How to utilize design thinking as a mindset to create a solution that can help to enhance inpatient healthcare operations among clinical staff? This case study is an UX/UI research for an inpatient app concept for doctors and nurses. Time to investigate.
Problem — Overwork and Repetitive Tasks
Healthcare workforce faces an overload of work, shortage of staff and poor work-life balance. These issues can lead to declining morale and poor well-being, which can further affect decision-making and influence both the patient’s and staff’s satisfaction and experience. This questions the sustainability of the current workflow models.
Healthcare industry needs to embrace technology as a form of supporting workers and thus enabling more focus on patient-facing activities, shifting from volume-based to value-based care. How could this be possible and why are doctors so overworked? A lot of technology is already being embraced by the healthcare industry with excellent results, but doctors and nurses are still overworked and under-staffed. A general assumption could be that there are so many people and so few doctors. However, looking at the scenario from a more information-based perspective — a lot of daily (administrative) tasks take a heavy toll on the workflow, which is what Newwward aims to solve.
Clinical Staff Need a Supporting Tool to Enhance Daily Workflow through Task Automation and Digitized Care Delivery
- Reduce doctors/nurses workload
- Enhance clinical staff’s workflow
- Scalable and sustainable solution
- Business Goal: Reducing overhead costs and improving clinical staff’s workflow for a better provider patient experience
Newwwarrd is an inpatient care delivery app that enhances workflow through smart patient and task management. Clinical staff have an instant view of their patients information, real-time analytics of their condition, as well as management and delegation of (administrative) tasks. Immedite overview, automation and tracking allows more time for doctors and nurses to prepare and spend on client-focusing activities.
Concept section covers the design process, which demonstrates the research and how the concept came to be, how it works, insights, design iterations, and reasoning behind design decisions. UI design will be covered briefly towards the end, if you’d prefer to skip the design process part.
Why call it “Newwward”?
Giving each concept a name or working title will make it easier to refer to, it’s nicer than calling it “enhancing workflow idea”, “Untitled-01” or “Case” and it can give an extra creative boost (i.e. the cover image of a futuristic hospital complex). Idea behind the name are the words “new”, “ward” and W extending to ”www” as to communicating the Internet and a stable heartbeat. (Although, this name was perhaps also subconsciously influenced by awwwards. Great resource!). That out of the way — Onwards with Newwward.
The design process follows design thinking methodologies as a design mindset in coming up with a solution. However, it should be noted that this process does not include observations, behaviour or expert interviews with the user groups (doctors and nurses), which would be vital for insights and validation, and are the most important parts of the process. This concept relies on desktop research and assumptions. Hearing this, do bear with me and not to dismiss the idea immediately — perhaps it could developed into something more and this concept could be regarded as idea experimentation, and possibly the first steps towards a larger idea, if it would see the green light — the first iteration.
Define & Situation
Defining the problem. Understanding and familiarisation with the situation and industry, especially what is happening in the world of healthcare and technology. Getting a bigger picture of the situation at hand with the initial problem statement will help to further analyse and narrow down the scope to key areas.
Healthcare is one of the largest sectors in the world that can be further divided into diverse industries and sub-categories. Technical developments and innovative solutions for healthcare can provide new business and care delivery models, such as Internet of Medical Things (IoMT). Digitized solutions can enhance the level of healthcare; where timing, details and information can have life-changing effects. However, embracing technology and connecting to the Internet also brings new threats and challenges; information and data security being the top factors. Healthcare industry needs to integrate technical innovation to their workflow, but also adapt to the changing user needs, demands and expectations.
Clinical staff working on reduced time, rushing between patients, overworking with less time for rest and shortage of staff can potentially lead to life-threatening consequences, as well as result in dissatisfied and confusing patient and staff experience. Clinical staff need a digital tool that can help to improve day-to-day workflow.
Research & Discovery
Summary points of selected research insights. Findings are rather broad, as having solely an app might not work alone, but rather having a bigger infrastructure that can support various functions and information in a hospital environment, such as collecting information through wearable devices -> Displayed in the app, etc. Regardless of this being a bit out of scope for this concept, it should be still considered and kept in the subconscious as one of the goals is to create a scalable and sustainable product. For example, extending the system for patients and 3rd party providers (such as insurance) should be considered for future iterations. This concept scope focuses on creating an app solution.
