Collaboration, Accessibility, and Inclusion: Applying Lessons Learned from a Year of Remote Work
By Taylor Cook
The COVID-19 Pandemic forced the Design Institute for Health, like offices around the world, to suddenly adjust to working remotely. It was stressful, awkward, and hard — really hard. But we pulled together, learned new tools, got our home offices and Zoom backgrounds figured out and settled into new routines.
For designers, working remotely isn’t just about where we work. Good design is based on connecting with stakeholders, developing empathy for their experiences, and fundamentally understanding the humans that we are designing alongside. In the course of the last year, we shifted the majority of our research, workshops, and co-creation online as well, and we got really good at it.
In January of 2021 things were starting to transition again. Health care providers at Dell Seton Medical Center were getting access to vaccines, staff at the Design Institute for Health were eagerly awaiting our shots, and the possibility of working in-person was starting to peek over the horizon. It was at this time in early January that we started on a new project with Dell Seton to improve Transitions of Care between the inpatient and outpatient settings. Improving these hand-offs is critical for reducing readmissions and getting better health outcomes for our patients. It is a difficult, systemic problem with a diverse and complex network of stakeholders, which will significantly impact the lives of the people Dell Medical School serves — in other words, the kind of project that we live for!
Starting this project when we did afforded the Design Institute for Health the opportunity to return to some in-person work with our partners while continuing the day-to-day demands in our remote, virtual workplace. While we are ecstatic to see people again, our team took a moment to reflect on how we worked during the height of the pandemic and think about what benefits our remote tools and methods may continue to bring to this design project and others.
Digital tools can save time and foster more collaboration.
In the last year whenever we needed to work on something collaboratively, we turned to the white boarding tool, Miro, and we have grown to love it. While hand sketches are still a good place for initial thinking, putting draft work in Miro gives us the opportunity to quickly share work in progress with the team and partners for feedback. The partners we work closely with typically have adopted the tool in their own work as well. Joseph Joo, a medical resident on the team, developed a wireframe in Miro for feedback and rapid iteration. Another upside includes the ability to make changes easily and we save time on digitizing. Lastly, if we are presenting or sharing a digital version in a virtual workshop, we don’t have to troubleshoot printing issues, thus potentially preventing significant re-work and helping us avoid painful time crunches.
We recently met with our partners in a hybrid working session to get input on our discharge process map. This artifact will depict what we have learned the steps that different inpatient and outpatient providers take to create a successful transition and how patients experience their care through all the stages of the transition journey. This is a complex process influenced by unique combinations of providers, facilities, payers, medical conditions, and the circumstances of each patient. The session included seven participants in person with three facilitators and two online participants with a remote facilitator. We had maps printed in the room and a version on Miro that was projected real-time where the virtual attendees were working. This structure resulted in less transcribing and memory-based revisions after the session for the project team.
Opportunities for Continued Learning: While Miro is good for collaboration and drafting, we have found that really polished final versions may need to be created in Figma, Illustrator, InDesign or other more focused graphic design products. Faster also means we can’t take advantage of a slower manual process that, by its nature, forces us to be immersed in the content and thinking. We have built in breaks and time to intentionally slow down periodically, but we’re still working on processes that don’t trade reflection for productivity.
More people can participate in workshops when we have online options and it is often people that we may not otherwise hear from.
Online sessions are more flexible and easier for attendees to work into their busy days. This improved accessibility is an obvious benefit. Less obvious is whose participation is enhanced. In group sessions, we typically end up scheduling around the invited participants at the highest point in the org chart, with the assumption that their schedule will be the most difficult to coordinate. In the hospital this is most likely to be a doctor. By having virtual options we are finding that we can include more stakeholders from different disciplines who bring more diverse and extremely beneficial perspectives to the work.
Our project partners have observed more multidisciplinary participation in meetings during the pandemic when they relied on virtual meetings. Dr. Chris Moriates, Assistant Dean for Healthcare Value, observed that “while we all miss meeting in a room together, we have seen more engagement in many of our Zoom department meetings and educational sessions, reaching multidisciplinary participants at different clinical sites and with more diverse perspectives.”
By making meetings more accessible and inclusive we are benefiting from the perspective of new frontline providers who focus on helping patients with some of the social determinants of health that traditional providers have not been able to provide. An example of this kind of inclusion is shown when Brenda, a Community Health Worker, shared a recent experience with a patient in her care in a mapping meeting with stakeholders.
Opportunities for Continued Learning: It is more work to make two complementary facilitation plans; one virtual and one in-person. On the Transitions of Care project we are fortunate to have the resources on our team to do this but if we had a smaller team we may have to make other choices or have multiple sessions. The topic of enhanced interdisciplinary collaboration also merits further examination: If we noticed value from enhanced collaboration as a bi-product of virtual sessions, a necessary change during the pandemic, what benefits would we see if we intentionally strove to increase input from all types of providers and stakeholders?
In research, more flexibility means more insight.
When it comes to understanding our patients, we have traditionally worked from the perspective that in-person is best so we can include observations made in their home or work environments. While these observations can lead to important questions and key insights, a year of virtual research across all of our projects has reinforced the value of a simple conversation in any form. And, just like we have found that virtual work sessions are more accessible and inclusive, when we are open to input from patients in a way that is flexible and comfortable for them, we get a broader range of input.
In the Transitions of Care project we interviewed a handful of patients so we can include some of their experiences and barriers in the discharge process map. We were able to meet with some in-person but our last two interviews were over the phone. One was a busy small business owner who wanted to tell us about their care but may not have been able to talk to us if they couldn’t have taken the call from their truck between jobs. The other was a person who was only comfortable speaking with us in Spanish, and no one on our team is fluent in Spanish. We were able to use the same remote translator service that Dell Seton Medical Center uses for its providers to conduct this interview and hear from someone we would have not been able to speak with if we prioritized in person observations and interviews.
Opportunities for Continued Learning: We had the opportunity to test interviews with a virtual translator in this phase of the project and have input from a voice that otherwise would not have been included at this stage. It’s obvious that this workaround did not give us, the English only interviewers, the same nuance and understanding as it would have if we were speaking the same language directly with the patient. While this particular project has been provider-oriented, it is critical that we include multiple fluent Spanish speakers on our team if we reorient to patient-focused work in future phases. Otherwise, our ability to create inclusive and effective designs is severely limited.
This pandemic has shown that we can still collaborate with our stakeholders and produce high-quality projects even when we can’t be physically together. By combining in-person and virtual methods we have learned some strategies that can also serve to make our projects more inclusive and accessible. On the Transitions of Care project, we recently put these learnings into practice by hosting a hybrid workshop to engage people across Dell Seton Medical Center so people could join in whatever way worked best for them. We believe that this increased attendance, participation, and interdisciplinary representation- as a result we will have better solutions for our partners and will demonstrably improve patient outcomes at Dell Seton.
The fact that we might de-prioritize in-person and observational methods in favor of varied modes of accessibility and broader inclusion is a small but potentially impactful shift for the Design Institute. We’re hoping that it can be an enduring, positive silver lining that comes out of the challenging chapter that is COVID-19.
