design in healthcare

Design in H

ealthcare©

2012

Design in HealthcareDeveloping Methods of Communication & Learning

The University of The Arts Master of Industrial Design

Published by

211 South Broad Street, 5th FloorPhiladelphia, PA 19102

Copyright © 2012

Dominic PrestifilippoMatthew Van Der TuynSara HallWan Ting Chang

Alexandra ViscontiBen HillsonDaeun Song

Design in HealthcareDeveloping Methods of Communication & Learning

Copyright © 2012 by Alexandra Visconti, Ben Hillson, Daeun SongIllustrations copyright © 2012 by Alexandra Visconti, Ben Hillson, Daeun Song

Photography credits:Pages 1- 110, © 2012 Alexandra Visconti, Ben Hillson, Daeun Song;

All rights reserved. No portion of this book may be reproduced–mechanically, electroni-cally, or by any other means, including photocopying–without written permission of the publisher.

Book design by Alexandra Visconti, Ben Hillson, Daeun Song

Masters of Industrial Design at The University of the Arts212 South Broad Street, 5th FloorPhiladelphia, PA 19102

First printing April 2012

p.5 Overview of the ProcessResearch SynthesisPrototype + TestIteration

p.23 StoriesInterviewsProbesQoute CardsPersonasDeveloping PrototypeImplementing the PrototypeReflection

p.99 SummaryPresentations + Recommendations

p.105 AppendixThe Design TeamGlossaryReference

Table of Contents

2

Major healthcare organizations have recently been departing from traditional, Six Sigma methodology to Human-Centered Design thinking. Organizations like Kaiser Permanente and the Mayo clinic are recognizing the value of employing human-centered problem solving to a human-centered service industry. Inviting designers to help solve wicked problems within a healthcare environment can yield results that otherwise would not be recognized with traditional problem solving. Designers specialize in understanding people, examining their behavior, and being conscious of their needs while traditional methods of problem solving specialize in maximizing static measurables like improving the bottom-line and increasing volume. Research, synthesis, prototyping, and iteration are used to identify the root causes of problems, understand culture and behavior, sort through complex information, develop concepts to solve problems, and refine concepts along the way.

As design thinking is implemented, these healthcare organizations are seeing exponential improvements in the quality of care they deliver. Not only is design improving healthcare services from a patient’s perspective, but it is also improving the complex work environment for the employees.The University of Pennsylvania Hospital System invited a team of designers to address specific digital tools used for communication and learning. One of the tools was a newly developed digital platform called The Square. This was created to allow employees to engage with each other in a digital space to get feedback and co-develop ideas for improvement. The second tool is a digital platform called the Learning Management System. This is a platform that contains learning information, allowing employees to receive important documents as well as discover and schedule classes for professional training.

While the design team originally aimed at improving these digital tools, the research revealed that the issues revolving around communication and learning extended far beyond these two digital platforms. The resulting work developed a concept addressing the issues around communication and learning but also challenged the organization to address these issues at the root level beyond their digital tools.This documentation shows how a team of designers introduced human-centered design to the University of Pennsylvania Hospital System.

Design in Healthcare

INTRODUCTION

3

10.16 to 10.22 10.23 to 10.29 10.30 to 11.5 11.6 to 11.12 11.13 to 11.19 11.20 to 11. 26 11.27 to 12.3 12.4 to 12.10

Research

Interviews

Implementation of Workshop

Synthesis

Prototype Workshop

Testing & Iteration of Workshop

MiD & Penn Med / Semester Timeline

WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 5 WEEK 6

We Are Here

WEEK 7 WEEK 8

5

Research

Synthesis

Portotype + Test

Iteration

OVERVIEW OF THEPROCESS

6

RESEARCH SYNTHESIS PROTOTYPE ITERATE

7

This process is organic. The outline provided above is our take on how this process generally plays out, though we often visit and revisit the different facets of the process as needed. Standardized processes often produce predictable results and leave little room for experimentation. However the organic process we use allows for creativity to be leveraged to produce unpredictable results. The design process utilizes this organic process to develop a broad set of opportunities to build on, while cross-referencing these opportunities against research for a true understanding of relevance and effectiveness.

How Why

How Why

How Why

Revisiting previously synthesized information and considering feedback to develop and refine new prototype versions.Considering new research regarding discoveries.

To create a method of agile development and allow continuous improvement so that as our economy, health care policy, and culture change, Penn can continue to offer a better, more engaging method of innovation and knowledge exchange.

Prototypes validate or challenge new directions. Prototypes also give form to our insights, which enables conversations to continue with depth and clarity regarding the development of these tools.

Contextual Interviews with individuals in their own space, will provide us with rich information about how knowledge and ideas are currently trans-ferred. We will leave behind tools that will help us understand personal experiences.

To ensure both the new LMS and The Square are implemented and engaged as seamlessly as pos-sible. Through understanding the context of cur-rent learning we will be able to understand how the purposed tools would be integrated.

Revisiting previously synthesized information and considering feedback to develop and refine new prototype versions. Considering new research regarding discoveries.

Synthesis is important because it allows us to make informed decisions on how to move forward with the development of prototypes that are relevant and engaging. It also shows us interesting connections that will help us position these new tools in a way that makes them relatable.

Employing all subsequent information we will quickly develop and test small scale concepts that directly address the content, access and delivery in the LMS and create value in the Square.

How Why

DESIGN PROCESS

UArts MiD Project Work Statement

RESEARCHGathering qualitative data with a human centered

approach by considering ethnography and outliers.

The design team used design research tools of

cultural probes, contextual interviews, drawing the

experience, guided tours, and secondary research

at Penn Medicine to collect qualative data about the

culture of learning and communication within the

healthcare system.

9

10

R

Cultural probes are information gathering packages based around the principle of user participation via self-documentation that reveal perceptions and behaviors within or across cultures. The team designed a skin for a disposable camera and a small work book to use as a lens into the daily lives of employees. The employees were given a list of instructions of photos to take on the back of the camera.

