Thoughts on Inclusive Design

Stakeholder engagement, ensuring that you consult your end-users and user buy-in are key elements in any project which involves a change in process, a change in service design and an overhaul of how things are. There are a few facets of design and technology that I want to touch upon today but I have been thinking more and more what it means to have a service experience that works.

Digital transformation - this terminology in healthcare is rife and its almost becoming a cliche. Every. single. slidedeck. talks. about. digital. transformation. Heck, even I was talking about the phrase ‘digital transformation’ but really, does anyone have any remote idea of what the heck it means? Far too often it seems that organisations want to overhaul legacy systems and move to new ways of working. In the hospital system, we are rather prehistoric. Consider government funding (hence every dollar needs to be accounted for) and health is an extremely risk averse industry - we don’t like to do things unless it is proven to work 200% of the time. But the more I think about about digital transformation in the industries, it really isn’t about overhauling the systems and becoming an organisation that is just at the far end of technology, where everything is digitised and you have a super cool gadgety hospital that has glass ceilings and touch pads for every single thing (would look cool though). But in health, it isn’t really so much about the overhaul but rather, augmenting the digital technologies to what the objective of the healthcare system is about - care of people when they’re ill. So fundamentally, there needs to be a human element in the design of our services to ensure that ‘digital transformation’ isn’t simply leading the organisation down a rabbit hole of gadgets everywhere, but a transformation of the service experience for patients.

For example, if patient referrals still largely come through by paper - of course there is an efficiency gain there somewhere. Maybe we can create a back-end system where referrals are centralised and accessible by all staff to use and we can facilitate behaviour change from our service providers and patients by giving avenues and portals for them to use to file pre-admission paperwork and referrals. But herein lies the empathy side of service design, one cannot simply move a process over to a digital platform overnight without considering the population that will still simply want to use paper… and also, healthcare is an industry that thrives on the human to human contact. I think there is a point where you no longer just want a machine interface, but want to talk to a human being. Perhaps there is scope to augment digital transformations and look at ways to improve the customer experience… and therefore, you get a more complete experience that is empowering and fit for purpose…..

Ramble over.

I've been slack

Well, my apologies for my absence from this blog for nearly a year’s time. Life happens, inspiration wanes and getting down into a rabbit hole sometimes is inevitable.

My passion for UX hasn’t waned though, particularly in health. This past year has taught me a lot more about the health system in Australia and how there is ample room for improvement for the way do things. How do we create a healthcare system that rewards good behaviour? How do shift the emphasis from reactive to preventative medicine? The more I think about it, the more I am interested in the service experience, not just the user experience. Healthcare is a complex beast and there are beyond just interface touchpoints that we must consider in order to facilitate an experience that underpins the whole of healthcare; one that is empowering, one that works.

I’m now currently in a job that gives me a lot of insight into psyche of stakeholders within the organisation when exposed to a massive change. It’s interesting to say the very least and I feel very privileged for being exposed to all these learnings. I’m hoping in the next few months I can start sharing some of the insights I have been gathering as part of my UX journey.

Till then,

Katie

Stay Hungry, Stay Foolish

For a while on the internet, you could bet that almost every 20 something year old who had watched Steve Jobs’ Stanford commencement speech in 2005 was quoting that famous phrase ‘Stay Hungry, Stay Foolish’. It’s really struck a chord within me this past week.

I have attended HISA’s HIC Conference in Sydney this week (#HIC18) and it was one of the best conferences I have ever attended. They say that if you’re in a room and you’re the smartest person there, you’re in the wrong room. At the conference, I felt as if I was in the right room, there were so many brilliant minds among me that it was actually humbling to be there. I felt very lucky to have decided to attend the conference. It was akin to a ‘the more you know, the more you realise how much you don’t know’. The world of health informatics truly opened up my mind and led me to realise how much more is out there and how much more I have yet to learn and develop skills in.

This really isn’t too much of a post on UX but I feel compelled to jot down a few thoughts, as it will assist in my professional development anyway. 

