Onsite Care

Onsite Care

What

Research, UX, and UI design to create a delightful experience for helping patients get to know their care-team members on the cardiac unit.

User Research

Teamwork

Workshop Facilitation

Design Thinking

Illustration

When: July 2019 - March 2020 | Where: Boston Children's Hospital, Boston, MA

Why

The Innovation and Digital Health Accelerator @ Boston Children's Hospital wanted to tackle the issues patients, families, and caregivers encounter while physically in the hospital. We started with a broad question of what facets of onsite care could be improved and used design thinking to tackle the problems we identified.

How

The Problem

How might we improve the overall experience of onsite care interactions for patients, families, and providers?

The Solution

Use technology to visually represent the care team for the patient & family in a way that fits seamlessly into their day.

Benchmarking

Wall covered in post-its related to admitting the patient

As a starting point, I researched innovation onsite care solutions at other institutions and emerging startups. I took notes on various articles and presented the findings to my team.

Problem Identification

We knew we wanted to identify and address problems occurring physically in the hospital, but we didn't know precisely what, so we ran a design thinking session.

Providers

A mix of doctors, nurses, admins, etc.

Parents

Of current or former patients

Patients

From our Teen Advisory Council

We asked each group to run through a typical day and identify what their persona would be doing and thinking/feeling, on Post-Its. We then used dot-voting to identify the most important issues.

Team Lauren - The Provider
Wall covered in post-its related to admitting the patient
Wall covered in post-its related to collaborating with other care team members
Wall covered in post-its related to treating the patient
Wall covered in post-its related to discharging the patient

I facilitated for team Lauren, are we identified 3 top pain points for the provider during the caregiving process:

1.

Handoff

Coordinating exchange of information between providers

2.

Expectations

Providing realistic expectations for families and patients

3.

Prioritization

Prioritizing tasks and multitasking throughout the day as needs vary

a spreadsheet synthesizing the pain points generated.

The Post-It's were distilled into this easier-to-read chart - Thanks Jessica!

Solution Generation

a spreadsheet synthesizing the pain points generated.

We then used Post-Its to generate solutions for each of our three main pain points and repeated dot voting to prioritize them.

1.

EHR

Allow patient / family to update EHR with their expectations

2.

Dash Dots

“Dash dots” in patient rooms to allow easy restocking

3.

Visual Map

to show who has talked to whom and what information has been shared

You can download my complete notes from the session here!

Debrief

After the session, the facilitators came together to identify commonalities between groups, and synthesize our findings. We noticed some common pain points across all 3 groups.

1.

Knowing Who’s On the Care Team

Clarity around who’s on the care team at any point in time and care team roles throughout the patient stay.

2.

Understanding What’s Happening During Care

Consistent communication around care progress and daily schedule for providers, patients, families, & caregivers.

3.

Continuing Care Outside of BCH

Enable family/caregivers to actively participate in care away from the bedside.Help providers empower patients, families, & caregivers to prepare for recovery.

Brainstorming

Considering other ongoing initiatives at BCH, we opted to focus on "knowing who's on the care team," keeping the other main pain points as considerations.

The team consisted of me, a project manager, our clinical director of innovation (previously a nurse), a futurist consultant from the MIT Media Lab, and an internal strategist.

"A Day in the Life" Brainstorming

Patient Profile: Adam, age 11

  • Inpatient for antibiotics
  • Single room
  • Moderately healthy (not acute critical care)
  • Crohn disease: GI flare, connected to IV, go through testing during time, not post-surgery
  • Idea of being lonely, especially during care that is a flare-up and not post-surgery, because not sure exactly what care is coming next, when and how things might change, highly dependent on communication with care team
  • 9 South

We mapped what a day for Adam would typically look like, based on Kate's clinical knowledge. You can download that schedule here.

Initial Ideas Brainstorming

Using the day in the life of our patient as inspiration, we generated ideas to alleviate the identified pain points, and stuck them on the wall with - you guessed it - Post-It's!

Scheduled Rounds

Allows flexibility for families and ensures stakeholders are present

Thank Care Providers

Family wants to thank care providers following hospital stay

“Me on a Page”

"Me on a page” about patient with audience of provider

Identifying T-Shirts

T-Shirt: “I’m a nurse, ask me about…” Helps patients and families learn roles.

Badge

Could we use the ID badge in a better way?

Agency and Control

Especially in this situation very out of patient’s autonomy

Info Resource

Proactive reminders, "nearby", estimated wait times

Patient Movement

Augmented reality scavenger hunt, motion activities in the room

"Marauders' Map"

Interactive wand, incentive to walk around the hospital, magical element

Storyboarding

At our next session each team member took ideas that appealed to them and wrote a high tech and a low tech scenario in the voice of our patient, Adam. Below are mine.

Low Tech Scenario

I wake up early, and thankfully I have some time to myself in the morning. I’m worried about my upcoming CT, because my team said there’s a chance I’ll need follow up surgery. There’s a whiteboard in my room that says “CT scan 9/18” on it; I write on it “I’m nervous about this” and “how does a CT work?” When my nurse comes in she seems my questions (which is good, because by that time I had completely forgotten because I was absorbed in a movie) and not only does she tell me the answers, she writes them on the board right under my questions so I won’t forget. She also writes me a list of steps that will happen before the CT, so I can be prepared. Then she asked me to come up to the board and together we come up with some good strategies for staying calm in the CT machine. Now I can always refer back to the board and understand my care plan that we built together.

