What Does Care Have to Do with Healthcare?

A Conversation with Tina and Miya
post-Nordes Conference on Care

– By Emily Franklin


I met Miya and Tina for the first time as they were preparing their Journey Mapping workshop for the 8th biannual Nordic Design Research Society (Nordes) conference at this beginning of this month, prior to starting my tenure as their summer intern. They invited me to roleplay the workshop (sort of like a dry run) to work out any last kinks.  

Participants join the workshop at Aalto University in Helsinki, Finland

Participants join the workshop at Aalto University in Helsinki, Finland

This year Nordes centered around care, they explained. Miya and Tina were to present a workshop that draws on innovative design research methods—Journey Mapping probes that encourage self-reflection and storytelling, uncover unmet needs, emotions, delights, and obstacles that can be challenging to capture in traditional research. The Journey Map encourages participants to think of care experiences, not just treatment experiences, to inspire a more holistic image of health. Their workshop expressed the value of narrative tools in healthcare through three activities: First, participants visualized their own “Story of Health” using the Journey Mapping cultural probe. Second, maps were anonymously exchanged, reviewed, and embodied by participants to build empathy. Third, a co-design session analyzed the journey map outputs with a discussion around learnings and value of Stories of Health for stakeholders and communities. 

After being briefed about Diagram’s extensive experience with narratives in healthcare and the details of the workshop, much like the participants would be the next week in Helsinki, I filled out my own Journey Map. I, along with another volunteer, was prompted to think of my own health journey, using stickers depicting familiar objects, like celebratory champagne bottle or a sign indicating a crossroads, as metaphors to enrich our narratives. I was surprised by how evocative my story became, at how, through interacting with the materials, I was able to illustrate an emotional narrative arc. But I was most surprised about how an image—a raft specifically—suddenly became necessary in that moment to my ability to tell my story.  

Now that they’re back from Nordes and I’m officially in the office, I was excited to sit down with them to hear how actual workshop participants reacted to the Journey Map, and Miya and Tina’s take on the conference.  


Emily: You emphasize storytelling throughout the Journey Mapping process, and you offer that patients should be able to view themselves as the protagonists in their health. Can you explain a little bit about why reframing experiences through narrative language may ultimately help patients? And how does storytelling look across different cultures that might use this tool?  

Miya: We had a very diverse audience. There were Nordic people, Americans, a Japanese woman, a guy from South America, a woman from Israel, and through our activities around building a narrativeembodying narratives—which was probably one of the more interesting parts of the workshop where people had to tell their story to someone else and then tell that person's story out loud—and analyzing narratives, we learned about cultural differences in storytelling. One of the participants said, “In my culture, you don't like to share things about your health. It's very uncomfortable.” That was really eye-opening feedback. It told us that, Yes, it does work, but it may not be always comfortable. 

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Tina: I think that storytelling is undervalued in healthcare. We want to be the authors of our own story—it gives us ownership, it gives us agency, and it empowers us. People who oftentimes are in the midst of struggling with a healthcare challenge, or who have been for quite a long time, are never really offered the opportunity to tell their story or given the skill sets to do so. We’re asking ourselves how we can build capabilities in order to write that story, because ultimately that will lead to better decisions. 

Miya: Everybody talks about their health, but then they also talk about other things, like relationships and emotions and daily life, and you realize how intertwined all of that is. In a conversation with a doctor or in a health-related conversation, it's so easy to go to the practical things versus the things that really would help to shape a better experience. 

Emily: You've been doing Journey Mapping for a while, but were you surprised by anything coming out of the workshop? Do you have any new insights into Journey Mapping that might influence your process later on? 

Miya: The Journey Map has always been done at home and as a single person. It was interesting to see how people told their stories differently as a group. For instance, we asked our participants to draw the line of their journey, and instead of just drawing a single line, one woman created this kind of dense, scribbly line. Looking at that, you might say, Oh, it represents intensity, but she said that she drew the line that way because it was about her and her husband together. It meant it symbolized two people going along the same journey.  

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Emily: I hear you mention people going on a journey together, which is not talked about in healthcare. It's a very individualistic industry. Also, you talk about empathy and narrative, things that are often excluded from healthcare conversations. So, I’m curious about why conferences like Nordes, that value the care part of healthcare, are important right now. 

