jamin.org

For this service design project, our team worked with the University of Pittsburgh Medical Center (UPMC) Center for Quality Improvement and Innovation to identify design opportunities for Dr. Amin Kassam’s Neurosurgery Clinic. Due to being able to perform a rare brain surgery by going through the patient’s nose rather than cutting open the skull, Dr. Kassam’s once-a-week clinic is overwhelmed with patients.

Our team spent a fair amount of time at the clinic observing and interacting with patients. We worked closely with the staff and shared our process and insights with them every step of the way, which built trust and gained their support. This enabled us to gain access to patients in the exam room and interactions between Dr. Kassam, his staff, and patients. We also shared our concepts with the patients, iterating as much as we could to refine our ideas and final solution.

Team

• Melissa Cliver
  Interaction Design
• Jamin Hegeman
  Interaction Design
• Kipum Lee
  Interaction Design
• Leanne Libert
  Communication Planning and Information Design
• Kara Tennant
  Communication Planning and Information Design

Deliverables

• Dr. Kassam welcome booklet
• Concept and process documentation
• Clinic Chat concept video

Process

After many visits to the clinic, we had to sort hundreds of photos and observations.

Me, during a group meeting to synthesize the data.

Service blueprint of the patient experience highlighting opportunities for engagement.

We engaged with patients to get input and feedback as our concepts developed.

We generated and visualized numerous concepts through words and sketches.

Concept storyboards generating to solicit patient feedback.

In trying to understand the emotions and needs of the patients during their journey, we created this visualization, which we included in our final book for UPMC.

Concept rendering.

Page layout from the welcome booklet we created as an artifact UPMC could implement right now.

Visualization of the ideal interaction between patients, Dr. Kassam, and his staff.

Page from the book delivered to UPMC.

A system overview of Clinic Chat.

A part of our research, we went to the OR to see Dr. Kassam perform brain surgery.

More process and solution photos

Adam Greenfield seemed really excited about Matt Webb’s year-end wrap-up, so I checked it out. It’s a bit of an abstract ramble of ideas, which didn’t excite me as much. But one idea sparked a thought:

“In order to keep going, the path of a user through a website must be designed to never end. In order for the website to grow, the path of the user must be designed to bring in more users, as in a nuclear chain reaction.”

While he’s talking about a website, I don’t see why this wouldn’t apply to all products and services. The the point that is interesting is “designed to never end.” Often in design, we create flow charts or service blueprints—documents that show the beginning of the experience and where it ends. While these have their value, should we also create models of the experience that don’t end?

This reminds me of my thoughts on changing the way businesses think about cost, which was stimulated by feedback from UPMC regarding our design solutions. They asked how we could create buy-in or show that our designs reduce cost. If there were ways to show the experience as endless, continually growing, could this help the argument that producing great experiences that keep people engaged and coming back for more is a more fulfilling (both for the consumer and producer) than reducing costs (not that reducing costs isn’t important, just not the most important aspect)?

I believe I read something recently—perhaps in BusinessWeek—that mentioned companies are starting to focus more on the experience than the cost. So perhaps this change is beginning.

The business case aside, the idea of products and services designed to never end seems worthy of keeping in mind.

Designers often argue about whether we’re designing an experience or designing for an experience, and ponder the more philosophical aspects of having an experience. Is an experience something designers shape? Is it something participants make?

Arguably, every experience is unique. But if this is true, what do we mean when we talk about the experience?

This makes for some great debate for designers. But what do the people who use the products and services we make think when they talk about experience?

I’ve been thinking about this question a lot recently, instigated by my…um…experience…designing for patients of a neurosurgery clinic. The patients referred to the experience as what they expected to happen: what they thought the experience would be like in a general sense. They would check-in, wait, it would be crowded, they’d get called to an exam room, wait some more, see the doctor, then check out.

But there was also the experience of what actually happened. They complained about waiting. The doctor joked with them, saying it was his goal to make them wait. They laughed and felt better.

