Overview: More than 60% of physicians report being unable to provide equitable care to people with disabilities as people without disabilities (from IPHAM). Dr. Tara Lagu and the team at Northwestern University’s Center for Health Services and Outcomes Research in the Institute for Public Health and Medicine (IPHAM) challenged us to design a solution that increases access to accommodations in healthcare settings for people with disabilities.
Problem Statement: In inpatient settings, the standard call light is not accessible for people with impaired communication abilities. Use of the call light requires the ability to hear the nurse responding over a speaker, but people who are deaf might not hear what the nurse says. Similarly, the call light requires patients to respond to the nurse verbally through a microphone, but people with impaired communication may not be able to do so. How might we enable call light functionality for people with impaired communication?
Solution: COMMon Thread incorporates a Communication Preference Survey and Preference Hub to provide the patient with more seamless accommodation for their communication needs. The patient fills out a surgery-specific form before surgery to identify their post-surgery communication preferences. The form is then paired with a standardized board in each room to ensure that any healthcare practitioner who enters will be aware of how to best communicate with the patient.
Team Members: 6
Individual Contribution: Design Research, System + Stakeholder Mapping, Designing a Solution, Hand-offs
Timeline: 8 Weeks
Empathy Guided Research
Practicing empathy and creating the space for your interviewee to feel comfortable is key when it comes to gaining key insights. Throughout the interview phase, below are my personal takeaways in conducting good interviews to lead to insights:
1. Allow space to be vulnerable: Non-verbal positive feedback and verbal reassurance goes a long way. Have key questions but also include a section for tailored questions based on the interviewee.
2. Maintain a curiosity mindset: Invest in getting to know the specifics with follow up questions, and remember that it is also ok to go off script.
3. Ask about workarounds: Asking about what is currently done regarding the problem can lead to insights on what's missing.
Quotes that supported our design solution:
After conducting these interviews and organizing them into common themes, we realized that the problem of communication was not in the call buttons themselves, but in the system surrounding standardized communication documentation. Medical documentation is standardized, but sharing of communication preferences is not. Based on our research, we then reframed the original brief to:
HMW enable standardized documentation of a patient's communication needs and preferences in order to ensure consistent awareness and accommodation?
Designing for Viability Desirability and Feasibility
(+Stakeholder and System Mapping)
(+Stakeholder and System Mapping)
By mapping out the journey of the nurse and patient and looking at the problem holistically, it was clear where the break in communication was:
The areas of opportunity showed up in 1. after the patient received the surgery and 2. when there was a nurse hand-off/shift change.
Keeping in mind that it's not easy to implement change quickly in hospitals, the design had to be desirable and as easy as possible to implement. In addition, the solution also had to be feasible (created with existing technology), and viable (cheap to implement):
I created a first draft Pre-Surgery Check-in Form, making sure both the patient and doctor sign the form as well as utilizing carbon copy paper underneath so it can be distributed to nurses and made sure that everyone is on the same page regarding the patient's communication preferences post-surgery. For the patients that can't speak english, this would be in their preferred language.
We then iterated on the Pre-Surgery Check-in Form and combined it with the Standardized Whiteboard in the patient's room so anyone entering the patient's room will understand the patient's communication preferences, and how to best communicate with them:
Continuing the Work
Since we only had 8 weeks on this project, we wanted to lay the groundwork and make it feasible for the next team to continue the project without feeling unsure how the solution fits in and overwhelmed. We went through what next steps could look like using the Step Stretch Leap Framework, and we also created a 2 page PDF handoff for the next team that decides to take this on.
Hands Offs: a 2 pager Summary PDF to provide background of the solution in addition to a step-by-step guide on how to implement the solution, and how to measure success and improvements to be made.
Final Thoughts
Service design is messy and complicated with many stakeholders. With so many areas to improve upon, by employing research and human-centered problem-solving approaches and using frameworks to visually deconstruct the problem into smaller, manageable sub-problems, the process of designing a solution becomes less daunting.
Service design takes a long time to effect change. As people come and go, we need to make sure there are clear next steps and measurable actions so that whoever takes over can contribute to the momentum, improve on the solution, and move the project forward.
Special thanks to: Dr. Tara Lagu, Dr. Andrew Berry, Dr. Carol Haywood, P. Amy O’Keefe, Design Coaches mayed & Lindsay, and all the interviewees who made this possible.