Cultural Probes

Draw the experience

Asking participants to visualize an experience through drawing and diagramming which can debunk assumptions and reveal how people conceive of and order their experiences or activities. The work book portion of the cultural probe asked employees to draw aspects of their days that gave the team key insights into the way they see themselves in relation to others in the hospital system.

RESEARCH TOOLS

11

Guided Tours

Contectual Interview

Secondary Research

By asking participants to lead a guided tour of the project-relevant spaces and activities they experience helps them recall their intentions and values. The team followed their contact on a tour of the Penn Medicine Center for Innovation and Learning to get a better feel for the office space in which the contacts operate.

The interviews are conducted in the environment, or context, in which the service process occurs allowing interviewer to both observe and probe the behavior they are interested in. The team conducted over 40 employee interviews in which valuable qualitative research was recorded. This research included employees explaining various procedures and systems they use on a daily basis.

Supportive information including published articles, papers and other pertinent documents to develop an informed point of view on design issues. The team explored secondary research in the area of what is currently being innovated in health care, and what research has already been done at Penn Medicine.

www.hbr.org

Kaiser Permanente’s Innovation on the Front Lines

by Lew McCreary

Included with this full-text

Harvard Business Review

article:

Idea in Brief—the core idea

1

Article Summary

2

Kaiser Permanente’s Innovation on the Front Lines

Simply stepping back to observe how you work can yield game-changing insights.

Reprint R1009H

SYNTHESISMaking sense of the qualitative research gathering

through abductive thinking, visualizing information,

and sorting data. This process allows for producing

generative thinking.

The design team synthesized information many time

throughout their work. Synthesis occured at broad

and granular levels. Various artifacts were created

to help aid the process of sorting out information.

13

14

Card Sort

Card sorting asks people to organize cards spatially, in ways that make sense to them, revealing expectations and priorities about intended functions. The design team used a card sort to organize and group different types of quotes that were collected through the interviews and printed onto cards.

Affi nity Diagram

Affi nity diagramming is a method of data organization that is intended to defi ne categories based on likeness of information. The team used affi nity diagramming to group and organize various levels of information that was gained from the card sorting.

SYNTHSIS TOOLS

15

Concept Map

A graphical method for organizing and representing knowledge supporting meaningful learning through associative and hierarchical connection forming.Concept mapping was used to help understand the varying levels of information regarding the topics of focus.

Profile

A document that contains different categories to present information to be compared across different interviewees. Profiles were created for every individual that was interviewed. Once all of the interviews were complete, the group collectively examined each profile document.

PROTOTYPE + TESTPrototyping is developing concepts that are informed from synthesized research. These prototypes are a concept that is able to be tested for observation.

The research led the design group to develop a workshop as their prototype. During its testing and implementation, we observe the successes and failures. This informed recommendations for future workshops.

17

18

Scenarios

Illustrate a story line describing the context of use for a product or service.Scenarios were drawn out during the development of the workshop. This helped spell out how different parts of the workshop would be facilitated.

Experience Prototype

Simulation of the experience using the product revealing unanticipated issues or needs.While refi ning the workshop, the design team did several simulations where team members practiced executing the workshop. This tool helped refi ne how the workshop would be facilitated and what materials would be needed.

The Learning Management System (LMS)

The Square

PROTOTYPE TOOLS

19

Role Playing

Identify the stakeholders involved in the design problem and assign those roles to members of the team for them to enact activities within a real or imagined context.The design team played the role of participants while practicing how the workshop would run.

Storyboarding

A series of drawing or pictures that visualize a particular sequence of events.Storyboarding was used when planning out how the workshop would run. This helped visualize each step of the workshop and spell out eacvh step of the process.

Co-creation

Engaging people with different backgrounds and roles to work collaboratively as part of the same team, in order to examine and innovate a given experience.The workshop was designed to engage people from different backgrounds and allow them to design a resolution to an issue. This allows for many different perspective to be considered during the development of a concept.

Sort, Sythesize,Make Sense Prioritize

1

2

3{ {

Prioritize

1

2

3Brainstorm

Ideas

Implement Prototype

DevelopPrototype

{

{

RevisePrototype

AnalyzeFindings

20

Implement Prototype

{{

RevisePrototype

AnalyzeFindings

Revise Prototype

ImplementPrototype

AnalyzeFindings

ITERATIONObservations from testing a prototype inform the development of new versions of the concept. This redevelopment processis called iteration. Iteration can also lead back to any point of the design process. The execution of a prototype could reveal there is missing information from the initial research or that the research needs to be revisited and re-synthesized. Iteration can also occur at any point during the design process. A method of research may prove to be unsuccessful in collecting adequate data, revealing a new method for research must be created. A design concept can also be iterated upon as many times necessary to resolve an issue.

21

23

STORIES

Interviews

Cultural Probes

Qoute Cards

Profiles

Developing the Workshop

Implementing the workshop

Reflection

INTERVIEWS

27

We used the tool of contextual interviews as the basis for our research.

The team interviewed the primary contacts in the health system to gain a

better understanding for framing the employee interview questions.

Interview questions were developed for the employees around the

ideas of communication and learning within the system. The

team was presented with a list of potential interviewees. The team considered two

options for exploring those topics. Option one was to contain the interviews within

one department, and the second was to select employees from different

departments and entities. After consulting with the client, the team

decided on maintaining a diverse interview pool, pulling employees

from all different departments. The team worked with the client to select 50

interviewees and set up a schedule for the following six weeks. Then the

design team began interviewing the employees.

28

The interviews conducted at Penn Medicine gave the design team contextual research and data to build a case for the employee experience within the organization. After interviewing over 30 employees from all aspects of the health care system, the hospitals, University of Penn School of Medicine and corporate offices, we gained a better understanding of what employee life is actually like.

