we can experience the world and our engagement with it as meaningful. As technologists, then, our concern is not simply to support particular forms of practice, but to support the evolution of practice—the ‘‘conversation with materials’’ out of which emerges new forms of action and meaning.

Dourish’s wider point is about how the people that we interact with and the social norms that we establish inform, shape, and ultimately collaborate with us to establish the context from which we make meaning of the world.

In another article that Dourish collaborated on this idea manifests into an important implication for designers who wish to affect people rather than divorcing them from meaningful experiences.

This requires a shift from designing systems to model and transmit emotion to designing systems that support humans in producing, experiencing and interpreting emotions.

As designers we design for people to able to understand and use our systems efficiently.  The computing mediums that interaction designers often bring ideas to life in are biased toward an information based approach to the world that relies on representational models.  And so designing for people by creating computational models that match the observational models we see in the world becomes a natural extension of modern mediums.  But over time this disconnects people for the everyday world and leads to hollow, filtered interactions with the world around us.

Liz Sanders explorations in co-design offer a relevant counterpoint to consider.

People are naturally creative. As designers of scaffolds, we need to give them participatory tools to promote generativity in their thinking.

Sanders describes the designer’s role primarily as a facilitator: a conduit for other’s creativity.  I think Sanders overreaches in pushing all of the active creativity out of the realm of the designer and so I think her model is flawed as a model for methodology in the design process.  But they may offer a powerful model for how to think about the systems that interaction designers put into the world.

As with so many themes in design, the ethic for a designer emerges as a tension between competing needs.  Our medium requires us to think about how to leverage information models and our subject requires to consider how to create interactions that lead to meaningful understandings of the world.  So our task becomes to explore interaction scaffolds that give people the opportunity to create their own meaning and then create models of these scaffolds that are appropriate for the medium.  In this way we design systems that embrace the new interactions that are only possible in new mediums rather than simply creating a virtual shadow of meaningful interactions.

Thoughts?

-Scott

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Health Records: Reflections and Opportunities

As graduate level students at the Austin Center for Design, we are leveraging interaction design methodologies with the purpose of creating social change through double bottom line business endeavors.  Our design process is characterized by three distinct, interdependent phases: research, synthesis, and prototyping.  Over the course of the one year program at ac4d, students aim this process toward wicked social problems.

For the last eight weeks, our design team (consisting of Bhavini Patel, Jacob Rader, and Scott Gerlach) has been researching and making sense of the complexity in the health record system.  We conducted three weeks of qualitative research focused on how patients and medical professionals interact with each other and in which ways the documentation and artifacts created in that process affect the care given and received, respectively.  We had a specific interest in studying this topic through the lens of patients who are at risk due to insufficient insurance and access to care as well as people who face challenges like chronic or concurrent health issues.

Through our research process we had the opportunity to inform our intuitions by putting ourselves in context with people and orchestrating opportunities for them to share their latent knowledge and informed understandings of themselves and how they relate to the healthcare system.  As a result, we were able to develop rich mental models of the people we met and the challenges they face.

In synthesis we took this research, externalized it and started making sense of it.

Once put into malleable, moveable forms we created groupings of data that seemed related.  Our research area was so large that we found it necessary to arrange these groupings into broad categories.  Subsequently, we took these broad categorical groupings and went back into the details of the data to see if we could see a meaningful narrative forming across each broad category of the research.  This is inherently a deeply biased and subjective process meant to provoke new ideas and identify meaningful opportunities for impact through interaction design.

What follows are articulations of our design team’s shared understandings which were synthesized through this rigorous process.

 

Bureaucracy

The healthcare system is multifaceted and very complex.  As hospitals and clinics have consolidated and formed into larger heath entities, the systems and tools that they’ve created to manage that complexity have also grown.  As these systems of organization have rapidly dilated, they’ve outgrown their supportive role and now occupy an authoritative one that is creating it’s own layers of complexity.  Sadly, it’s primarily this bureaucratic structure that sets the tone for how, when, and why care is delivered to patients.

We were able to engage with these systems contextually: touring medical facilities, spending time in records departments, and interviewing nurses.  When you spend time in this world it’s hard to not recall the opening sequences of the movie Brazil, where our harried technocrat tries to navigate a convoluted and confused world of files and procedures.  We met some of those technocrats.  Probably more than anyone else in a hospital, they see the hospital’s behavior on the whole because they have to interact with every part of it. They’re smart, talented problem solvers who are constrained by both a system that is overbuilt and a dearth of qualified people who want to do the work.

