Personal Process Journal
Aditya Patil Master’s in Design Innovation & Service Design
Contents The Brief
3
Introduction 3 Initial insights
4
Desk Research
5
Interviews 8 User Journey Map 10 Designing the Engagement Tool Analysing the Interviews 15 Ideation 17 Storyboarding 19 Prototyping and Testing 21 Presentation 25 Service Blueprint 27 Conclusion 28
13
The Brief
Introduction NHS has been the first health service project that I have got to work on. Personally, it was a mammoth task as a designer to understand the operations of the health sector. NHS comprises of many stakeholders viz. Doctors, nurses, admins, therapists, pharmacists, health officers, directors, carers and patients. Every stakeholder plays a crucial part in the system, and their main goal is to achieve the healthiest life possible for the patient or service user. NHS Ayrshire and Arran comprise various hospitals, community hospitals and a rehabilitation centre. Douglas Grant Rehabilitation centre (DGRC), a part of the NHS Ayrshire and Arran Neurological Rehabilitation Service, has provided services for neurological diseases. We had to look into the current service offering of the DGRC and analyse the shortcomings in the offered services from the key stakeholders’ perspective.
Initial insights We started researching neurological diseases and their symptoms, NHS organisation, neurological rehabilitation and accessibility of the services. We carried out a small exercise of noting down our assumptions about neurological diseases based on that information. Later, we listed down the questions we had in mind about neurological diseases, logistics, service & processes, diagnosis & treatment, and communication. We also listed down the stakeholders involved. These activities helped us understand the working of the NHS, the pain points of the patients, and the structure of the health service. It also led us to questions that became the basis for our desk research. We noted down our challenges based on the initial insights.
Desk Research
The desk research comprised of 3 phases viz. research, understanding and conclusion.
Phase 1 - Research I researched the organisations involved in neurological rehabilitation. Some of the organisations like headway and MND Scotland are doing tremendous work in this sector. They have immense resources related to neurological diseases, which helped us gain insights about patients & carers and their action. It also provided information about the fundings a carer gets from the government to look after the patient. The insight from this exercise was that carers find it challenging to avail themselves of the funding services from the government. The information regarding the funding is not accessible to the public. I also went through many patient interviews and carer testimonies available on the respective organisation’s websites. These interviews were very beneficial to understand the journey of a patient right from the diagnosis to treatment. The interviews also highlighted how a rehab centre plays a vital role in the recovery of the patients. We also learnt about the delays in the system, which makes the patients more vulnerable.
We listed down all the possible questions we had in mind regarding the referral process, communication channels, the possibility of engaging with the patients for ethnographic research, how carers are involved in the process and how does a rehab centre looks like. We narrowed it down to five major questions: How is the communication between the doctors and the family? 1. How can we help rehab practitioners collaborate well? 2. How can we build trust and reduce delays in the system? 3. How to design a long term guide for patient recovery? 4. How to empower the patients to be in control of their rehabilitation?
From this activity, we also listed down the questions which we had related to the DGRC.
Phase 2 - Understanding
After the introduction session with the staff of NHS Ayrshire and Arran, we decided to reflect on the understanding of the current working of the DGRC centre. We divided the work into NHS, neurology and tools. NHS: We listed down the stakeholders involved at the centre. We investigated the location of the rehab centre. We analysed the rehab centre pictures available on the web. We learned about the accessibility of the DGRC ward. Neurology: We studied the different types of neurological diseases that are being cured at the DGRC: We learnt about Parkinson’s disease, motor neurone diseases and Huntington’s disease. I listed down the symptoms of these diseases and how it affects a patient. Understanding the service offerings of the DGRC helped us to understand the shortcomings in the services.
Tools: After researching the tools, we earned about the variety of tools involved in the process and how they are used based on the requirement. It also highlights how technology is being used to make accessible tools for the patients to make them less vulnerable and make them more empowered.
Phase 3 - Conclusion Desk research helped us to understand the working of the DGRC centre. The led us to insights related to patient expectations and communication. The research also led us to find our initial opportunities, which helped us design our interviews with the patients, carers and practitioners. From the research, we also gathered stats like • 28% of respondents disagree that their treatment and condition are effectively passed between the different people who care for them. • Only 10% of respondents have been offered a care plan. • 23% of respondents had not explained their diagnosis, that they understood when they were first told they had a neurological condition. • 48% were not given written information when they were told they had a neurological condition Checking the rehab centre videos, we understood the patients’ dependency on the carers and the therapists. It also highlighted the communication gap between the patients and the practitioners. Opportunities and hypothesis Based on the desk research analysis, we found out various gaps in the system related to • Communication • Building trust
• Empowering the patients • Decentralised decision-making process. We listed down opportunities from the practitioner’s point of view because we did not have access to interview the patients and carers because of the NDA with the NHS. Based on the above-listed opportunities, we listed down our hypothesis. We categorised it based on: Desensitised practitioners: The doctor may feel normal about the patient’s pain, so the patient might think doctors lack sympathy. Boundaries: Patients might feel a lack of interaction with the health staff regularly.
