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Category Archives: Reflection

queery: “Is it working…?” and Our Ponderous Process

Hey everyone!

Alex and I have been touch and go on the blog posts, and I do apologize—today I’m making up for it by posting some progress shots to show you where we’ve come from, and what we have so far.

As Alex mentioned, we’ve come out of the end of this developer hole that we put ourselves through trying to build the application from scratch. Not a good idea, and I’m sure that the lesson Alex learned from that is when prototyping, build fast, and then iterate.

I’m pleased to say that our Google Forms, while perhaps too argyle, is working well:

So far we have a few responses, and enough to pair folks together via interest, so I’m looking forward to having folks meet with one another and gauge their feedback on the meetings! Functionally, it is doing what we want it to do, on a low-fi scale, and in the next four weeks, I want to bring up the fidelity of this bit by bit.

So about that argyle…
Currently, queery is lacking in visual design. Google Forms can only do so much, and in order to change the argyle pattern in the forms, we would have to host the form somewhere else and dig into the CSS. While it is possible, it’s not something I’d like to get into in the first version of our prototype, so Alex and I mutually decided that the next phase of queery will be built on top of a WordPress framework, which allows for decent customizability.

As a teaser, I’ll show you what we have in store for queery.

Our logo has shifted slightly, but has gone from this:

…to this.

We’ve shifted from charcoal and turquoise to navy and teal; our color palette is currently this:

We wanted to take the idea of the transgender pride flag and modify it slightly from baby blues and pinks to stronger, more mature teals and corals. We’re hoping that this palette conveys the friendliness and encouragement that we desire in the application while still maintaining a sense that this is a trustworthy, safe process.

What I’ve learned so far is to trust that we will probably not get it right the first time.  I have a lot of anxiety about how the coffee meetings will go because I so badly want to make a positive impact in the community that piloting this is a big deal for me. I also know that the designing process is an iterative one, and that through the stumbling and falling, we’ll pick ourselves up, dust ourselves off, and keep going.

Incredible thanks to the folks who are currently using queery—we wouldn’t be able to do this pilot without you. And to those of you who are in the LGBTQIA community in Austin, if you want to pilot queery, get in touch with me via chelsea (at) getqueery.com.

I’m looking forward to seeing what the coming weeks will hold.

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Build Scaffolds. Inspire Articulations. Make New Knowledge. And Repeat.

Access to information technology can make our lives easier, of course, but how people are affected and the sharing of their experience is where we can find meaning.

The diagram below maps 8 author positions around the roles and implications of technology and the meaning of experience and context. Click on the diagram for a full view:

 In What We Talk About When We Talk About Context Paul Dourish describes the interaction of information or object and activity as an alternate concept of context. Context as an interactional problem is the relationship of dynamic objects and activities.

But object interaction is more than the transmission of information, as Bohnear describes in Affect: From Information to Interactionit can be a form of social action, which achieves social ends collectively, in ways in which collective meaning shapes individual experience. 

So if you build scaffolds (supportive frameworks) people will articulate their own experiences that can be interpreted for new knowledge for others.

Posted in Classes, Interaction Design, Reflection, Theory | Leave a comment

The Special Nature of Ordinary

Ordinary gets a bad wrap.  Rarely do we celebrate ordinary.  Ordinary is the B student, the 3rd place finisher, ordinary is the domestic beer.  But within the ordinary there is something special, especially when we talk about design.  Ordinary is the nature of how we see the world; it is our default state.

Ordinary is often seen as being “not special” and this is a problem for  technologists and designers.  As designers we’re constantly asked to make something that will surprise and delight, but a thing can only be special for a limited amount of time; meaningfulness is a temporary quality.  Let us take a look at the default design example: Apple’s iPhone.  The iPhone was in many ways revolutionary, it changed people’s understanding of interactions with technology. It’s newness, however,  was short lived.  Smartphones have become interwoven in our culture to the point that they’ve reached the state of ordinary.  Rather than appreciating the appropriate and indispensable nature of the technology, we dwell on what’s the next big thing.

