Author Archives: samantha

Ethics Quest

HEALTH SHOULD BE EMPATHETIC

The Challenge: Ethics are a thorny topic for interdisciplinary teams to discuss. This is particularly true for designers and teams leveraging the power of design. In the design world, there is no common language, structure, or understanding as a professional community of our own ethical boundaries.

Designers make products, services, and experiences that affect our health, wealth, happiness, and sustainability. As design project teams, we need to be able to talk about ethics as a group creating products that can change the world. We must collectively understand the effects our collaborative efforts will have on the people and environment that we design for.

Inspired by this, we designed a game to facilitate these conversations within design project teams. We debuted this game, Ethics Quest, at a workshop at Interaction Design 2016 in Helsinki, Finland. Ethics Quest is a role playing game (or RPG) that brings teams together to understand, explore, and harness multiple ethical perspectives to improve collaboration and guide project outcomes towards the common good.

The Team: Me & 1 Managing Director of Behavior Change

My Role: Thought Leadership, Playful Design, Workshop Design, Workshop Facilitation, Visual Design, Public Speaking, Content Writing

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Why a design a game to talk about ethics?

Through play people are able to approach serious subjects with light hearts. This mindset helps us overcome barriers when discussing “serious” topics such as ethics. Gameplay creates a safe space with low risks that allows people to try new things and foster deep empathy. By playing a game, players are able to experience and build empathy for ethical viewpoints beyond their IRL (in real life) selves. Role-playing through difficult conversation in gameplay also helps players define their own ethical stance in the context of a team and allows them to develop strategies and tools for discussing ethics in real life professional situations.

 

Developing Empathy with Player’s Characters

Drawing on our experiences, we looked to traditional product teams as inspiration for creating our cast of characters that players could role-play as in Ethics Quest. Each character represents a team member who collaborates frequently when designing products: the designer, the project manager, the intern, and more! We dove deep into these characters’ motives, personality traits, perspectives, and super powers to inspire players to really dig into the characters and develop empathy. The first step towards empathy is understanding, so crafting these characters was essential in helping our players  connect with their in-game roles.

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Progression of in-game events

Ethics Quest gets more collaborative as the game goes on. This eases players into the character that they select to role-play as and helps them get comfortable acting as that character in in-game situations. The situations that players encounter progress as follows:

Round 1 is solo – helping players understand their character through tackling a situation on their own.

Round 2 is co-operative – giving players a chance to embody their character by working with one other person to tackle a situation together.

Round 3 is collaborative– having all players work together, as their characters, in a project team to define the ethics of the project everyone is going to embark on together.

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Leveling Up and Reflection

At the end of each situation, players are given the chance to reflect on their experience. A reflection card prompts them to consider how their character may have leveled up their abilities as a result of the previous situation. At this point of reflection, players also have the opportunity to unlock a superpower specific to their character. Mechanics like these provide moments of juicy, positive feedback. Not only does this encourage players and motivate them to continue, but it also facilitates their reflecting upon decisions their characters made, and how that may have positively or negatively affected their development on a larger scale.

 

Bringing Ethics Quest to Interaction Design 2016

We brought Ethics Quest to a group of design-minded people in Helsinki, Finland attending Interaction Design 2016. They played Ethics Quest for two hours with us facilitating. By taking on the mantle of characters in this RPG game, players were able to understand, explore, and harness ethical perspectives to improve collaboration and guide project outcomes towards the common good within their project teams. By building empathy for ethical viewpoints beyond their IRL selves, players learned to define their own ethical stance, developed strategies for discussing ethics in a professional situation, and completed their quest by collaboratively defining a code of ethics as a team!

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What we learned

During the workshop, it was clear that all the players were having a grand old time. We were able to observe participants transition into their characters, take on a new role, and carefully play through the situations presented to them in gameplay. By taking on a role that was different from their IRL role, participants listened more actively and carefully when other players were speaking that we observed them do before the game. This attentiveness is different than what we’ve observed in typical conversations around ethics.

 

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Health Ally

HEALTH SHOULD BE CLINICALLY COLLABORATIVE

The Challenge Working in partnership with a large academic healthcare system, how do we create a digital tool that improves the management and prevention of 4 chronic conditions in their patient population: diabetes, pre-diabetes, cardiovascular disease, and obesity? How can this tool motivate patients to become masters of self-care, help patients better navigate health system resources, educate them about their chronic condition, and strengthen the relationships they have with their community?
The Team : Me & 1 Design Strategist
My Role Behavior Change Expertise, Concepting, Creative Direction, Workshop Facilitation, Design Strategy, Illustration

Our Solution

We created Health Ally, a digital tool to help patients better understand their own chronic conditions and patterns of self-care so that they can better communicate with their care coordinators, participate in shard clinical decision-making, and make lifestyle changes to improve their health and well-being.

Health Ally inspires patients to become more engaged in their own health through intrinsic motivation. It provide patients with the tools to understand how adherence impacts how they feel and live. It promotes shared decision-making for a co-created healthcare experience, and involves family members and support systems in a patient’s care.

