Fred Wordie Open Source D - January 2015
Reflections
Brief
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Initial Research
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Patient Involvement
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Insights
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New Direction
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Role-play Development
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Role-play
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Year Outcome
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Presentation
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My Thoughts
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From desk research, user observations and interviews gathered from engaging with staff and patients at University Hospital Crosshouse, develop a design strategy model for how an health service organisation such as NHS Ayrshire & Arran might apply an open innovation design model to develop co-designed and collaborative solutions to problems such as Patient Flow. Apply your OPEN innovation design model to develop an improved Patient Flow user experience and service proposition. 1
Initial Research See page 8-9 of year PPJ for more info around systems the hospital use and their issues with them. The first thing that stood out to us in this first visit is how busy and complex a hospital is, this was reflected in the systems they used - which were incredibly complex and long. We also identified many areas that caused friction with the staff and patients, however one thing we realised very quickly is that we had only a very basic understanding of a lot of systems. Hence we decided to focus on just one area in depth; the area we chose was patient involvement, purely because it seemed to cause many conflicts in the hospital. Due to these conflicts we received many conflicting opinions from people we interviewed, even among nurses in the same ward.
Our Groups rough idea of questions for the first visit.
For this project we were tasked with helping the NHS deal with patient flow more efficiently. They asked us to help them have “people in the right place, at the right time, every time.� The first thing our research group wanted to get was a basic understanding of the hospital, we felt this was vital if we wanted to help the NHS in a constructive way. Hence The first time we went to the hospital we arrived with a loose set of questions about basic everyday procedure. We also wanted to interview a very broad range of people in the hospital, including admin staff, visitors, doctors and nurses. Seen on the right is our groups collected research from interviews, observation and shadowing. It focuses
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Our Groups understanding of the systems the NHS used.
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Patient Involvement See page 14-15 of year PPJ for more info also gather stories about his family who had also been at the hospital. Personal stories from a man about such things as missing bacon in the hospital, gave me a real insight into what it feels like to be a patient at Cross House. This interview and others like it helped form the patient journey seen right. The main take away for us from this user journey was the idea of patients losing independence in hospitals. Independent adults who often want to take an active role in getting better but have outlet to do so. They are therefore stuck in foreign place, bored and restricted to their bed.
Our groups mind map of areas of interest
After deciding to focus on patient involvement, we decided to brainstorm ideas and questions before our second visit to the hospital. This was split into 5 main areas of investigation (as seen below): Medical, Social, Personal, Activities and Environment. Unlike the many quick and informal interviews of the first visit, we decided to do more in depth and therefore emotional interviews the second time. This lead me to conduct an hour and half long interview with a patient. This interview was very informative as I was able to get a very in depth look at this patients life in the hospital and
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Our Groups storyboard of a user journey created from a collection of interviews and observations.
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Our groups collection of insights before refinement and analysis.
Insights
See page 41-42 of year PPJ for more info
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This insight was derived from many patients who told us they really struggled to understand their diagnosis the first time they were told by a doctor - this lead them to find alternative methods of understanding, for example the internet, which in turn left them more confused and panicked.
This insight was derived from many patients who told us they really struggled to understand their diagnosis. This lack of understanding passed from them to their family, who in turn wasted both doctors and nurses time with questions - nurses and doctors also echoed this issue.
This insight is derived from patients who felt they weren’t kept in the loop about when things would happen to them during their time in hospital. They described it as a state of limbo, waiting to be taken to the next stage of their health care.
This insight is derived from patients who described the ward they were staying in as alien - they felt because it was so different from home, they had no freedom or say in their day to day life. This coupled with odd smells and sounds made them more anxious and inpatient. 7
New Direction See page 41 of year PPJ for more info After the first two weeks of research we decided it was very important that we form a more collaborative and open source approach. So after deriving our insights from our own research groups, we decided to try and put all our data together. This accomplished mixed results, as try to find a format to collect data from 30 students who have never done this before was destined to fail. Some common themes did come about but the experience was a negative one and wasted a lot of peoples time due to not everyone being able to have their say or use their skills. Therefore we reorganized into outcome groups, based a new idea of how we could help the NHS with their patient flow. As a year group we decided to focus our outcome on designing tools for the NHS, that would help them identity and solve their own issues. We all felt this was the right direction to move in because we realised that as much as we tried we would never be able to understand let alone solve their numerous issues in 5 weeks. We also gathered from our time at the hospital that most design solutions forced upon the staff would be met with distrust. This was because even thought he staff
Our years1 collection of insights at the end of week 3
were aware their system was inefficient, it still worked for them and changing the system could cost lives. We felt that if the staff themselves could come up with their own solutions, they would be more open to trying them. Due to all this we split up into 5 new groups focusing on design tools to help the staff identify and solve issues. The first group would assemble our raw data into easy to understand infographics for the staff to get a overview of other departments, and to identify problem areas. The second group focused on creating insight cards, these would be based of our research group insights, and give the staff some starting points to build solutions on. The third group would design a role-play game, to help increase empathy and get the staff thinking creatively. The fourth group would think outside the box on other tools to help staff identify and solve problems. The last group would develop a process journal, that would explain what and why we did things in this project. The hope being the staff could learn how to engage with design the same way our course does.
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Our first attempt to compile data form the whole year into one format
Our evening year meeting where people could choose what outcome group to be in.