- Patient using a hospital app was found to improve the experience due to convenience. A patient didn’t want to bother a nurse to adjust lights, but was able to do so on an app, which made the patient happy and saved the nurse time for doing such a task.
- Majority of solutions work cross-platform. Cross-platform approach provides more flexibility and enables users having their own devices. Many entities have adopted BYOD (bring-your-own-device) as long as they meet security guidelines. User are also more familiar with their choice of device, which could help to enhance workflow, and reduce time spent on learning new devices, cost factor of acquiring new devices is high.
- Availability of both tablet and smartphone options (and desktop). Having the option to choose between using a tablet or a cellphone (or a desktop) is ideal. Doctors prefer tablets when consulting patients, whereas nurses prefer smartphones according to research done at Beth Israel Deaconess Medical Center. Doctors prefer larger screens due to having the chance to consult patients with images and graphs (i.e. explaining images and developments), whereas nurses responsibilities tend to be more towards the hospital environment and common patient/administrative tasks where a mobile app is more ideal.
- Shortage of highly skilled staff and work-overload is common in care facilities across the globe. According to a research by the American Medical Association 70% of patients prefer direct communication with their physician. Provider burnout can furthermore affect patient care. The face-to-face consultation between doctors and patients is important. Doctors should have more time and less disruptions when consulting patients, a notifications feature might interrupt this consultation.
- From ‘A Mobile, Collaborative, Real time Task List for Inpatient Environments’: “Paper is also a convenient method for most clinicians; the time needed to connect to a network and log in simply to add a task or check off a task as completed is by its nature longer than putting pen to paper. Entering tasks on an electronic device for this inpatient medical team was less efficient for clinicians than their current system of using paper and in person communication. Thus, although the team used Tasklist during the pilot, it did not reduce time spent on creating tasks.” Tablet note taking with a stylus or voice control could help to solve note-taking issues. Solution need to integrate to the workflow and not work against it. Adding and checking off tasks should be easy and straightforward. Commonly occurring questions could be automated.
- Administrative tasks and report creation appears to be the most time consuming tasks at hospitals and several existing apps are using automation and survey-type solutions to reduce time spent on completing these tasks. AI-powered nurse avatars are also being adopted to help with patient data collection. The research findings suggest that future workforce shortages could be tackled more cost-effectively if the efficiency and productivity of clinical activities were addressed through innovative approaches to workforce planning, recruitment, skills development, and technology used. Solving problems in tasks, scheduling, logistics, activities management and automation are a vital part in helping to enhance work-flow. Tracking metrics and getting real-time data on devices can save time.
- From 2019 Global Healthcare Outlook: “An example of AI-assisted workflow management is DeloitteASSIST, a patient communication solution that combines the capabilities of speech recognition, natural language processing, and AI to enable patients to request assistance without the need to press a button. Simply by speaking their request, nurses are alerted to their need, with AI prioritizing and smart-routing requests to the right resource (orderlies, patient support assistants, volunteers) to meet the patient’s needs.”
Existing Apps — What is out there?
Existing Apps and Modules include:
- GetWell Round+
- Paragon Clinician
- FLOW (which is a module part of V-Sign)
App screens or comparison tables won’t be displayed here, but a I’ll describe a brief summary of findings.
Existings apps work cross-platform, which makes the philosophy of BYOD (Bring-Your-Own-Device) possible. Task management and reporting are included in all apps, though the areas of reporting have minor differences. All apps provide a certain level of communication between staff. Survey-style reports are a good way to speed the process.
Empathize & Analysis
Stepping into the shoes of the users and analysing their behaviour and painpoints. Although I want to point again that these are assumptions that would need validation. Initially I analyzed 4 user types 1) Doctors, 2) Nurses, 3) Patients, 4) Management to get a bigger picture of the situation, though to narrow down the scope and make this article shorter, I’ll describe the main user groups 1 and 2, Doctors and Nurses.