Which is the experience? The perceived or the actual? Which is more important in the eyes of the patient? Which is more important in terms of the service? What can designers design?

I will continue to ponder.

Last week during finals, the four teams from the Designing for Service class presented their process and solutions to the class and invited guests, which included folks from University of Pittsburgh Medical Center (UPMC), for whom we were designing. During the presentation I took notes on what I thought were interesting ideas that were either brought up by the teams, the audience, or sparked in my head by one of the two.

Embrace the Situation

One of the initial problems my team heard from our client was that wait time is a problem. After our research, we acknowledged this and looked at it as an opportunity, defining our goal as to embrace wait time. Extending from that, in design situation that are perceived as problems, is it possible to embrace the situation or behavior and use that as an advantage?

Create Buy-in

The teams did not focus on how to create buy-in for our solutions, but it was of utmost importance to the people of UPMC. We were not prepared to answer how we or they could do this, which highlights a potential problem for the success of our ideas (or anyones). This is not new news, just good to remember. Involving people in the process was one possibility mentioned for achieving buy-in. But we should probably talk about this more in school.

What’s the Savings?

I hate to see design for a better experience reduced to a question of how much the proposed solution would save the organization, but it’s reality. We didn’t build a business case as part of this project, so we weren’t prepared to talk about cost savings when the question arose. Cost saving was also brought up by UPMC as a way to get buy-in.

This mindset that cost saving is such a dictating force irks me. Who’s to say that spending more money on a better solution won’t lead to greater profits? I wonder if we can reframe it so that cost is not necessarily monetary. For example, funding for a solution will reduce the cost of a crap experience.

Blue Sky vs. the Little Guy

One group decided that rather than design a solution for their particular client, they would propose a system-wide solution for UPMC, of which their client might benefit. The idea—to create a design practice and idea hub—was good, but I thought it did a disservice to their client, who got no implementable solution. When looking at the whole, it is likely that you’ll find problems throughout the system, and with the system itself. However, what may seem like small, local changes can actually have a great impact, first locally, then systematically. So don’t disregard what I’m calling the little guy and instead go straight to blue sky, unless, of course, you’re asked for blue sky ideas. Better yet, propose implementable solutions now, and a blue sky solution as a bonus.

Give People Time for Design

The clinic staff my group worked with were inspired by our presence and the design eye we brought to their space. One of our proposed solutions encouraged them to meet and continue to think about how to improve the experience. UPMC acknowledged a shift in health care toward our kind of thinking—design thinking, if you will. A problem with asking staff to think about the experience on top of their already busy schedule is…well…their busy schedule. Solution: give people time for design. Make design a part of their job description and give them time to do it.

What Is Experience?

This is a question I asked myself amid the discussion. But I’ll talk about this in a separate post.

After 13 weeks of working with the UPMC Neurosurgery Clinic, direct by Dr. Amin Kassam, we have decided to produce a small communication design piece. Compared with other projects, which have mostly focused on technological solutions, producing a booklet feels a little uncomfortable. I catch myself thinking, “This is it?”

Well, actually it’s not. In addition, we are also providing the clinic with a design guide that outlines our research, observations, insights, and possible concepts that they can reference as they continue to shape the clinic into a more ideal vision.

Service design is a holistic approach that focuses on understanding the service first before introducing products into the service. I see it as applying design thinking to a system to understand what products or behaviors might impact the system in a positive way, with a perspective that all elements within the system, from product to human behavior, are interrelated and form the service.

What this means is that there are intangibles that make up a service that you can design for but not actually see manifested in the form of a product. This is what has been making me feel uncomfortable, as the potential impact of our efforts and deliverables are not easily viewable.

Despite this discomfort, I know the small communication design piece will have an immediate impact on the patient experience and quite likely the way the clinic sees itself, which may lead to further positive changes in their behavior. And that’s not something I would have felt comfortable about without having done all the research in order to understand how all the parts of the service affect each other.