Miya: Nordes was looking at care in many different contexts—social, political, academic, health. The idea of what does care mean is not fully defined. It's nice to have the opportunity to look at care as something that is not just a thing, but also a verb. One of my favorite quotes from Victor Montori from the Patient Revolution is, “Language in industrialized healthcare has made us say things like, ‘We deliver care’ or ‘We provide care,’” and his point is that care is already a verb.  

Tina: It's always refreshing to hear about how people manage health care in other countries, because the US can get so insular about our system and our process. We want to broaden our definition of care and try to garner some inspiration from other sources, and not forget that there are other ways to deliver care, and to care for people or communities or society. 

Emily: Do you have a favorite image from the Journey Mapping probe? And if so, what is it? 

Tina: Right off the bat, there was a lot of dialogue around the cave image—it was a dark cave and I remember people mentioning it and using it a lot. Also the egg! 

Miya: Tina is really great at coming up with these images that people connect with. I initially didn’t want the cracked egg because I thought it was too obvious, but our team really fought for it. It’s funny, an egg can say so much—whether it’s cracked, turned on its side, or upright.  

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Tina: Yeah, the process of developing the Journey Map images can be difficult. You end up scrutinizing the details and it’s frustrating and exhausting. But it is also really rewarding to see people fight for an image, or when some of these images speak to participants. 

Emily: Ok, last but not least, you brought back a lot of candy from Helsinki—maybe in honor of National Candy Month, or maybe by coincidence. Which candy do you like best and which will you not be trying again? 

Miya: Licorice! The chocolate and licorice—I’ve never had that combo before.  

Tina: That was my least favorite. I didn’t even have try it, and I won’t, but I know I wouldn’t like it. I like gummies—anything gummy and anything sour. I like the fake stuff, none of those natural gummies. The texture is weird.  

Miya: I’ve never met a candy I didn’t like. 

New Post by Sean Nazari

For this blog post, our intrepid junior design researcher Sean, wrote a little something about his experience with storytelling at Diagram. Enjoy...

Storytelling For Impact

In March, I joined Diagram as an intern. I came to this small, healthcare-centered, design research studio wanting to find some way to intersect my background in academic research with healthcare product development. Though armed with a background in scientific research and writing, I knew coming in I’d be entering foreign territory. My vision was to convert my science-oriented knowledge into marketable products. What I found was that in order to build better healthcare solutions, I needed to uncover the root of the problem, starting with the patient first. I quickly learned that communicating the needs, challenges, and desires of patients in order to better develop products and services for them, meant carefully crafted storytelling, a staple for the work we do here at Diagram.

In my previous life of research, information is published in peer-reviewed journal articles in a way that is easy to retrieve and can be readily duplicated. Collected data is presented in a standard format that has developed over the past three centuries: Title, Abstract, Introduction, Methods/Materials, Results, Discussion. I was encouraged to present all the pieces of information so that readers with similar knowledge could make a decision for themselves based on the hypothesis, backed up by the phenomena observed. I could let the data speak for itself.

When I think of narratives and stories, noir films come to mind. I enjoy these movies for their complex and intricate plots without being complicated—a single thread that I can latch on to. I think of Chinatown, L.A. Confidential, Who Framed Roger Rabbit. I think of the line, “Just find the girl, Mr. Gittes.” I think of Rollo Tomasi and saving Toontown from Christopher Lloyd.

At Diagram, I’ve learned it’s essential to communicate a narrative through the eyes of a patient so that others can understand the “why” and “how.” I realized I could apply the narrative elements that I’ve always loved to communicate the challenges that patients face every day. Finding a memorable quote, painting a real portrait of a person, uncovering conflict, and revealing idiosyncrasies are some of the hooks that pull a story together. Using these elements helps me to communicate patient stories in a way to build empathy and ensure that the design of future products and services addresses how people feel, think, their values, motivations and what challenges them. 

There is a myriad of ways that clever storytelling highlights different information. Instead of simply dumping data onto the audience to figure out, good storytelling requires me to synthesize the data and information, think about the message I want to convey (what the patient story really is), and consider the narrative sequence to highlight the components that will make the story memorable and actionable.

