Are you satisfied with your care?

Grace G Lau
Jan 2 · 11 min read

Or “Design for innovation by connecting the dots for better patient experience” A talk from World Usability Day Los Angeles 2019

The theme for World Usability Day 2019 Los Angeles was “Designing the future we want”

Backstory

I was invited to speak at World Usability Day Los Angeles about 6 weeks before the event on November 14, 2019. “Think about it,” Marcella told me. “The theme is ‘Designing the future we want.’”

I looked into it. I wasn’t sure. At the time, I was planning the last few events of 2019 for San Gabriel Valley UX. I was the interim president for the new World Information Architecture Day. I was working full time at PatientPop. I was sleeping 4 hours a night. I was starting to feel over my head. But I still felt that I should get out of my comfort zone and do more. Be useful. Bring impact. Add value. I said yes and my heart pounded.

I’ve been working on healthcare-related projects since I left Disney in 2013. Determining the backend information architecture and content strategy for consumer health content. Designing and developing a navigation schema that aligned terminology for both patients and healthcare professionals. Building out a taxonomy to be used for content tagging and personalization. As I saw them, these projects were solving all first-world problems, not exactly world-shattering social causes that would define a greater future.

Then I found it. An epiphany, a universal truth that unified even the most disparate environments in healthcare.

Disclaimers

The following are the talking points for a talk I gave at World Usability Day Los Angeles. It is not a transcript and may include additional details omitted from the original talk due to time and nervousness. A video recording may be available, but not at the time of this publication.

Opinions are my own and not representative of my employer.


The actual talk

Last year around this time, my 8-year old child fell off the jungle gym at the school daycare. He was following his friends. While they jumped off the jungle gym and landed safely on the ground, he didn’t. He landed on his right elbow. Technically, he would tell me, as kids love to correct adult retellings of their experiences, he slipped and fell.

When I saw that it was the daycare calling, I was anxious. A call from daycare is never a good call. You need to come, they said. He won’t stop crying. I had a feeling that we would be going straight to ER.

I left work, picked him up from daycare, and found our way to the ER.

We walked up to the security desk where the security guard directed us to the registration desk.

“What are you here for?”

“My son fell and I think he broke his arm.”

“Name, date of birth, and insurance”

We registered (more like, got tagged and labeled with a wristband) and sat down. We saw the triage nurse and they took my son’s vitals. We sat and waited. We signed insurance and consent forms. We sat and waited. Got called up to get x-rays. Came back, sat down, and waited. He whimpered, “It hurts, Mama.”

Eventually, they called us back in and told us the results. It was a bone fracture. Very close to a certain area of the elbow where he may need surgery. He’d need to see an orthopedic specialist. All they could do for now was put the arm in a sling.

Was a fracture the same as a broken arm? I looked up the medical definition of a fracture, while we were waiting. The nurse came back with a stack of paperwork, including information about car seats for infants and a summary of our visit. We signed some discharge papers. We were told again to see an orthopedic surgeon for further treatment. After 4 hours, we were on our way out of the ER.

It was already well into the evening and most medical clinics were already closed. The search for an orthopedic surgeon would have to wait until the next day.

The next day I pulled a list of orthopedic surgeons from my medical insurance provider within 25 miles of my home and I started calling. I wanted the first available appointment. My son was in a temporary splint. He was still in pain.

My opening line for each call: “Hi, my son broke his arm yesterday. We need to see an orthopedic specialist.”

Every call responded similarly, “What kind of insurance do you have? PPO or HMO? Have you been here before?” Once I answer their questions, they would tell me that the doctor was not available until several weeks out.

My son’s arm was in a splint. He was still in pain. And I couldn’t do anything for him. I’ve never broken a bone before. I didn’t know what to expect. How bad was it? Is he going to need surgery? How was his arm going to heal? How long would it take? What should we expect? Was it going to affect his future?

The front office receptionists were focused on gathering insurance and contact information before letting me know that there was no one available to see my son.

No one seemed to care… until the last call. They paused, asked me what happened, said someone could see us right away, and even told me what to bring into the office.

We went to the office. The receptionist recognized our situation from the phone call. The nurse took my son, asked him what happened, and cracked a few jokes to put him at ease. While I went to fill out patient paperwork, the radiologist took him to take x-rays. The physician assistant got the results and explained to us what had to be done and what to expect for the recovery period.

They put a cast on him. He chose to get a purple cast. Four weeks later, we went back to the office and changed out to a different cast. Six weeks later, the cast was removed. The next week, my son was playing basketball.

How much time did I spend? How many interactions and who did I interact with? What happened each time? How did I feel throughout this journey?

This is the “patient experience” — it’s the sum of all interactions, shaped by the organization’s culture that influences a patient’s perception across the healthcare continuum. In UX terms, this is the patient journey and all the touchpoints a user had with the system from discovery, (medical) testing, diagnosis, treatment to recovery/management and self-care.

