Duo-Wei Yang
Georgia Institute of Technology
Service Design with Innovation Skåne
April - June 2019
User Research, Service Design, App Prototyping
While studying abroad in Sweden, I had the opportunity to work with a regional innovation company, Innovation Skåne. As part of our Service Design course, our class collaborated with the company to develop a healthcare service for the Osby municipality, a small rural region with a high elderly population. The issue my group tackled was to increase trust between medical professionals, especially the nurses who did home visits with the elderly and the doctors who gave consultations and advice over long-distance.
We conducted ethnographic research to collect qualitative data and used co-design methods to find the best potential directions for us.
Research
Overview and the users
In Sweden, when an elderly person is no longer able to do everyday life tasks on their own, he or she can apply for the municipally funded home care service. They will receive various assistances around the clock, including shopping, cleaning, and personal hygiene. They can also receive a separate security alarm and an alarm watch if they pay additional fees.
At the time of this project, 94% of the elderly over the age of 65 live at home and can live independently through this home care service. As a result, demand of this home care service is high in Osby and requires constant improvement, especially through incorporating technology in the service.
Interviews
To understand the nature of the service, we interviewed different stakeholders including four nurses, two doctors, one care assistant, and one district coordinator from Osby. We made observations during interviews with the medical personnel that helped us reach a better understanding of their work life and the issues that concerned them. We then visualized the service system on a stakeholder map to refer back during the design process.
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My teammates and I wrote a series of interview questions the medical professionals. We recorded our interviews then translated and transcribed them into English afterwards as none of the stakeholders we interacted with spoke English.
Creating diagrams to gain insight
Compiling the insights from our interviews, we created several diagrams to summarize our findings and better understand its details. One diagram we did was a journey map in a timeline form (inspired by Mike Godlewski’s method). We defined the touchpoints, which include some of the following:
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The nurse visiting a patient
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The phone calls nurses make to communicate with the general practitioner and Falck (emergency-services company)
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Doctor using a digital platform to view medical records
We also created a chronological timeline of a nurse's work process when he or she visits a patient. The steps the nurse takes during a home visit are meticulous:
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The nurse examines the patient and uses the medical record. Depending on the situation, the following will happen:
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If the patient is in a normal state, the nurse will go through the patient's medical records (paper) and add on details from the visit.
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If there's an emergency, the nurse uses the digital medical records and calls 112 for an ambulance.
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If the patient is not extremely sick, the nurse will go through the following initial steps:
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Use the VISAM form, a personal checklist to determine what to do
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The nurse may call relatives or another nurse
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Use the SBAR form to structure their potential phone call to the doctor
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If the time of the home visit is somewhere from 8 am - 5 pm, the nurse will call the general practitioner (GP) he or she is typically in contact with for consultation. If necessary, the doctor will see the patient.
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If the visit is outside of 8 am - 5 pm, the nurse fills out the form for Falck services and calls them.
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If it's not urgent, they will speak to a Falck nurse. If it's not urgent at all, the patient may or may not schedule an appointment with a doctor at a later time.
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If there's some urgency, the nurse will speak to a Falck doctor. If it's especially urgent (i.e. patient has an infection), there will be a home visit within 4 - 6 hours.
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Insight
Overall, somewhat to our surprise, nurses generally felt that there wasn't a significant trust issue between them and the general practitioners they spoke to. However they did point out that there were some small issues with the Falck services in terms of building trust.
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The nurses don't ever have regular face-to-face time with Falck personnel as the services are located several hours away from Osby. The nurses believe that it's difficult to build trust
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The nurses don't speak to the same people on the phone each time when calling Falck.
The nurses also noted that the current communication system was convoluted and often not structured.
For example, the nurses fall under the municipality jurisdiction and can only access the Alfa and NPÖ medical record systems. Falck is hired by the region and can therefore only access the PMO system. Falck personnel are also not allowed to make changes to its medical records. To the nurses, the complexity of the record systems was a barrier in trust between them and Falck.
