UX Case study : Understanding a wicked problem, the French Public Healthcare system
Ironhack — Project 1 : Wicked problem
Our client was the Public Healthcare system.
We spent 8 days on this project.
2. Problem Statement
This was the initial brief :
“Technology is changing the way we interact with each other. Many processes and tasks that required a long time to do in the past are now a matter of clicking a button and voilá!
As the public system incorporates technological solutions to big infrastructures, our experience as citizens should see that change too. How Might We transform the end-to-end experience of access to public healthcare ? From requesting an appointment with the doctor to the unfolding of the consultation and the access to drugs and treatments.”
Over the course of the project, the problem changed (so much that we will wonder why later in this article), and gave birth to this problem statement:
Elisa, a devoted but exhausted healthcare professional, needs to spend less time and energy in searching for clear and complete medical information, because each medical mistake can be critical.
We will know that we reached our goal if Elisa has less time to dedicate to administrative tasks, and more time and attention to dedicate to her patients.
3. Users & Audience
Our users were public healthcare professionals in general. Our interviewees were people we were friends with, or people who kindly accepted to answer our questions even if we had never met them. We chose to interview different actors of the healthcare system, to have varied inputs concerning the global situation of the system. We interviewed two nurses, a psychologist, a director of the Caisse d’Assurance Maladie, an ergotherapeut, and an inspecting pharmacist at ARS. Their age range was from the twenties to the sixties.
Based on our secondary and primary research, we created a persona, which we will discuss in more detail in the section concerning our process.
4. Roles & Responsibilities
We worked as a team with my Ironhack comrades : Dahyun, Eloïse, Morgane and Victoire. We are all studying UX/UI Design.
What was my specific role?
Working remotely, we collaborated at every step of the project and took every decision together, until we presented our work, which is the only moment when we split the work. Nevertheless, we enjoyed the fact that everyone of us had her special talent and for example, Eloïse took care of most of the illustrations, when some of us focused more on the writing.
This means that agreeing on every choice was part of the challenge.
How did I collaborate with the rest of the team?
I felt more comfortable when writing, synthesizing or organizing the information, but I enjoyed every step of the process.
5. Scope & Constraints
We had a strict timeline, eight days, considering we didn’t spend all of our time on the project. Every step of the process was strictly timed.
For this challenge, we faced three main difficulties :
- We had to think about the Public Health System at a very special time: during the covid crisis. We had to take into account the flaws revealed by this crisis, but also think about the fact that our present does not reflect the situation as it is outside of a health crisis.
- We had to succeed in interviewing the people who are experiencing the greatest difficulties and facing the worst problems, but in covid times, these people are busy saving lives so we could not interview them.
- We carried out each step of this research as a team, and in a very limited time. There were a lot of debates and we had to shorten them quickly so we didn’t fall behind.
6. Our process
We read articles and surveys found on the internet. I focused on news articles concerning the access to public healthcare during this sanitary crisis, because I think this crisis reveals the flaws of the system, so I decided to take it into account.
What were the insights?
Since the beginning of the Covid crisis, people are postponing their doctors’ appointments, or their care is postponed, and it is a very critical problem especially for cancer patients (increased risk of mortality), chronic illnesses like diabetes (increased risk of arteritis and amputation), gynecological appointments (pregnancy or chronic illnesses). After the present crisis, there might be a secondary crisis, because of the postponed health problems. Covid revealed how fragile and insufficient our Healthcare Public system is. It has been very deteriorated during the past twenty years, because it passed from one of the first positions in the world, to the sixteenth.
Several problems occur:
- lack of beds, especially for intensive care
- lack of budget
- lack of digital and material tools
- lack of healthcare workers
- lack of communication between reality and government, between professionals because of a lack of time, and between patients and professionals, also because of a lack of time
- inequality in the access to Public Healthcare because of medical desert in the countryside (hard to find specialists)
- low salaries
- burn out
- mental health greatly damaged for professionals and patients
Once we sorted out the information we had gathered between team members, using post-its on Mural, we prepared our interview guide together. Each of us wrote ten questions and then we chose together the most relevant ones and narrowed it down to 14 questions.
