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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 AC4D Events, Design Education, Design Research | Leave a comment

Intent vs. Practicality: On the desire to develop Research Insights Databases

Many of the faculty have been in the position before: a client wants to maximise their research ROI by having you simultaneously conduct design research AND help them develop a means for efficient knowledge-sharing of your (and all future) research insights. I just wrote a little diddy on some of the reasons this is tough, and why asking for a more efficient means of sharing insights is missing the point.

http://www.laurenserota.com/blog/2014/5/4/intent-vs-practicality-why-a-research-insights-database-is-a-bad-idea


Commentary welcome.

Posted in Design Research, Reflection | Leave a comment

UX for Good: Meeting the team

A group in Kigali marches toward the memorial

This post is my third 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.

 

Today I watched part of the team visit the grounds of the Kigali Genocide Memorial.

It dawned on me that we externally worked through an issue that many observers & participants of the design process also have to work through: Just because you are studying X problem, doesn’t mean that your end output will be directly attributable to this problem.

 

I.e. – just because our design focus is “creating action that stops genocide”, doesn’t mean our design solution will be directly attributable to stopping a genocide.

 

Yesterday I asked a man at the memorial the following question, “What is this place to you?”

His response, “In one way, it is a home.  The bones of my mother and father are here… But in another way, it is hope.  Hope that the people who come here will be moved to see the hatred and intolerance that generated this – and take it upon themselves to say something when they see it happen in the future.”

He’s not stating he hopes people stop mass killings (not that it needs to be stated).  Rather, it would seem he observed a different problem altogether; that hatred and intolerance between individuals set the stage for the event to happen.

This is different than the problem that most of us perceive.

When you visit KGM, and other holocaust memorials, you will see a single statement at both of them – “Never again”.  Someone in our group made the observation, “this statement feels hollow… what makes this feel so hollow?”

We’ve had this decree since the Holocaust. Yet somehow there have been multiple instances of massive atrocities since then.  It might feel hollow because our awareness of these atrocities conflicts with our belief in the statement – in effect, exposing the facade.

When I reframe this concept within the context of our mission statement – I can’t help but ask a question.

 

“Never again”…  Never again what?

 

One answer might be that we find a way to generate a swifter response to future instances of foreseeable atrocity.

If there is mass killing on any scale, we should make a concerted effort to mitigate it as soon as possible.  But this is an obvious statement that everyone already largely agrees upon. And yet, history has demonstrated this isn’t enough.

 

What if killing isn’t the problem “we” should be trying to solve?  I.e. if the killing has started, “we” are already too late.

 

An alternative answer is that we find ways to design counter measures to the subtle forbearers that set the stage for an atrocity to flourish.

Design concepts in this problem space are difficult to craft.  More often than not, our “business minded” culture doesn’t permit taking action unless it is directly attributable to the end result.

I.e. If you can’t show that doing X will stop a pending atrocity, no one will take any action.

The result, as history has continued to show us, largely inaction.

This is the same type of thinking the plagues the companies I worked with every day as a consultant @frog design.  Business leaders want imperial evidence that making a move will result in all of the return.

“Guessing the future” doesn’t work like this. 

 

Edison knew this during the development of the light bulb. When asked about all of his failure, he responded, “I have not failed.  I’ve just found 10,000 ways that won’t work.”

Edison would not have lasted in our world of quarterly returns.

Changing the future requires rigor, iteration, and sometimes a hopelessly optimistic attitude about reaching the end state.

I have hope. 

As a designer and systems thinker, my value to a team often lies in reframing a given situation.

Consider the following: if the subtle forbearers to a major atrocity are largely cultural undertones that have potential to evolve given the right circumstances, they inherently happen over time. Thus, they may have a higher chance of being noticed by someone who intimately participates in the culture in which they exist.

Designers often make reference to a potential solution as abiding by specific design principles.  They are a way of saying, we can create any product, system, or service; but if it is to be successful, it must do the following.. Design principles are the result of research, reflection, reframing and rigorous iteration. They guide us in crafting meaningful solutions that are not always directly attributable to the initial perceived problem.

