Empathy for the Content - WIAD DC

Copyright © 2014, Peter Jones

Empathy for the ContentDesigning for Touchpoints of Care

Peter Jones Redesign Network

OCAD University, Toronto

World Information Architecture DayWashington DC, Feb 15, 2014


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?


“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?

Enabling understanding is Care.


1. Health‐Seeking Experience.Touchpoints of Care.

2. Patient‐Centered Care.Information as a Care Service.

3. Clinical Workflow. Adaptive Content for Performing Care.

Care-Centered Design


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


1. Understand what is wrong. 2. Gain a realistic idea of prognosis. 3. Make the most of consultations. 4. 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.

Patient Information Needs (Motivators & Triggers to action)

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

1. To better understand father’s condition2. Identify risks in treatment & care3. Learn how to care for her Dad at home4. Prepare to discuss with clinicians

5. Assist in self‐care. 6. Learn about services &

sources of help.7. Provide reassurance &

help to cope.

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 CareInformation 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


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

PCC (not) in today’s Content

Copyright © 2014, Peter JonesIDEO + California HealthCare Foundation , 2012

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.

Copyright © 2014, Peter JonesIDEO + California HealthCare Foundation, 2012

• 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

Value to Patient


3. Clinical Workflow

• 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.

Many Points of Care.


1. Inform an examination2. Support patient evaluation3. Inform a diagnosis / Compare diagnoses4. Specify screening & tests5. Assess & select treatments / procedures6. Plan patient followup 7. Help patient understand condition & procedures. 8. Educate patients (prevention, meds, maintenance)

Clinical Information Touchpoints(Canonical workflow)


Clinical workflow is scheduled AND complex


Point of Care ContentWhile 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 amuch 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

• Information helps Orient & Decide, may guide Act

• Can content construct an answer for < 30 second loop?

OBSERVE ORIENT

DECIDEACT


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!


• 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.

Improving Health Design Outcomes


• 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

Caring for the rest of us?


Peter Jones, Ph.D.

[email protected]@designforcare

Book discount code (20%) DFCWIADAt designforcare.com

Empathy for the Content - WIAD DC

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