Learner Experience Design, Carnegie Mellon University (51–886)

Learner Experience Design is a graduate course offered by the School of Design, Carnegie Mellon University and is taught by Professor Stacie Rohrbach. The course focuses on researching and designing learning experiences by understanding the overlap of design thinking, UI/UX design, cognitive studies, social sciences, instructional design, and educational pedagogy.

Class 1 (01/15/2019)

PART 1

The first class kicked off on a very non-traditional note, instead of the general round of stand-up introductions, we played an interesting activity in class. Everyone got a sheet with an array of unique human traits and characteristics and we had to go around the room asking people if they possessed those traits, the catch being we could only ask each person one question and then had to move on to the next. The time was fixed and the reward was a full-sized bar of Hershey's Chocolate(yum!). There was an excited buzz around the room for the next 15 minutes as people hurried about introducing themselves and asking questions.

Reflections-

I feel that by the end of this activity, even though I still probably didn’t remember the names of majority of my classmates, I still remembered certain traits about them and certain funny or amusing conversations I had with them about that particular trait, like the fact that Michelle has two siblings, whom she never gets along with, or the fact that James hated middle school. I think this activity really helped us all get comfortable and familiar with each other. It also made us feel more open in approaching and talking to people, something which usually takes a month or maybe more.

PART 2

The second half of the class was spent on organizing the class into teams of three/four and playing Kahoot, a game based classroom response system played by the whole class in real time. Multiple-choice questions are projected on the screen. Students answer the questions with their smartphone, tablet or computer. We answered many questions, mainly focused on Interaction Design and related domains as a group.

Reflections-

I feel that this game challenged each of us to put our best foot forward in order to help our team win the game. When the team scored, there was a shared sense of celebration and motivation for the person who came up with the right answer. On the other hand, negative feelings associated with guessing a wrong answer were also shared by the team. Scoring was based on how quickly you answer a question, so people had to agree on an answer as soon as possible. This helped generate a sense of teamwork and mutual trust when someone insisted they knew the right answer. Also, most questions were based on topics that every Designer ought to know, so any questions answered incorrectly were actually disguised learning opportunities.

Class 2 (01/17/2019)

This semester we will be working on a project for UPMC- to reduce their readmission rates. Ellen Beckjord from UPMC stopped by to walk us through the current situation, statistics, the aim of the project. She explained how this project is very complex as it has dependencies on various levels and affects various tiers of stakeholders. She explained the past efforts which failed and why they failed. She also talked briefly about the current initiatives underway to help solve this issue. She patiently answered all the questions we had.

Reflections-

Personally, I found the presentation a bit dense and difficult to digest. There were a lot of medical terms used, and she referred to a lot of medical processes which I didn’t know about. The speed of explanation was also pretty fast and I gave up on taking notes after about 15 minutes into the presentation. I was left clearer on certain topics but equally confused on many others. I plan to go through the readings in detail and get a better understanding of the issue. It should hopefully be easier now that I know the meaning of many medical acronyms.

Class 3 (01/22/2019)

This class was focused around perceptual blocks. The reading assigned for this class was Chapter Two of Conceptual Blockbusting by James L.Adams.

BLOCK 1- Stereotyping

Activity-

We were asked to draw four items, a tree, a scallion, a TV and a Fridge. We then walked around observing differences in the drawing made by different people.

Reflections-

Most people drew similar trees with the trunk, the branches, and the leaves. However, very few people drew the roots too. When asked why, the unanimous response was that since it’s not visible, it wasn’t drawn. This made me reflect on the human tendencies to not interpret and represent what is invisible to us. We see the picture in a very literal sense and interpret an idea on the basis of what is visible to us, however, we often don’t consider the other side of the picture, or the remaining part, even though we might be aware of its existence. It is often not the fact that we don’t want to, but the fact that the mind automatically assumes the partial picture to be the whole. Extrapolating this analogy to the scallions, most of the class drew the scallions with the root, since mostly scallions are sold with the root intact, and that is the form they are visible in.

Another amusing observation was the fact that most people drew the television as the antique television box with antennas, in spite of living in the current age of plasma TV screens. It raised the question as to why we as humans tend to stick to older versions of technology when it comes to representing technology? Do we find comfort in the older versions of technology? Does it elicit a sense of nostalgia? Or are we afraid of change and accepting new technology? Or is it based on the simple fact our perceptions got formed as kids when we first started using the television in its box form? Does that mean the current generation which has grown up with plasma TV screens will perform this exercise very differently? On the other hand, most people drew the fridge in a pretty similar manner with two doors, rather than the single door refrigerators of old times. Why did they not stick to the antique representation of the object in this case? More questions than answers.

BLOCK 2- Difficulty in isolating the problem

Activity-

Students participated in a discussion about the characteristics of a water bottle, they were then asked to redesign a means of carrying water.

Reflections-

Students came up with various solutions to the problem, right from redesigning the shape of the water bottle to carrying water in a non-aqueous form to prevent spillage and reduce weight. I feel that the way the question was positioned was very important in the solutions students came up with. Had the question been to redesign the water bottle, the solutions would have adhered to the typical characteristics of a water bottle and simply tweaked them. However, understanding the fact that the water bottle is simply a means of carrying water, we could isolate the problem more effectively and design a solution to carry the water instead. This helped students come up with more non-traditional and non-linear solutions to carry water.

BLOCK 3- Tendency to delimit the problem area poorly

Activity-

Students were given an object per team and asked to list down three characteristics that their object MUST have. They were then asked to re-design the object without those characteristics.

Reflections-

My team got a Cafe as the object. We came up with the following MUST have characteristics- Table and chairs, food and drinks, cashier. Redesigning a cafe without these essential commodities was a tricky challenge, but then it forced us to ask these questions- Who decides what a cafe can serve? Why is cafe associated with only food and drink? Why can’t it serve anything else? Why should the service method involve entering the cafe and sitting at a table? What if the cafe served experiences rather than food, such as food for your mind? We came up with the concept of a “Soul Cafe”. People could enter, select what therapy they wanted- Did they want to be refreshed? Or relaxed? Or pumped up? Depending on their choice they could be guided to immersion rooms where they will be immersed in sound+light+aromatherapy to help shift their current conscious state to the intended state. We don’t need tables and chairs for this. And there is no need for a human cashier, the checkout process can be a simple digital card pay interface. In hindsight, we would probably never have come up with this solution had we not questioned the pillars that “define” the problem according to the current perception of that object. Removing these constraints helped us delimit the problem area hence helped us to think out of the box and come up with unique innovative solutions.

BLOCK 4- Inability to see the problem from various viewpoints

Activity-

The Problem statement involved a scenario where multiple peers were catching up in an unspecified location. Different groups of students were given different stakeholders such as manager of the meet-up venue, custodian of the venue, spouse of the person meeting up, children of the person meeting up etc, and were asked to note down three major points that that person would want to keep in mind.

Reflections-

This activity helped us imagine the activity from different perspectives. It was interesting to see how different stakeholders viewed the activity from different perspectives, with a different set of concerns.

BLOCK 5- Saturation

Activity-

Students were asked to draw their unlock screens my memory.

Reflections-

We use our phone every day, and perform the activity of unlocking our phone multiple times a day. However, most students could not draw their unlock screens accurately by memory because their mind simply does not store this unnecessary information in the Long Term Memory. This is an example of Saturation since we keep seeing the screen, again and again, day after day, we stop remembering the tiny nuances of the screen.

BLOCK 6- Failure to Utilize all Sensory Inputs

Activity-

Students were assembled into groups. The aim was to design a fire alarm tutorial/promotion campaign primarily using one sensory input. My team got ‘SMELL’ as the primary sensory Input to design our fire safety campaign on.

Solution-

How often have you walked along the road and let your eyes glaze over many hoardings without really processing any per se? What will help you snap out and pay attention to a particular hoarding? We decided to use a burning smell in particular areas in public places to grab the attention of the nearby public. Once a person smells the pungent burning smell, they will instantly be on alert and look around. Their attention will be drawn to a fire alarm vending machine with a display screen asking the question- “Do you smell something burning?” The screen will display short messages and visuals to capture the attention of passersbys and urge them to buy the fire alarm then and there itself (people tend to put important matters on the back burner when they get involved in their daily schedule). The vending machine will dispense the alarm with an instruction manual which will guide the user on how to install it, where to install it and other details.

Class 4 (01/24/2019)

Using Adam’s Perceptual Blocks we analyzed the UPMC readmission issue and came up with questions on various aspects the hospitalization and readmission.

Questions based on Adam’s Perceptual Blocks

The different colored post-its stand for different perceptual block-busting concepts. We came up with a lot of fascinating ideas during this session, some of them as follows:

1. Creating support groups amongst patients, so patients with the same illness/injury can communicate amongst themselves instead of running to the medical center whenever they face any issue/symptom. This will help people who have earlier visited the doctor for similar symptoms help others facing those symptoms now.
2. How else can the patient communicate with his/her doctor other than having to visit the medical center? Can there be any other platform for the patient to communicate with the doctor rather than rushing for getting re-admitted?