The interviews were the capstone of the design team’s involvement at Penn. They allowed for direct qualitative research within the employee system. The contextual interviews are an important tool for discovering new possibilities within the confines of the culture in an organization through the employee voice. The interviews that were conducted examined the deeper issues of each of the digital systems the team was asked to look at.

Why contextual interviews

STORIES INTERVIEWS

29

Before the designers could begin to interview the employees at Penn Medicine, the team first had to show the value of the research to be conducted versus the research that had already been done. This was a tough process for the team because it was hard to stop the momentum of the project to explain a way in which a process is important, when that process seems inherent and necessary for the greater good. This aspect of explaining the process helped the designers to slow down and keep transparent about what was

Pre-interview process

going on. Transparency is a huge concept when trying to communicate the value of our work to a larger established entity. After recogn izing this, tensions eased and we were able to pursue our greater goals at Penn. One way the team helped ease that anxiety was by trying to describe the process with a series of maps, info graphics and text based documents that conveyed the same information in different contexts to see which one was easiest for the client to grasp.

30

The interviews were conducted by 2-3 members of the design team at the location of the employee’s position (ie. The hospital, office or other work space). Interviewing the employee in their space not only put them at ease, giving us the most honest information possible, but also allowed us to literally see what the layout of their spaces were like and how the office dynamics played out. This information was invaluable.

In each interview, one designer led the discussion while the other one or two were responsible for notes, photographing, and voice recording and interjecting when he/she saw fit. These pieces are essential in conducting the interviews because it is nearly impossible for one person to retain all the information relayed. These elements, especially the voice recording, were a necessity for the synthesis process because they allowed for the accurate recall of information and the ability for closer examination of the data. The photos helped us to keep the face to the name of the employees the team connected with.

How we excuted it

STORIES INTERVIEWS

31

Stages of interviewing

Stages of Interviewing

1

2

3

?

Pre Interview Preparation

Organize Information

Interview


1

2

3

?



Interview


1

2

3

?



Interview


1

2

3

?



Interview


1

2

3

?



Interview


1

2

3

?



Interview

32

STORIES INTERVIEWS

33

On more than one occasion an employees may not have had an experience himself or herself, but called on a colleague to enter the discussion. Being in the employee space also allowed the employee to show, not just tell, what they were talking about. Often it is hard to explain a computer system or piece of equipment without being able to see it. Being in the employees space gave them the opportunity to show the interviewer exactly what they were trying to verbally explain.

This interview style allows for a more conversational atmosphere. Instead of relying on the questions we developed, the interviewers were able to flow with the discussion instead of strictly adhering to the outlined questions. This ability to divert from the standard allowed for insights that would not have come up if the interviewer had been more rigid. This speaks to the designer’s ability to “go with the flow” and gain valuable information from it.

Why the interview was important / valuable

CULTURAL PROBES

37

The time constraints of the interviews were realized. Research was done to discover

methods of extracting information. The team decided that

leaving behind a cultural probe was the best way to extract information from

employees once the interview was over. The cultural probe was comprised of a camera

and a workbook. The camera acted as a lens into the visual world of employees

while the workbook encouraged employees to think of their experiences using their

right brain through visualizing answers with drawings and

creative storytelling. The probes were delivered with a preaddressed

stamped envelope to be returned within a week. When the team received the probes,

the photos and responses were compared and grouped to discover common

themes and patterns.

38

The cultural probes were developed out of a tool used in This is Service Design Thinking by Stickdorn/Schneider. They consisted of a disposable camera and a small six-page workbook. Each of these designs was refined and iterated many times, through quick tests and prototypes. The employees were given the camera, booklet and a self addressed and stamped padded envelope to send back to us upon completion.

All of the cultural probes were kept anonymous when presented to the client. Anonymity was stressed in the interviews and with the collection of the probes, which put the employees more at ease. This gained initial trust with the employees, giving the team a much more accurate look at employee life at Penn, which was crucial.

What is a cultural probe

STORIES CULTURAL PROBES

39

The camera was a standard disposable camera. We removed the paper labeling from the camera and designed a new one to go over it. The new label had instructions on how to use the camera and brief descriptions of specific items the design team was looking for, with a box next to each in which the participants wrote the number of the exposure of the photo for that item. In addition to suggested topics, there was also more than enough extra exposures for employees to photograph whatever they wanted as well as room on the camera covering to write in what it was that they photographed.

The camera was developed to give the design team a visual look into the lives of the employees and their insights. It also gave the employees a second chance to relay any visual information they didn’t feel comfortable revealing in the interview or thought of afterward.

The camera

40

The workbooks were six pages in which the participants were asked to draw various parts of their days, fi ll in a “mad lib” type of story, and room for any additional comments as well as our contact information on a perforated card that the participant would tear out of the book and keep.

These cultural probes were important to give the designers a visual look into the lives of employees while introducing an element of play. Most people know how to work a disposable camera and have some strong memories associated with it. The probes also gave the employees permission to think in a different way. It pulled them out of the charts and spreadsheets (a typical left brain way of working) and into the world of drawing and creativity (a more right brain way of working). Some people were uncomfortable with this new way of thinking, and some were delighted in a world of medical professionals at a top hospital.

The evidence of this right brain thinking’s signifi cance is in the comments afterward. Many people expressed that they felt as though their voices were heard and grateful for this new perspective on their current positions.

The workbook

What is the most satisfying part of your day?Please draw your idea below.

Share with us | We are a team of designers who work to improve the daily lives of individuals and systems through listening, understanding, and implementing action. This toolkit was designed to give you a voice in the larger system in which you work. Please share your voice with us.

Caption:


41

Many of the employees had concerns about being able to finish them or even have the time to devote fully to the camera or workbook. This very fact reinforced what we had been hearing throughout interviews; employees don’t have any extra time.

This realization became important in the synthesis of our research because it allowed unintended connections between what the employees expressed in interviews and the very completion of the cultural probes.

