Scott Wendall Gerlach is mild mannered fellow with serious hermetic tendencies. He is drawn out of his cave by his passion for exchanging ideas with thoughtful folks. He values clarification over simplification. At various points in his life he has been unmistakably obsessed with snails, lizards, snakes, bubbles, swimming, music, mathematics, tutoring, virtual smelting, rocket jumps, football strategy, gardening, and he always enjoys sharing with others.

Most recently he has been on a ruby on rails and javascript bender. Scott lives in Austin, Texas under a roof with his girlfriend Cheyenne Weaver and his dog Jackson where they get up to adventures and down with the boogie.


Reflections

Recent Tweets

@Scott_Gerlach: RT @AC4D: Just 3 weeks left to apply to Austin Center for Design - change your career trajectory! http://t.co/1cnN1XWver for more informati…

@Scott_Gerlach: Design in Healthcare: Improving Support During Recovery | A summary of our last few months of work @AC4D http://t.co/3ZhKdfbVSE

@Scott_Gerlach: @eboggsyboggs @jkolko @joyclee Hey Eric, thanks for taking the time. I offered some follow-ups in the comments: http://t.co/weuFK9DwdY

@Scott_Gerlach: RT @AC4D: New Blog Post: Healthcare: A Proposal for Supporting Recovery http://t.co/xGEsVIpejb

@Scott_Gerlach: @garychou thanks, Gary. A public health record API would have facilitated a slew of ideas we’ve had: http://t.co/4IuD5Ghn99

Recent Blog Posts

 

Building a pragmatic definition for sensemaking.

The one-year course at the Austin Center for Design is aimed at helping students build a framework for approaching interaction design in a way that builds autonomy for the designer while helping them address problems worth solving.  For me personally, some of the sharpest spikes in learning and independence have occurred when I am able to see how the practice that we are learning is also embodied in the design of ac4d itself.  Typically, we have already been applying a technique for a while in the program before the theoretical underpinning really makes sense.

Most recently, we have been exploring the role of perception and abductive reasoning in the sensemaking process.  After already going through sensemaking in a variety of different ways in the last seven months, I’m starting to develop my own ethic and practice as an interaction designer.  And so while the theoretical readings around perception were very dense, abstract, and seemingly unrelated… my tacit knowledge of the sense-making process made it possible to delve into them a derive my own meanings.

I think one question central to the question of design practice (of which sensemaking is at the core) is why it has largely eluded definition or refinement in the past.

So our understanding of design is in many way inhibited by our lack of understanding of the mechanisms of the creative process.  Because we see a linear causal chain, we are fooled into thinking that the decisions made along the way were the result of deductive reasoning or else just a spark of randomness that can’t be defined.  What we lose in this sort of retrospective is the context of each decision and how a pragmatic consideration of context results in a kind exploratory reasoning called abduction.  What we think of as creativity may in fact only be the result of practicality in the right context.

If it is possible to highlight some of the mechanisms that push us toward new insights, then of course it’s also possible to build a methodology that refines and enriches those mechanisms.  I tend to think of abduction not just as a lateral thinking process, but actually as a sort of filter that helps us select from all of the ideas in our subconscious from moment to moment.

And so the sorts of problems that are the most difficult to navigate–ones with complex external dependencies and incomplete information–are also the problems where a rigorous sensemaking methodology will differentiate itself as most useful because it’s the sort of sensemaking that puts the highest premium on a pragmatic, integrative approach to exploring new ideas.

Pragmatism is, of course, highly dependent on intuition.  And in order to be pragmatic in a way that is mostly likely to be relevant to a problem, designers must make their intuitive understanding of a problem space rich with of the context that is most likely to make their ideas relevant.  Perhaps most importantly, context can’t be abstractly understood, it is inherently informed by activity in the problem space with the affected people.

And while ethnographic techniques are widely used in design research today, I think there is a lack of definition around the sensemaking process that follows research.  Just as a perceptual layer exists between the interactions that users have with systems, there is also a perceptual layer that exists between the designer and the system they are designing.  In order to create an effective dialog with a design, the designer must externalize their ideas as often as possible in the form of iconic artifacts that allow for new projections and subjective reactions.  During our course on rapid ideation and creative problem solving, our class had a shared experience around the need for this sort of dialog as we rapidly prototyped and iterated on designs of thermostat systems.

Externalizations create a kind of relationship with a system and the system itself starts to impose its own constraints and shapes the designer’s understanding even as the design shapes it.  Resilient traits survive this dialog and a solution eventually emerges.

This articulation from the designer isn’t the solution it’s a solution: it’s an argument through a rigorous and methodical creative process.

Thoughts?

-Scott

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

Designing Meaningful Models for Interaction

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Thoughts?

-Scott

Posted in Design Education, Interaction Design, Methods, Theory | Leave a comment

Design in Healthcare: Improving Support During Recovery

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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.

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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.

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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

Posted in Design Research, Social Innovation | Leave a comment

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.

Posted in Regulation, Social Innovation, Startups | Leave a comment