Problem Space of Interest-

I am realizing that my problem space of interest lies in managing the nervousness/anxiety of the patient when symptoms start to resurface and helping him find a way to connect with either his doctor or other peers who had/have similar illnesses, in a timely manner, to discuss his observations. This will reduce the number of patients rushing to the medical center for re-admissions.

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

DIRKSEN 2 READING NOTES- WHO ARE YOUR LEARNERS?

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

What do your learners want?

Why are they there?

What do they want to get out of the experience?

What don’t they want?

What do they like? (may be different from what they want)

Intrinsic vs. Extrinsic Learners

Intrinsic Learners- Interested in the topic. Have a specific problem they’re trying to solve.

Extrinsic Learners- Motivated by outside reward or punishment.

Reflection- Designers should try and make the learning of their product an intrinsic process rather than extrinsic.

Dealing with Intrinsic Learners

• Thankfulness
• Making sure your learners have time to work on their own problems because that is what motivates them.
• Leverage them as teachers because they usually learn a lot on their own and even more as teachers.

Reflection- In contrast to other schools, CMU is a school with more number of intrinsically motivated students than extrinsically motivated students. Which is why the achievements by the CMU students far surpass the achivements from alumni from any other school. However, the tight assignment and academic schedule often keeps students from having the freedom and time to explore and use the knowledge elsewhere. This often makes the students feel handicapped rather than enabled. What would be a solution in this scenario? Educating students on how to take out time from their already busy schedules for exploration? Or giving specific “exploration time-off” periods to the students?

Dealing with Extrinsic Learners

• Is there anything they find intrinsically motivating about the subject matter? Ask questions on what they will do with the information.
• Figure out what annoys them and show them how their learning can help alleviate the annoyance.
• Avoid unnecessary theory and background.
• Include an interesting challenge or puzzle that learner needs to solve. Will help convert extrinsic to intrinsic

Your learners want to NOT feel stupid

Your job is to make your learners feel smart and capable, even when you’re teaching them something they don’t know. However, they should be challenged- things that are too easy aren’t a good way to learn either. You want to give your learners a safe path into the material. One way is to take guesses- What do you think? What is a wrong answer? Give me an answer that would be too high/too low.

• Leverage what they already know.
• Give them some early successes.

Create safe spaces to fail.

What do your learners like?

If there are any specific activities or items that your learners like, you can leverage those to enhance your learning experience.

What is their current skill level?

Your expectation of the learning curve

Reality- Learning curve for novice beginners

Reality- Learning curve for experts

Often while you have control over the learning material, the outcome is often determined by your learner’s ability. Here’s what they would want-

NOVICE JOGGER-

• Lots of guidance
• A careful introduction that doesn’t go too quickly in the beginning
• Structures experience. Immediate goals
• Increasing self-confidence
• Gradual difficulty progression. Rest opportunities
• Coaching and feedback on their performance

PROFICIENT RECREATIONAL RUNNER-

• Practice of new concepts
• Advances topic information
• Coaching and shaping to improve existing behavior
• More autonomy

EXPERT MARATHONER-

• Give information and then get out of the way
• Information about specific characteristics of a particular route
• Help with measuring progress
• Full autonomy
• Opportunity to act as a resource by teaching or coaching

Reflections- A newer learner needs more structure and hand-holding and encouragement. An expert learner needs more freedom to choose what he wants to learn and can access whatever resources he needs whenever he needs it.

How do you decide how to shape the learning experiences for graduate students coming from different backgrounds? Such as in the master’s program in the School of Design at CMU?

Some learners already know a lot

How do you tailor the same learning material for both experts and novices without frustrating either party?

• Don’t make every part of the learning material compulsory for everyone such as compulsory menus and videos without adjustment.
• Pull vs. Push- Expert learners often know what they want. Let them pull the info they need.
• Leverage their expertise by letting them add insights- a new level of engagement.
• Embed some novice info which can be accessed by novice learners if they need rather than adding it into the main body.
• Test your learners and tailor material to their skillset.

Reflection- How do you determine what is the testing level and how do you prevent your context from affecting the questions you are setting.

• Ask if they need anything? Get out of the way.

Scaffold the incline

If the topic is too complicated for novice learners, the steep learning curve can be scaffolded to ease the learning. Good scaffolding is like learning wheels- provides support learners need to complete tasks that they wouldn’t do otherwise.

Reflection- How do you balance between scaffolding too much (making the learner feel dumb) or scaffolding too less (making the learner feel incapable)?

• Reduce the complexity of the learning environment by hiding unnecessary data at that point in time.
• Have the learner walk through a simplified case.
• Provide support- Embed easily accessed references in the experience.

How are your learners different from you?

Different learners have different focus, different motivations, and sees the world in a different way than you do. Don’t assume.

How much you know vs. how much they know

You need to change your style of talking when talking to novice beginners. How hard is it for you to remember what it was like not to know it? You want to be able to explain complicated aspects to your learners and have them understand it.

Closet Analogy

Expert Mind- Already knows information, well arranged and organized.

Novice mind- Less structure around information. Lots of random facts, no organization between facts.

When you provide information, the expert puts it in the exact spot on the exact shelf. Novice learner will chuck it on the floor with the other information.

When you ask an expert to retrieve, he will know exactly which shelf which pile. Novice will have to rummage through lots of randomly thrown clothes to find what he needs.

How do you help novices structure their closet?

• High-level organizer — start them with a structure such a list of categories.
• Use visuals- visual communication has extra cues to give learner more hooks to store and retrieve information.
• Use a story- well told, arouse emotions
• Work through problems- helps them start developing their own structure
• Have them design shelves- How would you organize this data? compare with expert and look for the scope of improvement.
• Use metaphors or analogies- compare learning with information your learner is already familiar with. Leverage the storage and retrieval capabilities of existing mental models.

The experience filter

All learners filter their new learning through their past experiences. We are sense-making animals, and try to make explanations for things we don’t know.

How can you know what your learners are thinking?

Traditional Model-

One way communication. Possible misconception formation. The realization about misconception occurs later after the optimal period of misconception correction.

Interactive Model-

Construct opportunities to see how your learners are interpreting and applying what they learn. Timely misconception identification. Extend understanding. Reinforce learning.

Learning styles and how to customize learning

• Not everyone learns the same way- create learning experiences that incorporate a variety of approaches- provides many memory triggers. Varying learning- prevents habituation.
• There are different kinds of intelligence.
• We all are similar in the sense we all learn from visual, auditory and kinesthetic methods.
• Vary the learning according to the subject being taught.

Methods for learning about your learners

1. Talk to them- They will tell you how it works in real life, rather than what it says in theory. They can tell you what was difficult during learning. They can give you examples that will help them learn and provide an idea of their current context.

Questions you should ask:

2. Follow your learners around- Will help you get an idea of the context your learners exist in and help you make contextual triggers. Even new learners have started to build shelves so they would end up skipping details when they are talking to you. Following them helps you catch those steps and ask questions like — ” Can you tell me more about this step you just did?”. Seeing people in their actual environments helps you create better scenarios or examples.

3. Try stuff out with your learners- Create prototypes, do user-testing, have pilot tests. Are there parts where people get confused? Do certain parts drag? Do you find yourself talking for a long time? Were your audiences confused by the instructions for an activity? You think you are being clear but you know how its supposed to work. You will also get good ideas while testing and as feedback. It is more efficient in the end.

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

Class 5 (01/29/2019) — via Skype

We discussed Dirksens reading- Who are your learners?

There are five points to keep in mind when you are understanding your learners-

1. What do your learners want?
2. What do your learners know?
3. What do your learners like?
4. Are their learning motivations extrinsic or intrinsic?
5. Are they novice learners or experienced learners?

Depending on our learner’s characteristics we can design the way their learning experience is, for example extrinsically motivated learners work well with small successes which helps boost their motivation. Novice learners need handholding and scaffolding to help construct mental models, whereas experienced learners need help only occasionally when they want to deep dive into any particular area of interest.

Dirksen-2 discussion

Bernice McCarthy- A tale of four learners

Quadrant 1

Meaning- Feeling+Reflecting

We question the value of new learning by connecting it to ourselves. (WHY?)

Quadrant 2

Conceptualization- Reflecting+Thinking

Conceptualized content, structuring knowledge into significant chunks that form the essence, the coherence and the wonder of new ideas. (WHAT?)

Quadrant 3

Problem Solving- Thinking+Doing

Usefulness and transferability into one’s life. Problem-solving with learning. (HOW?)

Quadrant 4

Transformation- Doing+Feeling

Adapting the learning into something new and unique. (IF?)

4MAT Cycle

Every learning activities follow all steps of the quadrant listed above. But people are different, some people are Type 1 learners while others are Type 4. Each person has his comfortable quadrants and his uncomfortable quadrants where he is pushed out of his comfort zone.

Some people focus more on learning (analyzing), and others focus more on doing(synthesizing). Both these elements should be added to each quadrant while moving through a learning experience:

• synthesizing and analyzing meaning
• synthesizing and analyzing conceptual understanding
• synthesizing and analyzing application
• synthesizing and analyzing adaptation

We did an activity of finding our learning quadrant and mapping ourself on McCarthy’s 4MAT system. My coordinates were on the first quadrant which indicated that I was more of a reflective learner than a synthesizer, and I predominantly pursue the question “Why?”. I don’t entirely think this analysis was accurate because according to my perception I am a quadrant 4 learner instead and tend to synthesize and ask the question “What if?” more.

