January 24, 2019

DESIGN. CLEAR! A designer’s insights from the back of an ambulance.

DESIGN. CLEAR!  A designer’s insights from the back of an ambulance.

As an industrial designer in the medical field, and an EMT (Emergency Medical Technician), I’ve been lucky enough to combine my passion with my career. My training as a designer has helped me to uncover the needs of the people I design for. However, caring for patients in the back of an ambulance helped me develop a deeper appreciation for the nuances worth focusing on that lead to innovative outcomes. Here are few thoughts on how to avoid some common pitfalls that limit discovery of those insightful gems and maximize the potential of good design decisions.

THINK FAST, FAIL FAST, AND MOVE ON

When an EMT receives a call, it’s all about rapid problem solving. You get a lot of practice developing swift critical thinking skills and an investigative mindset. The rhythmic process of analysis then synthesis to assess and treat patients fine tunes a person’s ability to frame the problem quickly, connect the dots, and decide on the best intervention. EMT training is laden with assessment and treatment algorithms; these types of mnemonic devices create shortcut cognitive maps that accelerate your ability to learn, think, and act. If things don’t go right, the mnemonics mentally ‘hyperlink’ you to the next set of questions or processes to keep you moving toward a solution. Here is one example:

Primary Assessment ABC is used when conducting your initial assessment of a patient at first contact to identify life threatening issues.

  • A: Airway: Look, listen, and feel for open airway.
  • B: Breathing: Check quality and rate of tidal volume.
  • C: Circulation: Determine heart rate , quality and rhythm of pulse, assess skin color, moisture and capillary refill.

Constant training coupled with experience binds these ‘shortcuts’ to muscle memory, and eventually, execution becomes as reflexive as your elbow covering a sneeze. Yet every patient is different and every call unique. There’s a lot that can trip you up, and if you’re not prepared, time is wasted, and your response is delayed.

To put things into perspective - A 911 call comes in, you’re dispatched, arrive on scene, protect yourself with gloves/masks, size up the scene, and get to work. You’re in assessment mode, asking questions and looking for clues to figure out what’s next.

  • If it’s a patient with shortness of breath, what other clues indicate why? Are there Asthma inhalers? Cigarettes? Known allergens? Do they need an epi pen or 6 liters/min of oxygen?
  • If a patient is spurting blood from his/her thigh and shows no sign of breathing, which do you treat first to give them the best chance?
  • Is a patient slurring their words because they are having a stroke, had too much to drink, or exhibiting signs of hypoglycemia? What do you do?

As it turns out, EMT problem-solving techniques are a great mental work out for design thinkers too. As product designers, we are on the lookout for compelling insights to inform our work, much like EMT’s. Strong investigative skills coupled with a willingness to scan wide when exploring a subjects’ landscape can be an advantage, but only if we are efficient and suitably impactful with breaking down the problem. Like working as an EMT, problem definition and prioritization is of utmost importance. Luckily, product designers have some handy mnemonics too .

AEIOU is a great design research categorization tool to codify data and get to a better understanding. The mnemonic represents key elements to focus on in the field and sets the stage for analyzing and observation to better understand the event. Through this categorization, relationships can be discerned, and fresh conceptual thinking can be introduced, setting the stage for design teams to synthesize something new.

AEIOU FRAMEWORK

  • A: Activities: Goal-directed sets of actions—paths towards things people want to accomplish. What are the modes people work in and the specific activities and processes they go through?
  • E: Environments: The entire arena where activities take place. What is the character and function of the space overall, of each individual's spaces, and of shared spaces?
  • I: Interactions: What is the nature of routine and special interactions between people, between people and objects in their environment, and across distances?
  • O: Objects: Key elements sometimes put to complex or unintended uses (thus changing their function, meaning and context). What are the objects and devices people have in their environments, and how do they relate to their activities?
  • U: Users: Whose behaviors, preferences, and needs are being observed. Who is there? What are their roles and relationships? What are their values and prejudices ?
  • And sometimes T: What are the specific tasks and time ?

Companies strive to collect data in one form or another to stay connected to their customers. Collecting this data doesn’t necessarily reveal what to do or make though. The pitfall often encountered is spending too much time hung up on learnings that don’t bear fruit, contributing to a lack of follow-through with analysis and synthesis showing the way forward. It’s not easy to get right, especially when working through problems with multiple stakeholders and broad ecosystems of products and services with no clear solutions. The ability to ask the right questions AND coalesce a vision forward is what’s needed. Having some ‘mental shortcuts and handy hyperlinks’ to call on can be a good idea. They’ll help your learning agility and keep the momentum needed to unwind those wicked problems. Without a reliable framework for getting to the root cause and casting a vision forward, the steps to follow will likely become an exercise of misguided judgements; the results will show, and opportunities will die.

GET OUT OF YOUR OWN WAY

The scenarios EMTs encounter are as varied as human beings themselves . When working closely with patients, it becomes very apparent how our world views can influence the ways we respond, especially when experiencing life’s more challenging moments . Solely relying on our own lens can obscure the bigger picture . Decisions and judgement that impact a person’s well-being need to be met with cool-headedness and clarity. An empathetic approach is very important. Practicing self-awareness and checking your bias at the door can help achieve a more authentic view.