We recruited 6 participants, through Instagram public announcements, and among our friends.
What are the insights from primary research ?
The big insight from our primary research is that the public healthcare system is very disorganized and has terrible lack of means and workers, which causes suffering for both workers and patients. Burn out for workers, suffering of not doing their job properly, and mistreatments and violence for patients, who are hurt sometimes morally, sometimes physically, by late diagnosis, medical mistakes, failed or badly done acts of medicine, lack of care for their mental health, lack of support, lack of information.
At this stage, we were confused because we didn’t understand if our challenge was to design a digital tool, or to understand a “wicked problem”, to propose a new process, and therefore Service Design. I think that this misunderstanding of the point of our challenge led us to a biased interview guide, influenced by the idea that our solution could only be a modernized digital tool.
Through an Affinity diagram executed on Mural, we sorted out 7 categories of themes covered by our interviewees :
- Psychological support
- Material and financial problems
We selected digitalization because we thought that solving this problem would save time on such a large scale that it would significantly improve the quality of care.
Health professionals all complained a lot about the backward state of the French digital system, and one of them even compared it to a “dinosaur”. The importance still given to paper seems to belong to another age because it slows down or even prevents the centralization of patients’ data. Some softwares do not even allow scans to be imported, and the administrative procedures, on these old tools, are extremely time-consuming.
It seemed to us that improving this problem would have an impact on the other categories, because it would :
- speed up patient management in the event of a health crisis such as the covid crisis,
- it would facilitate communication between caregivers and from caregiver to patient
- and thus improve the geographical inequality of access to care
- it would improve organization
- it would relieve the already overburdened mind of caregivers,
- provide a material solution in an environment lacking modern tools,
- and, to finish, it would facilitate access to information and perhaps free up time for training.
Way further in our process, we ended up having reservations about those results. As mentioned earlier, our study was biased from the start of the interviews, and it was therefore natural that the majority went for the category of digitalization, which seemed the most obvious. It might have been more interesting to have gone towards a more complicated problem to solve, as this could have been an opportunity to be more innovative and to be more surprised by our results.
The persona has been a good tool for empathy, but also for synthesis. Gathering similar points of view from our different interviews allowed us to see what was most common and agreed upon as pain points, and to classify this information to differentiate motivations, needs, goals, beliefs and frustrations. We came up with this sum-up:
Archetype: Devoted but exhausted
Quote: « This situation is horrific »
Age range: 30s
Income level: low
Goals: Taking care of every patient correctly and managing to find more time to do so is a wish Elisa constantly has in her mind. Gaining time to rest and finding ways to feel better in the middle of a seemingly permanent emergency state is a strong desire that seems very out of reach. Nevertheless, she tries to keep focused and organized, and to stay in touch with everybody she needs to talk to.
Needs: Elisa’s basic needs, in this chaotic daily life, are to have more time to rest, to treat patients and to spend quality time with her pairs as a team and to collaborate easily. It also would be very important to her to be able to find patients’ information quickly and easily, and to communicate in a simple, safe and pirate-free way with her pairs and with patients. She also feels that it is outrageous not to have access to the existing tools that she needs to do her job properly.
Frustrations: Elisa loses time searching for information, and she already is in a permanent rush because she doesn’t have enough colleagues in her department. She is also very annoyed by the very old and hardly understandable software she uses and all the time she has to allocate to administrative details.
Motivations: Elisa is animated by the desire to help others and feel useful. She loves her fellow humans, and she really hopes that someday, her working conditions will be better, for everybody’s sakes. To her, the access to healthcare is a human right.
The User Journey was the occasion to visualize how our solution could help our persona. We selected the changing shifts moment, which is to say the start of the day, for Elisa. She arrives already tired and listens to her exhausted colleague telling her what happened to patients in her absence. It allowed us to identify three pain points concerning the written records she has to decrypt, the organization of her day and the emergencies that interrupt the moments when she would like to be taking care of her patients attentively and properly.