A majority of the time spent by a doctor is not visiting with patients, it’s filling out paperwork and documenting their procedures; in many cases they have to retell the same story in multiple formats in order to appease the requirements of the system: the records department, the billing department, and the legal department all of which draws their attention and energy away from patient interactions.

As daunting as this systematic problem is, we are compelled and convinced that it is ripe for design solutions.  A co-created medical document, where the doctor and the patient create the record together would allow the doctor to spend more time with the patient and help build understanding and consent while still obliging the hospital’s bureaucratic requirements.  There is also the possibility that if we put more power into the hands of the people that know this space, those heroic technocrats, they could build a more robust, agile system to better serve everyone’s needs.  Finally we feel that the biggest potential comes from the patient side. If patients have a way to become more engaged and invested in the record system the balance of that system would shift from a focus on legal and billing toward patient understanding and stories.

 

Patient Stories

One of the most stark disconnects we observed in the medical care system was between two parties we would expect to have the strongest relationship: the doctor and the patient.  The disconnect is created on both sides.

Doctors expect a patient to have an understanding of their own health and to articulate it quickly. Of course this isn’t the case in practice and as a result doctors treat patients articulations anecdotally and have relied more on tests and metrics to determine a patient’s health.  This in combination with faster appointment times and less contact with patients in the context of their day to day means that doctors don’t develop a deep, intuitive understanding of their patients.  

Patients don’t have a good way to manage or tell their health story.  The way the modern health system is built, we often see multiple new doctors and the prospect of starting over with a new doctor can be exhausting for a patient.  Many people have a binary view of their own health: sick or healthy.  Since they don’t feel heard or well understood in interactions with doctors, they are less likely to have a meaningful dialog about their own view of their health or develop a more nuanced and autonomous approach to their health care.

Additionally, patients don’t have authority over their own health story.  Healthcare providers own and manage patient records.  As a result the most tangible versions of our health history are spread out, fractured, and obscured from us making it almost impossible for patients to see or understand an authoritative narrative of their health.

At present medical records exist as part of the billing cycle, but we see the opportunity to craft a two part medical record, one part that exists similarly to the current system, with metrics and test results, and a second part that is a narrative around the patient’s health.  These records could be built cooperatively between patients and doctors and would be a living document that would travel with a patient no matter where they went or who their doctor was.

Patients need to tell their stories, and doctors need to understand a patient’s history.  This dual record system would lead to more patient ownership and engagement in their own health and a more productive contribution in the patient-doctor dynamic.  In turn, doctors would gain more respect for and reliance on a patient’s perspective on their own health which would help restore the trust and intuitive understanding that are crucial to patient and doctor interactions.

 

Healthcare as a Bully

When we have health issues and emergencies, in many ways we become victims of our own health.  When we enter into the healthcare system it’s usually when something is wrong.  Once in that system, our choice and control is stripped away from us and reduced into a the form of a yes or no question; will you accept care?  And, of course, that question is loaded with huge and often obscured implications.  If we choose to reject care we’re denying ourselves, in some cases, life saving procedures.  But by accepting care we’re agreeing to accept it at poorly communicated outcomes and ambiguous costs.  And the price ends up being entirely disproportionate to what we normally expect things to cost.  One of our participants, who had insurance, incurred $30,000 worth of debt from her accident, that’s on scale with other large ticket purchases we make in our lives, like a car or a house, but without the planning that’s associated with those items.

As we are making some of the most impactful decisions in our lives, we’re turned into consumers and denied the tools to apply critical analysis by the lack of information and emotional context.  Furthermore, during our recovery, we are hounded by hospitals and collection agencies, bullying us for payment. It’s not surprising that the lasting impression for patients is that the very system that should be caring for us ends up victimizing us.

Everyone is constantly calling you and sending bills and all this stuff about how much you owe and why you owe it… I remember talking to someone about it and being in a hit-and-run and how it would be better if the person would have stayed.  And I remember being so frustrated because, of course I know it would be better if the person who hit me would’ve stayed and given their insurance information, but the fact that they didn’t… it’s not helpful to me as a victim of a hit-and-run.