Time stress

42


43

Upon return of the cultural probes, the team got the fi lm developed and synthesized the booklets by pinning each of the same pages up to a board for better comparison and manipulation. This qualitative data revealed some shocking information. One employee mentioned that she would be leaving Penn Medicine because she felt as though there were no opportunities for professional development in her current position, a fact she did not reveal during the contextual interview. It is through looking at these outlier comments that we can fi nd value.

This one page in one booklet made concrete the evidence we had gathered during the interviews; that employees were concerned with professional development.

Summary

QUOTE CARDS

47

Quote cards were created as another method of externalizing the employee interviews.

The cards had two levels of categorizing information. The top

of the card contained five categorizes that would relate to the content

of the quote. These categories included learning, the LMS, the Square,

collaboration and communication. The left side of the card was reserved for indicating

the framing of the quote through three categories; obstacles, opportunity, needs/

ideas. The audio recordings during the interviews helped

ensure accuracy of the quotes. The cards were used for physical

synthesis through sorting to help create themes. The team invited

the contacts to the studio to help with this process. The end result of this sorting was

visualized in four webs containing various degrees of depth.

48

The design team developed the quote cards as a method of manipulating the qualitative data that was collected from the contextual interviews. The cards allowed for the interview information to be organized in ways that can be dissected.

As the team came back to the studio and re-listened to the recorded interviews, they found that a lot of what they heard was very quotable and needed to find a physical form to collect and view their findings. The words and language that the employees used was direct and distinct. These direct quotes would make our case stronger for what the employees needed. The power of those words was communicated to the client through the direct voice of the employee.

These are irrefutable because the team did not interpret the information at all; it was exactly as the employee said it. The team honored their confidentiality agreements with the employees and did not attach a name, position or place of work to the cards, so when viewed by the client, they would not be able to figure out who exactly said what.

Greating the cards

STORIES QUOTE CARDS

49

What the cards allowed the team to do was to see the connections between employees’ quotes and topics that were most pertinent to the employee experience and frustrations, or areas for improvement. By having a physical representation of these abstract words, it was easier to see these connections because the quotes could be moved into physical proximity with each other. This visual format allowed for a quick read as to how many employees agreed with each sentiment, where the patters would emerge

Working with the materials

and when they were most important.The cards were small enough that they

could be printed, cut, rounded and moved around. They were pinned up, placed on tables and manipulated into forms and ways of seeing that would have otherwise be impossible, especially in a digital format. They also allowed for the engagement of all the team members at once. As the process unfolded, team members were able to explain to each other why they moved certain quotes or what the interviewee actually

meant in the context in which the quote sat. This discourse and discussion proved to be most useful to the process of synthesis. A necessary part of synthesis is being able to defend or frame pieces of evidence in a different light.

50

The quote cards are organized in two ways. Across the left side there are one of three categories in different colors: Obstacles (red), Opportunities (blue), and Needs/Ideas (yellow). These categories spoke to the nature of the quote, what it said about something in the work experience. The quotes that were pulled fit into one of these categories and was appropriately assigned the color. The text of the quote is in the middle of the card and is grey, except for the most important bit of information; a couple of words that summed up the entire quote were highlighted in the corresponding color. Along the top of the card there were 5 categories revolving around the topic of the quote; learning, collaboration, culture, LMS, and the Square. These topics were then highlighted on the card indicating which of the topics related to the quote. These topics were what we targeted in the interviews and allowed for a second, more detailed level or organization.

Organizing the cards

STORIES QUOTE CARDS

51

Position | Entity | Interview 00

OP

PO

RT

UN

ITY

learning

LMSthe square

collaborationculture“Place quotes here...”


OB

ST

AC

LE

S

“Place quotes here...”

learning LMS the squarecollaboration culture



NE

ED

S/

I DE

AS

“Place quotes here...”learning

LMSthe square

collaborationculture

OPPO

RTUNIT

Y

“the square would help as a forum and exchange of ideas”


OBSTACLES

“when you have to get collaboration externally...

thats the challenge”


NEEDS/ID

EAS


“if they offered certain degree tracks or programs for employees,

that are geared to our needs”

52

STORIES QUOTE CARDS

53

Because there were so many ways to organize the information, the team was able to keep shifting the cards around until they formed a visible pattern. At first it was a few members doing the initial sort in which a matrix was formed and grouped by quotes of the same nature as well as the same topic.

Next the deck was shuffled and examined by the whole group, which came up with larger, big picture topics that the quotes were expressing. At the end of the quote card sort, the team was able to take these larger themes and synthesize them further.

By breaking down the larger more lengthy interviews into smaller more granular pieces, the team was able to take large ideas and make them manageable. After those pieces were re-grouped and ordered, new larger themes emerged from the raw qualitative data.

Different methods of sorting

PROFILES

57

The team reviewed pre-existing persona documents that

attempted to identify different types of employees. The team decided to create a

document from scratch that would be informed by the qualitative data

gathered from the employees. This allowed the document to be shaped

by the information instead of forcing information into a pre-existing

layout. The profiles were created as a database to house and easily compare

employee information. Externalizing this information allowed the entire

team to understand each of the employees without attending the interview. This

physical artifact allowed for a more easily comparable document that revealed

trends and patterns between different employees. When sharing this

information with the client the team amended the documents to be anonymous.

58

These profile documents allow for the same information to be compare across all of the employees. This would naturally create statistics that the design team could refer to when developing a prototype. Placing information into these documents allows the information to be broken down to a granular level. Picture of the interviewees were also placed into the profile documents to help the designers reference the information to the people.

After each interview, one of the interviewers would return to the studio with the audio recording from the interview, and dissect the information. As the interviewer reviewed the responses from the employees, they would plug the information into the appropriate field on the profile document. Once the interview was reviewed and all of the fields within the profile document were filled, the profile document was then printed and pinned onto a wall.