Imagine you’re an EMT responding to an alcohol-induced domestic disturbance in which a male is being verbally aggressive toward a female. What’s your initial reaction? What experiences, mental models, and feelings do you impulsively project? What assumptions do you make about this individual? Once on the scene, you learn they are husband and wife who lost their son in a car accident a year prior. What comes to mind then ? As an EMT you can’t go in with an agenda or judgement, with practice you learn to ACCEPT it for what is , put your script and society’s conditioning aside, then focus and help. Whatever feelings you have, they are yours; don’t let them get in the way. Emotions are tempting and can lure you away from asking good questions and discovering illuminating facts. Often there is an underlying truth to be learned, exposing it will inform the way.

The example of the husband wife is based on an actual event. Inexperienced responders might have concluded a simple overnight dry-out in the ER or jail might have been the best answer. But the probing questions and thoughtful approach of this particular first responder team allowed them to extend assistance for both their grief and alcoholic dependency, ultimately having a potentially better long-term effect for both people involved.

Product designers go to great lengths to empathize and understand people’s needs. When conducting ethnography, users will often respond with the ‘WHAT’: how they define the problem and the better ‘thing’ they’d like to have to solve it. The key is to know not to stop here or get hung up on your own assumptions as to ‘WHY’ the problem exists in the first place. Getting to the ‘WHY’ is what reveals the underlying story - the root cause-potentially inspiring a more relevant solution, or a way of bypassing the issue all together. This is what potent insights are comprised of. What’s learned is woven into conceptual exploration to ensure the new design delivers the value it intends .

I’m not the first person to write about the power of empathy in the design innovation space. It’s a well-established tool for getting at the ‘WHY’. It’s basic emotional ability but a skill that needs honing nonetheless. There’s a great book by Dev Patnaik, “Wired to Care,” that’s worth a read for anybody who wants to dive deeper into its relevance in the innovation space. Following all the good research practices and design thinking methods can be a worthless exercise if you don’t know how to observe and learn without an agenda and ‘get out of your own way’. I always know I’ve hit ‘opportunity gold’ when initial assumptions are called out through unbiased insights and the design team’s thinking transcends to a new, more authentic place.

BE A GOOD SHEPHERD

As an EMT, you’re one of many touchpoints along a continuum of caregivers. You, your family, friends, first responders, Medics ER doctors, PA’s, nurses, medical techs, and others all play a role. With so many handoffs, it’s easy for vital information to be lost in translation. It’s like the game ‘telephone’ where what’s whispered to the first in line isn’t what’s revealed at the end. According to an article in EMS World, 70% of hospital related events causing death or physical and/or mental injury involve bad communication. 50% of those mistakes occur during patient handoff. The WSJ reporting on the issue referred to it as “the Bermuda Triangle of healthcare .”

To mitigate the risk of errors occurring during handoff, healthcare organizations adopt standards to alleviate problems associated with communication between HCPs. One such model is SBAR (Situation, Background, Assessment Recommendation). First used by the Navy and aviation industry, it creates a framework for quickly conveying a holistic view about a problem, the underlying context, current state, and the analysis for what to do next. It’s an efficient way to frame content, tell a brief story about the patient’s needs, and advocate for them along the continuum of care.

  • S: Situation: Identify the general problem and any focused priority.
  • B: Background: Focused history of present issue/injury, prior care, and relevant history.
  • A: Assessment: Key findings and vital signs, including the patient’s current state.
  • R: Recommendation: Identify the patient’s immediate needs, if any.

James Best Leading a Design Meeting

Not unlike advocating for patients, designers need to know how to effectively advocate for ideas. The best way of doing so is by always keeping people’s needs front and center. There’s a lot that can get lost on a project as business, engineering, and manufacturing weigh in. And as a designer, working across multiple disciplines, you’re in a unique role to keep the team focused on what matters. Supporting ideas by referencing uncodified facts and compartmentalized criteria is too disjointed to convey a vision that everyone can rally around. It’s easy for people to misunderstand and overlook parts they don’t own . Good ideas die on the vine all the time, because they were unable to navigate the twists and turns of development and resonate with decision makers. A good designer can make sense out of visual and interactive artifacts, but good design leaders are good storytellers, consistently making clear connections between design decisions and the underlying insights that deliver value and give the work a reason for being in the first place. If you can do this, you’re an effective advocate and someone who can shepherd a vision to the people who will benefit.

PEOPLE FIRST

It’s good to be curious. Having varied interests widens your exposure to new things and keeps your inner student sharp . Working in the healthcare innovation space and having both a design and EMT background has been beneficial for me professionally. The two jobs could not appear more different, yet, the underlying principles within each profession are, at their core, the same. Both jobs exercise proficiency in a single fundamental practice: understanding people and their needs. It’s not a – one – size – fits - all world. People vary with how they think, feel, make decisions, live, and interact with the world and the artifacts that permeate their lives. Whether you’re providing medical care or designing a medical device, it takes skill and an ongoing practice to be able to serve people in a thoughtful way. The willingness to take on the perspectives of others engenders trust so that we might better address people’s needs with products and services that deliver value through meaning, and designs that make these connections ‘clear.’

References

Tags: User centered design Product design Medical device design

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