News and blog posts from our students and faculty

Category Archives: Social Innovation

Highlighting The Work of Non Profits

For quarter four I am pushing through to build out my wireframes with Story Share in a second iteration. It has been an interesting process on going through this design state, again. In quarter 2 I was able to get a taste of what it is like to do user testing with thermostat wireframes. It is interesting to find each time I go through the process that the first concept or iteration to me feels like the best one. Each iteration after that becomes the reality of the world imprinting its true functionality.  Through testing and talking to industry professionals this project is beginning to tighten up in direction and concept.

Below is the second iteration of wires that I will be using for testing this week. The goal of this wireframe is to allow new users to arrive at a space and understand how to achieve a specific goal. This intro slide focuses the user to make the choice of investigating the Story Share app as a new user or to sign in as a previous user. In this scenario the user is new to the space and looking to volunteer. Ex. 1 is of the main page and Ex. 2 is the following screen of a user story.

 

 Once a user finds a volunteer opportunity they are interested in they are brought to a more in depth level of the app. While viewing the story the option to volunteer with the event becomes a major icon listed at the bottom part of the screen. If a user decides that this is an event that they want to be apart of they tap the “help out with this project” button. Keeping this action as a consistent feature to new users is a form of a reminder to sign up. Basic information is collected as seen in Ex. 4 and email notification for registration is sent to the user. This is to engage the user but not overwhelm them with a barrage of front end questioning.

The ability to allow users to read through projects and navigate the space without being registered is important. By doing this people who are exploring this app can see what level of importance it might have to their needs and goals. Advocacy is a primary function to the purpose of creating stories for Story Share. Creating a continuous feed of information for particular volunteer opportunities can show the on going challenge that many non profits and their clients go through. My goal is to allow users to share stories in order to continue the advocacy of the clients they are helping.

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BringUp selected for the 2nd round of the $50K Arch Grants Global Startup Competition

Although Will Mederski and I may have been in radio silence around AC4D recently, that doesn’t mean we haven’t continued to work on BringUp.

This past fall we got our software about 2/3rds complete with help from 2 students from MakerSquare. The automated parent signup process now works, and you’re welcome to try it out by texting the number  27  to 512-861-8455.

This winter, we submitted BringUp for the 3rd Annual St. Louis Arch Grants Global Startup Competition (www.archgrants.org) This organization provides $50K grants to about 20 companies willing to relocate their headquarters to the St. Louis area, along with lots of free accounting, marketing and legal assistance. It’s free money, no strings attached. Will and I are proud to announce that BringUp has made it to the 2nd round of the 2014 competition!

The 2nd round is a bit of a lighting round, as we had one week to prepare a 3 minute YouTube video, as well as an additional presentation. Luckily, Will and I were readily prepared from the work we did last year at AC4D. Creating this material on top of SXSW and a bad case of strep-throat was no problem at all. Please check out our video here: https://www.youtube.com/watch?v=v25N0fNBCCs

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Empowering Volunteers

Story Share is a project that focuses on providing the best volunteering opportunities to high school students. This project allows high school students to curate their personal profiles in order to share their schedules so that organizations that need volunteers can be alerted to their availability. One primary goal of this project is to create a website that can record volunteer work so students have a working portfolio that can easily be used for their professional or collegiate ambitions. During the next quarter, my plan is to test and revise the user flows for a working website dedicated to this service.

-Student meeting with counselor to go over college admission requirements.

The website is derived out of design research collected at the Onion Creek Flood in Austin, TX. On October 31, flood waters caused damage to communities in South Austin and surrounding towns. From the events that unfolded, it became important to me to build a site that works as an online resource for advocacy, response, and safety. The intention of the project is to create an organic interchange between community members who wish to volunteer and those organizations that are in need of volunteers. One under-recognized demographic of Austin’s community are high school students who are seeking volunteer opportunities. This project aims to help them become a voice of advocacy in a time of need.

This site is intended to function as a valuable tool for high school students in that it creates a place where students can find volunteer opportunities. By testing design functions of the site with various users’ insight can be learned to find the most effective forms of how to communicate this site. Many students are unsure of what, where, or how to even get started in volunteering. Story Share recognizes that this is a problem and seeks to offer a solution.

 -Initial design layouts of Story Share website.

Motivating factors for High School Students to volunteer are:

  • College Admissions.
  • High School Requirements.
  • Curriculum requirements for Academy of Global Studies.
  • Student clubs.
  • Personal interests.

By allowing students to include photos, stories, and schedule volunteer times the chances of the students to find opportunities that work for them become more realistic. Story Share plans to allow users to share experiences social media sites in order to help draw volunteers towards events that need more participation.