Gathering Information

STORIES PROFILES

59

The design team developed a method to synthesis the information extracted from the interviews. This was based off of a document that Penn Med originally supplied them with called a personas document. The purpose of the persona documents is to be able to identify characteristics that employees share to inform categories to record information. This would make comparison between employees much easier to understand.

The original personas documents were

Original Material

created by PennMedicine as an attempt to understand employee’s wants and needs through the creation of eight personas. These personas were not informed by any information about what type of employees exsist in the current system. The information within the persona documents covered different aspects of the an employees work experience. This included a daily schedule and how each persona fit into the heiracy at PennMed and what level of automony each individual had.

60

The design team initially made a new persona document modeled after Penn Medicine’s. Once the design team discovered the information from the original personas documents were speculation, they developed different documents of their own which would be used throughout the synthesis process. These documents were developed to gain a deep understanding of the experiences employees face within their current environment.

These new documents were profiles basedoff of the questions and content of the interviews. Instead of trying to generate the way of absorbing the information, the designers allowed the information gathered from the interviews to inform the design of the profile documents. This allowed a more natural recording of the data instead of trying to fit the information from the interviews into preform documents. Space was designated to record data about experience with LMS and the Square.

Creating a new format

STORIES PROFILES

61

Computer Access

Full

Moderate

Minimum

94%3% 3%

Knowledge LinkExperience

Positive

Neutral

Negative

18% 26% 57%

Learning Style

Hands On

Example

Self Teach

Other

42% 42% 13%3%Social Media Use

YesNo

65% 35%

Collaborationin Department

Always

Sometimes

Never

50% 39% 6%

Analysis of all profile documents

62

STORIES PROFILES

63

Pinning up the profile as they were completed created a unique work environment. This externalization of the work allowed the designers to surround themselves with their work, which naturally encouraged conversation about the work.

These profile documents also helped those team members who were not present at each interview understand what the interview was like. Sharing each other’s experiences in the interviews helped keep everyone on the same page. Once all of the profile documents were completed, the team presented each employee to each other. Reviewing all of the documents in on session revealed trends and commonalities between employees at PennMedicine.

As the design team revealed their process to Penn Medicine, names and pictures were removed from the documents to maintain anonymity. Sharing the profile documents with PennMed helped them understand the designer’s process. This reduced some of the anxieties and reinforced the legitimacy of the prototype that was developed.

Utilizing the material

THE WORKSHOPDEVELOPING

67

The research informed that employees desired a method of learning that included

collaboration and experiential learning. The best way

for the team to address these issues, was through a workshop. The workshop

allowed the team to teach a different method of addressing

problems and communicating. The content and focus of the

workshop was derived from the direct quotes and synthesis

of the interviews. The team decided to hold two workshops that would allow

each to address one of the original topics of focus regarding learning and

communication. A number of tools were designed to help facilitate the

workshop, such as facilitation cards, an agenda, a process map, and brainstorming

and externalization methods. Once the concept was developed, the team refined

the prototype by practicing the workshop in the studio prior to implementation.

68

The team reviewed their findings from their research and brainstormed ideas for a prototype. The client wanted to learn more about what employees desired for professional development but also wanted to generate material to put on the Square. The approach was to achieve these goals while considering the employees preferred learning methods, their desire to be heard, and feel a sense of autonomy.

The team’s research revealed most employees preferred learning by engaging with hands-on activities. This also included learning by example. The design team concluded that a workshop would offer an opportunity to engage employees while teaching a new problem solving process. This process needed to offer employees a new way to approach problem solving that deviated from the standard, hierarchical methods.

Each member of the design team was tasked with generating his or her own concept for a workshop. The concepts were then shared with the rest of the team. This allowed for each concept to be studied and dissected. Then, pulling good attributes from different concepts, a single workshop was developed. This workshop was our prototype.

Workshop as a prototype

Learning Style

Hands On

Example

Self Teach

Other

42% 42% 13%3%

Collaborationin Department

Always

Sometimes

Never

50% 39% 6%

STORIES DEVELOPING THE WORKSHOP

69

The concept that was generated addressed a variety of issues including teaching a new approach to problem solving, offering an opportunity to generate new ideas for professional development, and also generating content that would compliment the function of the Square. There needed to be a sense of autonomy, which would be achieved by allowing participants to chose which topics were most important to them an agenda was created that revealed the

The concept of the workshop

entire schedule to the participants. This purpose of sharing a schedule was to help reduce the anxiety associated with an unfamiliar format. The schedule also included a break at a transitional point in the workshop to prevent the participants from losing interest or growing fatigued. There was also a visual representation of progress that would be posted on the wall. This showed the steps of the workshop and as

each step was completed, a marker would be placed on the next step, indicating where the participants were in the process. This was another method of reducing anxiety by allowing participants to see their progress and also anticipate how much work was to be completed.

70

Openness to criticism

Culture

Authority distribution

Power structure

AutonomyPower in numbers

Buy in

Who you know

Lack of feedback

More collaboration

Address anxiety

Openness to criticism

Who controls it?

Individual / unappealing gain

Political influence

Political connections

Where’s the money?

TeamworkPast experience

Under utilization of skills

Fear

No recognition of there role in the large system

No meeting structure to address problems

Need process

Planning actions Taking responsibilities

Lack of support for new ideas

Resistance to change

Process

Ambiguous

Lots of monkey wrenches (Bureaucracy)

No structure

No transparency

Transparency

Clash of priorities

Penn-wide

Entity specific

Progress status

Feedback

No resources

Cultural divides

Judgement

Criticism

Physical divide

Hierarchy

More custom solutions

Feeling inferior

Time

Lack of time for learning Accessible classes

ScheduleAccommodating

Too much time scheduling(Not enough time doing)

Condensed content

Lack of meeting structure

Too much time planning(Not enough time doing)