Mapping class on the 4MAT Quadrant

Class 6 (01/31/2019) No Classes

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

DIRKSEN 3 READING NOTES- WHAT’S THE GOAL

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

Determine goals

Critical to have clear goals defined while designing a learning experience. If you don’t have a clear destination, you cannot plot a clear path and you definitely cannot communicate that to your learners.

Identify the Problem

A lot of learning projects start with the goal directly without putting forth a problem statement. Hence we are not even clear on the problem, but we are working towards the goal.

Some questions to help identify the problem:

Break it Down

Sometimes the problem statement is too big- break it down into smaller and more specific problems.

Set the Destination

Define your goals in as specific terms as possible. Use action verbs which are observable in nature so that milestones achieved can be tracked and the goal route can be clearly defined. When you are creating learning objectives, ask yourself- Is this something the learner can actually do in the real world? Can I tell when they have done it?

How sophisticated or complex should your learner be?

Bloom’s Taxonomy-

• Remember- remember the concept
• Understand- understand the meaning of the concept
• Apply- learn to apply it in real-life scenarios
• Analyze- be able to identify real-life applications of concept
• Evaluate- be able to analyze and compare real-life applications of concept
• Create- be able to create their own real-life application of concept

How proficient should your learner be?

Gloria Gery Scale (What level of expertise do you want your learners to attain?)-

• Familiarization
• Comprehension
• Conscious Effort
• Conscious Action
• Proficiency
• Unconcious Competence

Communicating learning objectives

• To focus the learner’s attention on the key points in the objectives.
• To let learners know what to expect.
• To let them know what level of performance they should be working towards.

Determine the learning gaps

• Knowledge gaps
• Skill gaps
• Motivation or attitude gaps
• Environment gaps
• Communication gaps

How long is the trip?

What are the types of concepts being taught? Can they be taught as quick formulas or information? Can they be used to recall previous knowledge and connect with it? Are they quick to learn? Or do these concepts take time to build? Do they take practice to develop?

Example-

Problem-solving skills learning is somewhat like this and cannot be imparted in a quick session.

Pace Layering — Stewart Brand

The idea of pace layering is that some things change quickly, while others take time to change. In terms of learners, pace layering occurs somewhat like this:

Fast or Slow?

Is the learning point fast and quick to grasp and imbibe? Or is it a slow point, which will take time to learn and understand gradually.

If you understand something as a fast point, how do you approach it

• Find a few throw pillows- Find easy ways to make an impact like checklists, model, tools, job aid. Will help solve small pesky problems.

• Provide some sturdier pieces- Give them more concrete material, but understand this will take time as they will need to set it up, move it into place, get rid of the old piece, rearrange their existing stuff, get used to it etc.

• Recognize you aren’t going to change their structure- Move along current renovations. Help them start planning for the future. Cannot do major renovations in a short period of time.

• Respect the foundation- Bedrock comprised of elements like culture and personality. If your structural changes aren’t going to sit well on foundation, then you’re better off changing your design, because the foundation is unlikely to change.

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

Class 7 (02/05/2019)

We got into teams and started working on stakeholder relations.

We started off by discussing our ideas and areas of interest in addressing the issue of reducing re-admission rates at UPMC. This helped us to get a general idea of what each person is interested in and a sense of what direction our final project is headed in.

We then discussed the following topics and plotted them on the chart provided:

OBJECTIVES- What are we trying to achieve?

• Improving discharge protocol and make it less taxing on the patient.
• Increasing trust between patient and doctors/nurses.
• Improving follow-ups.
• Reducing the financial burden on the patient.
• Improving communication of post-discharge care.
• Improving the post-discharge support system.

PROBLEMS- What are the current problems?

• Patients do not have access to healthy food and medicines.
• Patients do not have good after-care systems in place.
• Poor communication of post-discharge instructions.
• Patients do not follow-up.
• Patients do not follow care instructions.
• Patients do not understand the purpose of instructions- lack of motivation.
• Patients do not understand the instructions provided- too complex.
• Instructions change for different phases of time.
• The environment during discharge is not conducive to learning after-care instructions.
• Patient not in a good financial state to carry out medication post-discharge, leading to relapse.
• Patients don’t know help options available.

Stakeholders- Who are the stakeholders involved in this scenario?

• SNF
• Patients
• Patient’s support system
• Employers
• Nurses
• Doctors
• UPMC as a corporate
• Dependents of patients
• Insurance company
• Hospital infrastructure
• Hospital staff

Class 8 (02/07/2019)

This class was spent defining stakeholder states and bridging the gaps between the stakes. We analyzed all these aspects from five categories- Knowledge, Skills, Motivation, Environment and Communication.

CURRENT STATE- What is the reason that the stakeholders aren’t meeting the objective of the experience?

Knowledge-

• The patient doesn’t know how to take care of themselves.
• The hospital does not know about the full condition of the patient in terms of both finances, after-care, or the patient’s ability to perform tasks/skills.
• The patient does not have adequate information about follow-ups.

Skills-

• The patient doesn’t have the skills to take care of himself.
• The patient has incorrect skills.
• The SNF/ aftercare system lacks the skills to take care of the patient.
• The SNF/ aftercare system has incorrect skills to take care of the patient.

Motivation-

• Patients need to go back to work to support their family, motivated to heal.
• Patient doesn’t understand the effects and benefits of the after-care instructions- lack of patient “buy-in”.
• Patient chooses to continue with previous harmful habits that caused the condition.

Environment-

• Patient wants to change habits and recover, but his post-discharge environment prevents him from doing so.
• Patient finds after-care too expensive.
• Patient finds the hospital environment stressful which exacerbates illness.
• Patients feel isolated post-discharge.
• Patients do not have the ability or means to go for follow-ups.

Communication-

• Information too unclear.
• Incorrect information provided.
• Information too broad for the specific patient context.

PREFERRED STATE- What is the reason that the stakeholders aren’t meeting the objective of the experience?

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

AMBROSE 3 READING NOTES- WHAT FACTORS MOTIVATE STUDENTS TO LEARN?

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

Expectancies and Values interact to influence the level of motivation to engage in goal-directed behavior.

Goals

A learner’s motivation to learn keeping an end-view in mind.

• Performance Goals- Involve protecting a desired self image and projecting a positive reputation and persona. Students with ‘performance-approach’ goals focus on attaining competence by meeting normative standards. Students with ‘performance-avoidance’ focus on avoiding incompetence by meeting standards.
• Learning Goals- Learners truly learn what a task can teach them. Strive for deeper understanding.
• Work Goals- ‘Work-avoidant’ goals people want to finish work as quickly as possible with as little effort as possible.
• An activity that satisfies more than one goal is more effective in increasing motivation levels. Social and affective goals come into play here. Similarly, people who have more than one goal are more motivated learners. For example, for a group project, people might look to learn, make friends(social) and engage in a stimulating activity (affective).
• Learners might also have conflicting goals and are usually forced to choose one. Values and expectancies interact to influence motivation.

Reflection- How do you help align teacher’s and student’s goals. How do you properly tap into such overlap to the best extent possible?

Values

Value is what makes a goal important. A student will pursue the goal which has the highest value to him.

• Attainment Value- Satisfaction that one obtains from mastery and accomplishment of a goal or task.
• Intrinsic Value- Satisfaction obtained from simply doing the task than achieving an outcome.
• Instrumental Value- The degree to which an activity helps the learner reach another goal or objective.

All these above types are not conflicting, they are potentially re-inforcing.

Expectancies

People will be motivated to pursue goals and outcomes that they believe they can successfully achieve

• Positive Outcome Expectancies- The belief that specific actions will bring about positive outcomes. Ex. if I learn this, I can ace at my test.
• Negative Outcome Expectancies- Specific actions have no influence on the desired outcome.

How perceptions of the environment affect the interaction of Value and Expectancies

value, expectancies, and environment interact to produce an array of distinctive student behaviors.

What strategies does research suggest?

Strategies to Establish Value-

• Connect the Material to Student’s Interests- Students are more motivated to engage with materials that interests them or has relevance for important aspects of their lives.
• Provide Authentic, Real-world Tasks-Assign problems and tasks that allow students to vividly and concretely see the relevance and value of otherwise abstract concepts and theories.
• Show Relevance to Student’s Current Academic Lives- Make explicit the connections between the content of the course and other courses to come. Students can better understand the value of each course as building blocks for future courses to come.
• Demonstrate the Relevance of Higher-Level Skills to Student’s Future Professional Lives- Students often focus on specific course content and undermine the importance of broad general skills they obtain across courses and the importance of those skills in their professional lives.
• Identify and Reward what you Value- Explicitly identify foe students what you value.
• Show your own Passion and Enthusiasm for the Discipline- Your enthusiasm might raise curiosity and motivate them to find out what excites you about the subject.