User Group: Doctors
User Group: Nurses
I want to know that nurses are following my instructions so I can focus on other issues at hand
I want to have a full grasp of how my patients are doing so I can be ready for possible changes
I want to be notified when one of my patient’s condition changes so I can treat them as fast as possible
I want to have access to patient’s medical notes and history as fast as possible so I can assess and advice patients as efficiently as possible
I want to alert nurses to help me so I can quickly treat a patient that is in critical condition
I want to complete admin work without needing to write down same things all over again so I can have more time for other tasks
I want to know and be reminded what needs to be done everyday so I can work work more efficiently
I want to know what are the vital statuses of the patients so I can be ready for possible changes in their condition
Considerations for ideation:
Task List, Scheduling, Status, Views, Reporting, Accessibility, Collecting, Alerting, Automation / Learning based on patterns.
This step is mainly to go back to assess the original problem statement and reconsider (if needed) whether the inital problem still persists based on the research insights, and choosing a direction for ideation/prototype.
- Creating a solution that easily integrates into the existing workflow and culture (using it in full capacity)
- Security and privacy
- Avoiding information overload
- Easy, clear, fast and intuitive user experience for a vast range of information
- Priotizing tasks, alerts and notifications without interrupting, while being informative
- Responding to alert notifications (who, what, where, why, when, how)
- What tasks can be automated and what needs to be customized or left open to customization
Aiming to declutter less important areas for an ideal structure and user flow.
Defining what is important — internal linking and flow.
The structure describes two main areas: Patients and Tasks, but I’ve left Wards as a reminder for internal linking as without a ward there are no tasks or patients. Ward is needed in the app, but it is not a priority over patients and tasks.
How the users engage with the app
Iterations towards a desirable outcome. Decluttering — What is really important to consider content-wise and from a visual perspective?
Looking at the first idea, which was influenced a bit by Apple Health and Material Design — might be quite a fun approach, but the app doesn’t really need such boxes, it doesn’t have to be fun, and doesn’t go towards the idea of trying to enhance the workflow or what really needs to be seen on first sight when opening the app. This approach gives the users extra steps to finish the tasks they need. In this context the less time the users spends in the app, the better.
There is no need to think about conversion rates, cool trends, exquisite animations, or branding. In an hospital environment, the mindset should be about using it as tool, not as an app for an app’s sake with a large color palette and cute icons. These considerations made me to wonder towards using a more Material Design style approach.
Material Design approach was more clear and went towards the initial goal, and even the colors resembled a hospital environment. However, is this coloring really important? Is it really needed? For a hospital context, the information should be as clear as possible. Thus the last approach aims to be as simple as possible and using colors only where it has a specific purpose, such as red for danger. Branding and beauty aside, the goal is clarity, speed and ease of use. More decluttering was implemented to avoid information overload. I.e. if a patient’s condition is stable, it is fine to not specifically indicate this in the home screen. Through these iterations and reflections the simple light theme was chosen for creating an initial prototype.
Not a completely refined prototype, but initial concept ready for validation before heading towards higher fidelity prototypes. Main areas for validation is the focus on patients and tasks. Thinking further, patients might take importance over tasks in the app. This is not to say at the moment patients are less important than tasks, but it is about what actions can help to improve the workflow. UI Screens only show a mobile app, but the app itself would ideally need both mobile and tablet options. Talking with a patient about their heart rate on a mobile is not the best possible experience due to size, but talking about it on a tablet would be better, though for nurses a mobile version would be more ideal for mobility and task management.
Hospital environment is complex and this concept is just scratching the surface. Perhaps in the future there will be a chance to go more in-depth to creating such a solution and continuing to iteration 2. Would be great to hear any thoughts or feedback, and if there is a reader who is working in the healthcare industry, would be great to hear directly whether such a solution is heading towards a right direction, or whether it should go back to the drawing board. It was an interesting research and hopefully this article can be found useful — this research didn’t have any monetary gains involved and I’m not working on this app as a project, it is merely concept ideation.
Thank you for tuning in!