- Participant B

[Is there any any item or, or place that makes you feel anxious in your house?] I guess the mailbox, but it’s not in my house.  But I guess the mailbox is where I have the most sense of dread. I hate getting the mail … ‘cause there’s bills in there and I hate them bills.

- Participant K

We think healthcare providers will benefit greatly by being exposed to and embracing a view of themselves as patient centered services.  They must give weight to supporting the healthcare needs and all the surrounding service touchpoints with patients.  This would leave patients with better perceptions about the care they receive and make them more likely to engage in outpatient care and adhere to treatment and payment plans.

 

Care vs. Perceived Care

Fundamentally healthcare is a service. There isn’t a tangible product that we get from the healthcare system. We go to the doctor to get care; they’re called healthcare providers.  As we went around talking to individuals and hearing their stories it’s clear that, as patients, we have built a mental model and understanding of healthcare as a service.

The breakdown comes around the fact that healthcare providers don’t view what they view as a complete service.  Their focus is on the life and death decisions and care that they provide, and rightfully so.  But by ignoring all the other aspects of their service, health organizations are fundamentally driving people away from engaging in their system in a more proactive way.

Even if you save someone’s life, if you treat them poorly throughout the rest of the process and bully them, you drive people away from the very system that they need.  When people have a negative experience with a service they are less likely to engage in that system again.  The healthcare system is unique in that, for the most part, people can’t avoid it completely, they have to engage in care when their sick.  This creates a mental model for patients that healthcare is only for when you’re sick, and in turn individuals ignore preventive care that in the long run would improve their overall health and reduce costs.

A significant disconnect is that healthcare providers don’t seem to see what they do as a service. This is reflected in even something as simple as the word patient; it implies that we need to be “patient”. The negligence of many of the service touchpoints leads patients to have worse outcomes because it encourages systemic procrastination which turns health problem into health emergencies.  If healthcare providers looked at what they do as a complete service, not just one focused on saving lives, they would create better outcomes, both in an individual’s health and experience, and would encourage better engagement overall.

 

Informed Consent

Interactions between doctors and patients are layered with complexity and mismatched expectations on both sides.  Patients expect doctors to offer packaged explanations and solutions.  Doctors expect patients to be able to absorb information rapidly and adhere to treatment plans outside of care.  Increasingly, doctors have less time, less context, and less familiarity for each patient and naturally there is less comfort, honesty, and trust reflected from patients toward doctors.  Meanwhile, the decisions that both doctors and patients are asked to navigate through these stressed interactions grow more and more difficult because of increased bureaucracy, cost, and latent social factors.  Overlaying these themes together, it’s no surprise that Informed Consent–a clear appreciation and understanding of the facts, implications, and future consequences of an action–is often not really achieved in these interactions.

It seems unlikely that doctors will magically have more time for each patient or that healthcare options will suddenly become less complex or expensive.  There seems to be a clear opportunity for interaction design, in particular, to significantly impact both patients and doctors through the creation of mutually beneficial, agile activities that help doctors foster better rapport of their patients and help patients build a more relevant understanding of their options.

One example of this, observed in our research, was a surgeon who hand-draws the basics of a surgical procedure in front of patients and uses the process to facilitate an open, questioning dialog.  

The creative process serves as a series of queues for her to ensure that she is covering all of the pertinent information with a patient as well as naturally pacing the interaction to give space for her to address questions and assess comprehension.  The activity also builds trust between her and the patient as a result of her ability to distill a complex procedure into a simple sketch that shows them important details like where incisions will be made, how surrounding anatomy will be affected, and what to expect in terms of outcomes.

An area we are interested in pursuing is in piloting a series of creative articulation activities with a healthcare provider as a means of facilitating more consistent and robust versions of informed consent and less erosion of doctor and patient trust.

 

Behavior Change

Long-term, self destructive, habitual, behavior is pushing itself to the center of the healthcare crisis.  Like many of the issues related to this problem space, there is an imminent rising tide without any clear plans of action.  The most serious health issues that people are being treated for are largely the result of the lifestyle they lead.  Diabetes, obesity, heart disease, liver damage, renal conditions and arguably even cancer and HIV result in part from negligent or destructive lifestyles and require persistent care plans that overwhelm the system on a logistical and financial basis.