Strategies that help Students build Positive Expectancies-

• Ensure alignment of objectives, assessment and instructional strategies- Students have a more coherent picture of what is expected of them, they feel more in control of their learning and of their grade.
• Identify an appropriate level of challenge- Setting challenging but attainable goals is critical for optimally motivating students. Important to know who your students are, where they come from. Pre-assessment, reading preceding course syllabi, syllabi from the same class taught previously etc is usually helpful
• Create assignments that provide the appropriate level of challenge
• Provide early success opportunities- Experience for future performance is determined by past experiences. You might incorporate early assignments that count for a small percentage of the final grade, but provide a sense of confidence and competence.
• Articulate your Expectations- articulate course goals so students know what their expectations are, make it clear to students what they have to do in order to reach those goals, (this will help make connection between the desired action and intended outcome more tangible), help students set realistic expectations, and profess your confidence in them and their abilities.
• Provide Rubrics
• Provide Targeted Feedback- Timely feedback allows for changes to be incorporated in time. Constructive feedback targets strengths, weaknesses, and suggestions for future actions.
• Be Fair- be sure that standards and criteria to assess students are used fairly.
• Educate Students about the ways we explain success and failure- This will help them shape their attribution for success to include appropriate study strategies, good time management, and hard work.
• Describe Effective Study Strategies.

Strategies that Address Values and Expectancies-

• Provide Flexibility and Control- Allow students to make choices and choose among options that are consistent with their goals and the activities they value.
• Give Students an Opportunity to Reflect- What did you learn from this assignment? What was the most valuable feature of this project?

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

Class 9 (02/12/2019)

Stacie started the class by declaring that we’re playing musical chairs in the classroom. She did not give us any rules or instructions and told us to figure out stuff on our own. We realized we’re going to have to twist the rules to be able to play the game in the small classroom space with all the immovable furniture. A fairly simple game, it took us almost 20 minutes to come to a decision on how to play it. We played various rounds with some amusing instances.

Debate on how to play the game

The game in full swing

An increase in player motivation and buy-in as the levels progress

Later we had an interesting discussion regarding insights from the activity:

• We saw that during the discussions, some people emerged as leaders and were directing the discussion regarding rules of play. Others were observers and were helping implement the finalized solutions.
• A lot of time was spent discussing rules and implementation.
• Some people, who did not know how to play were struggling to understand the rules from the discussion or from asking others.
• The first few rounds were slow and boring, but as the number of people increased, the intensity and competitiveness level increased, we saw a stark increase in the motivation of the people involved in the game.
• As the game progressed, the buy-in increased. We had an interesting discussion regarding buy-in point, when do you hit the buy-in point? How is it relevant to designing learning experiences?

We then discussed the magic circle:

The Magic Circle

The Magic Circle explains the characteristics and benefits of moving in and out of the synthetic world.

The synthetic world can be envisaged as any learning experience such as a game or activity. The player enters the magic circle from the real world. He has certain fears, insecurities and concerns.

When within the magic circle, he is fully engrossed in the game. He plays the games by the rules of the game. The game provides him feedback on his actions performed. He is immersed in an enjoyable imaginative environment that is enriching him as a human being.

Once is completed the activity, he exits the Magic Circle as a richer human being. He enters the real world, now with an added learning from his experience in the Magic Circle.

We can have three different types of Magic Circles:

• Magic Circle is closed- this means that the game system is closed and the rules are rigid.
• Magic Circle is partially open/closed- players have a choice to shape the rules but to an extent. An interesting observation here is that players often get their past experiences into the game to shape it.
• Magic Circle is open- players have full scope to shape the rules of the game. A great example of this is culture. Culture can be envisaged as a Magic Circle experience where the people involved in creating the rules/ playing the game have full authority in controlling how the game is going to play out.

Once done with this discussion, We had certain interesting questions posed in the class:

• How malleable are your rules going to be while designing a learning experience? Is it a closed rigid experience? Or is it open?
• Are they going to change the characteristics of malleability/rigidity with time or context?

Reflection- How do you decide how to make a learning experience malleable enough to obtain a good level of player buy-in, yet make sure that the objectives and the learning experience of the entire activity is not compromised? Would too open a system make players lose the sense of direction, lose track of the goal and get frustrated?

Next, we had a discussion about Ambrose’s principle of Motivation which spoke more about the values and expectancies and motivations of the learners. In this model, the values and expectancies of the learner transform into motivation and then this motivation leads to goal-directed behavior which in turn generates a rich learning experience.

Ambrose’s principle of Motivation

Our final activity comprised of understanding how Ambrose’s principle of motivation could be applied to our UPMC project. We listed down the Values, Expectancies, and Goals of our stakeholders to help us build mental models of their motivations.

LIsting out the Values of our stakeholders

GROUP MEETING 1 (02/13/2019)

Building a Mental Model for approaching UPMC issue of reducing patient re-admission

We met up the next day to start narrowing down our focus on the UPMC project and finding the areas we want to work on. We had seen a general direction of interest of our team during our discussions the class before- viewing the stakeholders in a more humanistic way and increasing the patient and his family’s understanding of post-discharge care and increasing the patient buy-in to help him stick to his post-discharge routine.

We wanted to get on the same page and decided to construct a mental model to illustrate our thoughts. We brainstormed on the whole experience of discharge, i.e. pre-discharge, during- discharge and post-discharge.

Pre-Discharge-

• One of the reasons why patients often stopped adhering to their post-discharge routines is because they felt helpless and felt they had no control over their recovery. We realized we could make them feel empowered by giving them small controls over their environment, such as clothes, bedding, lighting, colors surrounding them etc. This would be a simple, low-tech approach to increase their sense of control.
• We also realized that we could help improve the patient buy-in before discharge itself by conducting activities, games and having talks with the patient. We could provide them recipes which would be suited to the diet prescribed to them and maybe even hold activities to help them learn about what is good for them and what is not, and why. This will help them learn important skills required to take care of themselves, get the necessary knowledge to understand why the post-discharge care instructions are important and relevant to them. This will help increase patient buy-in and help develop good habits- give them a win, so they feel more invested. Once they feel better, hit them with the knowledge

During-Discharge-

• We realized that most patients get post-discharge instructions in a very impersonal manner such as a printout, or a robotic dictation by a nurse. We realized that this experience could be made more personal by having the doctor or nurse interact with the patient in a more connected and personal manner to explain the instructions and answer any questions.

Post-Discharge-

• We realized we could provide discounts for timely follow-ups to motivate patients to stick to their follow-up routine.
• Create online/in-person support groups amongst patients.
• Establish a channel of post-discharge communication with the doctor or nurse so they can answer any questions the patient might have.

Over-arching integration-

• We also realized that one idea would be to integrate all these systems seamlessly by modifying the current portal to incorporate all these activities.

Class 10 (02/12/2019)

We started this class by visiting a website per team and noting down our observations on the learning experiences involved in the experience. The website we visited was slaveryfootprint.org.

We then moved on to the next exercise which was applying the magic circle to our UPMC problem.

The magic circle applied to our UPMC project

• Pre-Magic Circle experience- Before the user enters the magic circle, he has certain fears and insecurities. He fears that he does not know how to take care of himself, that he lacks the skills required or the motivation to keep up with the post-discharge care. He is also fearful about understanding the instructions wrong.
• Inside Magic Circle- The magic circle can be any experience, either in the hospital or at home. I can be via a digital interface or through a narrative experience. The circle has certain rules, such as it will have learning divided over various levels with a certain chronology to each level. The learner will be allowed to revisit the previous levels/information, he will be given freedom to make decisions to shape his experience but to a certain extent. He will be provided with assistance during his experience in the circle.
• Post-Magic Circle- The user will emerge from the Magic Circle enriched with the experience of having been in the circle and with the learnings he derived from the circle. He should be well equipped with the skills required to take care of himself and should have adequate knowledge to do so. He should be well invested in following through his post-discharge care plan and should be confident in his capabilities to take care of himself.

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

DIRKSEN 5 READING NOTES- How do you get their attention?

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

The Rider and the Elephant Analogy

The Rider is the conscious controlled part of your brain, it tells you useful things that you know will provide you long-term benefits

The Elephant is the automatic, emotional, visceral part of the brain. It is drawn to things that are novel, pleasurable, comfortable or familiar

The elephant wants but the rider restrains- the rider allows you to plan ahead and sacrifice short term wants for long term gains.

The rider is conscious verbal thought, it talks to us and we believe the rider is in control. When the elephant and the rider are aligned then things go smooth, but when there is conflict, the elephant usually wins the battle.

Attract the Elephant

The rider does have the capability of controlling the elephant, but not for a long time as cognitive resources of memory, focus and control are finite. There are methods to keep the elephant attracted, but they need to be used with caution:

• Tell it stories- People learn and remember a lot from stories.

Class 11 (02/19/2019)

We started off class by discussing the Ambrose 2 and Dirkson 5 readings

Ambrose 2-

• Make connections explicit.
• Try and chunk-group information.
• Provide an explicit structure for the information
• Integrate multiple structures. Provide multiple paths to get to the same way. Learners will be more engaged in the process of building structures that resonate with them.
• Look for boundary cases- what is something that can be resonated to, but not make sense in the way intended to.

