LEARNING ABOUT THE HOSPITAL & DESIGNING FOR CAREGIVERS
We set out to understand the hospital from the perspective of patients and families, and identify ways to improve their experience, resulting in a handful of initial design interventions focused on improving communication, inclusion, and resource access.
FAMILY CAREGIVER RESOURCE BOOK
But no sooner than we began experimenting with interventions, hesitation from nursing reminded us we needed to better understand their needs too, and create opportunities to collaborate and leverage their expert knowledge in designing interventions.
CO-CREATING FOR CAREGIVERS WITH HOSPITAL STAKEHOLDERS
STORY-BASED
ENGAGEMENT FRAMEWORK
CODIFYING THE APPROACH FOR
OFFICE OF PATIENT EXPERIENCE
After honing a stakeholder engagement framework to identify and design for opportunities to improve patient and family-centeredness, the Office of Patient Experience became interested in adopting our approach, resulting in its codification in a toolkit.
STORIES FOR
CARE TOOLKIT
MICHIGAN MEDICINE HEALTH SYSTEM
Stories for Care at Michigan Medicine
What began as a brief opportunity-discovery engagement with the Office of Patient Experience at Michigan Medicine quickly grew into a joint effort to develop and prototype service improvements for patient family caregiver inclusion and resource access, culminating in the codification of a patient-centered approach hospital engagement approach in the form of a toolkit that the Office of Patient Experience continues to use in their work.
Our collaboration began as Michigan Medicine embarked on a shift towards more patient and family-centered approaches to care
Across the country, healthcare institutions are experiencing a paradigm shift in the way patients, regulators, and insurance providers expect them to deliver care.
TOMORROW
To one which is centered around providing value of care - the right kind of care for the right patient - leading to better health outcomes.
TODAY
Healthcare is shifting from an approach that emphasized providing volume of services - more treatments, more tests, more medication . . .
This is a welcome shift for many practitioners, but the accompanying day-to-day changes can be disruptive to established practices and policies
This change affects everyone from doctors and nurses, to security personnel and environmental services staff, and even a popular mission like this can fall apart without the engagement, support, and - most importantly - specific knowledge and contributions of everyone involved in delivering care at each step of the way.
We worked with the Office of Patient Experience at Michigan Medicine to design strategies for creating and implementing more human-centric approaches to care in the hospital
Designing for patient family caregivers
We set out to understand the hospital from the perspective of patients and families, and identify ways to improve their experience, resulting in a handful of initial design interventions focused on improving communication, inclusion, and access.
DESIGN CO-LEAD
One of three collaborating designers working alongside the Office of Patient Experience at Michigan Medicine
Preview - Please view on desktop to see full overview
DISCOVER
We began with exploratory observations to better understand the people, systems, and relationships that make up Michigan Medicine
Our first ventures into the hospital were intentionally broad and unstructured. Each of us set out to build an understanding Michigan Medicine from the perspective of patients and families, but at this early stage we felt it might be advantageous to let our individual sensibilities guide us. To strike a balance between our individual sensibilities, we agreed to a set of ground rules ahead of time.
OPEN OBSERVATIONS
Some of us used highly structured observation methods, and others were more improvisational resulting in a rich breadth of perspectives we couldn't have otherwise planned.
EQUAL ROTATIONS
But to balance the breadth of observational approaches and individual sensibilities, we made sure to rotate positions every time we returned to the hospital.
REGULAR CHECK-INS
After every observation session, we met to share what we'd seen, heard, or thought about. This helped maintain a shared sense of knowledge along the way.
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SEEKING PRIVACY
"I noticed a lot of people trying to find these patient family rooms - it seems like those are in demand. I think they were just looking for a place to collect their thoughts, or gather with family."
COMFORTS OF HOME
"One of the units I saw had blankets and pillows for family members to borrow, and couches in the family waiting rooms on the unit where they could nap."
ANXIOUSLY AWAITING UPDATES
"I talked to someone waiting on their wife to get out of surgery. He showed me this beeper - like the things you get at Panera. It's supposed to tell him when his wife gets out of surgery and give him updates. He was feeling hungry, but was nervous about going to the cafe because he didn't know how far the range was on his beeper."
UNEXPECTED AND UNFAMILIAR SITUATIONS
"I met a woman and her adult daughter whose husband had been admitted to the hospital for routine surgery, but had complications during the surgery. They originally only planned on being at the hospital for an afternoon, but they've been there for 24 hours trying to keep up, and trying find places to sleep."
