a safe space.
A healthcare redesign attempt to empower patients with a history of trauma and improve patient-provider communication.
PROJECT OVERVIEW
Context
Preventative healthcare for sexual assault survivors has shifted towards a less compassionate, more procedural approach, emphasizing checklists and standard interventions. This trend can re-traumatize survivors, especially during invasive procedures like pelvic exams, exacerbating their already higher rates of anxiety and PTSD.
Role
Product Designer
Timeline
Oct - Dec 2023
Team
4 Designers
About
Academic Project @ UW
RESEARCH
Doing the groundwork and desk research 👩🏻💻
In order to structure our surveys and interviews, we needed to discover existing information to establish a foundational knowledge when it came to sexual violence which included identifying existing resources, statistical data and demographics, and how practitioners currently conduct their procedures in clinics.
WHAT WE FOUND
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Nurses receive SANE training (Sexual Assault Nurse Examiner) as part of their profession.
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People who have experienced sexual violence in the past can identify as either a survivor or a victim.
RESEARCH · QUANTITATIVE
Understanding the problem through surveys
With a limited amount of time for our project, our goal was to gather a breadth of data across 3 target user groups. This way we ensured had a diverse participant pool and could look at the problem from multiple perspectives. It was important to us to gain a holistic understanding of the problem.
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4 survivor/victim respondents
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7 healthcare professionals (including residents and interns)
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healthcare educators (unfortunately, there were no healthcare educator respondents)
RESEARCH · QUALITATIVE
Identifying opportunity by talking to our users and digging deeper
Building upon the surveys that we conducted, survey participants were given a choice to participate in a semi-structured virtual interview. In addition, we reached out to individuals outside the survey who volunteered their time. We wanted to gather more qualitative data with depth to our research and learn about victims' and providers' experiences in a more personalized setup.
We conducted 6 interviews (3 providers and 3 survivors), out of which I completed 2 of them.
WHAT THEY SAID
WHAT WE HEARD / PAIN POINTS
Exam rooms are cold and uncomfortable and patients feel uncomfortable due to the physical space and doctor's tone
Providers and patients alike are uncertain about the provision and understanding of trauma-informed care.
Patients often enter appointments feeling uninformed about their rights and unclear on what to expect from exams.
Providers have a patient-quota to meet each day and hence, feel rushed and short on time
Care is fragmented across different providers and therapists, thus hindering holistic care
Providers lack training in trauma-informed care during their medical education, necessitating self-directed learning to create supportive spaces.
DEFINING DIRECTION · PRELIMINARY ANALYSIS
Scoping out education on trauma-informed care, provider-patient consultation time, and provider soft skills
Addressing a few of the pain points around adequate trauma informed training would require changes on an institutional level, disrupting structures in place, and a revamp of the quality of trauma-informed education providers are given, all of which are unfortunately outside the scope of our domain:
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Revamping trauma-informed training for healthcare providers
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Addressing consultation and patient time constraints (providers are often running against the 20-minute appointment time limit, which affects how they offer care.) Providers also must meet clinic requirements and see multiple patients a day.
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Healthcare practitioner soft skills such as offering empathy being sensitive to their patient's needs and working under the assumption that every patient experiences some form of trauma
AFFINITY MAPPING
Working through all the data
We transcribed and synthesized all the data gathered from surveys and interviews into our digital dashboards for easy analysis. By affinity mapping the responses around shared themes, we were able to identify key problem areas.
UNDERSTANDING THE USERS
Who are we designing for?
Through the research, we gained a better understanding of who are users are, as well as their frustrations, wants, and needs. Those who will be directly impacted by our solutions fall into two main categories:
01 Survivors/Victims
Patients seeking preventative care, particularly those with a history of sexual trauma.
02 Healthcare Providers
Doctors, nurses, and residents who directly interact with the patient, provide care to the patient and conduct exams in the room.
REDEFINING THE CHALLENGE
Now that we had a thorough understanding of our user's needs, pain points and our scope, we revisited our design question to make it more specific.
Design Question
"How might we help healthcare providers create physically & emotionally safer spaces for trauma victims during their preventative exams?"
274 DATA POINTS LATER...
Turning insights into concepts
We took insights from the affinity mapping and explored potential solutions
CONCEPT IDEA #1
How might we make patients more informed about what to expect from their upcoming appointments and avoid surprises during their exams?
Redesign the appointment booking process to give patients the necessary information and help them learn their rights before the appointment.
Why could this work? We discovered that the most prevalent issue that survivors would like to change in the patient-doctor interaction is having more time to be walked and talked through the process during exams. This solution focuses on a core need of survivors for patient choice and autonomy and through the additioal, create a more prepared and informed patient and provider within the constraints of a 20-minute block, therefore setting a safer space during the appointment itself. Because the portal explicitly asks these questions, it not only can lessen the shame felt by survivors about feeling uncomfortable during routine exams, but can also give the provider information that can help them adapt to the patients’ individual needs. Integration: Involves a few changes and redesign of an already existing patient portal when patients book an appointment for a wellness visit.
CONCEPT IDEA #2
How might we help patients feel more psychologically and physically safe in the exam room?
Optimize the physical space in the patient room through the integration of smart technology and physical elements such as calming colored walls, heating pads etc. to increase a patient's sense of comfort and safety.