Dirkson 5-

• Encoding and retrieval of information
• Tell a story
• Avoid monotonous activities/objects- What are the things we perform, that are monotonous and are often overlooked? They must be different enough for the learners to value and pay attention.
• Attract attention- How to get learners to pay attention?
• Matching emotional context- What states will learners be in when they are learning?

Reflections- In the UPMC project, what state will the patient be in while getting discharged? What about after discharge? How might we teach them in a way they would understand correctly and completely at a time when they are in a better mental state?

We then conducted an activity, we were provided multiple props and were asked to pick a concept from our UPMC problem list. Using the props we were asked to prototype a learning experience using our learnings from the Ambrose and Dirkson readings.

Prototyping Learning Experiences

We decided to focus on the concept of educating the learner on how to take his medicines with his food and what to eat according to the diet plan provided to him. The activity is intended to be performed with the learner by the doctor or the nurse. The way we prototyped it is as follows:

The user had three blank slates in front of him, signifying three meals. The number of blank slates can be increased or decreased according to the number of meals required.

The puffy balls indicate the number and types of pills he needs to consume. The pills were placed around the meal slates to indicate which pills need to be consumed before meals and which after. Here he needs to have the blue pill before breakfast and dinner, the orange pill after breakfast lunch and dinner, and the red pill, two of them before lunch.

The colored confetti indicated major food nutrient groups

• Purple-Carbs
• Red- Protein
• Orange- Fiber
• Green- Vegetables
• Yellow- Calcium
• Blue- Fat

The doctor/nurse would place the major nutrient groups and the portion from each nutrient group that needs to be consumed by the patient each day. This indicates the patient needs to consume one portion of fiber, three portions of veggies, two portions of calcium and one portion of fat during the day.

The patient will have the freedom to select how he wants to consume the nutrients, in what arrangement. For example in the picture, the patient has decided to consume calcium and veggies for breakfast and lunch, and fiber, fat, and veggies for dinner.

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

WIGGINS + MCTIGHE READING NOTES- THE SIX FACETS OF UNDERSTANDING

— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —

When we truly understand, we can-

• Can explain- provide thorough, supported justifiable accounts of phenomena and data
• Can interpret- tell meaningful stories, translations
• Can apply- effectively use, adapt what we know in diverse contexts
• Have perspective- see points of views through critical eyes and ears
• Can empathize- find value in what others might find odd
• Have self-knowledge- perceive personal styles, prejudices, projects and habits of mind

Class 13 (02/26/2019)

We discussed certain problem statements forwarded by Kristen.

Class 14 (02/28/2019)

Design for Skill Acquisition

Embedding small challenges to achieve larger skill development

How do you teach a student a large skill? You can break down a large skill into multiple smaller skills, and then break each smaller skill into multiple smaller challenges.

For Example, if the overall skill to be taught is nutrition management, it can be broken down to teaching small diet management steps, which can be further broken down into smaller steps regarding food choices.

Alternating steps to work on challenge and ability

The learner can be started with a relatively low challenging task and the level of challenge can be increased in a stepwise fashion alternating between steps to increase the challenge, and steps to increase ability. The aim is to make sure there isn’t a parallel increase in frustration or a decrease in confidence or a decrease in perception of one’s ability to master that skill.

Game Activity to test Skill Acquisition

We broke into groups to test certain physical as well as digital games to see how they fared in terms of helping players learn skills and understand the goals of the game.

Quiddler

The first game we played was quiddler. None of us had played the game before. We had quite some trouble understanding the rules of the game from the handout provided in the box. We went through a few rounds and discarded them midway to return to the handout. Soon we gave up on reading the handout. There was a scan code on the box to watch videos but it wasn’t explained how to scan it, so after a few tries, we gave up on that too. Finally, with the help of Stacie and a few YouTube videos, we were finally able to complete one round of the game, and it turned out to be pretty simple after all. It taught us various skills like planning, strategy, bluffing and vocabulary strengthing.

I feel that the learning experience could have been much better handled. The hand-out was very non-linear in terms of explaining steps and the language used wasn’t very clear. Maybe smaller sentences, more granular instructions and easier links to videos might have helped.

KernType.com

This was an online game to teach the players how to kern. The skills being taught were understanding spatial approximations of alphabets in a word. There was feedback after every round in terms of a score. The difficulty level was increased after every round. The steps were relatively easy to learn and execute and the concept was conveyed properly. Our motivation levels increased game after game, as we saw our score increase with every game- instant gratification and feedback of progress. Each round ended with a round of cheerful hurray. We even managed to get a perfect 100 score on our last round on the game! 🕺🕺🕺

Our perfect 100 score!

Class 15 (03/05/2019)

This class we broke into teams of two and discussed our understanding and areas of interest for solving the UPMC Re-Admission issue. I worked with Jeffrey in understanding our ideas in terms of

• Who?
• What?
• When?
• Where?
• Why?
• How?

My idea was based on the idea of habit formation-

• Who- This idea is more for people who need help with forming habits of post-discharge care routines
• What- This is aimed to focus on the lack of understanding the value of post-discharge care steps or the implications of not following them.
• When- This can be done both pre-discharge or post-discharge
• Where- This knowledge can be imparted both in the hospital environment(pre-discharge) or at home(post-discharge)
• Why- To help people build habits
• How- Personal trainers/coaches to help persuade people to follow steps. Feedback on progress.

Class 16 (03/07/2019)

As a team, we discussed who we want our solution to be for and what are the major motivations, fears, insecurities, life events of these people who we are proposing this for. We decided to aim our solution towards people in their late thirties to early fifties.

We then decided to understand all our solution in terms of Who? What? When? Where? Why? How?

Serina wanted to come up with a Health Assistant for the middle-aged people to help them follow their schedules. Megan was interested more in empowering the patient before they leave the hospital to increase send of control over one’s life. My solution was focused more on habit formation before and after discharge to help incorporate care routines into daily lives.

Meeting with Lisa Molyneaux at UPMC Passavant (03/15/2019)

Tanvi and Me at the UPMC Passavant Center

Why do people not tend to stick to post-discharge care routines?-

There might be different reasons why people don’t follow up with post-discharge care routines, maybe they cannot afford it, maybe they have no motivation to change their current routines, maybe they’re afraid of change etc.

There have been no observed shifts in tendencies of a patient to follow post-discharge routines over the past few years

There are no observed patterns for different age groups when it comes to following post-discharge care routines:

• A younger person might understand all the instructions but has but no time to follow them. They are also often working and have weird shift hours which might further hinder their ability to follow the care instructions.

Reflection- Help younger patients plan their care around their routines

• Old people usually need more solid support systems, their care requires more focus, it’s usually more complex, the diseases are usually more advanced and the treatment and care are usually costlier.

Reflection- The discharge routine is the same for all age groups currently. (Will having different routines for different age groups help them understand better? Will it increase buy-in?)

Case Managers or Practice-Based Care Manager-

Care Managers are from the UPMC Health Plan Insurance. They have a vested interest in ensuring patient readmission rates are low. They talk to the patient when they are in the hospital or call them after discharge to make sure they understand the instructions and steps, and that they are well connected to all the resources they need to take care of themselves. Patients have to have a need to be allotted a care manager, like transportation problem, living alone without any support system, trouble affording medications, some sort of need. Lesser care required by the manager if the patient is going to a skilled nursing facility.

There are General Care Managers who manage all patients for physical health and lifestyle changes, and then there are Practice-Based Care Managers who manage specialized patients for specialized care. Each kind of care category has a Practice-Based Care Manager. Lisa is a PBCM for COPD (Chronic Obstructive Pulmonary Disease)

Care managers are also divided into, In-Hospital managers, Out-Hospital manager (for post-discharge) and also managers in the pharmacies.

Some SNF have UPMC care managers too

Patients are contacted whether or not they want a care manager, based on their illness/ state and they can say yes/no. Patients often say no. A Doctors prescription is not required to assign a care manager except for certain high-monitoring practices like Advanced Illness Care Program (AIC) for patients at the end state. There is no copay for the high-monitoring services.

Reports are run daily with the top diagnosis that people are coming back for, managers pick them up and assign them to their workflow. Each care manager tries to monitors each person on his worklist every day.

All these services are billed to the Insurance of the person, only co-pay needs to be paid.

Different hospitals have different affiliations, UPMC hospital is obviously affiliated to UPMC Health Plan, they have friction with the Allegany County Health Plan Care Managers and won’t let them stay in their building even if they have patients with that medical insurance provider.

Realization Breakthroughs-

People may not follow their post-discharge care for a number of reasons, but more often than not there is a point when something connects with them, and they change. It might be anything from “you want to be alive to see your grandchild grow”, or “you want to walk your daughter down the aisle” or “you want to save money by avoiding surgery later” etc which causes them to reconsider lifestyle choices. You never know what time is the time they get it

Care managers never give up on the patient, they keep pushing, trying to get the patient to change, trying to reach that realization breakthrough.

It is harder to get introverts to talk about their personal life, so it’s harder to get hooks to help them change.

Reflection- I asked Lisa how useful would it be if they had a mechanism to to help doctors, nurses and care managers get more information on the background of a patient, important past events or future events, his motivations and goals, to help them be able to shape conversations around post-discharge care in a way to ensure patient had enough hooks to keep them following the care regime. Her Reply- It will definitely help, but doctors and nurses are involved in an acute care setting, the focus should be the acute problem, they are not here to solve a social problem. This solution would be more appropriate for an outpatient setting such as during discharge.

