the
keystone Program
a human-centered design proccess
Problem Research Ideation Prototyping Next Steps
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Consistent feedback from patients, families, caregivers, and clinicians indicate that a significant number of uninsured or underinsured patients in the BJC Healthcare Network struggle with transportation to and from the hospital. These issues may trans late into the deterioration of their condition, which often results in additional healthcare services, increased costs for patients and providers, and prolonged pain and distress for patients and caregivers.
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How do we ensure the availability of safe, reliable transportation for patients?
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Research
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interviews BJC’s Center for Clinical Excellence assisted our team to schedule patient interviews in order to gather our user data. Each team member traveled to either the Barnes-Jewish Flagship Hospital or Christian Hospital to ask different patients questions about their transportation routine. We purposefully asked open-ended questions and encouraged storytelling in order to better understand the problem from the user’s perspective.
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ruth Ruth is a patient that has to travel to the hospital on a weekly basis. She has lung cancer and Chronic Obstructive Pulmonary Disease (COPD) and is unable to walk long distances. She relies on her electric scooter to travel from place to place and refers to it as her “Cadillac�. When she cannot go somewhere with her chair, Ruth relies on the Metro Transit system to take her all around the city. Although she knows the routes by heart and rides public transportation almost everyday, she never feels safe on the metro. Her first chair was stolen from her and after witnessing the passivity from the Metro Transit security, she feels constantly anxious and fearful, waiting for the next time someone tries to steal her scooter. 12
“You might as well kill me if you take my scooter”
“my chair is my cadillac” 13
“i would be dead if it wasn’t for my social worker.”
“i don’t know what my options are” 14
excell Excell is an elderly patient who is recovering from a serious illness. He needs to go to the hospital every couple of weeks. He depends on his BJC-assigned social worker to schedule his appointments as well as his transportation. Excell’s insurance covers vouchers for cabs to and from the hospital, but his social worker must coordinate everything: calling the cab, scheduling the cab, etc. Excell is deeply grateful for his social worker’s help, but his insurance is changing and he is unsure if he will continue to get free transport. He does not know how to use public transporatation and when he has tried, he got lost. If he can no longer get transportation, his health will suffer immensely. 15
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experience map After our interviews, we collectively mapped out our patients’ experience to and from the hospital to find common themes. We broke down the transportation process into stages, then categorized the patient’s actions, feelings, and needs for every step. This allowed us to find “touchpoints”, or places where the process was especially difficult.
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research reflections
Transportation to and from the hospital is often a lonely process for our patient. They usually travel alone and often lack support from peers & family.
Patients who ride public transportation often fear for their safety because there is a lack of empathy from authority figures (security, drivers).
Patients who rely on an electric scooter for mobility have added fear of having it stolen due to its high monetary value.
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Health insurance policies such as Medicaid and Medicare lack clear communication about the coverage of transportation costs.
Some patients are entirely dependent on their social worker to schedule transport to and from the hospital in addition to their appointments.
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Ideation
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brainstorming Our team ideated both as a group and individually to come up with numerous patient solutions. During this stage, we were more concerned about quantity than quality in order to have a wider selection of ideas to choose from. From there, we clustered different ideas that would work well together and continued to refine the ideas until we chose the five that we thought would suit our patients best.
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axis mapping In order to organize our ideas and visually see which were the strongest, we created two grids with the following axes: User Action vs. Service Community vs. Individual Simple vs. Complex Small Impact vs. Large Impact
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the big ideas
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Life alert for scooters
Online doctor chat
Every patient who relies on a scooter would be able to purchase an attachable security box system that would track their scooter and sound an alarm in the event of a robbery or health emergency. This would help ease the robbery concerns of patients who rely on a scooter.
BJC would provide all patients with an online social network platform where patients and doctors can live chat with each other about medical concerns. This would lessen the need of having the patient come into the hospital.
Uber bracelet
Buddy system
Inspired by the popular luxury car requesting service, all patients would be given a simple bracelet that would locate and allow them to hail a car with a push of a button. This would ensure that patients would always have a way of getting to the hospital even without owning smart phone technology.
BJC would create a patient-topatient buddy system to help foster a sense of partnership when traveling to and from the hospital. This would help ease patient fears of riding alone on public transportation and build relationships between patients.
Insurance, wellness, & Metro transit classes Provide easy-to-understand, instructional classes about how to navigate the rules and regulations of Medicaid, use the Metro Transit System, and live healthy, long-lasting lives. These classes would be held in community spaces in patientdense communities. This would help foster a sense of community and fill information gaps for the patients.
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ideal experience map After reflection on the patient problem and research we gathered, we decided to pursue a buddy system idea. The basic concept is to create a buddy system between patients who go to the hospital on the same recurring schedule (i.e. weekly, bi-weekly, monthly) and live within 5 miles of each other. We mapped the experience for a patient by dividing the process into the following steps: Action, Thinking, Feeling, Doing, Touchpoints/Issues
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Prototyping
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storyboarding To visualize how the patient would interact with our proposed solution, we created a storyboard that defined the problem and our proposed solution. The content of our storyboard is driven by our two users, Gertie and Stanford. Gertie is a seasoned metro user, but she often fears for her safety due to the fact she would be immobile if her chair were to ever be stolen. Stanford, on the other hand, relies on his family members to transport him to his appointments because of bad experiences getting lost using public transportation. Through the storyboard of our buddy system, we demonstrate that both patients are able to become more independent and find companionship when traveling to appointments.
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the
keystone Program 40
our name In order to develop a brand identity for our project, our team did a naming exercise in which we described what the project represented, the people who would interact with it, the user’s feelings when participating, and applicable visual metaphors and attributes. Eventually, we chose the name “The Keystone Project� because the keystone is the central piece at the summit of the arch that holds the two sides together. Since our users live in St. Louis and the arch is such a symbolic visual metaphor of the city, we agreed that this name was appropriate. Furthermore, the keystone also symbolically signifies that our buddy system would bridge connections within the community and create a strong support system for our patients.
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Next Steps
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future plans User testing
Additional research
Due to the time constraints of the project, we were unable to complete the entire process. As a next step, we recommend that BJC follow up with the patients that participated in interviews to receive their feedback on our proposed solution. From there, additional tweaks could be made to the project before implementation.
Since our system depends on our patients having appointments at the same time, additional research is needed to understand how appointments are made and who the stakeholders are in the process.
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our team
Shelby Lindblad
Kristy Okada Special thanks to:
Blake Rutledge 46
Doug Powell Abram Siemsen James Macanufo Erica Kochi Maggie Breslin Gaby Brink Joe Meersman Heather Corcoran Enrique Von Rohr Karolina Michniewicz Erin Roesemeier Liz Schulte & many more
This book was designed by Shelby Lindblad in the Fall of 2013 at Washington Universtiy in St. Louis for Interation Design. Copy was written by Kristy Okada. Typefaces are Helvetica Neue and Mathlete.