If you or someone you know is interested in helping with the efforts of making this into a reality please contact Kurt at kurt.hanley@austincenterfordesign.com Assistance in the form of time, advice, or contacts is extremely valuable for the success of this project.

Thank you.

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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.

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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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Healthcare: A Proposal for Supporting Recovery

Over the last few months Jacob Rader, Bhavini Patel and Scott Gerlach have been studying healthcare.  Our research focused on the documents and records that patients interact with and how these artifacts affect their relationship with the medical industry as well as their understanding of their own health.  Through contextual, qualitative research we had the opportunity to learn from a wide variety of people and identify many opportunities for design to make an impact in the healthcare system.

 

 

Patients

In talking to patients in at-risk communities we encountered a disconnect between the quality of care that people have access to and their perception of that care.  Put simply, most people’s perception of healthcare is largely linked to the extent that their healthcare reaches out and meets them on their level.

Insight
Patients will not be proactive in their own care, they need the system to guide them and help them establish accountability.

Through our research we found that when healthcare was at its best was when patients were being proactively engaged by their healthcare provider; the provider would meet the patient on their level and would facilitate care for them.  Even in situations where the technical care was good, if the system didn’t reach out to them, patients didn’t feel as stable.  Whereas, people who have access to healthcare that addresses simple things like helping them schedule appointments and arrange transportation feel much more supported and cared for by their providers.

 

Professionals

On the other side of this we saw that healthcare professionals are stretched very thin, pulled by both the volume of patients they care for and the bureaucratic demands of their work.  Much of the time and energy that professionals have to expend is not directly perceived by patients.

Insight
Due to the technical nature of modern healthcare doctors have lost a common language for communicating with patients.

As modern medicine has developed it’s become increasingly complex and specialized forcing doctors and medical providers to develop a vernacular and understanding of the care their providing which is increasingly disconnected from their patients.  Additionally, most professionals’ technical workflows don’t lend themselves to an understanding of the patient’s experience of healthcare: so problem areas like confusing or conflicting documentation don’t get addressed and become an additional obstacle that patients must negotiate.

 

Good Communication

When the two previous insights are layered together, we start to understand why miscommunication and misunderstanding so often develop in medical care.  If we understand some of the factors driving poor communication between health actors, it becomes crucial to define what good health communication looks like.

Good health communication happens through interactions that meet the patient on their level.  It gives patients small, understandable pieces of information as well as the time needed to process them.  It gives patients actionable information and prompts when they need it.  Ultimately good health communication helps a patient build understanding while encouraging self reflection.

 

Supporting Patient Recovery

Our goal is to leverage interaction design to help extend more support and clarity to patients without demanding more time and energy from professionals that are already stretched to their limit.  In our research the most pronounced need for this sort of good health communication is in the transition from inpatient hospital care to outpatient recovery.

From the moment a patient enters the hospital, the hospital staff must be preparing for that patient’s departure.  The high-volume nature of the hospital along with the reality that so many individuals in the hospital have a part to play in the care of each patient means that there must be very clear goals that create some alignment between all the professionals.  Near the top of that list is ensuring that the patient can leave the hospital as soon as they are well enough to do so.  The consequence: as they are leaving a hospital’s care, patients receive a condensed burst of information about their recovery.

Many of the doctors and nurses who participated in our research reported that the majority of patients who call during recovery are asking redundant questions that had been addressed with the patient through written or verbal instructions prior to them leaving care.

Clearly, patients are not processing the information they are being given in a way that is relevant to their recovery.  This doesn’t just lead to confusion and redundant phone calls, it also leads to complications in recovery.  Patients don’t understand or adhere to the treatment plans that doctors have in mind for them.  They don’t heal properly, aggravating weakened areas which often forces them to be readmitted to the hospital.  This causes extra strain on an overloaded system.  Readmittance is a problem area that many hospitals are actively trying to problem solve, in part because of new guidelines in the Affordable Care Act.

 

Our Proposal

The current system overloads the patient with a deluge of technical information at a single moment.

We propose taking all the information and sending it to the patient in manageable pieces over time via text messages.

We see a system that reinforces the education that patients receive while in care with timely reminders after they return home. What might this look like:

Patient is informed about the text messaging program as they’re preparing to leave care.

The patient starts receiving texts while still in care and the messages continue after care at targeted times that corresponds to the patient’s recovery.

Weeks out of care and the patient is still receiving helpful recovery information and appointment reminders.

 

Impact

We believe that a system like this will help on a number of levels.  Firstly, it will connect patients with information at appropriate times in a formats they are more likely to digest and act on.  Secondly, it will reduce preventable complications and readmissions.  Finally, systems like this will encourage patients to think about their health on a more continuous basis and will help them feel more connected to their own health and the healthcare system.

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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.