In their book “Super Normal” Naoto Fukasawa and Jasper Morrison purpose the concept outlined in the title.  Morrison argues that “The Super Normal object is the result of a long tradition of evolutionary advancement in the shape of everyday things, not attempting to break with the history of form but rather trying to summarise it, know its place in the society of things”.

What they are arguing for is a better understanding of design as something that should be, in its purest state, ordinary.  Ordinary is something special that should be revered.  So the question comes: What does it mean for an thing to be ordinary?

A thing becomes ordinary when it becomes ubiquitous within a group, both in use and cultural acceptance.  In this regard ordinary is a dynamic social quality actively managed through our use and interactions.  As a thing becomes ubiquitous in a culture it becomes ordinary.  We don’t look at everyday objects like chairs or utensils as being special, but at the same time we can’t imagine a world without them; the same could be said of the smartphone. Our collective sense of ordinary is shaped by our experiences over time, so as we learn new things our sense of ordinary changes and evolves.

In this way ordinary can be seen as an evolutionary mechanism in design. Ordinary isn’t a quality designated by a committee or marketing firm, nor do designers get to define what becomes ordinary.  Only through use, over time, will technology reach a state of ordinary and it’s that ordinary use that defines the requirements of the next round of technological development. Technologists can put things out into the world but only through use and cultural acceptance will a thing become ordinary, everything else falls off and is forgotten as evolutionary chaff.

Not only does ordinary highlight the useful nature of a thing, it reveals cultural appreciation and acceptance.  We have plenty of methods for measuring usefulness, but cultural relevance is much more difficult to gauge.  Ordinary can provide an opportunity to not only examine the usefulness of a thing but also the softer qualities, things like sentiment and emotion.  By focusing so closely on those things that are the most familiar it introduces an element of strangeness into the design process.  Strangeness can be a powerful provocation providing us a way of teasing out behaviors and patterns that might be normally overlooked.

As a design provocation, ordinary encourages us to focus on the longevity of a thing.  If meaningfulness is a temporary quality then by focusing on the ordinary we’re encouraged to make things that will last.  If a thing is built to be continually useful it provides the user with an opportunity to re-discover and reinterpret it’s meaningfulness over time.  In this way a thing can both grow with us individually and culturally.

Ordinary becomes a lens that highlights the things that are collectively important to us. In a time when cheap, temporary convenience and disposability are primary drivers of innovation, ordinary provides us with the impetus to pursue a more holistic and long-term view of design. Focusing on the special nature of ordinariness we get the opportunity to  better understand what makes a thing truly special.

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Let them Add the Drapes

Happy Valentine’s Day!  I bought a bacon rose for my girlfriend – #ihopeshethinksitsawesome?

I’ve been thinking a lot over the last few days about how to design applications that give users the foundation – the house – but let them add character and flair in a way that isn’t obtrusive.  Even better, without doing much or any work on top of what they would be doing normally.  Those type of interactions done well are delightful.

For example, in the CareWell application I’m designing and building for caregivers and their families, any user in the family can add and change the group’s photo.  This will also update the background to the logo, visible on every screen.  I’m betting that users will change the photo, not only because it affects what they see – but that because they know other members will see that photo and delight in it.

My guess is that individuals become more attached to things that represent their uniqueness, and are therefore less likely to stop using them. Individuals are also more likely to use things that help them express that uniqueness to other people.

This is the anti-path/fb Paper approach to design.  They’ve gone ahead, curated, and built the whole shebbang.  With perfect pixels and manicured swipes, the apps look great (I’m actually extremely envious of their design team talent!), but I’ll never use them again.  There’s no room for me to make it mine.

This may very well be the fundamental difference between interaction design and industrial design.  I want something physical designed to perfection, because it is immutable.  It’s also easier to show off.  Pixels, on the other hand, are hidden and ephemeral.  Great design in this sphere requires thoughtful usability, restraint, and the respect to let the user co-create delight.

