When asked about my line of work, I talk about the project I’m currently working on. It’s fresh (if not dominant) in my mind, and often results in some conversational common ground.
But one project alone doesn’t describe the variety, or the common thread — people.
There’s a good reason for the saying to ‘check your biases at the door’ – carrying assumptions and your own worldview into any situation will influence the way you experience it, even how you behave. But these viewpoints can work in our favour, too.
Design research in a hospital environment is super rewarding. You’ll reveal a wealth of insight and opportunity to improve patient experience but face some unique challenges, especially when interviewing patients at their bedsides.
With a few of these projects under my belt it’s time to share, in case you’re ever in the humbling position to do the same. (yes, more humble pie)
My top tips for patient experience research:
This work will squish everything you’ve got in your soft skill set. You’ll be relying on your instinct for what’s ‘right’ and ‘polite’ in the circumstance. I think doctors call this ‘bedside manner’ …you’re going to need a good one.
Be considerate – happy hour or not.
It goes without saying to be sensitive to this context.
You’re asking people to share their thoughts or story when out of their comfort zone and feeling vulnerable, emotional, philosophical or all of the above. Try to relax patients – make them comfortable, offer to top up their water, pass things, adjust curtains, charge their phone.
I prefer to ‘cold call’ on patients at their bedside, inviting them to share their experience on the spot. This lacks the certainty of ‘appointments’ but adds in-the-moment authenticity you simply don’t get if you give people the chance to collect their thoughts and arrange themselves in advance.
A chatty, social ward is a good place to find stories.
Each ward or room has it’s own atmosphere, from patients trying to sleep while machines gently beep, through to chat and laughter of visiting families. You’ll need to quickly read the mood and adjust your tone and approach to suit. Pick a lively, social ward and you might find patients are more willing to participate. (but beware of the bias this introduces).
While you’re building empathy for each patient’s circumstance and viewpoint, some of their emotional load will shift to you by osmosis. This is a sign you’re doing a great job of listening, but be ready for emotional exhaustion at the end of each day.
To avoid becoming a patient myself, I start necking immune boosters and vitamin C the week before this work and wash your hands frequently during each day.
It’s essential ward staff know who you are, and what you’re doing in their working space. I’ve always had a chaperone who’s known and trusted by the staff introduce me and the project objectives. Without this, nurses will be suspicious of who you are and what you’re up to.
“Hi, I’m Nick, and I’m not a doctor”
Patients will assume you’re clinical staff, a specialist, or coming to discharge them, so get any expectation out of the way as part of your greeting.
Ward staff will point you to the most appropriate patients to talk to, and those to avoid.
Ask staff to suggest which patients are appropriate, and not appropriate to approach. This can save embarrassment for you and patients if they are not completely ‘with it’.
Maintaining eye contact and looking for non-verbals is essential in this context. You’ll need to record each interview and review later, or bring a note taker.
If it’s your turn to take notes, sketch-noting works very well for feelings, emotions, environmental factors etc. and is super easy to socialise later.
Patients love to see what all that doodling was about, and will elaborate on aspects given the chance.
Here are my top tips for sketch-noting during an interview:
Ask for permission to interview the patients after discharge in their homes. The in-context interview will be revealing, but you’ll hear a different perspective and mood when they reflect on their in-ward experience.
Cameras are an even bigger distraction than usual on a hospital ward, so if you’re filming interviews (and it can be very compelling footage in this context) conceal your camera until you have each patient’s permission to film.
Clear audio is a priority. Patients in a shared ward will tend to whisper out of respect for privacy of others, or so as not to be eavesdropped. Go for a wireless lapel microphone or at least a directional one.
The contents of my hospital kitbag are sparse compared to this lot for home visits. (image from my article in link below)
Check out my article ‘Ethno unpacked – A design researcher’s toolkit‘ for details of the gear I use.
Oh, and one more thing…
The more I work in this context, the more I feel like a newbie, and there’s much more to learn.
What have I missed?
What are your experiences?
The second half of the year was no less exciting with client work, but was boosted by the buzz of my own product hitting it’s stride in the market.
From July to December: Home brewing, TV, Mr. Tappy and Motorhomes.
Here goes…
Location: Portland, Oregon. Micro brewery capital of the world.
Client: imake / (Part of the Better by Design programme).
Portland is the world’s capital of micro breweries and craft brewers. Visiting with imake’s team from NZ, Australia and USA, we stepped inside the garages, basements and minds of craft brewers, aiming to understand what makes them tick, and how they approach brewing.
My role as part of Better By Design is to help build design capacity within NZ export companies like imake. In many cases this starts with understanding customer needs, so getting out in the field like this was a perfect first step towards customer empathy.
