Sprint Five: A Brighter Future — Research, Insights, & Reframing
Greetings from sunny Naples, Florida!
Optum’s senior leadership was kind enough to invite us to attend their quarterly business review, where we were able to present and discuss our initial research findings with about 20 executives. We were thrilled to have such a warm welcome, and opted to start our 9 a.m. presentation with an interactive exercise.
Synthesizing Research + Trip Prep
Prior to our trip to Naples, our team was fast at work synthesizing what we’ve learned through different research methods. To do this, we leveraged dovetail to meticulously tag the interviews and conduct a large affinity mapping exercise, revealing one core theme: cognitive overload.
Our project centers on physician burnout — caused largely, from what we’ve been able to deduce thus far — by cognitive/workload overload. The physicians we heard from echoed common, consistent sentiments about their workload (too much to do in too little time) as well as the general lack of support that their digital tools provided (too much clutter, too many clicks, lack of knowledge in the world).
Empathy Exercise
In order to give our ‘participants’ (Optum executives) a small glimpse into the daily lives of the physicians we heard from, we developed an empathy exercise meant to induce information overload. Using this exercise as a conduit to introduce ourselves to the team a little more, we each presented four slides on ourselves — with accompanying, purposefully ill-designed slides — before giving the group a pop-quiz on what they heard. Realizing that they would need to recall certain facts from the plethora of information just presented, one participant commented, “my heart is kind of racing right now.” What we weren’t able to simulate from our analogous exercise was the criticality surrounding physicians’ work; forgetting what Sophia’s astrological rising sign won’t hurt anyone (she’s an Aquarius rising, if you were curious), but forgetting what patient needed a prescription refill might.
What are some of the design and cognitive principles we wanted to show?
Lack of Redundancy — Important information, alerts, and required actions are often not reinforced through multiple cues.
Lack of Information Hierarchy — Critical information is not made salient, with the presentation of information obscuring what was or was not truly important.
Rapid Task-Switching — The human mind cannot really ‘multitask’; we rapidly switch between tasks, with the fluency of return indicating how easy it is to return to the primary task after being interrupted.
Engaging Multiple Resources — Multiple Resource Theory suggests that the human mind has a limited amount of cognitive resources; when multiple tasks are done in parallel, the more similar they are (such as writing notes while speaking, related to language processing), the more likely overall performance is to suffer.
Research Insights
Cognitive load — and its direct link to physician burnout — emerged as the overall ‘thesis’ within our work. Loosely branching out to key three areas — information processing, workflow friction, and psychological stress — we were able to categorize many of the quotes we pulled out from our interviews within these themes.
Walk the Wall
Engaging the Optum executive team with a ‘walk the wall’ inspired activity, we had about 30 quotes printed across the walls of the meeting room, and encouraged the Optum team to walk around the room and think about how they might begin to categorize them.
As they “walked the walls,” we asked them to consider the following key questions:
- What seem to be the top workflow pain points for physicians?
- What are common themes around burnout that seem to be emerging?
- What gaps exist in the current workflow?
- How do these learnings relate to what you’ve seen in your work at Optum?
- What was most surprising to you?
It was rewarding to see the amount of questions and conversations that this exercise prompted. While the overall sentiment roughly amounted to ‘none of this is terribly surprising, we know that the current state of clinical digital tools is not great’, it was powerful to be able to instantiate these quotes within real, lived experiences.
What We’ve Learned (so far)
A major effort that we’ve been working on has been consolidating the various anecdotes that we’ve heard from physicians regarding their average workflows and experience with digital tools into an overall (clinical) Journey Map.
We identified three primary work streams related to a typical patient visit:
Pre-Work — This is the time that physicians spend prior to beginning their overall work day. While most physicians mentioned reviewing their schedules and checking their inboxes, we often heard that this critical morning period was often spent catching up on work from the previous day(s).
Patient Visit — The patient visit compromises the main ‘human-human’ interaction, supported by an ecosystem of additional nurses, physician assistants, and digital tools (EMRs, Clinical Decision Support Systems, Computerized Provider Order Entries, etc.) We found a range of variations regarding the sequence of this work stream from provider to provider, as well as the relative scope of work put on the physician (largely determined by the support provided by the overall clinical care team).
Post-Visit Work — As nearly all of our physicians reported an inability to complete all of the required work during the patient visit (data entry, orders, referrals, etc.), much of this work was left to any time that was available post-visit. This residual work — multiplied by the amount of patients seen — left a significant amount of administrative tasks to be completed during the physicians’ lunch break or in the evenings. The term ‘pajama time’ was mentioned repeatedly in regards to when many of these tasks were ultimately completed.
Feature Prioritization
We ended the day with a final fun, future-oriented activity with the initial question: What are you Optum-istic about?
After synthesizing our research insights, we had developed 8 storyboards as our conceptual prototype, which directly related to information processing, workflow automation, alert organization, and data entry.
To prioritize these concepts with stakeholders, we gave each of our participants $75 worth of ‘Optum bucks’ and asked them to decide which of the eight storyboards we created — each inspired by some of the workarounds or common pain points we heard through our physician interviews — they were motivated to invest in.
We counted the votes and — tied for first place with $180 each — were “AI Clinical Decision-Making” and “Voice-to-Text Solutions.” We’re excited to get to work prototyping and testing these solutions in the next sprint!