Surprisingly, the medical professionals we interacted with don’t seem well equipped to help patients change their behaviors.  The general approach to many chronic conditions like diabetes involves regular, knowledge-based educational meetings with a medical professional.  And while these meetings are a good first step, they are inherently discrete. After consulting experts in behavior and habit modification like nutritionists and dieticians, we think a continuous approach with an emphasis on the patient’s development of tactics is more appropriate. One registered dietician we spoke to relayed a compelling story about her “non-compliant client”:

I would tell her what to do, but she never would do it. She still would keep coming back.  She still paid me, you know?  Every time … every time we talked, she paid me, um, and then suddenly, she shifted. And I was like, well what, what happened?  She went on a trip and it was like a … a mission, like a helping the children trip, right?  And she saw a picture of herself that wasn’t her.  Like the … the photo was of like 2 kids or whatever, but like her belly somehow made it into the photo and she was like, whoa, you know?  She kind of finally saw herself, but she had to like be in this other situation. And she was just like I’ve got to get it together.  I’m helping these kids in Africa like for wealth in their orphanage and you know?  I’m over here and not dealing with my own … my own stuff.  Um and it clicked and then she used all of the stuff that we had talked about for the last 2 years and like immediately dropped like 80 pounds.

-Participant PB

In many ways, behavior change can be hard to pin down because the moment that a patient changes their motivation is inherently serendipitous and the triggers for their behavior may not be easily identified.  This can feed into a false perception that behavior change is out of the hands of healthcare professionals.  But we believe just the opposite is true, no one is in a better position to give patients a reflection of their own behavior and create opportunities for motivation changes and awareness of triggers.

It’s obvious that if new tools and technologies are not developed and aimed at the issue of behaviors that are destructive to health, the system will not be able to address the volume and persistence of chronic health problems in the future.  The first steps are to help medical professionals make more meaningful probes into client behavior in their initial assessment process and leverage that to create greater trust and dialog in treatment plans.  Since interaction designers are already utilizing ethnographic techniques and cultural probes to reveal human behaviors and motivations, there are many opportunities for meaningful adaptations of existing practices.

 

Healthcare Encourages Misuse

Among the themes we observed in the healthcare system, one of the hardest to unwrap was the self abusive cycles that are gridlocking many healthcare facilities.  Consider an uninsured person who suffers from chronic renal conditions.  In Austin, they don’t have access to dialysis outside of emergency care.  The consequence: they wait until they are so ill that they qualify for hospitalization, they are admitted through the emergency department (which cannot deny them care), they receive life saving dialysis, and then they leave the hospital and repeat the same process over the next three-four weeks.  The hospital absorbs the loss (and ultimately has to compensate for it by charging more for care or cutting costs elsewhere) even though the patient could receive regular, less costly care that results in better patient outcomes.

On a broader scale, this sort of misuse of emergency care–as reactionary stop gap for challenges like chronic illnesses, mental health issues, and addiction management for populations without adequate healthcare access–reinforces poor mental models among at-risk populations.  Patients who finally get access to care via emergency room hospitalization are likely to return straight back to the emergency room in the future to attempt to gain access to any level of care.  One major healthcare network, here in Austin, calls these patients “frequent flyers” and has devoted staff and developed procedures for coping with the demands these patients put on the hospital.  In short, the hospital is forced to adapt and try to address gaps in other areas of the healthcare system because they are the last line of defense.  Paradoxically, the more the hospital adapts the more it attracts a disproportionate number of uninsured patients and the more difficult it becomes for the hospital to maintain a healthy revenue cycle.

Healthcare networks, particularly those in urban areas, have the opportunity to address the needs of the at-risk populations as well as reduce their own costs by taking a holistic approach with an emphasis on facilitating proactive efforts and maintenance care.  Put another way, they should emphasize outpatient care that reaches out into communities rather than inpatient care that is forced to catch everything that comes its way.

We see an opportunity to create pilot programs with local hospitals (in conjunction with city services like the Medical Assistance Program here in Austin) that develop mobile, durable medical records that are tied to proactive care, city transportation, and appointment services.

 

Holistic Care

Our research process gave us the opportunity to engage people who are facing many concurrent challenges in conjunction with managing their healthcare.  We talked to a homeless man who self identifies as alcoholic and bipolar.  He describes taking his bi-polar medication regularly as an attempt to do something healthy for himself and create some stability.