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Quarter Two in Review: Research into Wicked Problems

On Saturday, December 21st, students at Austin Center for Design presented the results of their 8-week research inquiry into a large, systemic social problem. Students explored topics like disaster relief, teenage pregnancy, health records, and gender identity and safety, and presented their work in an open forum to the Austin community. You can learn more about their progress below.

James Lewis, Meghan Corbett and Anna Krachey have been doing design research around pregnancy and child birth decisions. Their research led them to speak with expectant mothers, public health workers, doulas, and social workers, and they identified three core insights that can drive their further ideation and exploration. One of their insights was “taking care of a baby gives teen moms a sense of purpose and motivates them to take care of themselves.” This idea then led to the idea of “Daddy Doula” – a service that would help “fathers become more informed of the physical and emotional challenges of birth that their partner endures and learn how they can best support and assist them during labor. Teen fathers would then be empowered to take an active, supportive role in the birth of their child.” You can learn more about this idea – and others from this team – here.

Chelsea Hostetter and Alex Wykoff have been investigating the process of gender identity, and safety, for those going through gender variant transitions. Their research has identified heart-breaking stories – and opportunity for design-led change – and as a result of their synthesis process, the team developed over 300 divergent ideas of ways to help a community in need.

One of their ideas – Pickle – is “underwear exclusively for trans-men”, while another – Find a Family – is “a location-based app that allows open-minded families and individuals who have an extra seat at the table for holidays to invite others to participate in their holiday. The app connects people based on their location and interests, and facilitates a conversation that develops into a connection over the holidays.” You can learn more about their process here.

Kurt Hanley is exploring how a city, and community, responds to a disaster to provide relief and support. During his exploration, Kurt engaged with the Red Cross, with first responders, and with those who have been displaced by the recent floods in Onion Creek. He identified a number of socioeconomic inequalities and inefficiencies, and has begun to develop a hypothesis about how to better support those in need. You can read more about this hypothesis – often called a theory of change – in his recent post, here.

Scott Gerlach, Bhavini Patel, and Jacob Rader have been immersed in the chaos that is our health record system. The team spent time with hospitals and clinics, with health providers and the recipients of care, and with the impoverished and homeless; they acquired an understanding of the challenges faced by the healthcare system, and gained empathy with the various constituents in this complex system. Through sensemaking, the team arrived at a place advocating for holistic care and patient control, and will then carry this idea framework forward during ideation and design development. You can learn more about their work here.

Next quarter, these students will further ideate and begin to iteratively develop systems, products, and services that can offer social and cultural value.

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Health Records: Reflections and Opportunities

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

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

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

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

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

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

 

Bureaucracy

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

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

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

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

 

Patient Stories

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

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

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

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

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

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

 

Healthcare as a Bully

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

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

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

- Participant B

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

- Participant K

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

 

Care vs. Perceived Care

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

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

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

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

 

Informed Consent

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

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

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

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

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

 

Behavior Change

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

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

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

-Participant PB

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

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

 

Healthcare Encourages Misuse

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

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

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

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

 

Holistic Care

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

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

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

-Participant L

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

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

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

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

-Participant N

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

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

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

 

Going Forward

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

Thoughts?

-Bhavini, Jacob, and Scott

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Natural Disaster Relief Project and Service Design

After weeks of interviews and gaining understanding of Natural Disasters I have narrowed the focus of our IDSE 203 class project down. So far the focus has been researching natural disasters and the impact they have on a community. This has led into many areas of the current relief efforts for the recent Onion Creek floods here in Austin. Moving forward the focus attention on understanding what available resources and next steps are communicated to survivors and how transparent and accessible that information is.

There are so many areas that can use attention and could use design research to better improve. The beginning of our research we focused on gaining an understanding of what the perspective of disaster responder and a survivor is like. To do this I got involved by working along side case managers with the Red Cross at an evacuation center. Doing this type of research allowed us to investigate current disaster relief efforts and the impact being made first hand.

During the research I was able to get to see what it is like from their shoes. Being exposed to the environment a relief worker goes through in order to assist those in need is an experience I will forget. The long days, changing elements, crowds of people, and being so busy that many times the first meal of the day is at 7 pm is difficult. There are many people doing great work to help in rebuilding a community.

Piecing together the stories and events of a disaster we hope to uncover how communities rebuild together. The focus on communicating resources is something that design can help to empower the rebuilding efforts. Below is a service design model that outlines what it is like for a survivor of a natural disaster, it can also be viewed on the link here. By putting the experiences through different design lenses the hope is to expose design opportunities. The service model is one of the tools that helped gain an understanding that communication is an area that has breakdowns. This is highlighted in the flowchart in the area of leaving an evacuation center and returning to an evacuation center. The hope is to discover ways to close the looping that happens for survivors back into the system.

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