Some of the nurses expressed the need for digital tools. They believed some tools such as digital stethoscopes and blood and urine analysis tools that can upload data online could be highly useful. Our team took all the above concepts into consideration.
Ideation
Compiling ideas
Following our interviews, we went through a brainstorming phase. Using the suggestions of our interviewees, we created three possible concepts that could help reduce trust between the nurses and Falck personnel.
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One of our first ideas was a matchmaking system for the on-call physicians, patients, and nurses during phone calls. The more experience the physician had with a specific patient, the more likely the patient's nurse would be connected to them on the phone. If no physician with prior interaction is available, the physician with the closest relationship ot the nurse will be prioritized. This concept focuses on building a relationship between medical professionals to increase trust.
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Our next idea was to merge all medical record systems into one larger, more accessible system. By digitizing the systems and making them accessible through an application, more time can be saved. Access to the same information would also promote more efficient and clear communication between the medical professionals on a specific patient.
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We believed that adding digital tools to the nurse kit was a potential direction we could tackle. By using smartphone-cameras, for instance, doctors from a long-distance may be able to understand a situation more clearly. Any other tools (i.e. digital stethoscopes, EKG and CRP support, blood and urine analysis etc.) that could be implemented could also be highly useful in providing more data. We believed that more data for the doctors to make a diagnosis could help bridge the gap.
Paper prototyping
As part of the ideation process, we individually created rapid paper prototyping in timed sessions to see what we could come up with. Although our screen designs somewhat differed, our ideas were mostly applications that could be used on a smartphone, tablet, and desktop.
The app would include the features the nurses suggested, such as the ability to upload data from digital medical tools, and a more efficient interaction flow compared to the various forms the system currently has.
Design
Quill: the app
Our service proposal, Quill, is an app that combines all the attributes that we believed were factors that would increase trust between professionals in the healthcare sector. Quill promotes consistency between professionals by giving the same access to medical records and improve communication during consultation calls between a nurse and Falck doctor.
1. Logging in
At the beginning of the day, the nurse logs into Quill with her id number.
2. Reading and writing initial details
When the nurse arrives at a patient’s home she enters their social security number into Quill. She can then see the patient’s medical records, a summary of their medical profiles (SMP) and details. She can then fill out the Visam form (personal checklist) with Quill.
3. Using another device
While the nurse fills out the VISAM for, he or she can look at the patient's journal or summary on another device to help with the VISAM form. This other device is connected to the same system and profile.
4. Adding comments
When the VISAM form is filled out, the nurse can see a recap of the values that he or she entered in the form, add a comment for the doctor, or use further digital tools to help the doctor with their evaluation.
5. Using digital features
The nurse can take a picture that will be uploaded with the rest of the information. He or she can also use digital medical tools, like a digital stethoscope that records a sound file for the doctor to evaluate.
6. Final recap
On the recap screen, the nurse can see if he or she has attached files before pressing call and connecting with Falck services. Quill will then try and match the patient that the nurse is visiting with a Falck doctor that has been in contact with the patient before. If this is not possible, it will instead try and pair the nurse with a Falck doctor that he or she has been in contact with before.
7. What Falck sees
The Falck doctor then connects with the nurse and all the information that the nurse has entered into the VISAM form shows up on their computer screen. While the Falck professional is evaluating the patient’s health and talking to the nurse, the nurse could then use the other device to, at the same time, look over the patient’s information or the information recently entered.
8. Determining what to do
After going through Quill and communicating with the nurse, the Falck doctor can then easily decide whether a visit is necessary or if the issue can be resolved by prescribing medication.
The new timeline
With Quill, the new work process for a nurse becomes the following:
This can be further explained by the service blueprint:
Video of prototype
We made a video prototype to show how our solutions would work in action. We went through the process of a typical home visit and how the nurse would use Quill to complete the same work as he or she did before.