Bringing Appreciation

How we empowered the most rewarding experience for doctors

Team & Duration

Anchal Aggarwal, Philip Begel, Pavithra Ramamurthy, Sean Smith

Fall 2016; 3 weeks 

(left to right; Philip, Pavithra, Sean, Anchal)

Role

Interviewing; Prototyping; Implementation Strategy

 

Deliverables & Methods 

Deliverables: Interactive prototype, implementation strategy

Methods: Interviews, co-design, mind maps, paper prototyping

Problem 

  • Doctors are assumed by the public as leading cut above average lives, privileged, but the life inside the hospital isn’t so extravagant.
  • Our research revealed that doctors work at the expense of their own mental and physiological wellness to provide the best treatment to patients. The mental and physiological well being of the people that take care of our health are under pressure.
  • The ordeal of young doctors though is that they are: overworked, sleep-deprived and steeped in a culture of medicine that demands that they suck it up and show no weakness, but they are humble, having personality types that don’t complain.
  • Doctors are not some obscure niche market and too easy to overlook by marginalizing their work environment with the life saving work they do everyday. 

Goal

  • We set out to utilize technology in novel places, in creative ways, to new ends in order to design and develop a product, policy or program to help lift doctors (a not-normally-designed-for target group) by broadening access to a certain activity.

    Outcome: ThanksDoc!

    • Our key insight was that the most rewarding part of doctors work experience is seeing patients cured and going home. So their health is important to deliver the best possible medical practice.
    • With an appreciation message service (interactive prototype below), we are allowing real-time thank you feedback to doctors to be sent directly to their email accounts. Seeing these reminders of how many lives they've impacted, regardless of the overworked thankless culture, acts as a motivator to keep doing what they do and know that it’s always worth it. Messages will also be sent to a common area on a wall-mounted display (Gratitude Board) to be seen by any hospital staff around to foster a sense of community among doctors.

     

    What I Learned

    • Bringing Meaning in Design:  While following my design process in this project, I realized that there are broader implications of our concept. This realization helped me understand that so many designs are about solving the "non-problems" of the world and something like this is about creating a better work environment and personal meaning to the hospital setting. Trying to tackle these types of problems are much more difficult in serving peoples' needs, but success may lead to a more empathetic world around us.
    • Involving the Stakeholders: Getting feedback at different stages of the design process helped us in validating the design itself once we narrowed down to our core insights. In this project, we engaged with nurses, doctors, medical students and even other hospital staff to understand the intricacies of taking on such a design challenge. Their feedback and participation in design sessions kept us motivated to continue moving forward.
    • The Big Problems: My team and I had to really dive deep into the abyss of what the design brief called for; a challenge of the status-quo and bringing to light issues and insights that otherwise would not have been considered. I found deconstructing the design brief for this project best by asking why the design problem for our target group, doctors, is important in the first place. This level of critique so early in the process kept the core of the design in sight and allowed us to always refer back to our research and insights to questions that arose throughout the process.

     

    Leveling the Playing Field

    • See the opportunities for applying both established and cutting-edge technologies in novel places, in creative ways, to new ends.
    • Potentially find a group you want to empower, or an activity you want to broaden access to.

      Co-Design

      • In order to better understand doctor's lives & gain insights that would guide and inform our design, we conducted interviews with doctors and nurses at various facilities in the Bloomington area including the Director of ER at Bloomington Hospital. 
      • To achieve the most authentic solution for our final design, an appreciation message service, we had doctors participate in the process by sketching with us the information to be displayed and also how and where they wanted to able to interact with the design.
      • Getting feedback at different stages of the design process helped in validating the design itself. Their feedback and participation in design sessions not only allowed us to make concrete, data-driven recommendations for changes, but also kept us motivated to keep evolving our knowledge of the problem space.

       

      Interviews

      Imagine freely walking into the White House at night and asking to see the President and you'll have some idea what it was like for my team and I to try and find a single doctor to spare some time to speak to us. We traveled around several wings of the hospital talking to wonderful nurses who helped put us in touch with available physicians. Eventually we were granted an audience with a night-shift hospitalist and an appointment with the Director of ER on another day!