Empowerment: Patients might have questions before the treatment and post-treatment, leading to a lack of trust in the process.
We came up with five significant hypothetical statements from the hypothesis mentioned above. We decided to test out through our next phase of the research involving interviews and engagement tools.
Interviews We shortlisted the actors involved in the health sector and decided to do one on one interviews with them. The list of actors interviewed were practitioners, patients, carers and nurses. I reached out to the MND Scotland’s information officer for an interview and a list of questions about MND Scotland as an organisation and its relation with NHS. However, due to busy timelines, the officer could not schedule an interview. Instead, they provided us with links to the blogs written by the carers of the patients who have Parkinson’s disease about their experiences. As I could not find relevant participants for the interview, I went through the interviews of Parkinson’s disease patients online. Reading the experiences and listening to the interviews was very beneficial to understand the difficulties faced by the patients and the carers.
My team members scheduled interviews with the NHS practitioners, nurses and patients. These interviews helped us plan the future road map to design the engagement tools for the project.
Insights from the interview From the interviews, we discovered the following points: 1. Practitioners do not have tools to lower down the anxiety levels of the patients. 2. Practitioners and nurses find it difficult to give personal care to every patient. 3. Patients and carers start getting the feeling of hopelessness over some time. 4. Family members need to quit their job for being a full-time carer. 5. The patient goes through trauma for months straight. Pathway These insights helped us design a communication pathway considering the major actors involved in the patient’s journey from diagnosis to recovery. We considered practitioners, therapists, family members (carers) and patients as our major actors. Initially, we designed a simple pathway, as shown in the below image.
Designing a pathway raised a question about what we want to learn further from the research using the engagement tools? Through this tool, we also got our initial HMW which was - HMW enhances the communication during the on-boarding of the patient?
User Journey Map To design a user journey map, we had to understand the complexity of the communication between the various actors involved in the system. Also, mapping down all stakeholders involved was necessary to design the journey map easily. Pathway To understand the communication complexity, we decided to redesign our pathway considering additional actors involved in the system. Separating the general practitioner from the rehab centre and categorising the rehab centre based on the various profiles gave us more clarity on the communication front. The pathway helped us understand the various touchpoints involved in the system from the patient’s perspective. This also gave us a clear understanding of how different actors communicate at various stages inside and outside the rehabilitation centre.
Ecosystem Map The ecosystem map is a synthetic representation capturing all the key roles that influence the user, organization and service environment. The ecosystem map is built by first displaying all the entities and then connecting them based on the type of value they exchange. Through this ecosystem map, we were able to map the stakeholders involved in the ecosystem. The map is designed by keeping the primary user, i.e. the patient, as the focal point and then placing all the actors involved in the rehabilitation process. The map is divided into three categories viz—community, services and institutions. The map helped us to understand the different layers in the process. The dependency of the actors reduces as we move away from our primary user, i.e. the patient. Using this map, it was easier to map our user journey map from the patient’s perspective.
User journey Map After mapping the pathway and the ecosystem map, it was much easier to design the user journey map. Using the ecosystem map, we listed the actors involved in the system on the left side of the column. The pathway gave us a guide-way to design the different stages involved in the different stakeholders’ communication with the patient. We designed a raw journey map initially.
We considered the following stages: • Stage 1: Before go to the rehabilitation centre. • Stage 2: On-boarding at rehabilitation centre - On-boarding. • Stage 3: Treatment in rehabilitation centre - Treatment. • Stage 4: Discharge from rehabilitation centre - Discharge. • Stage 5: Post treatment. Our interviews highlighted the user’s feelings, physical & virtual touch-points, opportunities, and further questions to understand the process in depth. Designing a journey map led us to more questions like: • Is rehab treatment voluntary? • What is the first touchpoint? • What kinds of question patients and cares will ask when they on-boarding at rehab? • How do patients communicate with the doctors when they are most vulnerable? • What are the questions patients and carers will ask before they discharge from rehab? • Does the patient or their family will receive some recommendation for caring or something like that? • How patients and carers contact with rehab currently? • How will the patient files be transferred to the next department or to GP?