Being grounded in data has always pointed me in the right direction. But now, incorporating narratives into my work allows me to translate information in a way that guides and inspires others to design better products and services. I find myself getting drawn more towards this ability of creating a bigger impact and change. I have come to realize that storytelling is a better way for me to communicate ideas and keep a unique perspective that supports and defends the patient experience.

A new Diagrammer!

We're growing! Welcome to Jennifer (Jenn) Bai, our new Design Manager. We've known Jenn for quite some time and we're excited to have her join our team.

Jenn, another Californian turned Brooklynite, is excited to join the team at Diagram. She spent the last 5 years at Johnson & Johnson’s Global Strategic Design Office on the research and strategy team, applying human-centered design across the enterprise. Jenn had a windy career trajectory but found her home in bringing together her creative eye, practical business mind, and an intuitive understanding of and interest in people. She believes strongly in the power of design to positively transform our experience of healthcare – an area of huge opportunity and an even huger need. Jenn also spent the last couple of years at J&J in a Credo lead role, fostering studio collaboration and engagement in the community. More than anything else, Jenn sees the potential for improvement in everything and works hard to bring that potential to reality.

When not racking (or wrecking?) her brain, Jenn tries to stay active and explore new restaurants, art shows, and places to see. She recently got into practicing yoga by way of a sweat-dripping, hip-hop bumping yoga studio (not your hippie, granola type) and just got back from a fitness retreat in Tulum, Mexico to reset her body and mind. You can probably find her trying out the latest healthy, bowl-centric restaurant (hi, Dimes), planning an excursion out of the city (upstate, anyone?) or starting a dance party pretty much anywhere.

We've been published!

How exciting is this? Just in time for summer reading "Healthcare, Disrupted" has been published and a project that we've been working on is in it!

For the last year and a half, we have been working together with Digitas LBI's Digital Innovation Group and AstraZeneca to build a digital coaching service for people recovering from a heart attack:
"AstraZeneca, is partnering with Vida Health, Inc. to offer an app called 'Day by Day' designed to help cardiac patients connect with coaches who will encourage them to follow through on their doctors' recommendations after they are discharged from the hospital, and in between visits to the doctor's office. For AstraZeneca, the app (which does not bear its name) will provide a way to track how well patients follow their medicine regimens when recovering from a heart attack or a cardiac operation. And it will work with other companies' drugs as well as AstraZeneca's offerings. So while AstraZeneca might not derive an exclusive benefit in terms of increased drug sales through 'Day by Day,' the app will provide valuable information that will facilitate AstraZeneca's push to create a care platform for patients with chronic illnesses."

We have been very involved with this project helping the team to prototype and iterate the end product. Since the beginning they have understood the need to continuously co-design with the end users throughout the product development process. We are very proud of the final output and excited to work together to evolve and expand its reach.

We've got 2 new team members!

We'd like to welcome our 2 new team members. They've been with us for about a month now, and we're super excited to have them. Introducing...

Lan Nguyen

Lan comes to human-centered design by way of cognitive neuroscience research and six years of nonprofit consulting experience. She previously served as Outreach and Engagement Consultant with Move to End Violence, a 10-year initiative to support the movement to end violence against women and girls. Prior to that, Lan worked at Boston University’s School of Medicine conducting eye-tracking experiments to study language and cognition in people with Williams Syndrome. Most recently, she worked as a design researcher at Veryday, a global design and innovation firm. 

Lan is currently designing her year with Experience Institute, a master’s level program based in apprenticeships and real-world experiences. She previously completed DESIGNATION, an intensive design program focusing on UX, UI, and front-end development. Lan received her bachelor’s degree in cognitive neuroscience from Amherst College and studied in Copenhagen, Denmark through the Denmark Institute of Study Abroad as part of the Migration and Multiculturalism program.

When not thinking about community and design, Lan likes to go rock climbing, take photos, or nerd out about things like Delaunay triangulation. 

 

Sean Nazari

 

Sean hails from beautiful Los Angeles, CA and is excited to be part of the amazing team at Diagram! His professional interest lies in developing products and services in healthcare and working on creative, socially impactful projects. As a researcher, he’s worked for UCLA on studies looking for therapies to reduce cognitive impairment in neurodegenerative diseases.

