The following case study is an outcome from a program hosted by D-THINK in joint partnership with the European Commission, Delft University of Technology, Netherlands as well as Karolinksa Institute, Sweden.
This had come at an interesting junction as I was able to reflect on how the theory (episteme) could be in conjunction with the practice (techne) for designing better products in the healthcare space.
To give you a bit of a background, I have been previously involved in developing healthcare products to reduce the risk of acquired infections across high-risk zones in hospitals.
The problems and challenges which one faces in the healthcare space are systemic requiring careful orchestration of various stakeholders. Through the D-think program, I was roped into a diverse group of participants involving biomedical engineers, scientists, policymakers, industrial designers as well as healthcare practitioners. All of us came together to passionately understand the nuances of applying design thinking methods towards healthcare.
After 4 days of intense discussions, we arrived at the design vision for StopSeizure, an epilepsy prediction device.
What does it do?
StopSeizure is an IoT based seizure prediction and monitoring system. It monitors the patient activity and administers medication in advance to stop an epileptic attack.
We chose to work on the brief given by the Centre of Excellence for Epilepsy and Sleep Medicine (SEIN). SEIN operates as a residential care centre for persons with severe epileptic disorders in the Netherlands.
As you might know, epilepsy is a disease that causes seizures which sometimes leads to convulsions and shaking of the body. These seizures are very unpredictable and sometimes, one also comes across (SUDEP) where the patient faces a sudden death due to a seizure.
How are epileptic seizures handled at the moment?
Currently, there are seizure detection devices that alarm the patients or the caregivers. In residential care facilities, you have an auditory system, a set of microphones that help pick up the sounds so that the caregivers can come to help. Some rooms, in addition to the microphones, have video cameras. Despite all this, the seizures are missed. Bed mattress which picks up movement. And we also have different kinds of bracelets which pick up movements such as heart rate which usually goes up when seizures appear. In homes, most of the parents have their own devices, sometimes baby phones are also often used.
For patients at home can also buy seizure detection devices, but unfortunately, they are not reimbursed by the insurance. In some cases, parents sleep in the same bed as the child so they notice everything happening. This can be a huge impact on the privacy of people.
What do the seizure detection devices do?
Seizures and the severity of the attacks vary greatly from person to person. For those that experience large seizures, they use a device that measures the movement of arms and legs.
Some parents don’t want to be alerted only for large seizures, but also for minor small seizures. As small seizures can also be a pattern for large seizures. They could act as a precedent. There could be a change in the behaviour, frustrating or annoying with small ones. So parents would want to know about such incidents as well.
With this as the context, we proceeded to go through the double diamond phase to investigate the pain points of children with epilepsy in such residential care centres.
Who are the actors involved?
To define the problem better, we started investigating the various actors involved. These residential care facilities usually involved the nurses and doctors who provide periodic assistance. In homes, parents also get involved to help their children through the seizures. The stakeholders were then branched to internal and external, direct and indirect and the various interactions between them were thought through.
The double diamond process was pretty straightforward. You had the Discover, Define, Develop and Deliver phases. The first two phases were to ‘design the right thing’ and understand the problem better whereas the latter two phases were ‘to design things right’ (better solution)
For the discovery phase, after outlining the stakeholders, we proceeded to make the current patient journey. The journey was articulated based on the stages, the steps, as well as the overall emotional journey. What are the pain points which the user experiences in this journey? What are those friction points? These were identified and charted out also taking the actors into consideration.
The journey of Maria was articulated. One aspect of this exercise which I especially liked was the emphasis on the journey, instead of just a single pain point. The method forced one to think in terms of improving the experience of the overall journey for the patient.
We then proceeded to identify those friction points and defining it further. Among those friction point cards, one such problem which we had identified was as follows — The caregiver would be overwhelmed by checking on multiple patients with seizures.
This proceeded with investigating this further using a problem tree which helped us understand the possible cause and effects.
After having done this exercise, we proceeded to the next step – The Define Phase.
In this part, we attempted to forget the previous patient journey which we had outlined and to start creating a perfect patient journey. What could be possible if there were no limitations? What could be the start and the end of this perfect journey?
This exercise forced us to think in terms of everything being ideal, and that constraint also provided us with possible prompts and directions on which we should proceed.
In this way, by the method of elimination, we arrived at the design goal which was to provide an epilepsy monitoring and prevention solution to make the patient feel safe at home.
With a reasonable understanding of the problem and having defined the vision, we proceeded to ideate and come up with possible solutions that could address those friction points.
We used two ideation tools to help us brainstorm and ideate faster as a group with the time restrictions present. We proceeded with the exercise of ‘How could you’, which involved splitting the problem into multiple sub-problems and ideating for possible solutions to diversify the space.
This was coupled with the brain drawing method. Here, the participants involved in a series of rapid sketches getting 4 minutes before passing on to the next person who adds on top of what the other person has done. As we didn’t have much time to critique, we quickly sketched before moving on to the next one.
In these exercises, to loosen up the constraints imposed by the criteria, we also proceeded to adopt the method of contradiction to get the creative juices flowing. Say, for instance, if it had to be a digital product used by the caretakers, then there should also be a solution that is completely physical and need not require the intervention of caretakers.
Sometimes the right constraints accentuate the creativity process.
It was then that there was an interesting tension that led to a creative spark, an aha moment. The final concept which we arrived at was to develop a relaxed sleeping device for persons with epilepsy. To articulate the interactions further, we developed the final patient journey with the concept in mind.
This exercise raised more questions than answers which we had to arrange and keep in a separate place. This was a 4-day workshop, we didn't have all the answers, and we were conscious about all the assumptions which we made.
Once the overall desired interaction with the product as outlined by means of the improved stakeholder journey, the program of requirements was articulated. During this process, the requirements were further classified based on priority (relevance). For instance, the comfort of the patient while wearing this device was considered to be of topmost priority whereas the notification system for refilling the drug was at low priority.
After this phase, we continued to do a lot of verbal prototyping and refinement of the final concept, taking all the assumptions and loopholes into consideration.
The healthcare bootcamp concluded with the completion of the respective elevator pitches that would be enticing for the various stakeholders involved (pharmaceutical industry) as well as the (caregivers)
What would an enticing pitch look like? This forced us to think in terms of the ‘promised land’ for all the stakeholders involved.
By the end of this hackathon, we were humbled by the complexity of this problem. The design thinking exercises made us realise multiple fronts to cover, and also gave us an action plan for taking this idea forward and the possible roadblocks we might encounter during this process.
Some reflections on this journey
As this program continued for 4 days along with a week in-between for preparatory material, we realised the limitations of the time allotted. The depth with which we could analyze the problem is not guaranteed. However, the magic of design thinking is that you could still adopt it for any time scale, be it 2 hours, 2 days, 2 months or even 2 years, and it wouldn’t be enough.
Good is better than perfect.
Sometimes, a time limit acts as a good forcing function to get faster to the next step. Bootcamps and hackathons play a great role in providing that forcing function to stir the pot and make things happen. On the whole, I loved the program organized by EIT and am looking forward to more such inter-disciplinary collaborations!