Reflections The tools mentioned above helped us to: 1. Understand the health eco-system from the perspective of different stakeholders. 2. It gave us clarity on the current communication system and the potential opportunities to investigate. 3. Analyse the interlinking between the different stakeholders. Designing these tools was a collaborative process involving the team members. Each member came up with different and unique perspectives while designing maps, which helped us have a divergent set of ideas. Overall collaboratively designing the maps is a good practice as it helps formulate the problem by considering all the possible scenarios, which is difficult while doing it single-handedly. This tool’s insights and questions helped us design our engagement tool, which has been explained in the following chapters.
Designing the Engagement Tool To test our hypothesis related to communication, we decided to design an engagement tool. We brainstormed different tools like applying emotions to the user journey map, simulating empathic exercises, communication games and a creative toolkit. We had to do our research online through zoom calls; we thought a creative toolkit (cultural probe) could be a perfect exercise to understand the patient’s emotions. However, due to the NDA signed with NHS, we could not go forward with that tool.
We decided to design an emotional mapping tool to understand the different emotions the stakeholders go through during the process. We listed down a list of relevant emotions from an emotion wheel and formulated scenarios based on the participants we were going to interview.
The engagement tools had a list of scenarios formulated from the user journey map on the right side, and the emotional wheel was placed on the left side. The emotions on the wheel had 3-6 circular markers. Based on the scenarios, the user had to pick up the relevant emotions and place them on the scenario bubbles on the right. Due to the technicality of the miro board, I was doing the actions for the participant.
Using the engagement tool I tested the tool on an occupational therapist in a group interview. The tool helped us to understand the emotional vulnerability of the therapists.
My reflections after using the tool were: 1. The engagement tool has been beneficial as a conversation starter. 2. The tool requires at least two facilitators to make it work efficiently. 3. The tool’s colour allocations need not happen at the moment. The participant should not feel quizzed or as if there is a right or wrong answer. The tool can be used as an information artefact when we use it after the interview to map the responses. 4. The tool was highly interactive, leading us to the questions like why, what, where, when and how. 5. The tool helped us to get the stories out of the participant, which helped us to understand the emotional connection between the patient and the therapist. Other team members used the tool with different participants, and it helped us to gain many insights.
Analysing the Interviews Thematic Analysis We had the opportunity to interview and use our engagement tool with occupational therapists, a gastroenterologist, a manager, and a specialist nurse. We did a thematic analysis of the interview to find patterns and themes. We came across themes like empowerment, patient autonomy, goals & motivation, emotions and medical constraints from a patients perspective. Themes like challenges, building trust, treatment, tools, and support came across as practitioner-driven interventions. We found that medical constraints were a problem for both the patients as well as the practitioners. The analysis helped us understand the system’s pitfalls and gave us a direction to find our ultimate HMW.
Deciding our HMW After all the interviews and analysis, we had to rethink our HMW Statement. We started posting all the possible HMW statements on the board. Later, we voted on the best ideas.
Later we selected the top ideas and articulated them in the form of a tree structure to see how different ideas intersect. This finally led us to our final HMW statement: HMW empower patients with goal-based treatment plans?
Ideation Sketching We decided to meet in a park for the ideation process, as it was a sunny day and do some real-time sketching. The sketching exercise helped us to explore wild and crazy ideas. Through this sketching, we were able to pick some of the tools like a guidebook, assessment tool, goal planner and many more. The ideation was a fun way to explore ideas.
Idea Bank We started brainstorming about ideas; the sketching exercise was a significant motivation for the ideas. We came up with ideas like a guidebook, goals & daily reflection, communication cards, mascot, assessment tools and a welcome kit.
We created an affinity map for prototyping the tools. We created a value vs effort graph. We placed all the ideas we had on the graph and based them on four different quadrants, viz. do it next, do not do it, do it when there is time and do it now. This exercise helped us to plan our further stage of prototyping and testing. It also gave us an idea about the essential and insignificant tools.
Storyboarding After the ideation process, we decided to design a storyboard to understand the touchpoints of the tools in the ecosystem. We individually designed five different storyboards.
Getting inspired by all the different storyboards, we narrated the story from Bob’s perspective, recently diagnosed with a neurological disease. We started the story from Bob’s first appointment with the practitioner and ended it with Bob being discharged from the rehab centre after the successful treatment. This activity gave us a clear idea about how the tools will be used for communication and assessment. Also, it showed us possible pitfalls which came to light while designing the storyboard. I think designing a storyboard is way more complex and beneficial. Here we connect with the users emotionally, which in turn helps us design better experiences, which is the crux of a design process.
Persona Design Personas are fictional characters that help us understand our user’s needs, experiences, behaviours and goals. We designed two sets of personas, one for the patients and the other for the therapists. We took the unconventional approach of deigning the patient personas because patients have specific behaviours, and based on that, their needs & goals changes.