When he’s not researching, writing or brainstorming for Diagram, you can find him: catching classic film noirs, cooking Thai dishes (only the best for Sean), satisfying his sugar cravings via pies and doughnuts (sweet treats prove to be his kryptonite), rock climbing or cycle touring for the eleventy-bajillionth time.

2016, already?!

Whoa, another new year? Says everyone over 35. 

Health coaching for patients and caregivers

We’ve recently been working with the Digital Innovation Group (DIG) and AstraZeneca on an exciting new coaching service for patients and caregivers. Day-by-Day is a service that provides emotional and practical support to equip heart attack patients (and their caregivers) in making healthy lifestyle changes. Ultimately, the goal is better user engagement and improved health outcomes.

Over the last 8 months, we’ve been collaborating with the DIG/AZ team to co-design the service with patients, caregivers and HCPs. We’ve been employing methods such as in-home interviews, prototyping, roleplay, workshops, and beta testing to fully understand challenges and design an engaging user experience. From the start, the team has embraced human-centered design to identify opportunities, unmet needs, behaviors, to define the user experience and we’ve been thrilled to lead the co-design efforts! A partnership with Vida’s coaching platform will launch the service. Read more about it here.


Drumroll…

Welcome to our new intern!

Gina has actually been here for about a month now, and boy are we glad.

Here are her own words:
A New York Native, Gina is a quirky designer excited to work at the Diagram Office. She is currently a MFA candidate for Design for Social Innovation at the School of Visual Arts, where she is working on projects around the topics of autism and inclusion. When she’s not drowning herself in work, she loves museum hopping, attempting to master her penny board, or having Netflix marathons.

Random facts: Enjoys rainy days, Has attachment problems to her dog, Piper, Obsessed with Serial podcast, Teal = favorite color

In our words she’s awesome.
She even made a cute little GIF as her intro.

We’re looking for talent, so if you’re interested hit us up. (and no, we don’t ONLY hire people with 4 letters in their name. We are EOE. 5, 6 or 7 letter names will also be considered)

Happy Holidays,
Diagram


Good things come in threes.

We’ve been pretty lucky to have been a part of 3 pretty cool things recently.

In June, we opened the Institute for the Future’s Health Horizons 2014conference. This conference focused on living longer and aging well. Our panel, called the “Design Thinking Jumpstart”, lead a group of very forward thinking individuals through an interactive immersion of best practices and insight seeking methods in how to design for aging populations.

Secondly, we received a fellowship from the Public Policy Lab, a non-profit, organization that is working with the Department of Education. We were pretty stoked to share our methods, and what we know about human-centered design and apply it in the education sector.

And lastly, we were a part of the New York Restoration Project’s Resilience in the Public Realm workshop. This is a multi-year initiative to improve quality of life in one low-income, New York City neighborhood. The goal is to create an open space network designed to disrupt cycles of poor health and entrenched poverty by transforming vacant lots, parks, community gardens, medians, housing developments and sidewalks holistically.

Pretty neat stuff, eh?

Stay tuned. We’re working on some website tweaks including some job openings here at Diagram!

Diagram + MIT Hacking Medicine Hackathon

Last weekend we had the privilege to be selected to participate in the MIT Hacking Medicine NYC Hack-a-thon. If you don’t know the MIT Hacking Medicine group, you should. They are a smart team that puts together hackathons to help create solutions for healthcare (and were recently written up about in the Wall Street Journal!).

We formed a team with someone in hospital administration and a cardiologist and prototyped an app that aims to reduce hospital readmissions in the first 30 days post-discharge. All in a weekend! It’s called Cahoots. We are so happy for the experience and we won a prize for best presentation! Very exciting.

So now, we’ve got a great idea that we’re working hard to develop and hope to launch into a pilot by the end of the year. We’re looking to build out our team with a developer and/or engineer, so if you’re interested in working on a great project reach out to hear more about Cahoots.

Happy Spring,
Diagram

Join us!

It’s almost Spring, right?

We’ve been trying to stay warm by working away in our studio and only going out for the necessary provisions (see, beer).

And now with Spring right around the corner, we’re looking for people to collaborate with!

  • A technologist- this should be a person who has familiarity working with startups and new product development; some technology related business experience preferred. Open to anyone awesome
  • A software engineer- doesn’t need a ton of experience, but be able to work with us and contribute their expertise to an existing project; builds are fairly simple but should be open minded; the ideal trifecta would be 1. a smart programmer, 2. has a love for working with designers, 3. is interested in entrepreneurial ventures

If you are or know any of the above, please get in touch!