Lightbulb Moments
There are often times in every working person’s career where they have a lightbulb moment of realisation. The path of figuring out what you want to do with your career isn’t easy. We are entrusted to choose what we want to do straight out of high school, when we are green and honestly haven’t seen much of the world yet. It is only when we burst out of that bubble that we understand that there is more to the world of careers than simply those traditional jobs that we know of. Ben Chestnut, the CEO of Mailchimp, put this quite simply where our careers are never linear but more like a zig-zag line. You have to stumble a little bit, work in something to realise that you really didn’t like it in the first place to actually find out your true calling....

Physiotherapy Days
Harking back to the few years I have been in the workforce, I have worked as a physiotherapist and now currently within the world of health management. I fondly recall those lightbulb moments when I was a physio student... It was when I was at my first clinical rotation at an outpatient department in a hospital. I honestly wasn’t sure if I physio was the right profession for me but after seeing how much of an effect that my treatments had on my patients, I felt that it was the right decision, purely due to the fact that I had such an influence on how I could help a person with their life and their health. 

The next lightbulb moment happened when I was a new graduate physiotherapist in the health system, coming to a realisation of the influential work that health managers do in the system. They may not have direct contact with patients, but they do innovative work that has direct impacts on the patients and can empower them in their wellbeing. That was when I decided to make the switch to management. 

#HIC18
At #HIC18, I had my next lightbulb moment. HIC truly opened my eyes to the world out there with regards to health informatics. There is so much to learn and so much that we can do to create bigger and better outcomes for our patients. The future right now is unwritten and we are on the cusp of the 4th industrial revolution. The future is clear, the way we go about our lives and how we deliver healthcare to our patients will be increasingly enabled through digital means. The onus and the responsibility of care will be in the hands of the patients and we need to collaborate/co-design our solutions with patients to empower them and deliver care that is personalised and relevant. 

DXC Technologies and the Consumer Approach

http://www.dxc.technology/healthcare

http://www.dxc.technology/healthcare

DXC Technologies provided a workshop on how  we need to drop the notion that ‘patients’ are ‘patients’ but that they are consumers and to utilise a customer centric model that is prevalent in other industries, to ensure that we deliver a solution that is targeted as opposed to poorly designed.

Dana Lewis on #OpenAPS and empowering patients to innovate

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@danamlewis provided a compelling keynote on shattering the notions that patients cannot innovate because they don’t have the qualifications or this or that. Dana challenged all these entrenched views and showed the audience how she proactively managed her health by taking control of her frustrations and developed the #OpenAPS (Open artificial pancreas) that enabled her to address the issues of glucose fluctuations in her T1DM. It was absolutely mind blowing to hear how her #OpenAPS has proliferated through the international community with more than 700 people having had access to it and have used it to manage their T1DM.

Soul Machines and the Future of AI

https://www.soulmachines.com/

https://www.soulmachines.com/

Soul Machines, a New Zealand company, provided a jaw-dropping keynote on the technologies for artificial intelligence. As opposed to talking to a chat bot, Soul Machines have developed technology for their Virtual Humans, that have virtual nervous systems and can process talking to a real human in real time to stunning results. The application of this technology is endless in the world of healthcare, where patients in remote communities can utilise talking to a virtual human to be directed in their care, saving both time and money whilst providing a comprehensive service. 

Blockchain in Healthcare - where are we going?

Another hot issue is Blockchain in health and this topic was hotly discussed in a workshop. After the rise and rise and then dramatic fall of bitcoins at the beginning of the year, Blockchain has seen it become rather famous or indeed, infamous. Akin to the Dotcom bubble of the turn of the Millenium, where people were freaking out about the WWW (yet now we see the WWW as probably one of the greatest inventions ever), blockchain is following that same trajectory. After the Dotcom bubble burst, the internet found its place and started to figure itself out and what its uses are. 