We took a traditional approach for designing the therapists personas as they have focused task and goals based on their specialization.
Prototyping and Testing Iteration 1 In iteration 1, we designed the guidebook, welcome kit, goal planner, assessment tool, mascot, and emotion cards. The first iteration was more of a co-creation tool. We wanted to reiterate the designs with the participants collaboratively. We prototyped every essential tool. We divided the work of prototyping. I took up the task of designing the facility guidebook.
Feeling Cards
Assessment Form
Mascot
Pre-rehab checklist
Planner & goal setting
Guidebook
Communication and assessment tools
Testing We decided to test our prototypes with the participants available in the studio. The important tools which had to be tested were the assessment tools, emotional cards and the goal sheet. We interviewed two participants. Lydia facilitated the workshop, I took the notes, and other members observed the participant. Planning We rehearsed the whole set with our fellow teammates. This gave us confidence and ideas about where could we go wrong.
We designed the steps to use the tools during the interview. This gave us a framework for executing the interviews in a disciplined manner.
Reflections The co-creation activity(Interviews and testing) was very insightful. It helped us to understand what a person goes through while consulting with a practitioner. Even though the participants we interviewed were not actual patients, we executed the interview in a controlled environment.
We observed that: 1. The users were getting overwhelmed with all the tools we had on the table. 2. Initially, the tools were helpful to initiate a conversation. 3. By the end, when we offered them to set their goals on the goal sheet, it started getting much more overwhelming for the participants.
The observations helped us to redesign our tools. We decided to reiterate our tools and services to make the participant more comfortable and less overwhelmed.
Iteration 2
Learning from the observations we found that: 1. It is unnecessary to place all the tools in front of the patient. 2. The tools are a medium for the practitioners and therapists to start a healthy conversation with the patient. 3. The tools can help the patients to build trust in the service.
While reiterating, we came up with two new tools, viz Q cards and type guide (persona guide), specifically for the practitioners to lead them to a meaningful conversation with the patients. Using these tools, the practitioners can also design a self-tailored goal map for an individual patient.
Reiterated Storyboard
Mascot and communication tools
Q cards, goal map and type guide
Patient Recovery Type Guide
Q Cards
The Dependant
The Driver
The Dreamer
The Doubter
Relies more on carer/family Often life long/ long journeys Requires more queuing Passive participant
Very self motivated Trauma or short/medium journey Independent and active participant Challenges treatment
Struggles to manage expectation Influenced by external voices Optimistic disposition Prone to disillusionment
Skeptical of others input Long term journey Prone to pessimism Part of the conversation
Positive reenforcement oriented
Progress oriented - Goal
Big goal oriented
Information/ fact oriented
Patients will often fall predominantly into one of the above categories. Use this guide to better understand their challenges and motivations. Patients should never feel diminished to one persona type, they may adapt and change through their treatment so use this guide to better understanding and bridge the communication divide.
Presentation We took a different approach to the presentation. We decided to shoot the storyboard and use all the artefact’s and tools while shooting it. It was a fun experience; we wrote a script before executing the shoot. This exercise got the team closer and helped us to understand each other in-depth.
Service Blueprint At the end of the whole design process, we designed our service blueprint to understand how our tools fit into the present service model. I think a service blueprint is a tool that was not required for this project. Moreover, the user journey map was more helpful in understanding the problem we were trying to solve. I learned that In normal circumstances service blueprint should be designed after the research phase to understand how the different services and stakeholders in an organisation are interlinked with each other. Also, it helps to effectively find the possible touchpoints in the services when two or three stakeholders cross each other, and it helps to understand the effects of those on the service.
Conclusion Throughout the project, I learned something new about team collaboration, service design process, design research, remote working and mainly about how to design an effective engagement tool. Team collaboration It is crucial to listen to the team members before explaining your part. The team I got to work with was helping and coordinating throughout the time. It was a great learning experience to understand their culture and how the health industry in their country works. Engagement tools and interviews In this project, I learned how to design an effective engagement tool, leading to openended conversations where the participants share their personal stories about the experience. Also, I learned that only designing the tool is not enough more skills are required to facilitate it effectively to gain the right insights. Also, I gained more confidence in taking user interviews. I also learned how to do a thematic analysis of the data. Also, I learned about different types of research methodologies and how to use them based on the situation. Online vs studios After this project, I am very much convinced how a studio plays a vital role in the design process. We were more effective in the studios as compared to the online working. I learned
about how a studio should be, and I was surprised how the other team members were using different tools to create prototypes. Overall it was great fun working on this project with the team. I got to learn a lot about the health sector. I still need to improve on my time management and project management skills. Also, I need to learn more about service design by reading more case studies.
Thank You