SPREADING JOY
"I noticed a lot of people trying to find privacy. There are a lot of these little patient family rooms in some of the units, and it seemed like those were in demand."
And after 127 hours in the hospital, we sensed that patient family caregivers -
the people who look after their loved ones - seemed to be the most underserved
Naturally, doctors nurses, and hospital staff are keenly focused on patients, but family caregivers seem to fall through the cracks even though they provide crucial patient advocacy and care that hospital staff don't have the time, resources, or ability to provide.
So we initiated a set of interviews with family caregiver, as well as clinicians and non-clinical staff, to learn more about the challenges caregivers face
Much like the first round of research, we took a divide-and-conquer approach to complete the interviews quickly, but this time with a more focused, less exploratory set of learning objectives. We agreed on the following approach.
SEMI-STRUCTURED INTERVIEWS
We didn't constrain ourselves to an order in which questions were asked, but rather that we cover them all, letting the conversation flow organically.
EMOTIONAL JOURNEY MAPPING
Every interview began with a grounding exercise, asking the interviewee to illustrate the high and low points of their caregiving experience.
COLLABORATIVE, TEAM CODING
We created a shared spreadsheet in which we could collaboratively input interview data, code, and extract insights together, even when we couldnt' always meet.
FEELING LEFT OUT OF THE LOOP
LOSS OF CONTROL
"Control is big for patients and families. The more control you have over your disease, the happier you are."
SELECTIVE FEEDBACK OPPORTUNITIES
"It's great to have a face-to-face meeting with somebody, but when you live in the country, you've got a half mile long dirt road for a driveway and don't have internet at home, you might not have the money to drive to Ann Arbor for meetings either. Their needs don't get represented as often in these family committee meetings."
"They don't come in volunteering information. I have to go ask them "How's he doing? What's going on?'" pretty frequently in order to get an update or response."
DIFFICULTY ENACTING CHANGE
"So I would meet other patients and ask them if they knew about the support groups, etc. For a year, more than a year I fought to get a thing on the wall to hold the support materials. People need to know this stuff is available, But I couldn't seem to break through to get it done."
"... For example, I didn't know there were showers here. I'd been driving back and forth from home everyday for hours before I realized that."
RESOURCE AWARENESS
Soon, a clearer picture began to emerge about their true needs and desires
While we continued to hear about uneven access to resources - especially among caregivers of long-term patients who had seen many corners of the hospital - we began to learn more about their state of mind and anxieties related to caregiving in the hospital.
CAREGIVER SUPPORT IS AVAILABLE
Pillows, blankets, rest areas, and emotional or spiritual support were often available to family caregivers, but not everyone was aware of them.
BUT NOT EVENLY ACCESSIBLE
Sometimes resource availability different by unit. Unit assignments could also change frequently depending on the needs of the caregiver's patient.
OR VISIBLE TO CAREGIVERS
Sometimes when resources weren't immediately apparent to family caregivers - whose awareness was sometimes clouded by anxiety and stress.
Family caregivers are an indispensable resource to patients, but their role is not always formally recognized and accommodated by the hospital or attending staff.
Caregivers play a crucial role in the healing process, but their role isn't always recognized or accommodated in a way that supports their wellbeing, and to allow them to provide the uninterrupted support their loved one needs. Caregivers often experience an elevated state of anxiety when caring for a loved one, which can be inadvertently exacerbated by interactions or environmental circumstances that left them feeling ignored, helpless, or overlooked. Luckily, support resources for family caregivers do exist at Michigan Medicine, but access to those resources can be uneven.
How might we help ease environmental and situational stressors that distract family caregivers from caring for their loved one?
DEFINE
DEVELOP
By now, we had a stronger understanding of the stressors family caregivers face,
and began experimenting with interventions to address the issues we identified
We communicated these findings to our project partner, who agreed with our assessment, and enthusiastically embraced our desire to prototype and experiment with ways to improve real and perceived family caregiver inclusion and support.
IDEATION AROUND KNOWN
CAREGIVER STRESSORS
We began with anything-goes, loose ideation around a tight group of topics derived from our research findings - inclusion, feedback and communication, and resource access.