In Oregon, I briefed the team on how to get the most from contextual interviews, supported them in the field, then coached them through collaborative analysis.
A deep dive into brewing culture, but my satisfaction came in that it was the client team who drew out the insights and identified opportunities for marketing and product development.
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Client: SKY TV.
Location: Around NZ.
A classic contextual study in homes around NZ to understand how TV fits into people’s lives and how? / when? / where? / why? they get their fix.
Having run studies like this for BBC and SKY in the U.K. back in the late noughties it was super interesting to see shifts in consumer expectation and behaviour. Back then it was ‘time-shifting’, now it’s ‘omni-screening’. From devices to content sources, this felt like a ‘snapshot in time’ in the dynamic landscape of TV.
Insights from this project fed into new product development and an upcoming redesign of SKYTV.co.nz.
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Client: My alter ego – Mr. Tappy.
Location: My kitchen table, and 30 countries.
Yes, from kitchen table to global tech giants in 2 years and just 700 easy steps.
My side-project, Mr. Tappy, (a product I’ve developed to help film people interacting with mobile devices) continued to surprise me with sales to the point where I can nearly hear myself blush when I see my list of customers.
Taking this product to market has been a humbling learning curve for me. Even when working alone I find myself being design, marketing, sales, distribution, customer service, etc., discovering how easy it is to work in silos and lose customer focus – Something nobody can afford to do, especially when your customers are expert product evaluators.
Having ‘skin in the game’ has resulted in greater respect for my design research clients‘. Running day to day operations, and shipping product is challenge enough let alone keeping an eye on customers. This first hand experience helps me understand my role as a design researcher with each client.
The entire product is made right here in NZ (some in my home workshop) and the next iteration will ship with a purpose designed HD camera.
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Client: Tourism Holdings.
Location: Australia and NZ.
We’ve all been stuck behind one on a hill on the way to the beach, but what’s it like to buy a home, and a vehicle at the same time? We set out to find out.
I worked alongside Ed Burak, THL’s lead experience designer to provide research muscle on a project around motorhome sales. Motorhome buyers are a fairly relaxed bunch, usually at retirement age and with some time on their hands, but buying one of these rolling holiday homes is not always a holiday.
From a few dozen interviews with owners, buyers, salespeople and experts, we poured our insights into a customer journey map highlighting parts of the buyers’ journey where the experience could be improved.
… and as you’ll see, some of my illustrations for the journey map were verging on the autobiographical. Yes, the waves were always like that in my memories.
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…What’s next?
All the talk of holidays and time away was perfect timing for the end of 2013 and inspired me to use the caravan (which was once my office) a few times over the Christmas period. Good timing.
If you missed my previous post, here are the first four dream design research briefs from last year.
Be careful what you wish for.
When I moved from design into design research, I dreamed of projects like these. 2013 was the year they arrived.
Contexts ranged from hospitals to homebrew, motorhomes to mobile devices, television to truck driving.
I was repeatedly humbled and surprised by the people I worked with, both research subjects and my client collaborators.
As much as I’d love to write a blog post from each, 2014 is in full swing, so…
Here are the first four of eight standout projects:
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Client: CDHB.
Location: Christchurch, NZ.
The most sensitive environment and subject matter I’ve worked with so far.
I worked with hospital staff on wards and at patients’ bedsides to capture in-patients’ emotional responses to the experience of their stay.
After discharge we visited patients and their families at home for a reflection on the experience. A clear picture emerged, of what matters to a patient, from environment, to information to service, and their associated feelings. Together, the team formed key design principles to meet the emotional needs of patients.
In some interviews I used live-sketching to capture notes, It was fun so I wrote a short article about my technique, with ‘top tips’.
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Later, in a GIANT warehouse, I helped lead a series of ward design / prototyping exercises with a super diverse set of stakeholders – from cleaners to clinicians, anaesthetists to architects.
I worked with a team of anthropologists and architects from Seattle-based design agency, NBBJ to facilitate full-size prototyping and simulation exercises, using cardboard for walls, medical staff and actors to test various scenarios of use.
Those cardboard walls in the photos are a system called Mockwall designed specifically for spatial prototpying.
Since then the CDHB team have taken the prototypes through to a convincing level of detail where they can be validated through ‘almost real’ use. You can watch a short video showing where they’ve come to.
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Client: Blackbay.
Location: Virginia, USA.
I was dropped into Richmond, Virginia and the world of the long haul trucker. As I found out, Richmond is smack in the middle of the Interstate 95, the busiest highway on the east coast, connecting 15 States.
My role was to capture the voice of the driver, the way they communicated on the road and the information they handled along the way.