Well, yeah. Dealing with issues on the street, and I try to carry my medicine with me, like 24-7 a day, in my bag there. It goes there with me, but it’s not guaranteed that I’m going to take my medicine every day because it’s just … I have… not substance abuse, but I drink a lot. Sometime that will keep me … Well, anyways, there a lot of stuff that goes on with everything; literally, you live on the street being homeless and all, dealing with issues. Then the alcohol doesn’t help either when you … I like to say, that’s my best friend. I don’t know what I would do without it; but now, the doctor’s telling me that I might have to … well, I need to stop.  Basically, just dealing with bipolar and everything.

I am 53 years old, and it’s coming to a point where I just need to focus on my health. It’s kind of hard, but I think in my house it’s sitting at about 100, 170 on the housing list; so, maybe I can focus on me taking my medicine and be healthy. I think God is with me. That God is with me. I just want to be better. I want to feel better. If I move I can take my bipolar medicines and stuff, that I would feel better. Yeah, maybe I might not want to have that next drink; so, I think that have a lot to do with it, me not being all night. It puts me out there on edge.

-Participant L

We talked to many people like Participant L who were having a hard time finding any points of stability in their lives to build on.  Somewhat surprisingly, we found a counter-trend among many homeless veterans who have access to VA care.

Okay, here’s my situation. I was in prison for 26 years. I was just released last year. When I got out, I wasn’t able to get a job right away. In fact, I’m still unemployed, but I’m a student. Without the VA, man, I’d be in a bad, bad, bad position. I’m really thankful to them that they help me.

Yeah, because I’m being treated for hypertension. The main medical issue that I have right now is hypertension.

With the VA, they schedule for me. They schedule for an appointment. They try to do it every 90 days. If you have an appointment that should come up before that, then you can always go, and they’ll schedule you an appointment.

-Participant N

In talking to homeless veterans, this theme was repeated over and over: their perception was that they had a much more stable and manageable relationship with healthcare than those around them without access to the VA care.  They also expressed that they knew the VA had their medical history and relevant paperwork.  The doubt and uncertainty about where and how they would receive care was minimal and they knew they could rely on the VA to contact them and set up appointments on a regular basis.

It’s unclear how the VA compares with other healthcare facilities in Austin on the basis of actual treatment of medical issues.  What is clear is that as a service the VA performs much better and as a result, it’s clients are much more likely to engage in proactive care.  And actually, it’s a mistake to decouple the two forms of evaluation because they are linked together by the affect they have on patient stability and behavior.

Our conclusion is that healthcare providers need to be much more holistic in their approach: especially as it relates to the logistics of getting patients in a routine of regular appointments and helping them prioritize their medical care.  There are many design opportunities in this area: like responsive appointment systems that operate through text messages or repurposed atm machines (or kiosks, etc.) to help patients engage in care more regularly.  We think this would be especially successful if it also helped address transportation logistics and tied itself to existing care services for at-risk populations.

 

Going Forward

Our design team is currently developing ideas for businesses and then narrowing to one that we feel has to most opportunity for a sustainable model that creates the largest social impact.  Now that it’s exposed publicly, we are excited about questions and comments related to our work on this topic.  If you’d like to share you thoughts, experiences, and insights or just give us feedback we’d love to hear from you at HealthRecords@ac4d.com

Thoughts?

-Bhavini, Jacob, and Scott

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Redesigning a Thermostat: Final Thoughts

In Rapid Ideation and Creative Problem Solving, we invested eight weeks of time into redesigning a Honeywell Thermostat’s Interface.  On a micro level this has been about tweaking the placement of a lot of pixels from week to week and spending entirely too much time thinking about temperature.  However, on a broader scale what we’ve been learning through practice is how to rapidly articulate ideas, produce meaningful representations of them, and coerce meaningful feedback from users.

And all of those skills mean that we can confront a problem space and apply our unique frame as designers in a creative, iterative process that leads to more meaningful interactions.  So although I don’t care much about thermostats, I thoroughly enjoyed the challenges we’ve overcome in the last quarter.  And I ended up with a design that I’m proud of:

You can also check out the Wireframes via User Flows

Although I’m happy about where the design ended up, I tend to struggle with premature judgement while I’m trying to get to that place.  So I’d like to talk a little more about the process that I’m coming to trust.