Why could this work? During our research, we discovered that survivors and victims experienced varying levels of discomfort during their appointments. One participant described the patient room as “ freezing, inappropriate, uncomfortable, I had a cloth…” indicating extreme unease and vulnerability. This idea informs the complexities of creating a trauma-informed space through the integration of physical and digital element. We proposed integrating elements to bring comfort and safety in the forms of calming colored walls, heating pads, lube warmer, seating below the patient’s eye levels and a Comfort Box that aids in sensory overload such as stress balls and similar objects that can feasibly be disinfected for sanitation purposes. In addition, this idea also integrates smart technology with settings manipulated via tablets owned by the clinic and utilized by the patient such as temperature levels, room lighting and the option of calming ceiling projections and hospital approved aroma diffusers. The ideas’ strengths lie within the elemental changes such as the Comfort Box and having the healthcare provider always be lower than the patient. Therefore certain changes can be implemented almost immediately for patient rooms.
CONCEPT IDEA #3
How might we bridge fragmented care and the communication gap between different providers and therapists?
Create a centralized patient profile that can be accessed and dynamically updated by various healthcare workers providing care for a patient to get all the providers on the same page.
Why could this work? Providers mentioned how due to fragmented care, "things might completely get dropped and lost, or if it is being asked again and again by different providers, this can be retraumatizing for patients." The intention, thus, with this solution is to give providers the option to add their prime takeaways from each appointment and cumulate them in a “clinical notes” section, where providers can add new notes, pin the important/recent or relevant information, and add any additional comments to notes written by other doctors in order to integrate information. This also avoids the possibility of retraumatization and saves time on the providers’ end during the appointment on gathering any details on the patient’s history of trauma and background.
REDEFINING DIRECTION · SCOPE
Deprioritizing designing for fragmented care
After ideating and conceptualizing designing a centralized provider platform, we quickly realized that this solution:
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could be a feature or project of its own
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and to understand how our solution could be integrated in real life, this would require us to create or gain access provider portal, which was not possible (unless we chose to get certified in medicine 👩🏻🎓...)
Given these constraints, we chose to prioritize prototyping design solutions for redesigning the appointment booking process (idea #1) and optimizing the physical patient room (idea #2).
WIRE-FRAMING
Mid-Fidelity Wireframes
Usability Testing
We asked 7 users to navigate booking an appointment. Our objective was to test:
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Discoverability of necessary information about exams they are due for
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If patients can seamlessly understand their rights
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If the verbiage is intuitive
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How they felt when they entered accommodation information
However, not everything went seamlessly. As we expected, there's always room for improvement.
REDESIGN · DESIGN IMPROVEMENTS
Task #1. Selecting Appointment Visit Type
Task #2. Viewing Information About Exams
Task #3. Viewing Patient Rights & Responsibilities
Creating a brand identity
We opted for calming and neutral tones of green that bring forth a feeling of warmth, comfort, safety, guidance, and peace.
Finally getting it right!
We identified the main three stages of a patient's journey and designed an integrated set of solutions that work in tandem.
Pre-Exam
01 Redesigning the Appointment Booking Process
The design focuses on patient choice and autonomy by allowing them to:
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pre-select exams they want are ready for
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get the necessary information on why they need to take the exams
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receive information on accommodations they can ask for
The optional disclosures page asks the patients clear questions, so they can:
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choose to disclose any history of trauma before the appointment
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ask for accommodations that can make them feel more comfortable
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can help providers adapt to a patient’s individual needs
Pre-Exam
02 Redesigning Patient Check-in
At the check-in desk, in addition to signing required forms, patients get:
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2nd walkthrough of what to expect during their appointments
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reminded of their rights and resources + ask for further accommodations
Hence, patients walk into their appointments better informed.
During-Exam
03 Optimizing the Physical Space: A Smart + Safe Patient Room
This solution integrates physical elements with smart technology. Patients can:
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Control temperature levels, and room lighting, and choose calming ceiling projections and hospital-approved aroma diffusers via tablets owned by the clinic.
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The intention is to have the healthcare provider always be lower than the patient and make the patient feel physically comfortable and safe.
Comfort Box
Calming colored walls and a comfort box containing stress balls, heating pads, lube warmer etc. brings further comfort and safety and can aid in sensory overload.
Post-Exam
04 Patient Feedback Form
A post appointment feedback form to collect feedback on how a consultation went (what went right? What could’ve been better?) and keep it on file will further personalize a patient’s experience for any subsequent appointments and help providers assist patients more effectively.
Looking Back...
MY LEARNINGS
🌍 Value of gaining holistic understanding of problems
As unique as a user's needs can be, they don't exist in isolation. Speaking to providers and patients allowed me to look at the problem from multiple angles and propose more balanced solutions.
⚖️ Balancing user needs with constraints
After conceptualizing a design solution, I switched to an engineering perspective to assess its integration with existing systems. This approach enabled us to define the project's scope and propose solutions viable for both business and development.
❣️ Empathizing with patients and providers alike
We had some difficult, but very informative conversations with patients and providers. However, talking to them also made me realize that the communication gap exists not because of providers' capabilities, but rather due to the tools, inadequate training, and faulty structures that are in place.
WHAT COULD HAVE BEEN DONE DIFFERENTLY + FUTURE WORK
🔨 Opportunity to address more issues
Understanding patient experiences has been challenging, and we kept patient-needs at the forefront. However, more effort is needed from physicians. The development of soft skills for trauma-informed care is not standard in medical education, leading to significant variability in physicians' knowledge. Thus, enhancing trauma-informed care training for physicians presents a crucial opportunity for improvement.
🧩 More Usability Testing
Ideally, I would have liked to conduct more usability testing of different user flows to refine the design on a more granular level and fill in any loopholes.