The design guide—also a print piece—will serve to embody the presence of our design team and of design thinking in the clinic. Embody design thinking? Yes. We found that by having us around and sharing our process and perspective helped the clinic staff make immediate changes in the way they viewed their work and the patient experience, which led to behavioral change that we had not expected. The great thing was that the staff would openly confess to being inspired by our presence and perspective to make changes themselves. This is definitely an intangible that we’ve essentially already delivered. But it’s difficult to see without a bit of reflection.

The aforementioned might not have been successful without having formed a good relationship with the clinic staff. This is a key point to service design. The people who deliver the service need to be on board with what you are doing. To this end, involving them in the process early and often is highly important. We accomplished this by presenting our initial research findings with lots of photos of them and quotes from them to show that we understood their experience. There was an immediate change in their behavior toward us after that because they then saw us as their colleagues.

So while the only design artifact we are introducing that patients will see is a small print piece, how it relates to the whole, and the behind-the-scenes design guide, and the other intangibles I mentioned, means that we delivering a lot more than is apparent by looking at the individual artifacts. Understanding that relationship is the point of service design.

For the Designing for Service class this semester, we are exploring design solutions for the University of Pittsburgh Medical Center Neurosurgery Clinic, specifically for Dr. Amin Kassam, who is acclaimed for his minimally invasive endoscopic surgery—a procedure that allows him to remove brain tumors by going in through the patient’s nose.

While our efforts are focused on improving the patience experience at the clinic, last week Dr. Kassam invited us to the OR to watch one of his procedures, “if it will help,” he said. We jumped at the chance.

Yesterday was the day. We arrived around 11:30. They set us up in the observation room, which was adjacent to the OR with windows dividing the two and had LCD screens projecting the view of the camera that was inserted into the patient’s nose that allowed the doctors to see what they were doing.

The surgery we were watching began around 8 am. When we arrived, they were in the process of creating a hole in the skull behind the nose to get to the tumor in a 26-year-old patient. They took a break to wait for Dr. Kassam, who was in another surgery. And the attending physician came out and showed us the MRI of the tumor, which was a few inches in diameter and putting pressure on the optic nerves, causing the patient to go blind.

When Dr. Kassam arrived to the OR to take over for his attending, he invited us into the OR itself. So we suited up and went in.

It took another hour and a half for Dr. Kassam to access the tumor. He used tools that he had created himself and named after his kids. During the surgery he asked if we could do anything to improve his tools, and made adjustments to the tools himself when they weren’t bent at the correct angle.

Six hours from the beginning of the surgery, he reached the tumor, which was rather quickly sucked up by a tiny vacuum. The tumor was the result of the formation of the embryo, all the way back before the patient was born. Some fat and skin cells got caught in the middle of his brain and over time did what they were programmed to do—create fat, skin, and hair. That’s what they sucked out.

Ironically, after drilling through the nasal passage, removing bone, and sucking up blood along the way, it was only after the doctors encountered the hair that they exclaimed, “Disgusting!”

Kipum Lee and I are proposing to create a sensor detector and ambient door location indicator for our Making Furniture Interactive (MFI) class. Kip and I are also working together on a team in another class to bring service design solutions to the University of Pittsburgh Medical Center (UPMC) Neurosurgery Clinic. Our work on that project inspired the ambient door prototype, as it was a concept developed from the research in response to seeing a need to find people inside closed exam rooms. More manual tracking solutions were attempted without success. So the team thought we’d suggest something more automated.

We needed a project for MFI, and we thought it would be sweet to prototype the ambient doors. For this project, we pretty much have to teach ourselves a bunch of stuff we haven’t learned, like how to use sensors to track people and link up wirelessly to an ambient display. But we’re excited to potentially demonstrate the concept to the client, even if it isn’t a component of our final delivered to UPMC. Ambitious? Perhaps. Fun? We hope.