 

It may be that the design principles for this particular problem read as follows (Note: this is purely a hypothesis that will change):

  • In-order to be successful, the person must be able to identify the undertones that led to a particular atrocity (any given person who visits an existing memorial).
  • In-order to be successful, the person must then be able to reframe these undertones within the context of their own culture; identifying similar patterns of action or behavior that act as a single block in an overarching foundation.
  • In-order to be successful, the person must then be able to generate concepts that have a purpose to achieve a more ideal outcome; and be able to execute upon these over time.

 

The solution we could then create would reframe the action we hope to generate as:

  • - a “thing” that is contextual (a person can apply it to their own cultural circumstance)
  • - a “thing” that is sustainable (the visibility of their action generates more action)
  • - a “thing” that may or may not be an external creation by the person doing the reframing – but solicits action towards the achievement of a positive outcome (Focus on crafting / executing small steps to the ideal state).

Tomorrow, we officially start research.  We will ingest the perspective of visitors, survivors, and hopefully perpetrators over the next 3 days.

These raw data points will be combined with our own understanding of the world around us, allowing the team to generate design principles that guide our creative thinking.

I hope to have another post sometime in the next three days.

Posted in Design Research, Interaction Design, Reflection | Leave a comment

UX for Good: Immersion


 
This post is my second 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.
 
 
At AC4D, we are the evangelicals of ambiguity.  Time and time again I’ve pushed people out the doors of the school with a single mission – go and explore the world around you.  Immerse yourself into the cultures and problems to which we remain largely blind. Not by choice, but generally by habit.  It’s our nature to become so comfortable in our routines that we don’t even realize what they are. I am no exception to this.

These moments of “motivation” are often met with disbelief & fear from the people we are forcing them upon.  “What do you mean I have to go out and talk to people?  Right Now?  I just learned how to do this?”

 
We try and provide words of encouragement, but you can see the fear in their eyes.

 
They are participating in a process that is forcing them out of their comfort zone without any clear understanding of the outcome. They are required to blindly trust us.

I attempt to remain aware of this problem in my own life; occasionally making adjustments in my patterns as a means to discover the unexpected. Like many of the design researchers I know, I think to myself  “You understand aspects of the world that others do not”, “you are so informed”.

But my first 20 min in Rwanda as part of the UX for Good design challenge generated a realization that my “informed state” has largely been one of false enlightenment.

What I thought were the boundaries that defined my perspective – those that I attempted to subvert in the name of “immersing myself in problems & cultures”, were not even close to the boundaries I’ve come to identify as a result of traveling here.

 
Our initial decent into Kigali was in the evening, just as the sun started to set & the area moved into twilight.  As we passed over the roof tops of small towns and villages, I couldn’t help but think they looked the same as the villages we saw while taking off in Brussels. Small clusters of white walls and red clay roofs that travel along the roads that connect them.

From 8,000 feet in the air, everything looks the same.

But as we approached the ground, an extremely unexpected difference in these clusters of homes stirred a panic that I have not felt in a long time.

There were no lights.

No visible lights in the street.  No visible lights on the homes. Or so few that I could actually count the number of them between each village we passed. For anyone reading, this detail might seem like an expected observation.  It does fall within the western narrative I’ve heard from friends and family before coming here; That Africa as a tarp ridden collection of unsafe villages. A narrative that is never explicitly stated, but always inferred. One of thousands of sweeping generalizations that I’m guilty of as much as the next person – and just as afraid to admit.

 
For me, the concept of limited electricity wasn’t what gave birth to paralyzing fear. If my computer dies, it’s not the end of the world.  If I have trouble charging my phone, it’s not really a big deal. These are the first world problems that I’ve grown largely accustom to solving on a daily basis.

Rather, this small detail pushed me into a state of awareness, and sheer panic, that only comes with the realization that you are completely out of your element. That you are entering into a state of un-retractable ambiguity. 