We used the Crazy Eights method to come up with “crazy” ideas. The key to be creative was to take a step back each time we started over, and look at the problem from a new angle, reading each time a different part of the problem statement, to treat it from every possible angle. We came up with basic ideas, like digitalized beds for hospitals, but also with fun ones, like robots running next to every nurse and doctors to assist them. We then wrote down the last round of crazy 8s that we did, mixing our own ideas with the ones of the team, on post-its on Mural, and we sorted them in three columns, called “Ship”, “Keep” and “Discard”, so even if we didn’t keep an idea, we would still see it and be able to come back to it.
7. Outcomes & Lessons
The lack of budget for Public Healthcare causes a tremendous chain of terrible consequences. Patients suffer involuntary violent treatment during medical acts, because healthcare workers are tired, do things too fast, and sometimes it results in unnecessary pain or trauma. This violence can also be psychological. For example a patient who suffered from avc cried on his last hospitalization day because he was not ready to go home and didn’t feel autonomous and safe, but he had to leave the hospital anyway because he used all the hospital days normally dedicated to this illness, even though in his case, he would have needed more. But nothing could be done and nobody could even reassure him when he was crying.
Another sad example of these consequences is that autists can’t all benefit from the same care during the crisis, because some of them can’t read or use the phone. Some of them can, they can read, speak and write. But some of them can’t do any of these things so they are more isolated. The social bond is crucial for their well being, it is part of their treatment, and during the covid crisis, the people taking care of them have to do the opposite, isolate them, and it is heartbreaking for these caregivers not to be able to take care of them and seeing the suffering caused by this situation.
One more terrible example is that basic existing tools can’t be bought, and if an ergotherapeut has to fix a wheelchair, he or she can be drawn to handcraft solutions, like foam cut from her own sofa.
Any way we can help by at least saving time and simplifying procedures is already something that would make a big difference. Better thought-out and easier to use digital tools could also ensure greater security for patients, because if their data were all gathered in one place and easily accessible by caregivers wherever they are, some medical errors could be avoided.
With our solution, Elisa can now easily visualize and select the tasks awaiting her on the kanban, on a big board that is accessible to her and to her colleagues. She can assign tasks and prioritize. Then, she can go on her patient tour and still keep access to the same centralizing digital tool, which allows her to read any patient’s medical history, in the hospital or in any other hospital where he has been before. She can record her report orally, and the tool will automatically transcribe it into written text, and autosave it in the patient’s folder, to be easily accessible to any healthcare professional afterwards. Thanks to this tool, which centralizes way more information, we hope that patients’ safety will be improved and that the working conditions of healthcare professionals will feel a little easier. It might save them time and allow them to have more quality time both with their colleagues and with their patients, and maybe have more time for training, or for emergencies. Our wish is that this simplification of the process can at least lighten their spirits.
Knowing when to vote
One thing I would have done differently, if I could go back in time, is to propose a voting system for each disagreement. Debate is sometimes inevitable, but it takes time. A solution that might have worked out would have been to time the debate and then take a vote on each decision. This may seem procedural, but we all agreed, in hindsight, that this method would have been preferable.
How to stay on course
I also understood how easily you can lose direction, when you are going too fast and not taking the time to take a step back and check if you stayed aligned with your brief and your problem statement. An easy and powerful way to keep it in mind always, is, as we learned too late, to write it down and pin it at the top of every board, of every digital tool, at each and every step of your process. This is the most efficient way not to lose sight of it.
We were all so different, that our team was very complementary and I was amazed by how fast we could go when the five of us were collaborating on the same task, each of us adding her special vision to the problem. We also had each other’s back each time someone felt a little lost and this is, to me, the biggest power of teamwork. If you go in the wrong direction, or if you forgot something, there is always someone to help you to accomplish better work, all together.
My teammates are also on Medium!
They took care of the very nice illustrations presented in this article, made from a template found on Google Slides. The talented drawings illustrating our solution were made by Eloïse.