Before and during the time of discharge-

The next appointment is set up before the patient leaves.

Facilities for transport for follow-up is set up if they don’t have the means to travel.

The Care Manager has a conversation face to face with the patient before he leaves (it may be before the nurse gives post-discharge instructions or after). The things he discusses with the patient are-

• New medications
• Signs of symptoms they should be watching for
• Schedule appointments for follow up
• Do you need transport
• Changing bandage etc
• Weighting, measurements.

If the Care Manager is calling or visiting the home-

• Questions on instructions that were provided during discharge?
• Reactions to any medications the patient might have started
• Did you pick up pills from the pharmacy?
• Signs of symptoms they should be watching for

Why do old people refuse Care Managers?

Older people have a lot of fears and insecurities:

• They get nervous that medics are trying to make them lose their house
• They are afraid to accept help
• Refuse home care and they do not want to leave their house
• Intrusion on independence and privacy
• Home care nurses suggested- often refused
• A person coming to their house and telling them what to do
• They say no to skilled nursing facilities

However, later when they’re home, they often realize that their decision was a terrible idea. They have the option to request for Care Management on call. It is harder to set up a case management schedule for them once they’re home. Their PCPs are contacted who then may or may not set up a follow-up appointment before prescribing home care.

Pre-discharge Conversations with Care Managers?

They try to follow-up with patients every day. They want to build a Friendly, Trustable, Reliable image, they want to be the friendly face that appears every day to talk to patients. They try and figure out what the patient’s interpretation is of what the doctor said and if they understood instructions properly.

Reflection- Can the care managers go more in-depth with these conversations and help understand the schedule of the patients and how they are fitting their post-discharge care instructions and medications into their schedule? Maybe a little more hand-holding for planning might be required?

Post-discharge Conversations with Care Managers?

• They needed oxygen cylinders, which didn’t show up. Manager calls up Delivery company.
• They do not have money for follow-up appointments or further medications.
• They didn’t answer the phone to schedule follow-up appointments or order medications.
• They didn’t order medication yet, the manager calls up the pharmacy.
• If they can't cook, hook them up with meals on wheels etc. Some conditions (if the patient has Medicare, CHF, COPD, and diabetes) allow for two week worth meals to be delivered to the patient.
• They usually don’t go very in depth with calls when it comes to checking their schedules etc.
• Young people usually have very short calls.
• Old people usually talk a lot.
• Care managers push to schedule follow-up appointments.
• If they are having problems after they leave, they are connected to their PCPs or helped to schedule follow-up appointments.
• Young people usually don’t pick up.

Reflection- Can the care managers go more in-depth with these conversations and help understand the schedule of the patients and how they are fitting their post-discharge care instructions and medications into their schedule? Maybe a little more hand-holding for planning might be required?

Study on meals and recovery?

Study that people who had meals delivered have a lesser tendency to relapse or get re-admitted.

Reflections- Can we look at options for scheduling automatic meal delivery post-discharge for a specific period of time? Can we schedule for a cook to visit the patients at a subsidized fee, to help them for grocery shopping and cook healthy meals for them? Especially for older or disabled patients.

Building the public image of UPMC HealthCare

Care Managers are the face of UPMC HealthCare. They develop a relationship with the patient. If they say something, they have to follow it through, because they represent UPMC HealthCare, and if the patient loses trust in them, the patient loses trust in UPMC HealthCare. This can extrapolate to other issues.

Pilot program- UPMCAnywhwereCare.com

• Steel City internal medicine was trying to set up virtual visits for PCP follow up appointments. The government insurance program is called Medicare Medicaid. They need government approval for trials. Hence they had to use commercial insurance patients for this pilot program. Most of these patients were elderly and aging people in the Allegany County area, and not very tech savvy so as to appreciate the virtual platform (especially since the virtual visits had to be set up by as an in-app experience only due to the protection of patient data). The pilot program fell through.
• Another reason was also that the co-pay was the same as an in-clinic visit. And most old people are still comfortable with the concept of the doctor actually visiting them in person at their home, so virtual visits didn’t appeal to them.
• In terms of transportation, a van is available to pick up Medicare Medicaid patients for their follow-up appointments, but it has to be scheduled via the app.

Reflection- My view on why this program failed is lack of matching testing population with the population that this initiative is aimed for. This is a tech-based initiative aimed primarily at young, working, tech-savvy population who don’t have time to visit the hospital again and again for follow-up appointments. However, the program was tested with a relatively older population who rejected the initiative.

MyEmmi program

It is a self-training portal. Patient logs in and can view a customized link of videos or lectures for his health history. There are some videos which pay the patient if he watches them ($25-$50). Payment is done in terms of credit or money off his co-pay.

Reflections- While Lisa was demonstrating the website, her account was suggesting weight loss videos to her, probably because her details would have indicated she is over-weight. The concerning fact was that the first video pulled up was that of Bariatric surgery and she was offered $25 to watch the video “to improve her health”. This made me think, is the app trying to push people into medical procedures where simple lifestyle changes will suffice and motivating people by promising monetary gains.

Conversations vs. Mail

UPMC send way to much mail to patients. Patients usually read the first two pages and then throw the rest away. The mail usually contains an explanation of benefits, bills, health info, info to encourage follow up and tests.

Lisa believes that conversations work better than printed materials or web videos. It’s more personal to talk to a patient one-on-one rather than reading out from a paper.

Reflections- People prefer a more personal touch.

Medicare Doughnut-hole

So the Medicare is a government offered low-value insurance for people who cannot afford premium insurances. The insurance provides immediate support without any deductibles, but till a limit. After the limit is reached, the insurance stops the support and full amount is out-of-pocket of the patient till a “catastrophic limit” is reached after which insurance kicks in again.

Well-off people go for the premium insurances, and very low-income people qualify for government aid.

The middle tier has no option but to opt for the Medicare program.

Reflection- This makes me think, if you are in the middle tier, small illness means you are secure, but if you fall really sick and need to undergo procedures, you fall into the Medicare doughnut-hole. You really cannot afford the medical procedure, but what if it is life-threatening? What option do you have then?

Also, how exposed are you to substances or processes that will compromise your health if you belong to this economic category, and how often do such people exposed to such substances fall sick and slip into the doughnut-hole

And how often are they given a chance to stop this exposure? What if it is their daily livelihood?

Money as an Incentive

Money as an incentive to get people to do stuff always works. Works as an extrinsic motivating factor. Different people might have different reasons to not follow any instructions, but once money gets involved, people usually always follow.

Reflections- Can money be made as a motivation in the intended solution to ensure that people follow the instructions? How many people would actually be motivated by this factor? Maybe not the well off people. How many of the well-off educated people actually don’t follow the instructions?

Class 17 (03/19/2019)

Finalizing What? Who? Why? When? Where? How?

We spent this class brainstorming as a team on the five major parameters on which our solution will be based- What? Who? Why? When? Where?

Finalizing on the What? Who? Why? When? Where?

Who?

The solution will be focused on people in the age group of 50–80, suffering from Heart diseases, who need lifestyle changes and have the capability to work on themselves (patients who are not terminally ill).

What?

Our focus was on humanizing and personalizing the entire experience of post-discharge lifestyle changes.

Why?

Lifestyle changes are always challenging to start doing and even more challenging to keep up. We felt that is post-discharge lifestyle change can be made easier if scaffolded well and the adhesiveness to this change can be made stronger if we tie in human motivations.

When?

We planned for this experience to take place post-discharge, once the patient had been released to his home, or SNF or care center.

Where?

This experience would take place in the immediate environment of the patient, wherever he is post-discharge.

This helped us narrow down our solution to specifics. We each had a solution (How?) which fit into the direction that we had specified above and we started discussing the storyline that we would generate. We helped each other think throughout the storyline and decided to each sketch out our stories for the next class exercise.

Class 18 (03/21/2019)

Speed-Dating our ideas

We each had a printout of our ideas storyboarded into a storyline. We had three rounds of pitching all our group ideas to different people and receiving feedback on each, and then three rounds where we listened to someone else’s idea and gave feedback on them.

Our group ideas focused a lot on humanizing the experience and providing a lot of scaffolding to the user as he went through the process of lifestyle changes after discharge. While the medicine dispenser was more of a physical solution to the problem and did not involve much of a learning experience, the idea of attaining the point of realization and podcast was based on tapping into user motivation and using that to help them change their lifestyle and the idea of Habit formation was based more on scaffolding the change gradually.

I received a lot of productive feedback for all my group ideas from all the people I pitched my idea to.

I saw a trend in the ideas from each group. Although the parameters (What? Who? Why? When? Where?) were similar for all ideas within a group, I saw a similarity in the ideas too. Some groups were more food-focused, while some were more tactile experience focused. Some tended to lean towards providing services while others were more product oriented. However, all ideas in the group shared the same strong undertone- which came from the group understanding of the problem. I could see the group discussions from each group manifesting in the form of ideas of that group. It was fascinating to observe this, and then view your own ideas in perspective of this group understanding that you developed with your group. It was also fascinating to see how each of us formed a base understanding (built the same mental shelves together) but each of us had different ideas, based on our backgrounds and contexts. Each of us got in a flavour of our history into the solution and came up with a beautiful myriad of ideas to build it up.