Time consuming

Scheduling

Location


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Communication

Synchronous communication

Too many e-mails

Appropriate methods

More personal contact Face to face

Cross department collaboration

Silos

Networking

Resources

Logistical challenge

Variety

Under-utilization

Too many passwords

Paper and then re-entry

Redundant

Lower power + credibility

Information systems

Learning culture + Support

Supportive of individual

Unsupportive of group advancement

Closed system (siloed)

Learning by doingAutonomy

No formal training

Lack of professional development

Interactive demonstration

No interactivity

Aesthetically unappealing Growth plan

Needs

Strengths

Goals

Outside leaning opportunities

Outside resources

Interhospital collaboration

Interdepartment

UPenn

External to Penn

Visual engagement (Non-KL)

Hands on training

Unengaging (KL)

Learning

Customized classes

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The structure of the workshop would begin by revealing the four themes of issues, which were discovered through research (Learning, Time, Communication, and Culture). The participants would then collectively decide which theme they would focus on for the workshop. Once the group decided on a theme, a designer facilitating the workshop would reveal prompts. These prompts would be specifi c issues within a theme, informed by fi ndings from the research. The group then voted on which prompt the group would address.

The prompts were printed on cards, allowing the participants to physically engage with them. The allowed physical interaction allows for more vibrant conversation instead of just revealing the prompts verbally. Physical and visual engagement would further be reinforced by the voting method for the prompts.

Structuring the workshop

Voting

Stories Developing the Workshop

Each participant would be given two post-it notes one would be blue and one would be yellow. The blue post-it notes were worth two votes while the yellow post-it notes were worth only one vote.

This visual would not only reveal which prompt was most popular, but also what other topics participants feel are important. This could lead to later discussion about other shared issues.


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Brainstorming

Next, the participants would brainstorm ideas. The workshop had time allotted to generate both conventional and “blue-sky” ideas. The “blue sky” ideas would provide participants an opportunity to generate ideas that were idealistic and had no limitations. There would also be emphasis on generating a lot of ideas in a short period of time. Emphasizing quantity, not quality, was an important part of this step. The participants would then post their ideas on the wall to share what they came up with.

The next step in the workshop would allow the participants to physically group ideas. Both “blue-sky” and conventional ideas could be mixed together during this process. Once the group clustered their ideas into groups, the beginnings of a super idea would form. The participants would then decide which cluster they would prefer to focus on.

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Prototype

This point in the workshop is a good point for a break because it would allow participants to think about the cluster they are going to focus on for the remainder of the workshop. Once the participants got back from their break, the facilitator would explain the prototyping process. This is the part of the process where the participants would generate a concept to address the issue defined by the prompt they previously selected. The facilitator would share different methods of generating prototypes to help the participants become familiar with the process. The group would then develop a concept based on the ideas from the cluster, through discussion. Here, the participants are creating ownership of the concept from its inception. This would encourage easy adoption and implementation of the prototype. The facilitator would only be there to guide the group but would not be an influential part of the creative process.

The members of the group would then create a plan of attack. They would think about how their concept would be implemented and consider what resources are needed. The participants are the experts on this process because not only did they generate the concept but they also understand how their work environment functions.

Prioritize

1

2

3

Implement Prototype

{{

RevisePrototype

AnalyzeFindings


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BrainstormIdeas

Sort, Sythesize,Make Sense

Prioritize

1

2

3{ {

DevelopPrototype

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Once a concept was developed, the participants would divide responsibilities to fulfill once they left the workshop. Allowing the completion of the work to extend beyond the workshop would encourage the participants to experience this type of work outside of an organized, formal setting. They could maintain contact and chart progress using the Square.

At the end of the workshop the team would review their workand present to the other groups. The participants would look at the process they used to handle the work and how it was implemented. A connection could be made between their personal experiences in the workshop to the different parts of the process. This would be a reference as they try to grow professionally and solve problems within their work environments. The participants would be able to continue the conversation using digital tools.


Wrapping up

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Before the prototype could be implemented at Penn, the team needed to test it. This practice would reveal weakness in the design of the workshop. It also would allow them to get familiar with the process of facilitating a workshop. It is important to understand that the facilitators must have a complete understand to have absolute confidence in the process. When the facilitator of the workshop has a complete understanding of the task at hand, they will direct the

workshop with clarity. This will allow the participants, to feel comfortable sharing ideas and yield valuable discussions because they can have confidence in the direction of the workshop.

Testing with the team

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The team practiced the workshop three times. This repetition allowed for greater refinement of the workshop. During these practices, the design team had several realizations. There was a big difference between having one person facilitate and co-facilitators.

Using one facilitator kept the focus of the workshop on one person creating a more linear flow. However this required one person to take on the responsibility of directing the entire workshop. Having two people facilitate the workshop allowed people to share the responsibility of leading the workshop but there was an occasional miscommunication between the two facilitators, which to hiccups in the flow. The team decided to use both methods of facilitating based on what was comfortable for them. This flexibility is important because it allows the workshop to change with what the facilitator finds comfortable, leading to a more synchronous flow of accomplishing the work task, regardless of how it is lead.

The concept of the workshop

THE WORKSHOPIMPLEMENTING

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The workshop was held at the client’s space. Each workshop was held in a separate

room and had three team members to co-facilitate, while another team member was

focused on photographing both workshops. The workshops followed a developed

agenda with specific time constraints for each activity. The participants were

walked through the design process to address a specific problem

in their workplace. These problems were identified through

previous synthesis by the team of the interviews. The workshop gave the

participants an opportunity to design a prototype of a concept that

could be further developed as a potential solution. The end of the workshop allowed

time for each of the groups to share the concepts that were generated.

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Stories Implementing the Workshop

Introduction

Two rooms were reserved at Penn’s Center for Innovation & Learning. The workshops began by having all of the participants and designers meet in one of the rooms. As participants arrived, a designer handed out nametags for the participants to wear.

This was a way of checking attendance and would also help participants engage in conversation throughout the day using each other’s names. It is important to note that the use of names in conversation is more direct and personal than the alternative. Addressing people by name leads to a more valuable outcome.