      • Through interviews with these doctors at Bloomington Hospital, and also remote phone calls with Indiana University medical students, we collected research on many aspects of their work lives.

       

      Four participants; between ages 24-32; 2 male, 2 female; average 80 hour work weeks

      Field notes taken in the emergency room, doctor workstations, & the cafeteria

      We asked them questions about: 

      • Their daily routine in the hospital including daily challenges
      • Eating/drinking/bathroom/recreation/breaks
      • Communication and delegation of tasks in the hospital
      • Documentation of patients and associated time management
      • Hospital environment such as the doctor workstations and lounges
      • Impact of factors like depression, isolation, burnout, and stress
      • Coping with work demands
      • Social activeness outside work
      • Relationships with patients
      • Personal relationships affected by work
      • Technology used in the hospital
      • What do they enjoy most about their work

       

      "We get feedback 5 months after a patient is discharged. We get a lot of criticism and complaints."

      ~ Bloomington Hospital Resident 1, from interview

       

      "Suicide is a huge issue among young doctors. Mental health, depression, burnout, and stress are very real. Last year, I remember, two med students killed themselves."

      ~ Bloomington Hospital Resident Surgeon, from interview

       

       

      Mind Map

      The information we received was exhaustive and this activity was our attempt to make sense of it all. 

      • Based on our research, we followed up with an activity where we emphasized common findings between the doctors.

       

       

      >> Results: Negativity, negativity, negativity!

      • Communication and documentation takes most of the doctor’s time.
      • Overwork leads to stress, burnout, and depression. Suicides in worst case situations.
      • They neglect personal health which leads to not eating/drinking on time.
      • Neglect social life which leads to isolation.
      • Receive negative feedback and complaints.
      • Often do not receive appreciation for work they put in which leads to low confidence and dropout of medical profession.
      • Passionate about medical profession. Knew about the trade offs before entering the field.
      • Utmost concern is patient’s health and treating them

       

        Insights: Finding the Bright Spots

         

        • We compared and contrasted the results, but couldn't see our way through the mess: what could we do to help these doctors with their plethora of serious issues from depression to long work hours?
        • We changed our perspective to instead of trying to solve a huge issue like depression or communication among doctors, we looked at what they call the "bright spots." Rather than focusing on all the problems, we looked at the results that were working and asked ourselves how can we do more of it?

         

        >> Key User Insight

        • Positive emotions like fulfillment, motivation and happiness depend directly on their patient care!

         

         

        "Despite the tradeoffs, we put everything into it and when we save someone, it is beautiful. It is art."

        ~ Bloomington Hospital Resident 2, from interview

         

         

        Concepts

        • Our key insights boiled down our focus to the bright spot that a doctor’s source of happiness, and unhappiness, depends directly on the well-being of their patients. 
        • Yet, doctors hardly ever get real-time feedback or acknowledgements on the progress that their patients are making on an everyday basis. 
        • The current feedback system presents criticisms and complaints regarding the hospital facility or service after several months.

         

        • Through round robin sketching, we generated a variety of different solutions with approaches using artifacts, wearables and even ubiquitous computing technology. Why, how and when would the doctors use them? Were they non-intrusive and easily accessible? Would they be effective?
        • Taking our findings from interviews and design sessions with the doctors, we better simulated how the experience might play out for a created persona experiencing the designs.

         

        Final Concept

        Experiencing the disbelief these doctors had at our intentions really opened my eyes in how much they really don't expect anything in return for their 80-hour per week, life-saving services. Seeing them express an ounce of joy from the potential scenarios with the design and offerring their own additions to the concept was simply wonderful to see the meaning it could give them. I remember we all came to the hospital cafeteria after that day's session rejuvenated with a fire lit under our feet and began work on prototyping it immediately.

        Ultimately, through a brainstorming session with the Director of ER and other ER doctors at Bloomington Hospital, we narrowed down our concepts to ones where:

        • The technology was accessible to doctors and would fit seamlessly into their daily routine.
        • The concept of an appreciation message service integrated well with their work environment and this criteria they set 
        • This technology would provide a direct way for the doctors to receive a more real-time appreciation and acknowledgement for a job well done resulting in small fulfilling moments to motivate them positively in tackling their challenging days

         

          

        What if, one day... 