AFFINITY MAPPING AND CATEGORIZATION OF CONCEPTS
Very quickly, a wide range of ideas emerged. We had products, services, outreach efforts, etc. So we began to categorize them type by grouping like items to understand where there might be overlap or complimentary ideas to build on.
DOWN-SELECTION FOR POTENTIAL IMPACT WITH PROJECT PARTNER
We also brought in our project partner to help us down-select our pool of ideas based on her intuition of potential impact, and likelihood of implementation based on her experience working on similar initiatives in the hospital.
"COUPON BOOK" FOR RESOURCES
Unfortunately, after distributing a test run of our photo prompt cards to a few patient family waiting areas, we received only one response. We quickly moved on to focus on our more successful outreach efforts.
LIMITED SUCCESS
Our co-creation sessions were insightful, but often turned into conversational interviews more informational than creative sessions with caregivers.
"COUPON BOOK" FOR RESOURCES
"COUPON BOOK" FOR RESOURCES
Can we improve family caregiver awareness and access to resources by reminding them of their availability during admission with a booklet inviting them to use them?
The coupon books were wildly popular with former and current patients and family caregivers. Likewise, nursing supervisors we spoke with were excited to conduct trial deployments on their units.
"MAKE WITH US" CO-CREATION
Can we improve the effectiveness of hospital feedback channels among family caregivers by courting their input through generative co-creation?
"SHOW US" PROBE PROMPTS
Can we improve hospital responsiveness to patient and family needs by providing richer, more convenient modes of communication?
DELIVER
Our “Coupon Book” for hospital resources was a hit with our project partner, family caregivers, and nursing supervisors, and we were ready for a test run
Our project partner connected us with a nursing supervisor excited to host a trial deployment of the “Coupon Book” on her unit, and we collaborated with her to localize the content to match actual resources available to family caregivers on her floor. Finally, we were ready to brief her nurses on the concept, and give it a go!
But while our "Coupon Book" showed promise with our project partner, family caregivers and nursing supervisors, nurses were receptive, but slightly concerned
When it came time for a trial deployment of the Coupon Book on a unit, some nurses had reservations. While we'd worked closely with the nursing supervisor to develop the language and content of the book, matching it to the resources available on that specific unit for example, the transactional implications of it bothered many nurses, and understandably so.
POSSIBLE INFECTION RISK
GOOD IDEA, BAD EXECUTION
"It says 'ask a nurse or hospital staff' on here - does that mean we're going to be running around dealing with requests for things on top of what we already do?"
DISTRACTS FROM PATIENTS
“We’re already doing so much to just maintain the safest level of care we can provide. It’s hard to keep up with new things like this that feel more like a hotel than a hospital.”
COMPOUNDS EXPECTATIONS
"It seems like we're asked to do this kind of stuff a lot, but where does it go? What happens to it? Who comes up with these ideas?
EMPOWER CAREGIVERS INSTEAD
"Some of these things - we could give them more direction on how to find them."?
"I like the idea of helping people be more aware of resources, but if I'm taking these coupons from people in different rooms, then dropping them off at the nurse station, it could become an infection risk."
It was clear our “Coupon Book” was going to be unnecessarily burdensome for the nursing staff, and felt transactional - directing caregivers to nurses for readily available resources
It was clear that the interactions implied by the “Coupon Book” made nurses feel more like waiters and waitresses than healthcare professionals. More importnatly though, the consumable aspect of the interaction - tearing off a coupon and handing it to a nurse - could even pose an infection risk for nurses and other patients as the coupons are carried from room to room.
Version two began with a new name, and guidance to help caregivers find resource they were entitled to but might not have otherwise known about
It was clear that the revised version needed to be more personable to help caregivers feel comfortable seeking out resources. It needed to speak to them with approachable, relaxed language, and appear less formal and more inviting than the prior version.
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In a brief trial re-deployment with select patients and families, the revised version was already helping raise awareness and utilization of resources
Because the revised Resource Book was no longer as dependent on nursing staff, the nurse supervisor we worked with earlier offered to distribute them with packets given to newly admitted patients and caregivers on her unit. We provided a small batch of Resource Books to distribute, and after a few days found that the books were already helping connect patients and caregivers to resources like spiritual care and free snacks available to family members.