My irrational internal monologue went something like this:

  • You are alone.
  • You have just been dropped into a culture in which the behavioral norms and customs are completely unknown. You are exposed.
  • You don’t speak the language.
  • You have no local currency; as the Rwandan Franc wasn’t offered at any of the exchanges so far.
  • You are an American – so the association with your government’s foreign policy decisions are just one of many lenses in which you expect to be judged (In Rwanda, this history is particularly unkind – Read about the US & UN response to the genocide if you are unfamiliar with what I’m referring to).
  • You are the first to arrive in your team. A group of people you have never met.
  • Your transport may or may not be waiting for you. (I arrived early. So for 20 min I stood by myself outside in the dark)
  • It’s 7pm at night and you have no choice but to press on.  There is nowhere else to go.

I just crossed a boundary I was unaware of and I was letting my capacity for irrational narratives take charge.

 
 As a designer, the goal is to cross these boundaries.  To be immersed into a particular context, gain some form of empathy, and use that to create momentum towards solving a problem. 

 
Ambiguity is the hallmark of a good design project. In lacking an understanding of the end state, we are awarded the opportunity to craft it.

But until this point, my experience with these “moments of unknown” have been supported by elements of familiarity. The invisible support structures I’ve unconsciously relied upon were suddenly gone.  I have no team of trusted designers. I am not retiring to the safety of my home after a few hours of contextual research. I am not the facilitator who can choose to end the interview if things take a turn for the negative.

All I have is trust; to trust in the process I preach & the people that I meet.

I am now one of the growing number of student’s I’ve kicked out the door with a call to action to “embrace the unknown”, and I can once again empathize with the fear associated in doing this.

As I embark on this project, I hope the unexpected remains constant. I hope to exercise my capacity as a creative thinker in ways I have yet to imagine, and to maintain this state of ambiguity for as long as possible.

However uncomfortable, this process creates moments of reflection, clarity, and opportunity that provide me with the motivation to keep doing it.

 

Posted in Design Research, Interaction Design, Methods | Leave a comment

Coupling between thinking and actuation

As part of the creative problem solving process – designers research to understand a problem space, apply their own subjective point of view or intuition and create provocations to make sense of incomplete information.

In Organizing and the Process of Sensemaking, Karl Weick states, Sensemaking is not about truth and getting it right.  Instead, it is about continued refracting of an emerging story so that it becomes more comprehensive, incorporates more of the observed data, and is more resilient in the face of criticism. 

In Discovering Design Ability, Nigel Cross states, some of the relevant information [in a design problem] can be found only by generating and testing solutions; some information, or ‘missing ingredient’ has to be provided by the designers himself ... this extra ingredient is often an ‘ordering principle’. These ‘ordering principles’ give people access to new information on the whole and can take on various activities, such as the diagram below for example: 

In Theory of Interaction Design, we read 10 articles and discussed the relationship between creativity, knowledge, perception and strategy. The diagram above is an overview of each author’s summary along with my own position.

Thoughts? Make sense?  Your perception of it?  Can we design for an individual’s perception? Stavros Mahlke, in Visual Aesthetics and the User Experience, thinks we can and should by integrating ‘non-instrumental qualites’ like aesthetic, symbolic aspects and emotional user reactions with traditional user experience interaction design.   

In summary, it is in our thinking and activity where solutions are created and make sense.

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

AC4D Speaker Series Graphic Recording: “Aging in Place” by Jon Freach

At AC4D’s last Speaker Series, Jon Freach spoke about his research around Aging in Place and taking the design research he did into concept.

I did a graphic recording of the talk for your viewing pleasure, and I hope you enjoy it!

If you haven’t already, go check out the AC4D Speaker Series! This Wednesday is Leah Bojo talking about Policy Values and Getting Results. And if you want to see more of my graphic recordings, check out my site at chostett.com.

Posted in Design Research, Interaction Design | Leave a comment

Charting Times of Change: Money Practices and Behaviors in Myanmar

Earlier this week, GigaOm published an introduction to some work I’ve been a part of in Myanmar, exploring money practices and behaviors in rural and low-income households. Conducting design research in other countries, especially those in development, is a reminder of the applicability of the design process and of the work we do. So few people (or institutions) strive to understand “why,” and despite a heightened foreign interest and influx of opportunity in this newly opened market, so few products and services have been designed appropriately, or adapted from other markets to consider the needs and values of the people they serve.

http://gigaom.com/2014/03/04/as-myanmar-opens-up-will-mobile-money-emerge/

I hope you enjoy the read.
We’ll be sharing out our findings in early April.