Big rigs, 53 foot trailers, truck stops and the dedicated ‘tribe’ whose mantras were either ‘live to drive’, or ‘drive to survive’. After a few days of interviews I was talking their language of lumpers, spots, hooks, dead-heads and bob-tails.
I worked in classic diners and freight depots, alongside product managers to inform the design of plan an app to let drivers spend more time eating up highway and less time worrying.
Yes, the app is called No Trucking Worries
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Client: Tait Radio.
Location:Christchurch, NZ.
To help Tait adopt a user centred approach to product development I planned and facilitated a rapid ‘learning by doing’ user centred design workshop focussing on installation of their in-vehicle radio systems.
This was a hands-on capability-building activity focussed on a specific project with the idea they could roll out the same approach on other projects.
I coached the team around research and analysis techniques, then took them through to prototyping and testing their concepts with their live customers.
I loved seeing engineers dig deep to define customer needs, then work together with plasticine and pipe-cleaners, receiving valuable feedback before moving designs forward.
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Location: London, UK.
Client: UK Government.
“What is the purpose of your visit to the UK today sir?”, became what is the experience of travellers entering UK borders?.
This was a dream opportunity to work in airports, a context I’ve always been intrigued by.
Unfortunately, with my curiosity at it’s peak a week into this project, the project timeline shifted and I couldn’t eat into my next project in NZ, so frustratingly found myself experiencing the NZ border entry earlier than expected. …Maybe another time.
The rest of the year saw me into the world of craft brewing, TV, motorhomes and wrangling supply chain, sales and distribution with my own side project, Mr. Tappy. I’ll save all these for Part 2.
How do you share stories collected during dozens of interviews?
What if your ‘Customers’ are actually patients in a hospital?
…Rather than take notes and quotes, why not sketch it ?
Let me explain…
Collecting patient stories
I’ve been part of a team mapping the ‘patient experience’ through a hospital. The foundation for the project is collecting stories from patients in context.
This means interviewing patients at their bedside in Emergency, on wards and later in their homes. The context can be sensitive and the content emotional.
The scale of the work means a raft of interviewers and large number of interviews, each with their own style. The stories have been so rich, diverse and engaging that working to a note-taking template went out the door…
So I began to experiment…
Getting sketchy
At one patient’s house I began sketching her story freestyle, in real time, as she told it.
My partner steered the conversation, while I scribbled furiously with a fat marker and a flipchart on my lap…
Below is a segment of about the first 15 minutes of an interview:
I’m glad I tried it
I’ve spoken before about the power of visualising research findings, and particularly sketched visuals over polished.
A sketch on the project room wall is very accessible, so gets a lot of eyeballs – great for sharing the story. As well as a standalone artefact, It can be a great prompt for discussion – As you talk others through it, somehow the context and tone of the conversation comes flooding back to you. It’s not quite video, but it does bring the story alive.
Try it yourself…
Here’s a ‘Top 10’ …Some starters from my experience:
Give it a try…
This is something I’ll definitely be doing again, trying not to be admitted to hospital myself from marker pen fume inhalation.
Over the last couple of years I’ve been lucky enough to be involved in the R&D programme for a ground-breaking medical device to help diabetics manage their insulin treatment.
Part of the project was to reach a regulatory milestone, which has now been achieved.
To reach this milestone we tested the usability of the device to prove it was intuitive and the design prevented people from giving themselves a mis-dose or even fatal dose of insulin.
It was amazing to work in this ‘high-stakes’ context with so many facets to the user experience:
Aside from having my eyes opened to the world of diabetes and being humbled by the courage of the people I met during the research, …it’s been so satisfying to see design research deliver such a tangible impact.
I worked in conjunction with London User Research Centre and with Design Science in Philadelphia.
All too often, I’m working on one aspect of a product while valuable insights emerge relating to other areas of the broader customer experience.
Classic example: A website usability study generates feedback around physical product, brand, delivery, billing or in-store interactions.
In theory this offers double or triple whammy for the sponsor of the project. …but not always in practice.
…In some (often larger) organisations, each channel of the customer experience is ‘owned’ by a separate department, and there’s no guarantee insights will be shared with those who can use them to improve their part of the product or service.
In a welcome change I worked with a bite-sized firm where it was possible to actually ‘get everyone in the same room’, for industrial, web, marketing, packaging designers and copywriters all able to benefit from each round of research, acting on insights relevant to their design process.
Swiftpoint, a nimble Kiwi start-up were well aware their customers would interact with more than just their website, or the physical product.
I ran several streams of user research, covering all customer touch-points, knowing every insight would be put to good use.
…A refreshing change to know each part of the team could have their part of the customer experience informed by the research.
Here’s a step-by-step case study to reveal the approach I took.
Anyone else had similar experience getting this level of buy-in with small teams? … or better still, with departments in larger companies?