Rapid Ideation in Isolation

In order to keep moving forward in design, I’ve learning it’s crucial to articulate your thoughts in a way that can provoke feedback.

More and more I’m finding that I work best when I have a chance to sketch out a few ideas (like above) and provoke myself before I consider those ideas with other people.

 

Theory Testing

It can be tempting to spend far too long designing and refining in isolation, insulated from critical feedback because your design “isn’t done”.  In order to meaningfully test a design idea, you need to approach the process with intention.

Early on, I built a crude prototype of the physical size and feel of the thermostat to be use in conjunction with paper prototypes.  Then I gave people goals to test out and and tried to put myself in their head-space as they were interacting with the design.

In this course we employed “think aloud testing” to prompt the testers to speak what they were thinking out loud in a stream of consciousness to help facilitate our own understanding of their actions (or inactions).  I took this process and had fun with it, probably due to my background in teaching and tutoring.

After a tester completes all the paper prototype scenarios, they fill our a questionarre that is scored and turned into a System Useability Score on a scale from 0-100.

I found the SUS scores to be far less useful than the think aloud testing, but I think they do represent a meaningful verification of the progression of a design project for people that are completely outside the process.  Over the course of my 4 weeks of testing, my design improved from an average SUS score in the low 80s to an average SUS score of 92 on my final paper prototypes.

Prototyping

If you’ve been following along with me throughout this process, you know that last time, I was looking forward to building a digital prototype of my ideas.

I’m happy to report you can check out my digital prototype online now.  Although there are still a few minor issues with how the animations are timed, I’m happy with how the digital prototype conveys a much more complete vision of how each interaction should look an feel.  It’s clear to me that in a collaborative environment, it would be extremely valuable to bring design ideas toward this fidelity before handing them off to ensure the ideas are well communicated.

Lasting Takeaways

I think this project was important for my progression toward an interaction designer who can work autonomously.  Matt Franks did a masterful job of offering feedback at each stage that pushed me forward but forced me to find my own way.  As a result, I feel very confident in the process because it’s one that I helped shape myself.  Now, as a class, we can stop thinking about thermostats and apply rapid ideation and creative problem solving to problems that are worth solving.

Thoughts?

-Scott

 

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Ideal Thermostat – Iteration #4: Simplifying the Design

Last week’s iteration of my ideal thermostat interface included an overhaul in the way I thought about scheduling. In my previous iterations, I had always considered the schedule as a menu you could enter. Last week I made scheduling a mode you could toggle between; manual mode or schedule mode. The idea behind this was that you could switch over to manual mode if you didn’t want the system to change on it’s own or switch to schedule mode if you wanted to input a schedule that the thermostat would follow. This design decision eliminated the need for a hold button or a vacation mode since manual mode could accomplish the same goals.

While the new manual mode was well accepted by users during another round of think-aloud user testing, the functionality I had envisioned for the schedule mode proved to be overly complicated. After talking it over with Matt, I decided that the ability to skip ahead in the schedule was an unnecessary feature, which made my job to design a bit easier.

Now let’s delve into this week’s iterationview the full PDF of annotated wireframes here.

As with the previous iteration, the temperature is displayed front and center. I have made one significant change to the layout though. I eliminated the option to turn off the fan, because as Matt so helpfully pointed out, you cannot heat or cool your home if the fan is off. The fan is the method through which the heating or cooling is achieved. This conversation highlighted a gap in understanding I had about the way a thermostat functions and showed me that I need to do more preliminary research before I design. Luckily, this change was an easy one to make.

I also reconsidered the functionality of the dashed circle that appeared around an icon when selected. Instead of using it as a visual indicator that the system understood the user’s command, it now indicates when the heating or cooling is currently running. The fan uses the same visual indicator since as I mentioned, you cannot heat or cool without the fan.

Thermostat Off Screen

My conversation with Matt also made me realize that there was no need for a physical toggle to turn of the thermostat since turning the airflow off would disable the fan as well. To make the icon more clear, I decided to use the word “OFF”.

To fix the issues I had with users not knowing the schedule can scroll, I reconfigured it so the screen cuts through some of the content.