Group Meeting (03/23/2019)

Synthesizing insights from Speed-Dating session and finalizing on a final direction

All of us came together on Friday afternoon to synthesize our feedback from our speed-dating sessions.

IDEA 1- Feedback for Pill machine idea (physical assistant)-

The main feedback was that this idea didn’t have much of a learning experience involved, how can we incorporate a learning experience into this idea? Maybe have a trivia fact every time the machine dispenses a pill?

What if you have a pet at home, who might topple the machine over?

What happens when the pillbox gets empty, is there a mechanism to auto-order more pills from the pharmacy? If not then we’re back to the same initial problem that people don’t stick to medication because they forget/procrastinate buying pills.

Why would UPMC invest in an idea like this?

An interesting insight that we received from a fellow classmate from her visit to UPMC was that having pills is not a concern/problem in the first place.

IDEA 2- Feedback for Dreamboard (point of realization- intrinsic)-

What if people don’t want to share or open up? What if people are afraid of being vulnerable in front of a stranger?

This idea touches on the aspect of motivation, but it should also incorporate an aspect of achievability, even though people might touch that point of realization that they need to change, people should also be convinced that this is an accomplishable goal.

Some people thought that dream boards weren’t effective enough and would not be able to bring about a change in people’s attitudes.

An important point brought up was that, even though we are providing good scaffolding initially, how do we strip down the scaffolding gradually and make the learner independent.

To make sure the dream board is effective, set up a few initial questions to lead the learner into the activity

This idea has great potential to tap into all five senses- what smells, tastes, sounds, sights and touches trigger certain productive memories, for example, the smell of laundry makes people feel productive.

Combining the dreamboard and podcast might be a good way of reaching their point of realization plus making goals seem achievable. They will also help people who don’t have goals or motivations to extrinsically reach their point of realizations.

IDEA 3- Feedback for Podcast (point of realization- extrinsic)-

What is the motivation of the people to actually hear these podcasts? Do you give them the flexibility to hear them at their own free time? Or do you impose time constraints on them? Imposing time constraints might help make sure their follow-up appointment with doctors is productive, but the whole idea of imposing a timeline seems too restrictive. And even if timelines are being imposed, how do you decide how many videos are too many videos in the time provided?

Is there a way to personalize the entire experience by providing more personalized video? How do you account for rare diseases with not many cases?

One feedback we got was that people liked the idea of not feeling alone like you’re the only one in this struggle.

The follow-up appointment can be structured to maximize the possibility of the patient reaching a point of realization. Also since some people are not very comfortable talking about themselves or their private lives, discussing a podcast or something that happened to someone else could be a good way of initiating a conversation in a follow-up appointment.

Is there a way you can take the patient through the process of attaining self-realization without getting a care manager involved? This will make sure people have time to watch videos at their convenience, and then can undergo the discussion whenever they are done. How do we make sure that this extended time period will not result in the people being very detached from the process of self-realization?

How will you deliver the experience, will the podcast be on a device handed to the patient? Or will it be on their cellphone? If a device, then how do you justify the cost? If phone then how do you account for the population without a cellphone?

IDEA 4- ELIMINATED- Habit Formation-

People did not really buy into the idea of Habit formation as they felt this is something already practiced.

After discussing all the feedback, the final consensus was that we got more positive feedback on the ideas focusing on reaching a point of realizations. There was also a general consensus that we would try and merge the idea of the Podcast and the Dreamboard into a stronger more sturdy solution built on learning theories that we learned in class. We left the meeting feeling satisfied with having narrowed in down on an idea and having a new-found direction to focus our efforts on.

TO BE ADDED

Group Meeting (04/9/2019)

We had decided on three components to our entire solution- the Mood Board, the Podcast, and the Website page.

We had an extensive whiteboarding session regarding specifics about the components:

Discussion around Mood Board (Life Map)

1) The Name of the component

We realized we have been using the term Mood Board pretty liberally without realizing what it truly means. We also realized that the name “Mood Board” almost makes it sound non-serious and just a fun activity, which might not go down too well with the more serious older population, so we decided to rename it to something more serious, meaningful and impactful. We deliberated between Vision Visualization, Journey Board, Dream Board, etc and finally landed on Life Map as it aptly conveys the notion of this object being a means to understand what you want to do and how you want your life to map out. Some major points behind our choice of this name:

• It does not explicitly convey whether we are looking at a forward life map or a past life map. (read Section 2 for more information)
• It does not focus on any specific sensory input (taste, sight, sound, smell, touch) and is a more neutral name, whereas names like vision visualization leaned more towards sight. (read Section 3 for more information)
• It is more intuitive of a name and sounds more serious and impactful

2) Forward vs. Backward

A very important suggestion we got from Stacie was regarding making the Life Map board both forward-looking as well as backward looking. We decided to have two panels to our board, a forward-looking “GOALS” section, and a backward-looking “MILESTONES” section. The Goals section is intended to capture all the important things that the person wants to do at some point in his/her life, the aim is to move things from the Goals section to the Milestones section as and when they take place. However, we realized that seeing an empty milestone board might trigger a sense of not having achieved anything as well as a sense of intimidation on the journey ahead, so we decided to have the Milestones board pre-reflect past events of value or past milestones achieved to instill a sense an achievement in the patient.

3) Sound-Smell-Taste-Sight-Touch

Another factor we were discussing was that every person might not relate to sight as a means of connecting, some people relate to certain sounds, or smells, or tastes, or even touch textures. So we were brainstorming ways of adding these elements to the Life Map. Sounds may be incorporated with an embedded speaker and buttons? The smell aspect may be incorporated with parchments soaked in a certain perfume? But then how do you get certain unique smells that people connect with? The taste aspect was the biggest challenge, but then we realized that we can trigger a taste recall using certain images, so we decided to go with that. Sight and texture were relatively easier to incorporate.

4) Forward Questions

Some aspects of our conversation when we are looking forward:

• physical goals
• life accomplishments
• family goals
• travel goals
• bucket list

5) Backward Questions

What were your greatest moments of:

• happiness
• achievement
• belonging
• triumph

Discussion around Podcast

1) The Content

My father recently cured his Diabetes with some serious lifestyle changes. Since our main character, Bernie is also diabetic, we decided to interview him and understand his journey.

2) The Script

We took the content from the conversation with my dad and shaped it around a character named Emma who lives in New York City with her husband, two teenage kids, and a pet dog. The script talks about how she turns her life around and cures her diabetes.

3) The Execution

We decided to record it in the CFA Multimedia Recording Studio.

Discussion around Website

1) Access to Website

Each person will have their own account for the website

2) Life Map component

We decided that once the Life Map creation activity is done, the care manager will take a photo of the life map and upload it onto the website for future reference

3) Podcast component

The care manager will upload the podcast to the account of the patient

Discussion around Main Character for Story

We decided our main character is Bernie, a 68-year-old Diabetes es patient. She needs to get healthy in order to see the birth of her grandchild.

Discussion of Timeline

The timeline we decided is as follows:

Discussion of Inventory Required

• cork boards
• pins
• drawing paper
• sketch pens
• stickers
• artifacts

GROUP MEETING 04/15/2019

We got together and decided on specifics about the life map. Megan had stopped by an art store and had purchased the items required. We decided to start fleshing out specifics about Bernie’s life. We decided to work on Goals first. These are a few things we decided to put on Bernie’s Goal Map:

• Wants to travel to Europe and Asia
• Wants to see her grandchild being born
• Wants to redo her garden
• Wants to attend her 50th high school reunion
• Wants to attend her sister’s birthday in Ohio
• Wants to go to church regularly
• Wants to go to the park for walks with her friends
• Wants to buy a mobile home and go camping

This meeting ended with us deciding on the images to be printed to start working on her Goal board and the specifics of the podcast.

We also had a special little guest join us for our meeting, little Shadow :)

CLASS DISCUSSION 04/16/2019

We received a lot of critical feedback during class:

Push and Pull

We received feedback regarding introducing a Pull mechanism to let the patient pull the podcast. We decided to test sending a link to the Podcast on the text mobile of the patient to provide easy access to the video

Regarding Testing Session on Tuesday

Decide what questions do we want to ask? What do we want to know from the people?

Space and Cost

The cork boards are pretty big, they will take space in a patient’s home, and the patient may not have space. They will also be expensive and UPMC might not be able to afford cork boards for each and every patient. How about using Magnetic boards instead, so you can move around pieces, click a photo and upload it to their online account, maybe you don’t have to have a tangible board? But on the flipside, other questions arise- is a picture as effective as a tangible board?

CandleLab

Visit the CandleLab to see how different smells can be curated

Make it require effort

Make the entire activity of creating a life map require effort from the patient, like the collection of photos, artifacts, etc, so that they value the final piece more.