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Integration with Best Clinical Practices

The first step in our process was to conduct a literature review. This allowed us to identify the clinical similarities in the treatment of the target chronic conditions. It also allowed us to understand what interventions had already been tried in all of those areas so that we could learn from those successes and failures.

Through our literature review, we identified 4 common areas of treatment between diabetes, pre-diabetes, CVD, and obesity:

  • Nutrition
  • Physical activity
  • Sleep
  • Stress
  • Medication Adherence

Insights from Patient and Staff Interviews

We conducted interviews with patients and clinical staff at the health system to better understand the opportunities they identified within the chronic condition journey as well as within the health system itself. We identified key insights that influenced the direction of our project, such as

  • Patients were not in a state of mind to retain information directly after a diagnosis. This caused problems for both the patient and the clinician, as the clinician was unable to communicate important self-care information to the patient, and the patient couldn’t remember what instructions the clinician had given them after they’d left the clinic.
  • Patients were upset when they made lifestyle changes and their clinician failed to congratulate them at their next appointment. This was demotivating to patients and could put them at risk for behavioral relapse.
  • One of the biggest barriers to health in this community was a lack of support within a patient’s family and social networks.

Identifying the Ideal Point of Intervention

We discovered that the biggest opportunity for introducing an intervention to a patient is directly after initial diagnosis of a chronic condition. By introducing Health Ally through a clinician at this time, we can help patients make the best of their heightened sense of urgency and motivation to make lifestyle changes. Introducing Health Ally after initial diagnosis helps  patients feel supported by connecting them to the health system resources available to them as a newly diagnosed person and to patient communities that they can look to for support.

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Integrating with Health System Processes: Identifying a Clinical Champion

Within the academic healthcare system we partnered with, the Care Coordinator plays an important role. They are able to act as an in-between, helping patients find ways to make clinician recommendations actionable and fit in with their own lives. Clinicians and staff identified that the Care Coordinator would be an ideal person to pioneer the use of a digital tool that would help patients manage their chronic conditions. The Care Coordinator would be able to introduce the tool after diagnosis and could check in on the patient’s progress using the tool at follow up appointments.

Going beyond the clinical treatments

We wanted to do more than simply treat the physical causes of chronic disease. With Health Ally, we had three major aims: educate, facilitate conversations, and promote self-understanding.

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Education. Before a person can feel motivated to make lifestyle changes, they must first feel that they understand their condition and thus have the power to affect it. Health Ally incorporates four types of educational resources:

  • Daily educational trivia
  • Digital library containing disease-specific information & curated by the healthcare system
  • Digital resource library containing health system-specific resources available within the healthcare system
  • Location-based mobile notifications to inform patients when they are passing a place with disease-specific resources in their immediate area
  • Goal suggestions in the four common areas of treatment
  • Leveling to help patients increase the difficulty of their goals after they’ve been successful at a present goal

Self-Understanding. Once a person understands what their chronic condition is and how they can affect it for the better, they can start to focus on how their own habits, preferences, and perceptions can affect their condition and motivation to make change. Health Ally provides four self-understanding resources:

  • Tracking progress towards a goal
  • Prompting patients to identify barriers that prevent a goal from being achieved
  • Illustrating connections between behaviors and outcomes
  • Performance streak notifications
  • Personal reflection prompts based on progress

Communication. After a person understands their condition and how they feel and act with that condition, they can begin to communicate their experience to others to share their journey, foster or strengthen social connections, and ask for support where they need it. Health Ally provides physical and digital tools to facilitate conversations between the following:

  • Patients & care coordinators
  • Patients & family members
  • Patients & community
  • Patients & other patients

Health Ally Core Loop: Closing the Gap Between the Clinic and Life Outside the Clinic

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Leveling based on the stages of change

After patients achieve multiple successes in the goals they set to improve their chronic condition, Health Ally offers to “level them up”, increasing the difficulty of the goals available to them and helping them become healthier. These levels are based on the stages of change in the Transtheoretical Model developed by James Prochaska and Carlo Di Clemente. Patients in the early stages of change such as pre-contemplation, contemplation, and preparation would work in levels focused on education and learning (ex. Take five of your favorite foods out of the pantry. Locate the “sodium” on the nutrition facts panel. Which of them has the most sodium? Which has the least?”). A higher level based on a action or maintenance might be “eliminate salt from two of your three meals at least 5 days a week”.