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Testing Timelines

Preface: I’m in a group with Meghan Corbett and Anna Krachey researching experiences around birth and labor & delivery. This post is the second in a series of updates on developing a product to serve pregnant women. You can read last week’s post here.

Last week our group worked on a timeline exercise tracking how women view milestones in their pregnancy – things like telling their best friends, notifying their job or certain medical appointments – rather than thinking just in terms of trimesters. We looked at each step and evaluated the value proposition, emotional value proposition and incentive / motivations for a woman using our app at each of her milestones.

The milestones we came up with were:

  • I’m Pregnant!
  • I’m Telling People (Close Family and Friends)
  • I’m Telling My Boss
  • Formalizing Plans
  • Labor & Delivery
  • I Have a Baby!

Using these milestones, we came up with a timeline exercise. We wanted to make sure we were thinking about these milestones, and how those events affect sharing information, the same way pregnant women were. In it, we asked women to map out:

  • Milestones during their pregnancy
  • When they told their best friends, their parents, and the rest of their social circle
  • When they informed their jobs, clients or anyone else dependent on them that they were pregnant.

We tried to keep things pretty open so women could make it their own. In addition to marking milestones, one participant also indicated her levels of stress regarding her pregnancy and how that related to what was going on in her life.

This week we spoke with a first time pregnant woman, a woman pregnant with her second child as well as a Doula. Our concept of milestones appeared to be correct. Yay!

During this time one of our participants shared an email she sent out to her family and close friends. She was planning a homebirth, and her email laid out what she wanted everyone to do, how to communicate with her and how they could help. Such gems included:

“Please resist any urges to bring things to the house, such as food or drinks, during labor. I may be very sensitive to smells and we also need to keep all of our space clean and clear.”

and

“[My husband] will be communicating to people if anything changes and we ask that feelings be spared if changes on the day affect you.”

This participant was clearly able to set boundaries and expectations so that she could get what she needed and her family felt like part of the team – even if they weren’t there. We realized, however, that many women may not be able to do this or even think to do it, and speaking with our Doula confirmed this. During our initial research phase we heard:

“I’m just going to go to the Hospital and see what happens.”

We wanted to come up with a system to set these boundaries and parameters, so that women could start mentally preparing as well as focus on their birth. We heard anxiety from some of our research participants like:

“My parents want so much to be helpful, but my father is obese and my mother has cancer. It becomes more about me managing them instead of them being helpful.”

The tests I wrote about earlier, as well at the email I just shared along with many sentiments about pregnant women dealing with family members resulted in our current design idea: InnerCircle – The Birth Plan for Everyone Else.

We’ll continue to develop and refine the idea, but here are the main premises:

  1. Women share different information with different people about their pregnancy. They need a way to manage all that information and the complex relationships surrounding it.
  2. Women also need a way to plan and articulate what they would like their family and friends to do during her labor & delivery. They shouldn’t have to worry about keeping their mother-in-law happy while they are trying to give birth to a baby!

We are currently doing user tests where we will validate these ideas and see how women to respond to writing out directions for those around them. We’ve also come up with a paper prototype test where we’ll have women create circles of people around them in the same way we are planning to do it in our app. We want to see how women pick and choose whom to put in their inner circle – those who are closer and get more information – and those they put in their outer one.

We are currently recruiting pregnant women and new mothers to help test our design idea. If you know of anyone who might be interested, please get in touch with me at james.lewis@austincenterfordesign.com

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Our Continuing Adventures at AmbiguityC4D: Q3 Progress Report Post 1

It has been a month since we presented our research, top insights, and the three design ideas at our final presentation for quarter 2. Since then, our group has been trying to settle on one idea to push forward to wireframe and test with.

This has proven to be harder than we had anticipated.

To get to the three ideas we presented at end of quarter 2, we used a 2×2 matrix to evaluate which ideas we felt passionate about against which seemed feasible. Daddy Doula, My Birth Coach, and the Doula Marketplace each originated from the intersection of high passion and feasibility, but were all so amorphous as to what they could do that we weren’t able to settle on one over another.