We were also able to get some work done on the GOALS part of our Life Map

GROUP DISCUSSION 04/16/2019

Ekta and Tanvi and met in the evening to record our script for the podcast. However, while rehearsing we realized that we could not use this script which is based on Ekta’s father and his health journey, for our client UPMC- in the script, the main character Emma talks about how she starts naturopathy and eventually got off insulin and medications and is now Diabetes free. However, considering our client is UPMC, and they are pushing for people to be regular with medication, rather than not having medication at all, so we decided to alter the script a bit over the next few days, and make the main character mainly pursue improving her health. We made the event of her diabetes being cured as a positive side-effect of her health improvement.

GROUP MEETING 04/17/2019

We clarified and discussed several matters during this meeting:

Form and Mechanics of the Life Map Activity

We received feedback regarding the cost and space aspect of providing two cork boards to each patient.

• We discussed reducing the size of the board. But realized that it was still coming across as an expensive option.
• We discussed the option of recreating the cork board every time the care manager visits, clicking a photo, and then clearing it. But we realized that the activity of having to remake it every time just to move one or two images seemed like a painful affair.
• We also discussed the option of having the cork board as a tray of sorts, the patient can arrange the images on the board, the care manager can click a photo of the board and then the board can be reused. But the same issue of having to redo it persists here.
• Stacie mentioned the feeling of being able to lift up the board. So we started looking at magnetic boards instead
• Another idea we had was to use cheap foam core or cardboard to make the boards and use re-stickable glue to stick images onto the board. This was a cheaper option and the patients could keep the board as well.
• We also decided to have a preset collection of images and stickers to act as scaffolding material to help people get into the mood of making their life map.
• We also discussed the possibility of the care manager having a portable printer, they are not very expensive $70-$200, and is a one-time investment.

Navigation of Website

We decided to have the portal as a new webpage which can be logged in with UPMC credentials, however, we decided to embed links to the website via the other websites used by UPMC. We went through all the websites sent by Stacie in the email and narrowed down on a few relevant websites which could potentially link to our webpage.

Form of Website

We also had a discussion regarding the form of the website:

• The care manager can suggest podcasts to the patient
• Every time a care manager suggests a new podcast, they get uploaded onto the “Suggested Podcasts” tab of the website
• The patient also gets a text message with a link to the newly suggested podcast so that they can quickly access the podcast. *subtle push*?
• The patient can also view all other podcasts in other categories by on the “All Podcasts” tab. He can filter by various categories.
• He can also see what podcasts he has viewed as well as jot down notes for each podcast he watches.
• There will also be a Life Map section of the website where the image for the Life Map of the patient will be uploaded. Every time there are changes to the board, a new photo will be clicked and uploaded. The patient can also see the previous versions of his map as well as download them.

CLASS DISCUSSION 04/18/2019

Finalize on the Testing Plan for Tuesday

We decided that since Megan and Ekta have worked on the Life Map and Podcast, they will test the components with the testers respectively, while Serina and Tanvi will move around testing other people’s projects. Some nuances of our testing session:

• We will take people’s phone number and text them a link to the podcast.- What do you think of this method of sending videos? Would you rather log in and see a list? Or be texted the link? What do you think about the podcast? Do you think it would be effective for a diabetic person wanting to take control of his life?
• We will provide two sheets of papers for the two boards as well as some preprinted images around certain topics such as travel, graduation, jobs, marriage, hobbies, art, etc.
• People will also have the option to google images and print them right then and there on the studio printer. They will be allowed to cut and paste and arrange pictures on the board for their life map.
• A picture will be clicked and a tabloid size version of it will be printed and handed to them.- What did you feel while doing the activity? What did you like? What did you dislike? How would you improve it? What do you think about the aspect of having a photo of your life map rather than the actual life map in front of you? Do you think it conveys the same effect? How do you feel after the whole activity? Did you have some thoughts or realizations during the activity?

RECORDING SESSION 04/19/2019

Tanvi and Ekta recorded the preliminary draft for the podcast at the recording studio. Tanvi was the Host of the podcast Session, while Ekta was the subject being recorded.

We had to redo the recording twice because of erroneous settings in the first round. But it turned out pretty well and we were able to get a good recording.

The recording is around 13 minutes long and it works well with our proposed time of the Podcasts.

The preliminary recording can be heard — https://drive.google.com/file/d/1CABpMoJXEiZAjBBxdhY2_m-Py4_xPLft/view

Polishing the Recording

I worked on the recording over the weekend, polished it, added an intro and ending music to it. The final podcast can be found here:

Podcast Website

I also created a website to host the podcast and all other podcasts. You can visit the website here-

Link-

UPMC Health Podcast

Website walkthrough-

Class Testing Session (04/23/2019)

We had a very productive testing session. Megan and I were carrying out the testing for our prototype while Serina and Tanvi tested other people’s products. Our aim was to make people do a quick and dirty version of the activity we were intending to carry out in the 15 minutes provided. The steps we carried out were as follows:

1. Talked about the idea via the storyboard.
2. Explained what we were trying to achieve.
3. Explained what activity we will be carrying out with them that day.
4. Message them links to the podcast.
5. Carry out the activity.
6. Poke with questions, start a chain of contemplative thoughts.
7. Click a picture of their board.
8. Email them the picture along with a questionnaire of how they felt, what they liked and what they would want to improve.

We started off with a slightly different way of interviewing, however soon after our first interview, we realized that the plan of action might not work and we had lesser time than we estimated, so we tweaked out activity in the second and third rounds to optimize it and get the essence of what we wanted to understand. We realized that listening to the podcast might not be feasible in the time provided. We also realized that this activity required contemplation and that needs time. So we decided to focus the 15 minutes on giving them an idea of what we’re aiming to achieve and getting a quick feel of actually doing the activity. Then they would listen to the podcast whenever they had time and the next day they would receive a questionnaire asking about what they felt and what thought processes started off after the activity.

All the boards made in our testing session

On the Spot Feedback

1.

Jeffrey Chou & Audrey Zheng

(Each made a goal board as if they were Bernie)

• Does not make sense to have this done via one session, need time for contemplation.
• Why am I doing this? Aren’t there better things I can do instead. I don’t connect with it.
• Need more categories to help people think about what to start putting.

2.

Amrita Khoshoo & Ashley Chan

(Each made a goal board as if they were themselves)

• I find myself picking out vibrant photos because life is currently sad and I want this to make me happy.
• Know what I want already, I am an introspective person, this activity isn’t helpful to me.
• I find myself more busy with finding matching images and arranging them rather than learning anything here. I need guidance to help me think and structure my thoughts.
• I have a lot of stuff floating around in my brain, nice activity, helps me acknowledge them.
• It helps me streamline my thoughts if I am talking to someone.
• What about people who are not motivated or are not engaged to do this activity.

3.

Greg Bunyea & Rebekah Geiselman

Both made the goals and milestones board as if they were Bernie

• I would want to do this with my husband so that they can remind me of important instances of my life that I might have overlooked.
• This activity should be done as a mix of alone contemplation and with your close ones.
• What I have certain dreams that are almost unattainable? Will visioning them remind me how unattainable they are?
• I would want to take this home, and not just clear it.

4.

Elizabeth Wang & Duoduo Zhang

Both made the goals and milestones board as if they were Bernie

• I would want to keep it
• What if I have had a fairly boring life without major milestones
• What if they have goals but can’t afford it?
• I find this just a scrapbooking experience, no realizations as such
• Can you make goals more important and promising than milestones
• Goals for next one year only makes the activity simpler
• Maybe extend it later to five years
• Maybe section the board to show how to reach the goals, break down goals to attainable nuggets and arrange them in accession on board (learning element) this activity can be done with health coach once goals have been defined.
• Give prompts while doing the life mapping exercise
• It is okay to clear out the milestones board, but patients should be allowed to keep the goal board.

Sending out Questionnaire (04/24/2019)

I drafted out a brief questionnaire to find out how people felt after the activity and how they would improve it:

*Describe all steps of intended solution*

*Attach a photo of their board to the email in which this questionnaire link is sent*

*Also provide the podcast link in the email, in case they forgot or didn’t receive the message I sent*

Regarding Life Mapping Activity

How did this activity make you feel?

Did this activity (if you had more time) help you reach any conclusions or points of realization?

Did this activity stir up any thought process in your mind? Did you find yourself thinking about it later in the day?

If you could improve on this activity, what would you change, add or remove?

Regarding form of Life Mapping Activity

Would you prefer a photo printout as attached to the email you received, or would you rather take the life map you created with you?

Would you prefer if you could customize and print out your images right then? Or do you prefer working with presets?

What are your thought on the size of the board you worked on?

What are your thoughts on the type of the board, would you prefer anything else other than a cork board?

If you could improve on this activity, what would you change, add or remove?

Regarding Podcast

How did you feel after listening to the podcast?

Did it help inspire you or stir up any thought process in your mind? Did you find yourself thinking about it later in the day?

If you were a 65-year-old lady suffering from diabetes, do you think this podcast would help? How? How not?

If you could improve on this experience, what would you change, add or remove?

Regarding the form of Podcast

What do you think about the recording and the quality of the podcast?

What do you think about the platform on which it is hosted?

What do you think about the text message medium of sending you a link to the podcast. Do you think it helps you access it quickly? Why? Why not?

If you could improve on the Podcast, what would you change, add or remove?