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Blending the real world and the digital world

One of our core beliefs is that any digital intervention should strive to incorporate aspects of the “real world”. This is proven to make interventions more successful. One of the reasons for this is that it is difficult for anything digital to replace the complexities and richness of face-to-face human interaction, particularly when it comes to doing something as difficult as lifestyle changes. We blend the boundaries between the digital and the “real world” in Health Ally by

  • When a patient levels up, the app rewards them with a digital certificate of accomplishment. During their next appointment the Care Coordinator prints out and presents the patient with a physical copy of this same certificate. This allows the Care Coordinator to recognize and celebrate the patient’s progress in the real world as well as the digital.
  • The Care Coordinator checking in on a patient’s progress both through in-app messaging, data transparency, and during face-to-face appointments.
  • Connecting patients to groups both within the healthcare system and within the larger community. Think “Meet Up” for a specific patient population and geographic area.
  • Providing GPS location alerts through a mobile phone when a patient passes a geographic location with resources relevant to their goal or condition. Two examples of these could be a CVS with a blood pressure cuff or a local farmers market.

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The Designer’s Oath

HEALTH SHOULD BE ETHICALLY DESIGNED

The Challenge: Designers are now responsible for creating more than ever before—not only designing services, but also experiences, environments, products and systems for millions of people. With this increased influence, we must take a step back and recognize the increased responsibility we have to those we design for. We can learn from other professions, like healthcare, where those who practice medicine acknowledge their responsibility by swearing to uphold the Hippocratic Oath. This binds them to a clearly defined set of rules that guide the ethics of their interactions with patients. Designers also now have the ability to impact human health as well as the health of the environment itself, so we need a similar code of ethics to guide us.

The Designer’s Oath is a tool that helps multidisciplinary teams define the ethical guidelines of their engagement. These Oaths play a dual role: 1) sparking conversations within multidisciplinary project teams about the ethics of their work and 2) providing documentation of the ethics collaboratively agreed upon for reference and sharing. Designer’s Oath is a tool that is applied to our individual design processes to ensure that the end result does good.

Teammate: Me & 1 Behavior Change Designer

My role on the project: Thought Leadership, Co-Curation, Creative Direction, Public Speaking, Workshop Creation & Facilitation, Project Direction

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The Birth of the Designer’s Oath

The Oath began in an IxDA Boston workshop. Following an interactive session exploring the Ethics of Gamification, we asked 30 participants to reflect upon their experience by collaboratively completing a fill-in-the blank version of the Hippocratic Oath to make it more applicable to design.

Writing & Publishing a Designer’s Oath Article for the Service Design Network

We decided to continue experimenting and began work on an article for the Service Design Network publication, Touchpoint. We wanted to create new Oaths that would showcase the voices of individual designers and include voices beyond our geographic boundaries. We also wanted to hear opinions from designers working across the spectrum of design fields.

We asked 15 designers from across the nation to remotely fill out one specific piece of the Hippocratic Oath in a fill-in-the-blank template. We then combined those pieces together to create 3 Designers Oaths.

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Three Examples of the Oath from Our SDN Article

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Designer’s Oath Workshop at HxR 2015

Our next goal was to bring people together in one physical space to create Oaths. We had the opportunity to do this at Mad*Pow’s Healthcare Refactored Conference, or HxR. Working on the Oaths in a shared space fostered more conversations between people than was possible in our remote collaboration. We hosted a lunch and learn where we brought together conference attendees (clinicians, designers, entrepreneurs) in a single geographic location to talk with each other, share and iterate on their Oaths in real time.

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The Designer’s Oath Installation at HxR 2015

This is where we began to realize the real power of the Oath. It’s not about creating one oath for all designers and design teams and it’s not about the existence of the oath itself; the power of the Oath lies in the conversations it sparks! The Designer’s Oath has evolved into a tool that multidisciplinary teams can use to define the ethical guidelines of their engagement.

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Bringing the Oath to BarnRaise 2015

Moving forward with this idea, we brought the Oath to BarnRaise, an interactive conference/Hackathon for design-minded people exploring the boundaries of social design. There, we led one team through the entire design process from research to prototyping to pitching in one weekend. We kicked off the conference by asking our team to create a Designer’s Oath outlining their ethical guidelines as a single group that would be working together to solve a problem over the next few days.

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 The Designer’s Oath: A Year in Review

The Designer’s Oath has been a year-long experiment exploring the ethics of designers between 2015 and 2016. We partnered with designers from disparate disciplines and backgrounds to understand and document how they see their responsibilities. We encouraged designers, clinicians, students and faculty to create collaborative Oaths that speak across design practices, project teams and organizations. After a year of outreach, conversations, and trial and error, we finally hit upon the real power of the Oath. It’s not about creating one oath for all design teams, and it’s not about the existence of the Oaths themselves; it’s about facilitating conversations! The Designer’s Oath has evolved into a tool that helps multidisciplinary teams define the ethical guidelines of their engagement.

Zombie Health Game

HEALTH SHOULD BE FUN

The Challenge: How can we create a health game that translates physical activity in the real world (measured via Apple Watch and mobile phone) into an epic zombipocalypse survival game based on the popular TV series, The Walking Dead?
The Team: Me, 1 Behavior Change Designer, 2 Illustrators, 1 Project Manager
My Role: Conceptual thinking, Experience Design, Narrative Design, Content, Creative Direction

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