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Role-play Development See page 43 of year PPJ for more info scenario on GSA students. We did this because the only test subjects we had available were students, and they would not understand the issues the hospital staff faced. We realised early on that the role play scenario had to have just the right level of constraint, If we made the role-play scenario too strict, people would not get into the role and be able to empathise with their character. If we made the role play to loose, actors would not be able to get anything meaningful out of the interaction, due to a lack of conflict in the interaction. We therefore chose to give actors aims, rules and tones for their role play. Aims were given to give the actors a purpose to their interaction. Rules were given to cause friction between actors and tones were given as a starting point and something to empathise with.
A group from our year presenting their role play idea.
I chose to help develop the role play with 4 other members, as i felt it was an integral part of the project. Not just as a tool to allow the hospital staff to understand problems and therefore solve them - but because I felt the lack of empathy and understanding between members of staff and also patients was lacking. The first step in developing this role play was to generate many different formats quickly and test these basic ideas. So everyone in the year came up with a role play example and explained how it worked in front of the class. The most important lesson we learnt from this was that it had to be simple or the participants would get bored and not engage with it. We then set about testing variations and iterations of the role play game - to do this we designed a scenario based around a GSA issue and tested this role play
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A group of GSA students testing a early edition of our role-play game.
A group of students in our year testing a late edition of our role-play game.
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Role-play See page 43 of year PPJ for more info. issue and include everyone in the discussion. After testing the role-play on numerous user groups we felt we had established good format. We then took the insights from the insight group and designed 8 roleplay scenarios, based upon these insights. We also felt it was very important to give the NHS a blank booklet that would explain how the staff at the hospital could design their own role-play, this was done because we didn’t want to limit the staff to only the insights we had uncovered. We wanted them to be able to build their own role-play whenever they felt a conflict had arisen.
Packaging up the Role play-game
We chose to present the role play as a booklet, with the intention that everybody in the discussion group would have their own copy of the booklet - we did this so that everyone in the discussion group would feel part of the process. When we tested only giving the actors the scenario, the other members of the discussion seemed disengaged and less likely to speak up in the discussion process after the role-play. We also developed a discussion process that groups could do after the role-play - It was based upon the idea of “this is because X, X is because of Y, Y is because of Z.” We found that this helped user groups get to root of the
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The discussion form we designed to help the NHS get to the route of the issue. The finished role-play booklet.
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Year Outcome See page 42-49 of year PPJ for more info sion part of the role play. It gave the discussion members in the role play a really nice way to understand where communication broke down in the role play. This helped groups to better solve the communication issues after. In much the same the role play game built upon the insight cards in a very important way, but letting the staff better visualise the issues identified in the insight cards.
Our years final outcome.
As mentioned earlier our year out was a collection of tools that were aimed to help the staff at cross house identify problems and also to help the staff build empathy with each other and their patients. I think we achieved this with our tool kit, which not only worked as stand alone items but also worked well together. For example one group designed the triangle of communication which lent itself very well to the discus-
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The insight cards
The Triangle of Communication
The set of tolls we gave the NHS to design their own insight cards and role-play scenarios.
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Presentation staff to come and use our tools. This gave us a chance to really learn how the staff interacted with our outcomes, as well giving them a chance to ask questions. It was incredibly rewarding to see the staff engage with the role play game, and for them to understand it’s importance as quickly as they did. The workshop we conducted with them felt like such a nice way to hand over our work and see its real world potential.
Our presentation
For the presentation to the Crosshouse Hospital staff, we felt it was very important to make it interactive and not just our year explaining our process and outcome with an infinite power-point. Therefore we chose to split our allotted time into 2 halves, the first being a short presentation, taking the staff through our process and then giving a case study example of our outcomes. This quickly lead to a workshop where we invited the
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The NHS staff trying out the role-play game in the workshop. The posters we designed for them.
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My Thoughts It is important to say that I felt this project was incredibly rewarding both in the real world outcomes and in what I learnt about both co-design and team work. That being said there were a lot of issues and problems that had to be overcome, mainly due to the size of our year group and the use of a open approach. From quite an early stage it became evident that open source design is a flawed system, this is very apparent when it imposes a flat hierarchy; I can see this system working when every person in the team is motivated and every person in the team is motivated and are taking part in a project they actively believe in. However, because of the nature of the project and the fact that much of our team was made of exchange students - a lot of people became disengaged with the project early on and therefore it was a struggle to keep everyone in the year working towards a shared outcome. Knowing this I spent a great deal of the project trying to create a engaging atmosphere. As I myself felt the studio had developed in to a stale work environment in the first two weeks that was not conducive to creative and fun work-flow. Hence I started to take a more active role in bringing the year together. This took the form of helping set up daily meetings and team wide discussions, that not only tried to get everyone on the same page but also encouraged people to become engaged and excited
about the project. Due to this responsibility I imposed on myself, It was really disheartening to see some people become disengaged or focus solely on their own work, rather then seeing this as year wide outcome. At the same time it was incredibly easy to see why people became apathetic with the project, as very few people actually had a overview of the year group and could see how much progress we were making. Ironically the communication issues we saw in the NHS system were clearly reflective of our own issues and problems working as a year group. One of the side effects of this mentality was that it was often in the late hours of the evening when small groups of committed people came together was when most of our work came together, as oppose to in the day with everyone in the studio - this was as destructive to the team dynamic as it was beneficial to the project, as many people viewed it as those groups going over their heads and leaving them out of the decision making process. In conclusion, as much as the project didn’t work a lot of the time, we did manage to create something that works and is meaningful. At the end of this I do think I have learnt a lot about working in a big team and how it’s more than just working on a outcome; it also requires constant work to keep everyone happy, engaged and to create a stimulating environment where people can be creative and therefore able to produce great work. 18