High Tech Scenario

When I arrive at the hospital I get to choose a character to accompany me in my journey. I choose Charlie the Cheetah because I want to get out of here as fast as possible. Charlie becomes my companion along my journey; he has insider tips about the hospital, can get in touch with my friends and family, and helps me prepare for stuff that happens in the hospital (like scans and blood tests). Charlie also lets me tell him how I’m feeling and keeps track of my goals for my stay. I can either interact with Charlie on my iPad, or by speaking out-loud to the TV. When a new event comes up, Charlie will hop over to it and give me the details. Once I complete the task, Charlie and I earn a badge together, which sometimes comes with extra cool bonuses like a new hat for Charlie in the game. When I leave the hospital I get a book that has pictures of things Charlie and I did, as well as some of our important conversations and my goals. There’s also advice from Charlie about going home and I get to keep a little sticker of him, which I put on my new school folder.

Idea Refinement

We started to explore what an ideal state would look like for the concept we chose to pursue: helping patients get to know their care team through the use of cards (an idea spawned from collectible baseball cards) and augmented reality.

We wanted to create a design that would be interactive and allow the patient to be in control of the information they see. We wanted to provide opportunities for the patient to meet their team, learn about events in the hospital, and keep track of their schedule.

I did a series of drawings to bring the concept to life and imagine how it might function.

Drawing of a doctor entering a patient room. When they use the hand sanitizer dispenser, their name is projected on the wall.

When a care team member uses the hand sanitizer and enters the room, their info is displayed on the wall.

Drawing of a visualization indicating which care team members are currently on shift

The care team visualization indicates information about the staff members, including when they're on shift.

Drawing of a visualization indicating the daily schedule in the hospital

An adaptive schedule projection allows the patient to anticipate their day and easily convey it to parents.

Drawing of what the visualizations might look like from the patient's view

Envisioning how these projections might look from the view of the patient.

Drawing of how activating a card might change the projection.

Additional "cards" can be placed to unlock information about events (e.g. MRI)

Evaluation

As we investigated this concept, I raised some concerns about how realistic it would be to implement.

Care Team Behavior

A major challenge we encounter at the hospital is that care team members - especially nurses - are constantly asked to integrate new and disparate technologies into their work flow. This solution would require a lot of buy in.

Cost & Facilities

Short throw projectors are extremely expensive. Additionally, the rooms at BCH vary greatly in layout, making standardization difficult and installing anything is a laborious and highly regulated process.

Accessibility

This design assumes some degree of mobility for the patient, in order to get out of bed an view the smaller projected information. Given the diverse patient population, this might not be the case.

I highlighted these concerns to my team an we weighed the value of a high-tech solution (good press, exciting for patients) against these factors. We ultimately decided to significantly scale back the design and focus on creating an MVP that could be quickly implemented and tested.

Minimum Viable Product

I developed a written plan for validating this concept, and building and evaluating an MVP. You can download the whole plan here, but below are some of the key facets.

Goals

  • Learn how care team cards affect the overall workings of the unit
  • See how families respond to physical, tactile cards
  • See how families store and organize the cards
  • See how care teams respond to card distribution
  • See if cards help families connect more with their care team

Plan

  • Spend 3 days observing in the unit and interviewing staff and families
  • Create cards for the staff using handwritten index cards
  • Spend 1 week observing pilot where we ask staff to distribute cards to each patient
  • Conduct interviews with staff and patient families to see how they responded to the pilot

Research Phase

Observation

I shadowed in the cardiac ICU at Boston Children's Hospital, observing rounds and day-to-day activities. A large part of this was observing how many different people come in and out of a patient's room.

Handwritten notes indicating entry/exit from patient rooms

Chaotic iPad note attempting to capture motion in and out of the room.

timeline indicating how frequently different people entered/exited the patient room

I was surprised to see how many different people entered the room within an hour, and how much the length of stay varied.

Family Interviews

5

Parents (all moms)

3 - 15 years

Range of child age

1 - 21 days

Length of stay

To protect HIPAA, I will leave out the details, but I was able to have 5 fruitful conversations with moms in the cardiac unit and get their opinions on the proposed card pilot, as well as the possibility of an on-screen integration.

Findings

Physical Care Team Cards

  • It is significantly harder to keep track of care team member who visit less frequently
  • Some benefits could also be achieved with a larger name tag
  • Different ages may have different uses for the cards (game on the back vs. place for notes)
  • Could help patients & families know who to expect each day
  • Could help facilitate transfer of information between parents who may be visiting at different times

Digital Display of Care Team

  • Families were not interested in an iPad because they thought the care team was more of a background problem, not something they wanted to actively engage with
  • However, it would be helpful to have a way to access additional information about the team
  • It would be nice to have a digital version in case cards are lost or misplaced
  • More comprehensive overview of the context / relationships between care team members
  • More information available than can fit on a card

Staff Interviews

4

Staff Members

1 - 10 years

Tenure at BCH

3

Different roles

Findings

Interacting can be difficult when...

  • The parent doesn’t agree with the plan
  • Teenagers don’t want to be there
  • Parents are there with young kids who want to go home
  • Parents aren’t at the bedside
  • Some patients just don’t care about connecting
  • There is a language barrier

Care Team Cards

  • Could be a good way to connect to patients and families
  • Could help patients and families remember who they are and recognize them
  • Concerns about privacy - protecting their personal information (name, face, contact information)
  • Concerns about having to carry the cards around

Next Steps

Unfortunately, this project was derailed with the onset of the COVID-19 pandemic in March of 2020. The pandemic fundamentally changed how our onsite units function for the foreseeable future, so the project has been put on hold.

Learnings

This project allowed me to facilitate a large scale design session for the first time. I was also able to see a project from the very beginning stages through (part of) an MVP. I learned a lot about standing up for my ideas, especially when team dynamics are somewhat strained, and I gained comfort interviewing users and presenting my ideas.

Tools

Miro • Post-It's • Microsoft OneNote • ProCreate for iPad • Google Slides