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Blockchain - we still don’t know what the far reaching capabilities of it is (other than with people playing around with crypto and making a lot of money), but we are traversing another horizon with it. A speaker at the workshop noted that with blockchain, eventually it’ll find its place and we will understand more of its purpose and how it can put the trust back into organisations. The applications of blockchain in healthcare and within society will drive fundamental changes. With the technology of creating transactions within an open ledger, provides integrity and trust and security to data. In a context where people are increasingly concerned with their data (as we had seen in the rollout of My Health Records in Australia), blockchain has the potential to revolutionise institution’s relationships with patients regarding their personal information.

Healthcare IT in the US

David Bates provided a compelling and comprehensive international perspective on healthcare IT advancements in the US. I know about the IOT and how we can utilise remote monitoring in the community to enhance patient’s control of their care, but this talk made me realise how many more things are out there that can empower the hospital to smartly fit out their infrastructure to their advantage to leverage the technologies of real time monitoring for enhanced patient care. 

David Bates introduced technologies such as Centrella - which are smart beds in the hospital with sensors attached all around with remote monitoring smarts. In an age where patients are interacting more and more with each other on facebook and other social media platforms, David Bates challenged the audience to also stop thinking them as patients but as consumers, to create digital marketing strategies to reach out to these patients and educate them. Finally, patients LOVE data and LOVE monitoring themselves. It is an inevitable advancement due to the IOT. Open APIs are imperative to enable the revolution where it isn’t the Doctor that will see you now, it is the patient. 

Stay Hungry, Stay Foolish

And this is why this blog is titled, ‘Stay Hungry, Stay Foolish’. Props to you if you managed to read all my ramblings and thoughts from late at night. Well done. But if you’re a TLDR; Stay Hungry, Stay Foolish. There is so much out there to keep learning to keep improving. Don’t stay complacent in what you know, because as you continue to expand your horizons, you’ll realise how much more that you have yet to learn.

The Next Lightbulb Moment 

The world of health informatics is gaining traction and I am excited to be part of it all, within the excitement and within all the challenges. I know the health system will evolve and mature to cater for the next wave of our we as consumers engage technologies for our lives but for now, there is much to do. My next lightbulb moment - health informatics and definitely, more UX. I can’t wait. 

UX Workshop at #HIC18

HIC 2018 is in Sydney this year and this year I had the pleasure of going to the UX workshop that was held pre-conference. I particularly enjoyed the perspectives given by Bennett Lauber - The Chief Experience Officer at The Usability People (USA) and the workshop on co-design facilitated by Dr Emma Blomkamp and Dr Chris Marmo of Melbourne design consultancy PaperGiant. 

The Importance of Co-design

Telehealth is one of those things in healthcare which is often met with groans and resistance from clinicians due to many failed attempts to launch such initiatives. As such, the failure rate has been very high. Karrie Long of The Royal Melbourne Hospital provided a presentation as to how RMH used co-design principles to create a user centric telehealth platform that addressed user's pain points. Karrie showed us a picture of this entrance at RMH which is one example of extreme poor UX, how can anyone work out what is going on in this picture? The thinking with showing us this front door was that the team needed to create a digital front door experience that was easy and simple to use.

When you need signs in health you know that the UX is not functional....

When you need signs in health you know that the UX is not functional....

Considering the experiences that patients have at the RMH with wayfinding being such a pain, the team created a digital front door for telehealth that was simple and straightforward. This is extracted from the RMH Website. 

Credit: https://www.thermh.org.au/telehealth

Credit: https://www.thermh.org.au/telehealth

A simple interface for users to click directly to engage with their clinician whilst the administrative staff configures the access points to enable patients to attend their digital consult in a straightforward manner, encourages a positive patient experience and changes the negative attitudes to telehealth.

PaperGiant facilitated a workshop on the principles of co-design, which was interesting and very relevant to the work that is completed in healthcare. The facilitators walked us through a case study, looking at the questions that we need to ask to extract the core information that the client may want. For example, the client may THINK that they want a certain solution for their problem but in actual fact, what they are looking for is that they want to solve a problem - the method as to how this is achieved is irrelevant because this can be elucidated through your user research. 

Full credit to papergiant.net. This tool was provided to workshop participants.