Lastly, check out the one sheet that we’ve created to share a little more about what we do here at Diagram and pass it along to your friend, eh?

Diagram, out

Happy 2014

Welcome to the new year, says everyone.

We’re very excited for new opportunities, new collaborations and new healthcare changes. Our experience with design has been one with lots of cross-disciplinary teamwork. With this, in 2014, we’re pushing to talk to anyone and everyone who believes that there is opportunity for change in healthcare. Right now, we’re brainstorming new models for doctors that will allow them to engage in more meaningful ways with their patients. Our hypothesis is that this will sustain patient loyalty and lead to increased adherence. We need more brains! Want to get in on the discussion? Shoot us an email.

Patiently waiting,
Diagram

In Review

Autumn is in full tilt and so are we. What have we been up to you ask? Here’s the rundown:

  • Met some interesting people at a Health 2.0 meetup at Emblem Health. Healthcare is all the rage (thanks obamacare!) and we wanted to check out the conversations that were happening
  • The School of Visual Arts has also started and I’m (Tina) teaching the second term of graduate thesis in the Design for Social Innovation Program. Teaching has been a fantastic experience. It’s caused me to remember what it was like to be a grad student and be able to talk to my teachers about their work and hear their stories. Miya came in last week and took over the lecture hour to give a quick and dirty lesson on behavior design (a la BJ Fogg)
  • Been meeting up with some “blasts from the past” people over at Renoleum and BioLite to name a few
  • We made (and unfortunately lost) our submission into the Knight NewsChallenge. We thought up of a little idea called Patient Zero, that takes information in aggregate, and visualizes it, to help track and prevent the flu. It’s under a creative commons license and we’re going to continue to develop this, because we love the idea!
  • Submitted some work for a challenge put on my Eli Lilly, that focuses on re-designing clinical trial information for patients.
  • Just got back from the Quantified Self Conference where we got to catch up on our favorite data mongerers and enjoyed watching, listening, and talking to individuals and groups who are looking at what is interesting in biometrics- some of our favorites were Dr. Paul Abramson, an MD running his own quant-friendly practice that uses patient self-tracking as a way to change behavior and Doug Kanter over at databetes who’s really working hard at trying to make diabetes data simple and easy to use.

Lots of fun!

In addition, we’re working hard on putting some visuals up on our site now that we’ve got some things that we can share, so stay tuned for some new additions.

As always, reach out (info at diagram office dot com) if you want to chat by phone, email, skype, etc… better yet, come by and we’ll have a beer.
Until next time,
Diagram

Open Ideo Challenge + Mayo Clinic

We’ve just submitted an entry into the Open Ideo Challenge that asks: “How might we all maintain wellbeing and thrive as we age?”

This felt right up our alley as it is being put on jointly with the Mayo Clinic and addresses how to help the growing aging population remain healthy into their older years.

We started by considering the current needs and challenges that we know and understand and applied our own narratives to make the ideas come to life. One unmet need that we see emerge time and time again is the frustration of adult children and helping to manage their parents’ care from afar. Another unmet need is the challenges of older patients to make confident and informed decisions. To address these needs we imagined a tool that enables older patients and their adult-child caregivers make more confident treatment decisions together, be more involved in their healthcare, and build the skills to better the conversations with their physician.

You can take a look at our wireframe submission here. Join the community, “applaud” us and take a look at the other submissions from around the world.

Its not official until you’ve had a party. (or announced it on fb and linkedin)…

So here’s your invitation. We’d love for you to come, give you a hug, and talk about your hopes and dreams.

We started Diagram because we believe that design can change healthcare. Our work focuses on the translation of user insights into products, programs, and services that improve healthcare experiences and better patient outcomes.

See you there,
Diagram


Hello World

We’re excited to announce the official launch of our website! If you aren’t already, follow us on twitter or visit us here to keep up to date on our adventures. Occasionally we will be posting our work as well – at least the work that we’re allowed to share…

We’d also like to give a special shout out to 2 fantastic guys:Tim O’Donnell, who created our beautiful identity and Dan Lee who developed this here website that you’re reading right now!

Until next time, Diagram out.