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.
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.
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.
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.
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.
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.
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.
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.
Recovery Text is an opportunity for mutual benefit for both patients and professionals by changing the flow and timing of this information.
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.
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.
From patients we have learned a good deal about the tone and content of text messages.
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.
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.
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.
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.
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.
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.
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.
If you’re interested in more details about our project or discussing opportunities for meaningful design in healthcare, please contact us: HealthRecords@ac4d.com