Posted in Design Research, Methods, Social Innovation | Leave a comment

Design in Healthcare: Improving Support During Recovery

Final Q3 Presentation slide 01.001.png

Over the last four months, as students at the Austin Center for Design, Jacob Rader, Bhavini Patel, and Scott Gerlach have been designing around healthcare.  As a result, we are now in the process of developing Recovery Text: a text messaging service to support patients as they recover.   It’s a simple, direct idea but one that we are confident can make an impact based on the understandings we have developed through research and testing.

At ac4d we apply a rigorous, human centered design process and we focus it on wicked social problems. And so as we are developing our craft as creative problem solvers, we are also learning how to address worthwhile subject matter.

 

Our Research

In research, we put ourselves into context and attempt to quickly build rich mental models in different aspects of a problem space.  By connecting with people and engaging in activities that facilitate empathy and understanding with their behavior, we inform our intuitions much more richly than we would through statistical models, abstract principles, or academic exercises.  Design research is meant to provoke new ideas and creative problem solving.  And it’s in the complex, interwoven, and often self contradictory nature of specific human interactions that we are most likely to provoke ourselves toward innovative understandings.  So the drive to relate to people isn’t just an empathetic exercise, it’s a practical primer for building new mental connections.

Our research into Healthcare focused on how documents, artifacts, and medical records affect at-risk patients as they interact with the Healthcare system.  We sought out perspectives from patients as well as medical professionals.Final Q3 Presentation 01-5-all.014.png

Patients

One of the things that stood out in talking to patients was the contrast in perceptions.  We spoke to a number of homeless veterans who were happy about the care they have access to.  And we tried to unravel what the factors are that lead to that positive relationship.  Final Q3 Presentation 01-5-all.015.png

Over and over we saw that when healthcare felt most successful for patients was when it was reaching out to them and meeting them on their level.  The VA does things like help patients schedule appointments and arrange transportation.  When people didn’t have access to healthcare that reached out to them, they felt much less stable and supported.

We came to understand that a patient’s perception of care has a significant impact on how engaged they are and consequently on their outcomes from healthcare.  And these perceptions are often tied most strongly to the extent that their healthcare is able to meet them on their level and communicate with them.

 

Professionals

In professionals we saw a group of people who are constantly working near the limits of what time will allow them.  They have to interact with a high volume of patients.  And for each patient, professionals must perform rapid problem solving and significant documentation. Final Q3 Presentation 01-5-all.016.png

So it’s in parallel with this high frequency application of their technical know how that medical professionals must also attempt to convey as much pertinent information to patients in the brief time that they have with them.

In high volume hospitals that serve at-risk populations the gap between patients and professionals is the most challenging to bridge.  When the demands on professionals and greater needs of the patients are layered over one another, it becomes almost impossible to prioritize a patient’s understanding of their situation and facilitate a stronger  perception of their own care.

 

Hospital Discharge and Readmission

We had the opportunity to spend time with the medical records department at a large volume hospital. Seeing the processes that support the flow of documentation was like gazing into the circulatory system of a vast, incomprehensible beast.  And although it’s impossible to align all of the complexity in a large team of individual motivations such as a hospital, we came to understand that the hospital has been adapted to–above all–create legal, billable records of the care it provides.

From the moment a patient arrives at the hospital, the hospital is preparing for their departure; it has to be.  But as the volume and complexity of the care provided by hospital has rapidly dilated, the confluence of information, instructions, and paperwork directed at patients in the discharge process has become overwhelming.Final Q3 Presentation 01-5-all.009.png

The way that hospitals attempt to convey information as patients are leaving care and the lack of support during the recovery process create an obvious opportunity for design to make an impact.  We believe that many of the complications that patients experience and the resulting hospital readmissions are preventable.Final Q3 Presentation 01-5-all.013.png

Underpinning the idea of a text message service is a frank understanding of the constraints on patients and professionals during the discharge process.