        • Dr. Smith comes into work and sees his colleagues gathered around something in the office.
        • Apparently, a patient expressed thanks to Dr. Smith and used the hospital’s new service ‘ThanksDoc’ to send it.
        • The message digitally appeared on the ThanksDoc Gratitude Board in the office automatically as part of the cycle of appreciation messages that the board displays throughout the day.
        • Dr. Smith admires the (near) real-time feedback from the patient and the boost in morale expressed by his colleagues.
        • Because only the patients first name is shown, this design would not violate any HIPPA regulations (a federal law that, among other things, protects the confidentiality and security of healthcare information).
        • When he checks his email later, he sees the same message and the name of the patient that sent the message to him by a daily ThanksDoc email.
        • He feels a sense of reward that is usually only felt upon seeing a patient healthy and being discharged.
        • This small token of appreciation builds over the coming weeks, months, and years, giving Dr. Smith a building foundation of gratitude from patients one thank you at a time.

         

         

        Prototyping

        • Low-fidelity exploratory prototypes were sketched based on the concepts generated in order to push the boundary of the concept from paper to something tangible, or at least, a visual representation.
        • We then brought the concept back to two doctors at Bloomington Hospital again to invite their suggestions and feedback. 

         

        “It felt pretty good to see all the patients I took care of that day. It was personal and it would feel like the day wasn’t wasted after a long day at the hospital.”

        ~ Prototype testing participant 1

        “The overall interaction was nice and simple. It’s definitely a good mood boost for the hospital. Morale can get pretty low and I think this would work well for residents especially. Residents would have much more of a chance of interacting with it. For me, having that as a resident would have been helpful to get through some dark times.”

        ~ Prototype testing participant 2

         

        Interactive Prototype 

        • Various screens of the (now named) ThanksDoc! service from the doctor’s perspective were prototyped. It shows patient names and another screen showing each patient's message. The final prototype was inspired by the participatory design with the Director of ER at Bloomington Hospital and led to the design moving away from a solo app to a multi-faceted system.
        • A high fidelity prototype was created to demonstrate that the concept was technically viable and usable. This involved making the screens in a photo editing software (Sketch, Photoshop) and then connecting the screen digitally through a prototyping tool (InVision) to see the interaction flow.

         

        The doctor receives expressions of appreciation messages from patients addressed to themselves or many doctors on a ‘Gratitude Board’ display that is placed in the most doctor frequented areas of the hospital such as emergency room office areas, doctor’s common workstations, and doctor's lounges.

         

        This would encourage team bonding and community celebration since a team of doctors are actively involved in each individual patient care.

         

        This design would embed itself into the everyday routines of doctors seamlessly, with passive interaction. This is why other avenues like a personal app or an artefact of some sort like a gadget or toy were not pursued. This passive interactivity with the wall-mounted display supports their workplace environment. The gratitude board motivates them through colorful displays of cycling appreciation messages without taking the doctors away from their busy schedules.

         

         

        With an accessible daily email notification from ThanksDoc consolidating all the messages patients have sent daily, the doctor is free to check it on their preferred email address and device (mobile or web). This gives them the ability to view it in their own time through their emails, even if they miss seeing the gratitude board. 

         

        The messages instill a personal moment to help the doctors bond with the patients letting themselves know that they made a difference in someone's life even after the patient was discharged.

         

        Implementation Strategy

        I was directed with this role on my team and began research on how to hypothetically implement this service. From following the PRInCiPleS framework by Eli Blevis, I delved into how we would get the community involved, how we would begin to develop a business partnership, and how we would actually build the technology for the service. 

        Completing the design plan required producing a strategic diagram of how a concept system may be implemented according to social value, technology, and enterprise concerns.

         

        Acknowledgements

        Thank you to all the doctors and nurses at Bloomington Hospital who spoke to us and helped us get in touch with others. A big appreciation from all of us for taking time out of your busy days to participate in our design sessions!