We revisited our insights and thought a lot about what we saw as the goals of our final idea.

On Wednesday, we made a breakthrough and came up with this idea:

The Peach Project is tool that enables the user to share information about her pregnancy journey with curated communities of her choice, while building a visual history and journey of her pregnancy experience. Through provocation, this platform will prompt her to externalize and articulate her feelings and then share them with her chosen community and the peach community at large.  Sharing tacit knowledge and stories also allows for feedback, support, and empathy from others, strengthening the mother to be’s feeling of confidence around her impending birth experience.

We finally felt we were on the right track and were pretty amped up about the numerous possibilities when we met with Matt Wednesday night. He pointed out to us that while certain aspects of the idea hit home, once again we were trying to incorporate too many features into one product. “What does this platform really do?”

Hmpf.

Yes, ideas are free. But ideas that we were excited about seemed to be few and far between. We were spinning our wheels on the same thought avenues time and time again. We needed a new framework to view our research through.

Jon suggested we chart out a few main phases of pregnancy and then think through the value proposition, emotional value proposition, and incentive for each of our participants through this framework. For example, we thought about Lily’s experience with pregnancy and asked “what was she probably thinking when she first found out?”, “what about when she started to tell people?”.

 

This exercise was immensely helpful in getting us out of our rut. It enabled us to really understand the changing needs of soon-to-be parents throughout pregnancy and what specific areas are most stressful/have the biggest area of opportunity. While each phase includes a certain amount of stress, finalizing plans and the actual labor and delivery periods stood out as an especially tricky time.

From there, we zoned in on these two goals for our idea:

  • The mother-to-be feels connected to and supported by her chosen network of friends and family by assigning communication responsibilities to her closest friends
  • Soon-to-parents are able to easily create boundaries around communication with wider circle friends and family, enabling the mother to better focus on the process of labor and delivery.

One of the provocations for this design idea is that historically, women were supported through their pregnancy and birth experience by a network of women relatives and friends. The introduction of hospitals into the birth process has led to a deterioration of this system. The internet allows us to use social media as a way to manifest a new kind of support connection. Although this connection is crucial, the ability to create boundaries with family and friends is equally important in being able to focus on the labor and delivery process.

Inner Circle will help mitigate the overstepping of boundaries by friends and relatives who mean well but cause anxiety to the mother by being overeager or over-communicative.  Minimizing these distractions and concerns will allow the mother to better focus on the hard and long task at hand.The app will also act as a tool to delegate and manage tasks such as child and/or dog care easily and clearly, further allowing peace of mind and focus.

We are now in a user-testing phase, meeting with participants and verifying that our assumptions about the usefulness and incentives we saw for this new idea are correct before we start wireframing possible manifestations of this idea.

If you have any thoughts about Inner Circle, please don’t hesitate to comment here or email me at meghan.corbett@ac4d.com.

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

Before and After: Honeywell Prestige 2.0 Thermostat Final Re-design + Design Process Overview

 

 

Last week we presented our final re-design of a programable thermostat for Rapid Ideation and Creative Problem Solving. Our problem for 8-weeks was to re-design the existing Honeywell Prestige 2.0 thermostat system. Final Iteration 6 here as well as an overview of the design process and reflections below:

Understanding Complexities

As part of our design research, we engage in a problem space to help us understand the complexities of a system.  So I manually went through each screen of the Honeywell thermostat to create Concept Model 1.  Going through this process helped me zoom in and out of details to conceptualize an Ideal System.

Ideal System

My ideal system informed users about their energy consumption, air quality, incorporated color as part of temperature control and featured the list below.

Features List (should include at minimum)

  • Adjust temperature to warmer / cooler
  • Switch between heating & cooling
  • Turn the system on and off
  • Turn the fan on and off
  • Set / edit a 7 day schedule
  • Interrupt the schedule to adjust the temperature

Influences

1. 1950s Honeywell Thermostat by Henry Dreyfuss.  The design was simple but that’s why it was beautiful to me.