Professionals are conveying too much in too little time to each patient.  And patients are in a compromised state during the interaction that is supposed to inform much of their recovery process.

Final Q3 Presentation 01-5-all.019.pngFinal Q3 Presentation 01-5-all.020.png

Recovery Text is an opportunity for mutual benefit for both patients and professionals by changing the flow and timing of this information.

Final Q3 Presentation 01-5-all.022.pngFinal Q3 Presentation 01-5-all.023.png

Small, digestible pieces of information delivered to patients at the times when they have the most relevance will improve the chances of patients avoiding preventable complications as well as creating more opportunities for understanding and reflection during the recovery process.  This will help patients avoid reaching back for access to professionals in order to get redundant information during their recovery.  And professionals will be able to concentrate on only the most immediately relevant information during their interaction with patients.

 

Testing

Good design is tested and iterated early and often during the prototyping process.  Recently our design team has been testing and validating the idea of a recovery text messaging service with patients, professionals, and healthcare decision makers.

 

Patients

From patients we have learned a good deal about the tone and content of text messages.Final Q3 Presentation 01-5-all.027.png

We’re developing heuristics for the text messages in order to give them the best chance to resonate with patients over the course of their recoveries.

 

Professionals

With professionals we wanted to ensure that the concept of a recovery text messaging service made sense and seemed like something they could see as part of their workflow.

Final Q3 Presentation 01-5-all.029.png

We tested wire-frames with hospital nurses and social workers and found that not only did the idea feel useful to them, but they had specific advice about how it could fit into the hospital workflow and be the most useful.

 

Decision Makers

Finally, we’ve had the opportunity to put Recovery Text in front of decision makers at large medical providers.  Our goal was to gain an understanding of how this service might fit into the current trends of healthcare landscape that large healthcare providers operate in.

We found that many large healthcare providers are rethinking the way they provide care.Final Q3 Presentation 01-5-all.030.png

While many minds in healthcare have recognized that the fee-for-service model is at odds with the some of the underlying principles of medicine, the Affordable Care Act has helped hasten an impetus for change.Final Q3 Presentation 01-5-all.031.png

In our conversations with large healthcare providers here in Austin, it’s apparent that many of them are looking to interaction design as a means to help them find innovative ideas.  They are actively seeking new approaches to improving hospital readmission and expanding outpatient support.  Recovery Text has a good opportunity to fit into this overall initiative by addressing preventable readmissions and establishing a new foundation for communicating with patients during recovery.

 

Next Steps

Over the next eight weeks our team will look to pilot the most important aspects of this service.  We recognize that at the heart of Recovery Text are recovery timelines composed of meaningful messages.  We’d like to develop a deeper understanding of these timelines by embedding in a professional environment.  We’re going to closely study the discharge process to understand how Recovery Text could best integrate into workflows.  Our team also would like to run a pilot program with a handful of patients so that we can better understand how specific text messages affect their recovery process and perception of support from their healthcare provider.

 

Contact Us

If you’re interested in more details about our project or discussing opportunities for meaningful design in healthcare, please contact us: HealthRecords@ac4d.com

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The Spectrum Project Update 6 : Getting specific

Last week, my design partner Chelsea Hostetter introduced Scenario Validation, where we allow the user to read through and imagine particular uses of our application.

In particular, Chelsea highlighted the core of our application which we believe works well:

CoffeeRoulette’s best features include:

  • a curated community of trans*friendly folks, initially seeded by the alpha testers in the trans*community.
  • a no-hassle 45-minute timed meeting to meet with others (but not feel bad if your time runs out and you don’t want to meet them again)
  • a way of connecting others in a generally anonymous, one-on-one way to protect the privacy of individuals.

Having these fundamental concepts of the structure of our community and the ground rules of a time constrained meeting between anonymous participants, we were able to rapidly try various permutations of the meeting mechanics, continuously refining our concept along the way.

After a certain point though, if the design idea is to become real, you have to prune your options and make some lasting decisions.