Once all of the participants arrived, the design team gave a brief presentation. This introduced the method the designers employ in problem solving. The presentation also included an explanation of how the research informed the workshop they were attending that day. It also showed an agenda for the day to give the participants an idea of what they were going to do. At the end of the presentation, the participants were split into two groups and one group was sent to a separate room.

STORIES IMPLEMENTING THE WORKSHOP

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The groups were divided to create two types of experiences. One group was comprised mostly of nurses while the other group had a mix of professionals from different backgrounds. The purpose of creating two different types of groups was to determine if one technique performed better over the other. The two teams also experienced small differences in context. The team comprised mostly of nurses had context that was aimed at addressing issues regarding the Learning Management System and professional development. The other group did not have a singular focus and instead had opportunity to discuss different types of issues regarding their personal experiences at the workplace.

Creating these different types of groups and putting them in a workshop that has the same format, helped determine if there was a preferred method for future implementations of the workshop.

Dividing into groups

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Once the participants were in their respective rooms, they were introduced to the four themes (Communication, Learning, Time, and Culture). A facilitator explained that it was up to the participants which theme they would focus on for the day. To help the participants understand what the themes represented, the facilitator gave a brief explanation of each one. The group then discussed the themes and voted on which one they wanted to address.

Both groups decided to focus on communication. The communication card was posted on the wall to visually show the focus for discussion. The facilitator then revealed the prompts specific to the communication theme. The participants then read and reviewed the prompts. Their discussion about the prompts was about how each prompt related to their personal experiences at work and which prompts resonated the most. Each participant then voted using the supplied post-its, casting two votes on their first choice and one vote on their second choice.

Theme introduction


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The group of nurses decided that they wanted to develop their own prompt and merged two prompts to create their own.

The facilitators allowed this for a number of reasons. Most importantly, allowing the participants to create their own prompt develops very strong ownership and involvement within the workshop. This helped keep the participants engaged and ensures the content of the workshop is immediately relevant.

Being flexible

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The groups then moved on to the brainstorming phase of the workshop. Each member received a stack of post-it notes. The facilitators then allowed 5 minutes for them to generate as many conventional, feasible ideas as possible. Once time ran out, the participants then were given 5 minutes to generate “blue-sky” ideas. This was an opportunity to generate ideas regardless of how absurd they seemed.

Generating “blue-sky” ideas encouraged the participants to write down anything they could imagine that would address their prompt. Different participants have a different interpretation of what a “blue-sky” idea is. Some participants might come up with an idea that involved dinosaurs or flying pigs to address the prompt while other participants might think removing paperwork from an everyday task is “blue-sky.”

Brainstorming


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After the participants generated their ideas, they then grouped the ideas into clusters. Here the participants physically engaged with the ideas. They got out of their chairs, posted ideas on the wall, mixed “blue-sky” and conventional ideas, and labeled the clusters of post-its.

The participants then voted on which cluster of ideas they would focus on. Time was allotted for discussion and voting. The favored cluster would inform and act as a foundation for the prototyping phase. At this point the participants were then given a break. The workshop was designed so a break was incorporated to help the participants absorb what they accomplished so far. This point of the workshop was used for a break because they just finished defining a thought.

Clustering

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When the participants returned from the break, they were tasked with developing the prototype. Here the facilitator introduced different versions of prototypes and methods of production. This allowed the participants to understand what kind of things are produced so they had a metric for comparing their work.

The participants reviewed the cluster they selected to inform the development of their prototype. They began developing a prototype through discussion. Here the facilitator’s role was only to help visually record the group’s progress. The facilitator also kept the group on task as they might tend to veer from topic. Also it is important to recognize that while the designers have a great understanding of the process, they do not have an understanding or experience like the participants of the workshop.

Therefore the designers do not have as much potential to develop an immediately relevant concept as the participants who are from within the system.

Focusing

Implement Prototype

DevelopPrototype

{{

RevisePrototype

AnalyzeFindings


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As the participants started discussing the prototype, the facilitator began visualizing.

This allows for the natural flow of discussion to keep from getting disrupted for the sake of a participant creating visualizations.

Visualizing

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As the workshop came to an end the two teams were brought back together. Lunch was offered and as the participants ate, they discussed what they accomplished that day.

Each team explained to each other what prototype they came up with.

Review

The designers then explained that while the workshop ended, there work did not end. It was up to the participants to implement the prototypes they developed. Everyone was introduced to the Square and all participants were given access so they could continue discussion there. This would allow them to stay in contact with each other even if they did not work in the same part of the hospital system.

Continuing on

REFLECTION

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STORIES REFLECTION

The semester’s work with University of Pennsylvania Hospital System was involved. Our initial approach involved addressing current digital systems. Our research revealed that employees are already overwhelmed with the 200 digital systems they currently have access too. This, coupled with the feedback we received from our research, led us to develop a concept that allowed for development in learning and communication beyond a computer screen.

Getting our client to understand that the original approach needed to be changed from developing digital systems was a delicate and a time-intensive task. We had to gather information to reinforce this change in direction from different areas and in different formats. It was important for us to show where the idea of departing from developing another digital system was derived from. Throughout the semester, the design team was tasked with managing the anxiety of the client as they became uneasy with this change in direction.

As the design team discovered the four themes of time, communication, learning, and culture, they had to learn how to navigate and manage obstacles of their own regarding these themes. The team discovered the limitations of a work environment that was heavily dependent on digital systems for learning and training. Employees shared how their workloads made their days hectic and they had a desire to be able to devote more time to each of their responsibilities. The culture of this prestigious work environment allowed for egos to develop and inhibit the productivity of the workplace. This culture had a negative effect on employee’s ability and willingness to communicate. The design team had to learn how to manage all of the challenges with their client regarding these obstacles.

This was an issue when communicating over email, allocating time for meetings and workshops, finding participants who could accommodate these schedules, and being sensitive to the culture and egos within the system.