As patients, we focus the patient experience and our journey from a consumer’s point of view:

How often do we consider the other side of the experience? What is it like to be a doctor, nurse, physician assistant, technician — any healthcare worker?

Over the past decade in the United States, more attention is paid to patient experience and patient satisfaction. There has been a rise in patient satisfaction surveys that focus on waiting time, pain management, and the staff and provider’s communication skills. These surveys, called the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), are developed to measure patient healthcare experiences. They are the healthcare equivalent to Yelp.

The lower the HCAHPS scores, the lower the amount of Medicare reimbursement the facility would receive from the government. The scores are tied to the doctor’s compensation as well. For higher scores and a higher salary, providers and staff are more likely to overprescribe medication for pain to “satisfy” the patient who is not likely to have a medical background. Patient satisfaction is not a reliable success metric for good care.

Meanwhile, the US government had a mandate to get all facilities modernized with electronic medical records — the Health Information Technology for Economical and Clinical Health (HITECH) Act of 2009. It was the largest U.S. initiative for encouraging the use of EMRs/EHRs. Going digital was going to improve the quality of care and reduce medical errors. This technology would reduce costs by helping providers make decisions regarding patient care and automate administrative tasks.

But in the past decade, this technology has become a major cause of burnout in healthcare.

In the United States, at least 50% of doctors and 33% of nurses have symptoms of burnout. They are overwhelmed, demoralized, exhausted, cynical, and generally — overworked. They’re the superheroes who save lives yet they have a low sense of personal accomplishment at work. The numbers are higher in other countries: 80% in the UK, 87% in China, and 66% in India. It is an epidemic.

Why should we care?

Burnout has led to:

Burnout has resulted in a shortage of physicians and nurses. Who wants to be on the frontlines of healthcare if burnout is inevitable? Who wants to stay in healthcare if all they’re doing is spending more time in front of a screen than with patients? If people are burnt out, then who’s going to take care of us?

Almost all hospitals in the US have adopted the use of EHRs (electronic health records). That’s great, right?

A rap parody about EMRs by ZDoggMD

“EHRs have killed healthcare.”

Medicine is about human relationships.

Healthcare workers should be treating patients, not screens. How can we as designers help bring healthcare workers back to the patient? How might we give them the tools and autonomy to do their job as they were trained to do? Instead of documenting, let patient notes be about the patients and their charts and conditions, not documentation of the patient’s bodily functions.

How can we let doctors be doctors and nurses be nurses?

How can we as designers help healthcare providers deal with this information anxiety and reduce their cognitive load?

Have you realized this? The issues that they’re experiencing stem from a lack of structure. No one’s paying attention to the information architecture and the content strategy of these systems. How is this information being used? Where is it displayed? What is being used now and downstream?

Information anxiety is when people aren’t given the time or opportunity to transition from one idea to the next. There is no time to understand the information because the information/data is cluttered, disorganized, and disconnected.

That stack of paperwork that was given to me? The discharge summary consists of copied and pasted boilerplate information from various health documentation. Some outdated, some redundant.

Without doing the research and understanding how information is related, structured, and used, we have created information overload and anxiety. We have added to the burden of consumers of that information. We have inherently become a part of the problem that causes burnout. As designers, we may not be saving lives but our work has an effect.

How can we as designers, as information architects, as content strategists, empower healthcare workers to:

…so that they can connect with you, me, and us as patients and friends and family of patients?

Because… at the end of the day… Are you satisfied with your care?

Screencap from Big Hero Six where Baymax asks “Are you satisfied with your care?”

My name is Grace Lau. I’m a product designer at PatientPop and the UX lead for Hospital Run.


The Q&A afterward

What’s PatientPop and what do you do there?

Note that I had never explained what my day job was and what my current workplace was about. I could imagine the audience trying to figure out what the connection was between my talk and my work.

My current work at PatientPop is around building a platform to help small to medium-sized healthcare practices get started on our platform where they can promote their practice online, attract patients, and retain them for life.
As a product designer there, I focus on the customer flow through their onboarding process and support the customer success team.

You’ve gotten us all angry. What can we do?

Be a part of the solution. Do the research. Understand who all the users of your product are — hidden users, secondary users. Design for them. Remember that every person who uses your product needs time to understand, adapt, and use the information from your design. Consider how information is presented for their use now and downstream.

Contribute to HospitalRun. It’s an open-source health information system for healthcare facilities, i.e. hospitals, clinics. Their number 1 M.O. is usability, making sure that their platform is easy to use, customizable to any healthcare environment, can be used offline and even off the back of a truck to treat patients. As the UX lead at HospitalRun, I’m developing a research framework and working to understand the information challenges for a smarter, inclusive platform.

How’s the broken arm?

What can I say? Kids heal fast. The broken arm is now stronger than the other one. He’s playing basketball and swimming.


Grace G Lau

Written by

Information architect / taxonomist / UX researcher-designer based in Greater Los Angeles, California

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