2. Nest. Their integration of motion sensors inspired me to completely move away from manually programming a thermostat for while you are away.

3. Less but better… Dieter Rams.  My main framework for balancing design solutions and user feedback for each iteration.

Iterative and User-Centered Design Process Diagram Overview

Lessons and Final Thoughts 

When we started this project over 8-weeks ago, I thought the design process was to refine our initial wireframes by designing with and for people AND doing this over and over till we came up with a “good” design.  Which was part of it, but this process also allowed me to explore alternatives for design solutions.  In hindsight, this process has taught me a lot about myself and how to handle design problems moving forward, especially as we move into problem spaces not as well defined as a thermostat.

For any questions/feedback please leave me a comment or you can reach me at  bhavini.patel@austincenterfordesign.com

Iteration 6

Iteration 5

Iteration 4

Iteration 3

Iteration 2

Iteration 1

All Best,

Bhavini

Posted in Interaction Design, Methods, Motivation, Reflection | Leave a comment

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

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

Thermostat 6: Lessons & Reflection

Since October 2013, I have been working extensively on building a thermostat interface. Taking on the venture of designing a tool that most people have come into contact with adds its challenges and benefits. This is now my 6th iteration of what I have designed and tested to be the “Ideal Thermostat”. To build the initial understanding of what was needed in the thermostat design I focused on two things. One was the lesson outline from the professor that acted as a mock up version of a client requests and the other was to a build concept map off of an existing Honeywell Thermostat. This is the list of “client requirements for the thermostat project.

  • Adjust the temperature (warmer / cooler)
  • Switch between heating and cooling
  • Turn the system off and on
  • Set / edit a 7 day schedule
  • Interrupt the schedule to adjust the temperature
  • Have a date / time function
  • Have thermostat prompt when the the user could break the system by switching A/C on in winter.

After mapping the system, see: (Cleaning Up Design Complication), one thing became a focus to me, simplicity. Looking at the rough draft of the concept map it was apparent to me how overwhelming this particular system is. Initially, I wanted to scrap everything because of how frustrating it was to achieve objectives in the Honeywell system. After initial prototypes failed miserably I began to dive deeper into what the interaction of a thermostat is with a user. I used the book Microinteractions, by Dan Saffer as a guide to build a better concept. It helped me in gaining understanding with how to look at exploring using visual clues for user goal completion. This is using recognizable images and repeatable actions to form a basis in how to use a system. What I began to learn is that I was not designing for visual aesthetics but designing for visual communication. The more effective I can show the thermostat the better the user could make the system a tool to achieve desired goals.

*Bringing users to the desired goal by eliminating multiple options and highlighting interaction through text.

The thermostat successfully incorporates all of the requirements laid out in the beginning of the course. It has been tested with users and iterated upon to this point. The Version 6 Ideal Thermostat is an intuitive design that utilizes the benefits of progressive disclosure and feedback models. This thermostat communicates to the users in a language that is understood by users. The last tests for this thermostat provided feedback that the visual artifacts are successful in conveying importance and how to use them.

*Accounting for user choice. These are multiple states that users can get based off of there decision they make. They provide visual feedback for what the prior decision was.

Overall, I enjoyed this project very much. The thermostat provided me insight on how to investigate mental maps of others. I learned how important it is to use visual artifacts as tools to complete goals or initiate the interaction. Looking back I have been able to bring this thermostat from what I now understand as a conceptual nightmare into well designed deliverable. The process has pointed out the importance to be able to understand when to stop moving the project forward.

This is my final mapping of the “Ideal Thermostat”.

Here are links to the previous posts.

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IDSE201 – Final Revision of a Thermostat

Explore, Build, Test, Revise

The past 8 weeks have been a iterative exploration into the design of a thermostat, but the lessons learned along the way are much more varied than simply ‘do it again’.