With that said, we have landed in a pretty solid place and have decided that the way we would like to go is to ditch the games, focus on the trans* and gender variant community, and give people the most direct path from invite to first meeting.

Queery

After receiving a lot of feedback, we changed the name one more time. ‘Queery’ plays on two concepts, the primary one is that this is for a nonconforming community, the second being that so many of our participants have questions and would like to find some friends with whom they could explore these questions.

From the image above, you can see the first few screens a potential user would encounter. The very first is an email invitation from a current member.  We believe that this social vetting mechanism is a great way to keep the community safe and to keep the quality of the interactions high.  After clicking on the link, the user is sent to a web app (see forecast.io via your smartphone for our inspiration) where the user is given a carousel of discussion topics. Most of the topics are rather broad and inclusive of the broader community, some are very specific to the trans* and gender variant community.

The user has to make 2 selections, create a password, then they are given an option to confirm the meeting. We decide the location and discussion companion, but the rest is driven by the user.

Our goal is to help introduce members of the community to one another in a safe manner. We hope that these meetings will help our members forge friendships and build out healthy, supportive social circles.

So how do we know this idea is useful for our community?

More testing!

Our mission this week is to complete a series of usability tests which allow our potential users to give us feedback on not only if the app feels easy to use, but also if is it useful for their needs.  Preliminary feedback is certainly looking good.

Would you like to help us test? It takes an average of 30 minutes, you’ll get free coffee, a sneak peek at our design, and the chance to help the community. Please email us at spectrumproject@ac4d.com

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Testing Our Concept through Scenario Validation

When we last left off, we illustrated how we used the power of storytelling to elaborate on our design idea Inner Circle: the Birth Plan for Everyone Else— a smartphone app that guides expectant mothers through a series of questions regarding their impending birth, empowering them to have authority over their birth experience.

Over the weekend, our group tested some of the features of Inner Circle through a user-testing method called scenario validation. Scenario validation acts as a litmus test for whether the intended features and functions of our application are viewed as needed and useful by our intended audience. To do this, we create multiple short stories with accompanying visuals in which a fictional user would use our application to help solve a specific problem at a specific time. These sketches contained the minimal flows needed to communicate the feature in order to test the idea.

To validate the concepts, we held one group session with a total of 4 expectant and recent mothers, some who had hospital births, and some who had homebirths. We read aloud one scenario and had participants fill out questionnaires about each scenario. We then held a group discussion with participants about the features and usefulness of this tool and how they had perceived it.

As we expected, this type of concept validation proved to be invaluable. The feedback we received about the core concept was overwhelmingly positive:

“I think [Inner Circle] would be helpful for somebody with their first pregnancy. It seems to ask questions that I wouldn’t even think to ask. It feels like it really fills a void.”

“There’s something nice about having a birth plan for everyone else. It’s something that’s needed and I didn’t know that I needed it.”

“Every pregnant friend that I had, I would tell them, this would go into the package they need to prepare for their birth.”

Most importantly, scenario validation allowed us to see what features might need a clearer value proposition:

“I don’t think it would be that difficult to just send two different emails. I don’t know if I need an app to facilitate that for me.”

The discussion and feedback from participants informed us that a tool that creates communication hierarchy should be secondary to a tool that provocates the creation of a birth plan for friends and family.

This week, our team will be concentrating on constructing the wireframes which prompts the user to answer questions related to the planning of their birth–the location, people involved, communication boundaries, and tasks which need to be delegated. This feature will be complimented by the communication hierarchies which will disseminate information to the appropriate people–all people will receive opt-in links to tasks such as food prep whereas other people will also be able to volunteer to pick up an older child from school (inner circle only).

At the same time, we will be reviewing previously conducted research with mothers to make sure our design addresses the issues they wished they had known to prepare for. Our goal is to present this information in creating a birth plan for future mothers in their planning stages so that they know what to expect and will be feel more confident and assured entering into motherhood.

“This empowers you to be the boss lady, which is an important way to feel going into becoming a mother.”

Look for another update within the week. As always, if you have any thoughts about Inner Circle, please don’t hesitate to comment here or email me at meghan.corbett@ac4d.com.

 

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