But before a full deployment could begin, we needed to re-engage the nurses we had inadvertently excluded earlier on to co-create a deployment strategy with us
Co-Creating with Hospital Stakeholders
No sooner than we began experimenting with design interventions, hesitation from nursing staff reminded us we needed to better understand their needs as well, and create opportunities to collaborate and leverage their expert knowledge in the design of interventions
DESIGN CO-LEAD
One of three collaborating designers working alongside the Office of Patient Experience at Michigan Medicine
Preview - Please view on desktop to see full overview
Preview - Please view on desktop to see full overview
After revising what was now known as the “Resource Book”, we had a new challenge on our hands - collaborating with nurses who have little time to spare
We were very interested in collaborating with unit nurses, and after learning about the Resource Book, they were interested in collaborating with us as well, but the challenge was finding time to work together. Nurses have very little non-clinical time to spare in their schedules.
To begin addressing this, we were offered 30 minutes of valuable time during a once monthly, two hour unit-based nursing committee meeting, and needed to design an engagement to facilitate the co-creation of deployment strategies for the Resource Book to fit this time constraint.
After inadvertently excluding nurses in the design and deployment of the Resource Book, we needed to find a way to meaningfully
re-engage within tight time constraints.
How might we design an engagement to facilitate the co-creation of deployment strategies for the Resource Book with nursing during 45 minutes of a monthly meeting?
We needed to begin the engagement by quickly locating the nurses in a singular scenario or issue before diverging into potential solutions.
The nurses we had observed and interacted with seemed accustomed to problem-solving in a fast-paced environment. We chose to lean into this working style, and design our engagement to take advantage of their speed.
Given the rarity of our time with the nurses, we challenged ourselves to design our engagements to resolve in clear, tangible outcomes, with well-defined next steps.
DEFINE
DEVELOP
We were offered time during monthly meetings with three nursing units, and immediately began planning ways to make the most of the 45 minute time slots
In a short period of time, we needed to clearly frame the problem of resource access and deployment of the Resource Book, field questions about the scope of our engagement, ground participants in the issues at hand, and move into either convergent sense-making or ideation. We had a lot of ground to cover in a short amount of time.
IDEATION AND STORYBOARDING
Right away we started digging through design toolkits, methods books, and design literature for inspiration, and began story-boarding through possible workshop scenarios.
PLAY TESTING WITH MOCK-UPS
Once we arrived at a handful of workshop scenarios we felt strongly about, we began play-tested them using quick-and-dirty mock-ups of supporting materials, making changes on the fly.
RUN-THROUGHS WITH STAKEHOLDERS
Finally, whenever possible, we tried to share these scenarios with project partners and stakeholders to manage expectations and fine-tune them for our context and participants.
DELIVER
We designed and hosted two types of workshops with nurses - the first being an engagement to learn about the issue of resource access from their perspective
These workshops were designed to bring nurses into the sense-making process so we could better understand instances of caregiver resource access challenges from the perspective of the hospital, and build a new, shared understanding of obstacles and potential opportunities with our stakeholders.
LISTENING TO AUDIO STORY
We began by presenting participants with an audio clip from a caregiver interview describing a scenario where they were unaware of a resource available in the hospital.
REFLECTING ON STORY
Then we asked participants to help us understand the issue from the perspective of the hospital, taking a moment to think about how the caregiver could have arrived at their situation in the story.
DISCUSSING INSIGHTS
Next we opened the room up for discussion, asking participants to each take a minute to help us understand how they believe the caregiver might have arrived at their situation in the story.
SUMMARIZING INSIGHTS
Finally, in small groups we faciliated affinity mapping insights, but for large groups, we demonstrated affinity mapping asked participants to summarize their insights in small groups.
And the second, an engagement designed to build on shared understanding from the first workshop and co-create Resource Book deployment strategies
In a short period of time, we needed to clearly frame the problem of resource access and deployment of the Resource Book, field questions about the scope of our engagement, ground participants in the issues at hand, and move into either convergent sense-making or ideation. We had a lot of ground to cover in a short amount of time.
READING STORY
The sharing of story as provocative data in audio or written form. The story is a real world, first-person account of a lived experience in the hospital.
IDENTIFYING BREAKDOWNS
The critical act of sensemaking. It is the processing and analysis of the story, and the making of meaning.
GENERATING ALTERNATIVES
Making is the act of generating ideas and building solutions based on the reflections.
SUMMARIZING & SHARING
Combining ideas and having a debrief or discussion.