So how did the user testing go this time?

For this round of user testing, I approached unsuspecting victims at Dominican Joe’s off South Congress. I learned a few things this round:

  1. A user mentioned should be some indication that the temperature will “hold” in manual mode because it seemed unclear. Thinking about it now, I’m not sure if I agree but I will consider whether it should be part of a first time user experience introduction.
  2. Now that there are only two fan options, it is not as apparent what the difference is between the fan being on or automatic. I need to make this difference clear or get rid of one of the two.

I am feeling really good about the progress I have made with this interface. Yes, there are still some issues, but overall, I feel like I am getting better responses and encountering fewer issues during user testing. I’m sure developing more tasks will bring up a whole new set of issues, but I am more confident that I can handle them by trusting this iterative process.

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Final Iteration and User Testing

Testing an interface with people utilizing paper prototypes is a great way to encourage feedback and push your design in new directions.

Sometimes testing prompts you to make major overhauls to your interface because you are exposed to a critical flaw or limitation.  You draw, remake your paper prototypes and head back out to see if you’ve hit the mark.  A major benefit to paper prototypes is that they help you nail down the major paradigms for your interface before you get entrenched in a particular approach.

In Rapid Ideation and Creative Problem Solving we’ve been using this type of iterative process to design interfaces for a thermostat (concept map, version 1, version 2, version 3).  The major paradigms for my design were nailed down early: I wanted a device with a limited number of interactions that emphasized the most common uses of thermostat to be intuitive, quick, and easy.  I also wanted a design that wasn’t going to present as another screen in the home.  That meant avoiding rectangular designs.  There’s no doubt that I was heavily influenced by the Nest thermostat and I’ve tried to maintain Nest’s usability and compelling design as a bar for my design in this project.

You can check out some user flows as well.

Refining

In the last few rounds of testing my design has been more about refining details and creating cohesion across the device.  For instance, in the latest round of testing I realized that one trouble spot for people involved an inconsistency in how the interface was displaying information versus controls.  In order to exit sub-menus, users had to use the dial to select EXIT (below).

I had attempted to draw consistency between the controls in this submenu with font size, weight, and curvature.  But that relationship wasn’t immediately registering for some users and even though they were able to problem solve their way through it, I want the interface to be as intuitive as possible given the major paradigms I’m working under.  I think at least part of the confusion has to do with the way the top of the interface presents a unified circular set of controls and that makes the user feel like the top of the device is where they have control and the bottom is informational.  My previous version was actually reinforcing this impression because the interface offers prompts related to pressing the display in the same region where the EXIT appears (see below).

I have seen in previous testing that a few prompts like the one above helped users gain authority and confidence in the interface very quickly.  Rather than scrapping my approach to the bottom of the display, I decided to include a new hint to the user to indicate areas they can use the dial to select (see below).

It’s extremely satisfying when you can learn from testing incidents, identify an issue or limitation, and design a solution that unifies and strengthens your concept rather than forcing you to compromise some aspect of the interface.

Deciding When to Move Forward

There is no perfect interface that will be intuitive for every user.  Consequently, adjusting an interface through testing can be a never ending process.  How good is good enough?

One way of answering that question is to take that which is qualitative (the overall experience of using an interface) and attempt to quantify it.  In our testing each week, our users are filling our forms that rate their experience of the interface through a series of questions they can agree or disagree with.

Their responses are then scaled to an overall scale of 0-100 and this is broadly referred to as a System Usability Scale (SUS) score.  In my latest round of testing my interface scored an average SUS of 92 (compared with an average of 82 from a previous round).   But the SUS scores feel more like a backward justification than a rich indicator of progress.

Like most things in my brief experience as a designer, I’m finding that a significant portion of the answer of when to move forward is dependent on my own judgement and the constraints we are working under (certainly in a professional setting, constraint is a critical factor).  One of my personal goals with this project is to take this design into digital prototyping.  Given the amount of time left in the course and the strength and stability of my design at this phase, I’m comfortable leaving user testing behind (at least until the digital prototype is functional) and devoting my attention to the next phase.

I’m going to attempt to build my digital prototype using HTML, CSS, and custom Javascript. Beyond just the implementation, digital prototyping will involve new decisions and challenges.   What will animations look like?  What sort of transitions between states will present the most clearly?  How should a physical device’s controls be represented digitally?  Hopefully, I’ll have some new answers in the next few weeks.