Fortunately, the client was able to realize the need for change. The final workshop revealed that employees where very responsive to the opportunity to openly communicate. They were also excited about being involved with something that did not require a computer screen or the need to login. This sentiment was captured on feedback forms and delivered to the client for reinforcement. As a result of this work, UPHS has continued its relationship with UArts and continue to employ design to address other internal issues.

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SUMMARY

Presentation + Recommendation

101

+RECOMMENDATIONS

PRESENTATIONS

102

Over the course of the semester the team presented a number of times for the client, but the two most notable presentations happened at the end of the semester. The first presentation took place at University of the Arts. All of the direct contacts were invited, as well as the VP of human resources and other people involved in the process. The team covered the walls in the quote cards and employee profiles. This set the stage for the scope of the research done.

The team presented all of the research that was performed including the background paper research, orientation experience, contextual interviews, probes and the process of synthesizing the quote cards and probes. This presentation laid the framework for the workshop prototype. It was very well received by the client and gave an understanding of the value of the design process utilized by the team.

The final presentation took place at the Penn Medicine Center for Innovation and Learning. All of the same people were invited as well as a few others. The presentation was a follow up to the workshops and a presentation of recommendations for future steps. The team recommended certain actions that were derived from the outcomes of the workshops and the synthesis of the research. These recommendations were well received and the MiD program continues its relationship with Penn Medicine.

SUMMARY PRESENTATIONS AND RECOMMENDATIONS

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APPENDIX

The Design Team

Glossary

References

106

Dominic Prestifilippo2nd year [email protected]

Wan Ting Chang2nd year [email protected]

Matthew Van Der Tuyn2nd year [email protected]

Sara Hall2nd year [email protected]

APPENDIX THE DESIGN TEAM

107

Alexandra Visconti1st year [email protected]

Ben Hillson1st year [email protected]

Daeun Song1st year [email protected]

211 South Broad Street, 5th Floor, Philadelphia, PA 19102

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Cultural ProbesInformation gathering packages based around the principle of user participation via self-documentation that reveal perceptions and behaviors within or across cultures.

Draw the experienceAsking participants to visualize an experience through drawing and diagramming which can debunk assumptions and reveal how people conceive of and order their experiences or activities.

ShadowingInvolves researchers immersing themselves in the lives of people in order to observe day-to-day routines, interactions and contexts.

Guided ToursAsking participants to lead a guided tour of the project-relevant spaces and activities they experience to help them recall their intentions and values.

Cognitive Task AnalysisList and summarize all of a user’s sensory inputs, decision points and actions to identify potential bottlenecks where errors may occur.

Time Lapsed VideoRecording movements in a space over an extended period of time to be later viewed at an increased speed. This provides an objective, longitudinal view of activity within a context.

EthnographyA form of qualitative research that requires immersion in the natural contexts upon which work, play or culture are experienced.

Contextual InterviewConducted in the environment, or context, in which the service process occurs allowing interviewer to both observe and probe the behavior they are interested in.

Extreme User InterviewIdentify individuals who are extremely familiar or completely unfamiliar with the product or system and ask them to evaluate their experience with it.

Secondary ResearchSupportive information including published articles, papers and other pertinent documents to develop an informed point of view on design issues.

Activity AnalysisStudying in detail all tasks, actions, objects, performers and interactions involved in a process.

Personal InventoryDocument the things that people identify as important to them to catalog evidence of their lifestyles.

Unfocus GroupAssemble a diverse group of individuals to encourage rich, creative, and divergent .

Empathy ToolsCreate tools that alter your experience to understand the abilities of different users.

Research

APPENDIX GLOSSARY

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PersonasFictional profiles developed as a way of representing a particular group based on their shared interests.

Card SortAsking people to organize cards spatially, in ways that make sense to them, revealing expectations and priorities about intended functions.

Flow DiagrammingVisually representing the flow of information or activity through all phases of a system or process.

Social Network MappingDiscovering different kinds of social relationships within a user group and map the network of their interactions.

Affinity DiagramA method of data organization intended to define categories based on likeness of information.

Concept MapGraphical method for organizing and representing knowledge supporting meaningful learning through associative and hierarchical connection forming.

Mental modelA cognitive representation and simplification of a complex system.

Zoom OutA method for understanding and visualizing the larger system of people, products, services and environments within which a particular design exists.

Customer Journey MapA structured visualization of a users experience with a system.

Stakeholder MapA visual or physical representation of the various groups involved with a particular service.

ScenariosIllustrate a story line describing the context of use for a product or service.

Experience PrototypeSimulation of the experience using the product revealing unanticipated issues or needs.

Role PlayingIdentify the stakeholders involved in the design problem and assign those roles to members of the team for them to enact activities within a real or imagined context.

StorytellingA method for sharing insights and new concepts through the use of compelling narratives.

StoryboardingA series of drawing or pictures that visualize a particular sequence of events.

Co-creationEngaging people with different backgrounds and roles to work collaboratively as part of the same team, in order to examine and innovate a given experience.

Synthesis Prototype + Test

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APPENDIX REFERENCES

Gladwell, Malcolm. “Annals of Innovation.” The New Yorker 4 Oct. 2010. Print.

Mayo Clinic. From Foamcore to Function. Rep. Mayo Clinic. Web. 8 Sept. 2011.

Ruef, Martin. “Strong Ties, Weak Ties and Islands.” Industrial and Corporate Change11.3: 427-49. Web. Sept. 2011.

Easley, David, and Jon Kleinberg. Networks, Crowds, and Markets: Reasoning about a Highly Connected World. New York: Cambridge UP, 2010. Print.

McCreary, Lew. “Kaiser Permanente’s Innovation on the Front Lines.” Harvard Business Review Sept. 2010. Web.

design in healthcare

Documents

book design

humancentered design

healthcare environment

learning information

healthcare services

humancentered problem

traditional methods

developed digital platform