Case Study: NYULH Service Design Project
Background
Healthcare is a fundamental human right. All individuals should be able to have access to various types of medical services at all times, whenever, and wherever. With this in mind, healthcare is not experienced equally by people, and healthcare issues relating to discrimination and equity still remains a pressing issue in our society.
In this case study, NYU Langone Health FuturePractice lab sponsored my service design class at NYU Tandon on a project that covered patient experience for sexual and gender minorities.
The initial problem statement was:
How might NYULH improve its patient experience to be more inclusive, supportive, and positive for people who are transgender, nonbinary, and genderqueer?
This problem statement was a very generalized and broad problem statement, but it gave my team the opportunity to conduct in-depth research about the hospital system to identify an area to hone in on and reframe.
Research
Secondary:
The first steps taken were to conduct research on the healthcare experience for our end-users. My team and I did not have much prior knowledge about this beforehand, so we utilized many government health sites, nonprofits scholarly articles to build our understanding. In addition, we also wanted to learn more about the current systems and practices put in place at NYU Langone to better understand what is currently being done in terms of the experience of being welcoming, inclusive, and supportive.
Transgender, nonbinary and genderqueer individuals fall under a population referred to as sexual and gender minorities. This community of people are subjected the most to difficulties and disparities within healthcare. They are stigmatized for their identities and as a result, there is a lack of proper healthcare knowledge, resources, education, and care. And within the hospital experience, the SGM community is subjected to discrimination. It is estimated that nearly ¾ of transgender patients have had a negative experience where they may have been refused necessary care, refused to be touched, had the provider use excessive precautions, received verbal and physical abuse from a provider, or been blamed for their health status (Relias Media). An overall feeling of overwhelming fear and anxiety is prevalent when having to receive healthcare because of these challenges.
In regards to NYU Langone, they offered several gender-affirming and LGBTQ health services. All relevant information was found on their Transgender Health website, Transgender Surgery Services, and Caring for the LGBTQ+ Community.
Services include:
- Hormone Therapy
- Surgical Care/Gender-Affirming Surgery
- Rehabilitation (post-surgery)
- HIV testing
- Preventative healthcare
- Mental health screenings and treatment
- Transgender care for adolescents
In addition, NYU has been a recipient of a perfect score on the Health Equality Index by the Human Rights Campaign. The score reflects “their policies, programs, and sense of responsibility for lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ+) patients, visitors, and employees” (NYU Langone).
This secondary research allowed us to understand what problems could be occurring within a hospital system and what NYU offers and has done on their end for the patient experience for our target users.
Research Issues:
A challenge that was faced was finding someone to interview that was transgender, non-binary, or genderqueer that preferably had some healthcare experience. My team and I did not have any contacts within our personal network and reached out to some student groups and organizations but did not receive any responses or volunteers. We then looked on social media and looked for if anyone had posted about their experience. On Facebook, I came across a transgender woman named Arielle Rebekah who posted in April 2021 about receiving bottom surgery at NYU Langone. While browsing her social media pages, I was able to see that she was a writer, influencer, and activist and hosted a podcast titled “Trans and Caffeinated”. In one of the special edition episodes, she talked about her experience. This podcast would then serve as a creative way in our research process to gather information about the patient experience.
Podcast:
A podcast episode from the podcast Trans and Caffeinated documented the podcast host’s experience and journey in receiving bottom surgery at NYU Langone. Some key insights from this podcast included that it is a mentally challenging process throughout. The podcast host faced suicidal, depressive, and intrusive thoughts before the surgery and struggled with the process afterward as well. She also highlighted how there is a lack of knowledge and resources about post-surgery; what happens after surgery, what do I do with my new organ?
Stakeholder Map:
A stakeholder map was created to help better visualize and synthesize some of our findings regarding who has an impact and a relationship to a patient in the hospital who is transgender, nonbinary, or genderqueer.
Interviews
The stakeholder map also served as a resource to find people to interview. We specifically looked at individuals within the direct circle since they played a significant role in patient experience and could potentially provide first-hand accounts. Our secondary research mainly provided what the hospital provides but we wanted to use these interviews to understand where underlying problems could be.
Through utilizing the NYU Langone website and personal contacts, two interviews were conducted.
Our interviewees included an NYU Langone Student Nurse and the NYU Langone LGBTQ+ Clinical Coordinator/Patient Liaison.
Interview 1: NYU Langone Student Nurse & Student Extern
Role:
- A fourth-year student at Rory Meyers College of Nursing, coursework includes doing clinicals at NYU Langone (specifically Kimmel hospital)
- Has some experience working with Transgender/Gender Affirming Health in clinicals
Insights:
- Wouldn’t know where to refer a transgender, non-binary, or genderqueer patient if they needed a specific resource
- Lack of education in LGBTQ topics and sexual identity (both in nursing school and hospital)
- There are onboarding modules but they’re more focused on safety and precautions
Key Quotes:
- “We know the basics of things, but we still need to be taught more…we can go beyond that because the care a patient receives will reflect that”
Interview 2: NYU Langone LGBTQ+ Clinical Coordinator and Patient Liaison
Role:
- Help LGBTQ+ patients navigate around the hospital system
- Educating staff on LGBTQ related topics; has helped revise hospital policy
- Helping patients post-surgery issues ranging from mental health to physical health
- Help refer patients to primary care doctors
Insights:
- The role is extremely stressful because there is one of him
- Could get up to 50 calls a day
- Oftentimes, patients get redirected to him from patient relations
- Thinks that the current websites are an insufficient resource, can be improved to be more informative
Key Quotes:
- “People come to me because they trust me”
- “NYU is great but there is still a conservative old school thinking”
- “It’s still not great, but that thing (website) needs to be redesigned and rethought”
These two interviews were extremely insightful as they provide us with two key insights that reflected a problem that could affect the patient experience with someone who is transgender, nonbinary, or genderqueer.