Thoughts?

-Scott

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Thermostat V3: Form and Function

I am now into the fourth week of my thermostat design.  In previous weeks, I modeled and analyzed an existing system, I crafted a new system, and I removed complexity from that system.  This week I really wanted to take a look at the form and how that relates to the functionality of the device.

Recently, the thermostat has become the hot new thing to design, with examples ranging from the genre defining to the half-baked.  The idea of the connected home is as old as the structure itself with each generation of engineers creating technology to improve our lives.  In the 90’s the vision of the future was a home filled with little screens in every hallway, illuminating the space with eerie green light.  Now, when we think of a connected home, and the devices that we use to accomplish this, we don’t want something big and bright; we don’t want a house filled with screens. What we want is something that will blend in; ultimately, these are tools that should disappear until they’re needed.

When I started this project I created an idea board around the idea of home comfort control and temperature.  There were pictures of thermostats from every era juxtaposed next to HVAC diagrams next simple thermometers.  It was the later inspiration that led me to my latest design.

There’s a variety of thermometers out there, using all manner of mechanism, but for me there is something fundamental about the simple mercury thermometer. It does one job, but it does it perfectly.  There is a story that a chemical thermometer tells in its vertical narrative; there is a relative nature to the way it displays the temperature.   I want my thermometer to reflect this simplicity but to build into the idea of a connected home.

So I started with sketches:

This progressed quickly into wireframes (a process that I outline in week 2). Through this framework I was able to map the functionality of the old system design onto the new form.  This transition allowed me to streamline the system and manipulate the design to better reflect the underlying functionality as illustrated below:

Once the design was flushed out I put the frames in the hands of testers utilizing the Think Aloud Testing model (also outlined in week 2).  The responses were generally positive.  A few users had trouble getting passed the first screen, with there being confusion around the “Away Temperature” pull-down.  I’ve previously had trouble articulating the manipulability of my interface, and as I refine this design I’m going to work to raise and clarity of these interactions.

I have surprised myself every week with this project; through the process of continual ideation and iteration I’ve been able to build on good ideas and push away from bad ones.  This has produced progressively better designs. Over the next week I’m going to build a style board while starting to raise the fidelity of my design.

You can see all of my wires here.

As always if you have any comments, feedback or questions please leave me a comment or send me a message at Jacob.Rader@ac4d.com.

 

- jacob

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Thermostat Iteration 2: Less, But Better

As I’ve introduced previously (Part 1, Part 2), I have been using the skills and tools learned here at AC4D to re-design the household thermostat.

Last week I introduced my first design concept through the form of wireframes.  To reiterate, wireframes are a basic way to visually represent the functionality of a design, to focus on the usability of the design.

Following the feedback from the user testing I conducted last week I set out to further simplify my design.  In my design life Dieter Rams has been a huge influence for me (as he is for many others).  One of his core tenants is that “Good design is as little design as possible”.  Through testing it became apparent that, as simple as my design was, it was still difficult to use and confusing for my users.

The focus of my second round of wireframes was to re-examine the scheduling system.  While in the first round I felt that I had done a good job with this section, it was the area where testers struggled the most. Taking a suggestion from my classmate Scott Gerlach I decided to eliminate the scheduling entirely.  In its place I now have two temperature settings: Home and Away.  Fundamentally, the idea of a schedule for your thermostat is flawed.  Most people I’ve talked to don’t have a “usual” schedule, and even those that do, it’s flexible.  Really, all we care about is the temperature for when we’re in the house, and the temperature when we’re not.

This allowed me to simplify my design down to the two screens that you see below: 

Again I conducted user testing using the Think-Aloud procedure, this time yielding much better results.  All of my participants were able to complete the tasks without my help, and more importantly many of them found the design desirable.  The feedback I got on the “Home” and “Away” graphics were especially positive; this was something that I was worried would be difficult to understand.

I’ve always strived for simplicity in my designs, both in my engineering work and here at AC4D.   As Rams would say “Less, but better” – we have to concentrate on the essentials of a design and focus on the details. The next step in my design process is to raise the fidelity.

You can see my wireframes here.

Feel free to send me any feedback at Jacob.Rader@ac4d.com

- jacob

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