Full credit to papergiant.net. This tool was provided to workshop participants.

Usability x UX

The UX talk that challenged my thinking the most was Bennett Lauber's talk on usability. It was interesting to see the health system from an international perspective, in this case the UX and the various political agendas that have influenced the climate of digital health over there. The US has a much more mature model for hospitals that have EMRAM Level 6/7 (EMR Adoption Model) whereas in Australia, we are miles behind. Bennett emphasised the importance for conducting your user research through methods such as persona mapping (as I have blogged about previously) and surveys to really get to understanding the user's needs. And as a tip, Bennett noted that Contextual Enquiries, which is basically going to the client's context and understanding the things that they do, if there are workarounds or other pain points, to really see the impact of how the things we design impact the workflows for our clinicians. 

The thing that was most interesting for me was the 'myth of fewer clicks'. As a widespread belief, the fewer clicks it takes to achieve the user's objectives, the better it is. Bennett challenged this notion, by stating that perhaps in healthcare what we want isn't just fewer clicks, but instead at times we need to force the users to go through more clicks so that we can mitigate risk and attain better health data. This really made me think. Sometimes we need to burden our users to get better and more accurate healthcare data so that we can understand the larger trends that emerge. If we simplify the system too much, the richness of the data or the potential to attain that level of acuity of data might be missed.

Furthermore, users of the system can quickly turn from novice to intermediate users rather quickly. So as to why some healthcare software systems are deliberately complex, it is to enable the intermediate to expert users to have the ability to customise their user flows. What was striking to me was Bennetts comment that novice vs. an experienced user will interact with the software differently, perhaps simplifying software really isn't the agenda after all.... Definite food for thought. 

In a previous post, I mentioned Nielsen's Heuristics. Well, guess what? There are healthcare specific heuristics!!!! You can find the Nielsen-Shneiderman Heuristics HERE

How do we get our organisations to talk more about UX?

UX's value lies in the ROI for an organisation. The short term gains for investing in UX are not highly visible in many healthcare organisations. In a constrained funding environment with many competing priorities, there is no doubt that resources should be used to address patient issues. But considering poor UX in healthcare software, with a poorly designed experience, this creates the need for training the trainer and training the users, which is a high cost for organisations. Perhaps it is important to indicate to organisations that UX investment in the healthcare space has potential to reduce lost hours spent in training rooms and therefore, leave enough time for clinicians to care more for patients. And to that effect, with poor UX in healthcare software, risks may be prevalent for example, having interfaces that have too much cognitive load and thus, confusing the user and creating chaos..... 

Press and Go!

I visited a hospital that I haven't accessed for quite a while because I've been based at other sites. To my surprise as I walked onto the premises to be greeted with this as seen here:

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Kiosk

Kiosk for patient information

I was instantly really interested as I hadn't seen this on the hospital site before so started playing around with it.

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A quick look at the screen showed functions that people were looking for at the landing page. When I was a clinician, I had patients come up to me asking for directions and where ED was, so having this front and centre and other things below makes perfect sense. I was very impressed with it, those involved with bringing it to fruition surely must have done their research of user's pain points and have brilliantly created an interface that is functional and does perform what most patients complain about in the hospital. what is most awesome about this interface is that you can enter your mobile phone and have the URL of the map texted to you in real time, so that you don't need to memorise the whole wayfinding experience but actually have it on your phone. I like that this all promotes patient independence and caters for people who don't want to ask people for directions (myself included, I hate awkward encounters). 

This post isn't that interesting, but I am working on a few things on my own which I'd love to share with you all soon. To be honest, I just want to keep continuing working on my UX knowledge...because there is honestly just too much to learn. Given the many high profile suicides that have occurred as of late in the media and beyond and how depression is an illness that is close to my heart, I have decided to embark on a mini UX project on depression. I want to understand how we can connect vulnerable people with services to let them know that they aren't alone, that help is all around... watch this space, I truly hope I can shed some light on it with my UX project!

Till the next time with more interesting UX things in health, Katie.