The two key insights throughout all research were that hospital employees might not be educated enough which can impact an interaction and that the hospital’s current websites provided for this group of people was lacking in structure and information.
Our group decided to hone in on the website since more resources were available to approach this problem and we could create a higher fidelity solution. In addition, an improved website would have still an impact on education for employees.
NYU Transgender Health Website
We choose the Transgender Health Website as the site to redesign as it is the first website on search engines when searching for information related to someone who is transgender, nonbinary, or genderqueer. In addition, it had the most relevant information available.
When looking at the website again, it was looked at in the context of redesigning it. We specifically examined areas and touchpoints where it could pose a potential problem to the patient experience.
Key Findings:
- Contacts: the contact information for the support team had no images of the individuals and had no actual information for getting in touch with the respective employee
- Inclusivity information: there is a lack of information relating to hospital policies and resources relating to their commitment to the patient. It is not welcoming and does not really establish that they cared about the patient
- Requests: besides calling a phone number, there is no other place to ask a question or make a request
- Resources: the website only included services that are offered. There are no additional links to relevant hospital websites and resources.
- Information Architecture: a lot of the information is within the home page and not related to each other. The information is not well sectioned out.
Reframed Problem Statement
After our first round of research that included secondary research and interviews, pinpointing a specific issue that affected patient experience, and conducting further research on the issue, we were able to craft a more refined and specific problem statement.
Reframed Problem Statement:
The NYULH Transgender Health website does not translate to a welcoming and well-communicated health care resource for transgender, non-binary, and genderqueer individuals.
Looking at other websites
Before creating our for a redesigned website, we looked at other websites. Other hospitals that had websites about LGBTQ+ health and gender-affirming services were also researched to conduct a comparative analysis with the NYU Langone Transgender Health Website to see what other key features and information could be implemented to an improved site.
The sites that were researched were:
- UPenn LGBT Health
- Mt Sinai LGBT Health
- University of Michigan LGBT+ Health
- UChicago Gender Confirmation Procedures
- NYC Health + Hospitals LGBTQ Health
Key Findings:
- the home page has an emphasis on inclusion
- hospital documents, resources, and other links related to patient rights and policies
- accessible PDFs that contain relevant information are linked in the homepage
- hospitals that performed well on the HEI have a dedicated section that is highlighted
- separate tabs for different types of information
- services offered at the hospital: aftercare resources, LGBTQ+ resources
Prototype
Based on the NYULH website audit and audit on other websites, we were able to create our own prototype for a new and improved informative and inclusive Transgender Health website.
Prototypes Issues:
One challenge presented was prototyping to maintain the style and branding of the current page. Due to time constraints, starting from scratch was not feasible. To make designing the User Interface an easier process, screen captures of the original website were taken so that the foundation was laid out already. Information and sections that were going to be edited were photoshopped blank.
Home Page:
- the home page has an emphasis on inclusion through linked resources and text that helps create a welcoming and trusting experience
- more tabs for information to be seamlessly found and navigated to
- a printable patient guide to have easier access to key information
Support Page:
- contains images of the support staff as well as hyperlinks to contact them
Resources Page
- a separate page to access additional hospital resources; resources include patient resources, staff resources, post-surgery resources, LGBTQ resources, etc.
Next Steps
Due to only having a little over a month to work on this project, there were a lot more we wanted to include but did not have the bandwidth to do so.
Some ideas we wanted to implement:
- Developing a system for requesting additional help/requesting a callback
- More sub-sites for sectioned resources: LGTBQ+ Health sites should all be seamlessly connected: possible “hub” site to create a more streamlined system
- PDF patient guide
Comments and Feedback
After pitching to the NYULH FuturePractice team our idea and the research and process behind it, the idea of redesigning the website to be more inclusive and well-communicated was received well. They commented on the storytelling throughout, the unique research methods and how we were able to find interviewees, and the well-done execution of the final prototype. They noted that the reframe within our presentation was smooth and logical and noticed the significantly more informative and inclusive design of the prototype in comparison to the current website. One piece of feedback in regards to user testing on the website and incorporating it in the next steps since we were only given a very limited timeline.
Lessons Learned
- One lesson I learned through this project was that acquiring interviews is not an easy process. In total, we reached out to several people and only ended up with two interviews in the end. A lot of people are busy and don’t have the time to be interviewed and our challenges definitely reflect this. Moreover, it is important to use your student “card” because it serves as an advantage since most people will not question you.
- To piggyback off the last lesson, the next lesson I learned is to utilize all the resources available to you and be as creative as possible. In my Design Thinking class, one research method I learned was “Social Listening” which was to see what the discussion was on social media about your problem. I utilized this skill to help me find the podcast. In addition, for the prototype, I had used Figma before so I took advantage of that to create the improved website.
