When: July 2019 - March 2020 | Where: Boston Children's Hospital, Boston, MA
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.
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.
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.
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.
I facilitated for team Lauren, are we identified 3 top pain points for the provider during the caregiving process:
Coordinating exchange of information between providers
Providing realistic expectations for families and patients
Prioritizing tasks and multitasking throughout the day as needs vary
We then used Post-Its to generate solutions for each of our three main pain points and repeated dot voting to prioritize them.
Allow patient / family to update EHR with their expectations
“Dash dots” in patient rooms to allow easy restocking
to show who has talked to whom and what information has been shared
You can download my complete notes from the session here!
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.
Clarity around who’s on the care team at any point in time and care team roles throughout the patient stay.
Consistent communication around care progress and daily schedule for providers, patients, families, & caregivers.
Enable family/caregivers to actively participate in care away from the bedside.Help providers empower patients, families, & caregivers to prepare for recovery.
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.
Patient Profile: Adam, age 11
We mapped what a day for Adam would typically look like, based on Kate's clinical knowledge. You can download that schedule here.
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!
Allows flexibility for families and ensures stakeholders are present
Family wants to thank care providers following hospital stay
"Me on a page” about patient with audience of provider
T-Shirt: “I’m a nurse, ask me about…” Helps patients and families learn roles.
Could we use the ID badge in a better way?
Especially in this situation very out of patient’s autonomy
Proactive reminders, "nearby", estimated wait times
Augmented reality scavenger hunt, motion activities in the room
Interactive wand, incentive to walk around the hospital, magical element
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.
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.
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.
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.
As we investigated this concept, I raised some concerns about how realistic it would be to implement.
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.
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.
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.
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.
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.
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.
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.
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.