The workshops delivered - and several engagements later, we arrived at a suitable deployment strategy for the Resource Book at participating units
In fact, after an engagement, one of the nurses remarked “This is one of the most fun and creative things I’ve done all day!”
And in the process, found story to be an effective tool for grounding and provoking discussion to generate new understanding of an issue, and inspiring co-creation
Beginning our engagements with real, first-person narratives about resource access, and providing space for all participants to reflect and react to the story was highly effective in grounding participants. The personal, relatable nature of the stories also elicited highly empathetic responses, leading to focused, human-centric solution ideation.
After several of these engagements, a framework began to emerge
After our fourth engagement using story as a central grounding mechanism, we began to notice a common pattern to the engagements, regardless of whether they were meant to learn from stakeholders, or co-create with them.
PROVOKE
Sharing of story as provocative data in audio or written form. The story is a real world, first-person account of a lived experience in the hospital.
REFLECT
The critical act of sensemaking. Processing and analyzing of the story, and making meaning.
MAKE
Generating ideas and building solutions based on the reflections.
SYNTHESIZE
Combining and summarizing ideas in discussion or debrief.
Codifying our approach for the Office of Patient Experience
After honing a stakeholder engagement framework to identify and design for opportunities to improve patient and family-centeredness, the Office of Patient Experience became interested in adopting our approach, resulting in its codification in a toolkit.
One of three collaborating designers working alongside the Office of Patient Experience at Michigan Medicine
DESIGN CO-LEAD
We shared the results of the nursing workshops with our project partner, as well
as the engagement framework that had begun to emerge through our work
The Office of Patient Experience had recently been merged with another group in the hospital, and our projct partner was looking for a way to institute the co-creative approaches we had honed with new members of her organization.
And she was excited by our success using this story-based approach, and
became interested in adopting and operationalizing it for use in her organization
The Office of Patient Experience had recently merged with another group in the hospital, and our project partner was looking for a way to institute the co-creative approaches we had developed with the new members of her organization.
How might we codify our approach in a way that allows the Office of Patient Experience can quickly learn, adopt, and scale across their organization?
We needed to find a way to document and transfer our approach
to the Office of Patient Experience
DEFINE
DEVELOP
We quickly agreed the best way to codify our approach in a usable form was with a toolkit, but how would the content be conveyed, and what form would it take?
Based on our experience planning and conducting learning and doing engagements in the hospital, we understood the information and resources needed to be convenient to use and readily available to project managers, or they simply wouldn’t be useful.
CONTENT ARCHITECTURE MAPPING
We began by mapping our learning, doing, and newly created teaching engagement approaches to take stock of the content that need to be translated for the Office of Patient Experience.
FORM IDEATION
Once we arrived at a handful of workshop scenarios we felt strongly about, we began play-tested them using quick-and-dirty mock-ups of supporting materials, making changes on the fly.
RUN-THROUGHS WITH STAKEHOLDERS
Finally, whenever possible, we tried to share these scenarios with project partners and stakeholders to manage expectations and fine-tune them for our context and participants.
DELIVER
We listened closely to how our project partner hoped to use the toolkit with her team, and provided her with a toolkit library as well as individual kits for each of her project managers
Her team would be borrowing methods and approaches from the toolkit in their daily interactions with stakeholders in the hospital, but she also wanted it to have presence in the office, and to be accessible to her or her the team for reference. This led us to produce individual toolkits for project managers, and a “permanent library” where a master kit would live.
TOOLKIT LIBRARY
First, we created a mobile toolkit library to be kept in an accessible space for office reference by the team.
PROJECT MANAGER KITS
And then produced miniature toolkits for team members to reference individually.
SUPPORTING MATERIALS
Worksheets related to the activities and methods described in the toolkit were placed on Google Drive for team members to download, edit, and print on-demand.
The toolkit is comprised of an Overview and three guidebooks, which walk team members through planning and facilitating a Learn, Do, or Teach engagement
The toolkit framework provides OPE staff with a set of strategies for building story-based engagements spanning and complementing their existing partnerships with patient and caregiver groups, and clinical staff.
And each engagement type is accompanied by a set of method cards and links to online worksheets, tools, and templates to help plan and facilitate an engagement
Today, the Office of Patient Experience has begun adopting this approach in day-to-day engagements with hospital staff to create and promote patient-centered approaches to care
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