Empathy for the Content - WIAD DC

World Information Architecture Day
Washington DC, Feb 15, 2014

Empathy for the Content
Designing for Touchpoints of Care
Peter Jones
Redesign Network
OCAD University, Toronto
Copyright © 2014, Peter Jones

DESIGN FOR CARE in context
• How can design make a real difference in healthcare practice?
• By caring. Information care providers.
• Care is not a single value or practice.
Every discipline performs it differently.
• How should designerly care be provided?
• IS THERE A “STANDARD OF CARE” FOR DESIGN?


Enabling understanding is Care.
“Man finds . . . his place by finding appropriate others that
need his care and that he needs to care for. Through caring &
being cared for man experiences himself as part of nature;
we are closest to a person or an idea when we help it grow.”
Milton Mayeroff, On Caring

Can information design help people grow & feel cared for?


Care-Centered Design
1.

Health‐Seeking Experience.
Touchpoints of Care.

2.

Patient‐Centered Care.
Information as a Care Service.

3.

Clinical Workflow.
Adaptive Content for Performing Care.


Health Seekers
• None of us self‐identify as patients.
• Use an empathic design approach.
• We all seek health, as a sensemaking process.
• The design aim is to fulfill care. Cannot design health.
• Design better value for people seeking health.


Where do you Care for Content?


Touchpoints of Care in Health-Seeking


Patient Information Needs
(Motivators & Triggers to action)

1.
2.
3.
4.

Understand what is wrong.
Gain a realistic idea of prognosis.
Make the most of consultations.
Understand processes & likely outcomes of tests
& treatments.
5. Assist in self‐care.
6. Learn about available services & sources of help.
7. Provide reassurance & help to cope.
8. Help others understand.
9. Legitimize seeking help.
10. Learn how to prevent further illness.
11. Identify further information & self‐help groups.
12. Identify the best health‐care providers.


Coulter, A., Entwistle, V., & Gilbert, D. (1999). Sharing decisions with patients:
Is the information good enough? British Medical Journal, 318, 318–322.

Information Touchpoints of Care

5. Assist in self‐care.
6. Learn about services &
sources of help.
1. To better understand father’s condition
7. Provide reassurance &
2. Identify risks in treatment & care
help to cope.
3. Learn how to care for her Dad at home
4. Prepare to discuss with clinicians

7. Provide reassurance & help
to cope.
8. Help others understand.
9. Legitimize seeking help
10. Learn how to prevent
further illness.
11. Identify further information
& self‐help groups.
12. Identify the best health‐
care providers.

Health seeking includes information
seeking & explores alternatives.
Knowledge acquisition for making
sense of health issues.
One channel we have some access to.


Health Design Lab / Dr. Mike Evans


How do we help people
“grow & feel cared for?”
Differences we can’t easily measure ‐
• First, do no harm. Errors, usage, accuracy.
• Understood, in your language & terms
• Validated by your conditions of life & truth
• Real & relevant cases
• Affords action without being prescriptive
• Multiple mediators
Allows you to adapt to style / tempo
• Match channel to message
• Facilitates sensemaking (see Dervin)


2. Patient-Centered Care
Information as a care service.
• Gap between medical evidence & its use
• ePatients (in particular) advocate for access
• We ought to push for patient sensemaking
Person‐centered care …
•
•
•

Address patient’s perspective
Understand patient within psychosocial / cultural context
Involve patient in care to the extent desired

• Beyond UX or empathy as we know it.

PCC Touchpoints – Where & How?

Family &
social history

•
•
•


Nutrition
Exercise
Health Beliefs

•
•

Patient‐Clinician
Communications
Medication
Management

•

Home &
Continuity

PCC (not) in today’s Content
Joint Commission
‐ Universal Protocol
•
•
•
•
•
•
•
•
•
•
•

For invasive procedures (on you)
Nearly 40 bullets
Not one supports PCC
Only one suggests “involve the
patient”
A useless image!
What could go wrong?
What else could we do?
Color code for patient / PCC?
Prompt for language, meds,
understanding
Ask if there are questions
Check beliefs about procedure


CONTINUITY OF CARE DOCUMENT IDEO + CHCF
Project Synapse

•
•

•
•

Patients feel they are left on their
own to figure out next steps.
Patients with serious health issues
work around the system to get the
best care.
Episodic & disjointed care hides
valuable connections.
Both patients & physicians doubt the
reliability of (reported) health data.