By utilizing a process of exploration, user testing, and iterative development of wireframes, I was able to gain insight into how to made a useful product while projecting my own opinion of design into the world.

What follows is a listing of my lessons learned, with explanations of the process and tactics for receiving actionable feedback to drive product improvements.

Lesson 1: Explore what already exists

With any new project, having a starting point is important. Exploring the field to see what already exists can serve as a icon to aspire to, or a warning sign of what to avoid. In any product or service, tradeoffs have to be made. Seeing what was prioritized by others allow you to gain insight into their view of the world.

Lesson 2: Map it out

Making models allows you to visualize the organization and hierarchy of a system. It also allows you to project your own opinions and receive feedback before making a single screen. Above, you’ll notice the concept map of the Honeywell model, below is the original concept map of my ideal thermostat.

Lesson 3: Have an opinion

Having an opinion, well formed or otherwise, allows you to start. You can always change your mind later.  In the original concept model, I projected this concept of a thermostat as networked component, an instrument in the orchestra of a comfort control system. I also specifically split the interface between a central control located in proximity to the HVAC system and a mobile control which is in constant proximity to the user.

Lesson 4: Reduce the unnecessary 

This is more relevant in legacy systems which have built up extraneous features over time due to politics and scope creep, but distilling an idea down to its essence is, in my opinion, good design.  In the case of this thermostat, I view it as a means of controlling the comfort of the user. Every feature should be focused on maximizing the comfort of the user or be absolutely necessary for the proper functioning of the system.

Lesson 5: Build a thing

Until your concept is externalized, it avoids reality. The faster you can produce your first iteration, the sooner you will be able to expose and explore the difference between your ideals and what the real world expects.

One of the tools for rapid ideation are wireframes. These are medium fidelity illustrations which can be generated quickly, are easily editable, and give a reasonable amount of detail such that a feature can be developed by a software engineer without further explanation.

Lesson 6: The user is not like me

Thankfully, you don’t have to be an expert software engineer to build a prototype. Paper prototypes are cheap and fast to make (albeit slightly less than ecologically sound). Using these paper prototypes, and a list of actions which you wish the user to try, it becomes quite easy to know if your idea holds up against current cultural norms and expectations.

Lesson 7: Emotional resilience is a necessary skill for a good designer

Putting your ideas out in the world can be a very challenging task. To achieve an objective view of the quality of your work, you need to test your idea with strangers. The best method I’ve seen so far is to use a list of clearly defined tasks for the user and have them think aloud while attempting to achieve the defined tasks one at a time. Think-aloud testing allows you to quickly grasp if the user is understanding your system or if they are having trouble processing certain intermediate steps toward achieving their goal. Your ability to process this feedback from the user and use it to motivate change in your design is a critical factor to the success of your product.

Lesson 8: Try it again

Making revisions based on user feedback acquired via think-aloud testing with paper prototypes, allows you to build your way toward an ideal state without needing to have everything ironed out ahead of time. You can react to situations as they develop, like suddenly changing requirements, without scrapping the entirety of your product. Overall this method is a rock-solid way of articulating your vision and accommodating the user’s desires.

Reflection:

So how did my final revision stack up to my ideal? Let’s use what we’ve learned from Lesson 2 to find out:

If you compare this concept model versus the original ideal, you can see that I did not deviate too far. Having a clear vision of the technologies I wished to use and my philosophy of a thermostat as a user comfort system allowed me to focus on how to improve user flows rather than to explore (and likely get lost in) much larger ambiguous thoughts like whether to use a digital or analog interface, whether the device should be networked, and whether it should do more than control the HVAC system.

In summary, the method of explore, build, test, and revise is one which I am very comfortable with due to my background as a Software QA Engineer. This method of design maps very closely to Agile software development process and the expected outputs are rather similar. Rapidly developed, incremental changes based on real-world feedback, instead of large amounts of time in ‘the cave’ tend to result in higher quality products.

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