IDEO + California HealthCare Foundation , 2012

Value to Patient
• Represent what I truly care about
• Present information in a way I
can relate to
• Help me cross‐check my facts
• Help me close communication
loops among my care team
• Set me up to have clarifying and
guiding conversations
• Clearly lay out the next steps
• Show my trajectory over time

IDEO + California HealthCare Foundation, 2012

3. Clinical Workflow
Many Points of Care.
•
•

Points where care delivered ‐ differs by specialty & level of training
Information needs differ between roles, training, service.

•
•

No “one stop shop” exists …
No single resource (e.g. UptoDate) fulfills all information needs.


Clinical Information Touchpoints
(Canonical workflow)

1.
2.
3.
4.
5.
6.
7.
8.

Inform an examination
Support patient evaluation
Inform a diagnosis / Compare diagnoses
Specify screening & tests
Assess & select treatments / procedures
Plan patient followup
Help patient understand condition & procedures.
Educate patients (prevention, meds, maintenance)


Clinical workflow is scheduled AND complex


Point of Care Content
While available for over a decade in web (& recently in mobile),
Now integrated with the patient record as EHR assistants.

Infobutton Manager in CPOE

Del Fiol, et al. Infobuttons at Intermountain Healthcare:
Utilization and Infrastructure AMIA Annu Symp Proc. 2006; 2006: 180–184.


Clinical Decision Making is a
much a critical time loop as


Tips on Empathy from the Air Force
• In most cases doctors have less
than 3 minutes to update their
knowledge on situation
• Often just 30 seconds.
• In rapid situation assessment
we are dealing with fast OODA

OBSERVE

ACT

• Information helps Orient &
Decide, may guide Act
• Can content construct an
answer for < 30 second loop?


ORIENT

DECIDE

Then Add Complexity …
• Senior physicians employ different information cognition
• They take the complex cases, requiring sensemaking.
• Based on deep repertoire, experience with reasoning about
clinical problems, & pattern recognition.
• Most clinical content is tested at med student level.
• Medical students & junior clinicians employ a rote decision
making mode.
• Enabled by prescriptive POC references
• That optimize rule‐based selection from options.

Jones, P.H. (2010). Why do senior clinicians ignore CDSS? A case for clinical sensemaking. Advances in
Healthcare Informatics Conference, AHIC 2010, Waterloo, ON.

Information Preferences at POC
•
•
•
•

HOW do clinicians need to see information?
Where are they located when the critical questions arise?
(Are they really all using iPads now?)
Improve format design & information architecture based on:

Matching content to OODA

•
•
•
•
•
•

Orient: Long detailed titles save time!
Summary, relevant to context
Decide: Immediate critical steps
Standard clinical workflow order best
Act: Mix media types, linked to known
issues or contexts
Clearly we have not mastered the writing
styles needed for 30 sec decisions!


Improving Health Design Outcomes
•
•

Anticipate the information journey in health‐seeking
Design services that help at information touchpoints.

•

Democratize ‐ Multiple channels:
Websites, print, patient handouts, HIT, mobile apps.
Be responsive – but don’t rely on mobile apps.
(They are not TNBT @hospitals).

•

•
•

Move toward responsive service design for health‐seeking
Integrated information brands (e.g., Mayo), email
responses, humanized call centers.


Caring for the rest of us?
•
•

Care context not exclusive to Healthcare
(Riane Eisler’s Real Wealth of Nations ‐ Caring Economy)

•
•

Every issue applies to humanizing service design
Services economy has not addressed shared underlying
value problems
Efficiency of service has implicit aim of profit maximizing
– how might we balance values of social care?

•

•
•

As designers, expand “experience” to unit of engagement
Extend empathy to shared objects of engagement


Book discount code (20%) DFCWIAD
At designforcare.com

Peter Jones, Ph.D.
peter@redesignnetwork.com
designdialogues.com
@designforcare


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