HackED! Design thinking primer

- I just want to introduce myself real quick. My name is Karan, I'm one of the emergency medicine residents over at UCSF, and I'm one of the team members for EMIC. Really excited that everyone is here as part of this session, as you know, has been ongoing as a lead-up to our ACEP Hackathon. And today's session, so for those of you who have been coming to this session so far, you know that this year we're splitting up into kind of a software track and a hardware track. The nice part about today is that the design thinking session kind of transcends both, it applies really equally well to both kinds of tracks and is really essential for any innovator to master. So, I wanted to introduce Delphine Huang. She's an emergency medicine physician and she's really a national leader in design thinking for healthcare. She works as the medical director currently for innovation and design transformation at the California Mental Health Services Authority. There she really brings all her wealth of human-centered design experience to help improve care for some of our most vulnerable patients, our mental health patients. She actually graduated from the UCSF residency program back in 2019 and has worked clinically around the Bay Area at San Francisco General, at Kaiser, and at the Palo Alto VA. And most recently, before joining the Cal Mental Health Services Authority, she spent several years at IDEO, the design firm where she was a senior director working on healthcare projects. So, lots and lots of experience, and we're really excited to learn from you, Delphine.

- Thank you, guys, and thank you for inviting me. I really appreciate you guys letting me come and chat about something that I'm really passionate about. I hope this session's actually really interactive. So, you know, I know folks are definitely picking up kids or doing other things. I apologize, my own kid is going to be getting off school in about 20 minutes, so he might pop in here, but just to share with you guys a little bit. Yeah, definitely would love this to be interactive. Come off video if you can, and also if you want to share a little bit about your background, I just said, add your name and where you're coming from. So we're going to get started. So today we're going to be talking, there's a whole spectrum when it comes to design thinking, but we're going to just obviously touch on that a little bit from the focus today, a little bit of design research from the perspective of analogous examples and from sacrificial concepts and prototyping, mainly because I think maybe you guys have touched on this in the work that you guys have done, but they've become really useful when you're trying to come up with new ideas, trying to brainstorm about a different direction you could take a particular product or an idea or a service. And then I find it really helpful, especially around prototyping, of really testing ideas out to see whether or not they're going to work. So we're going to talk a little bit, a little bit intro here. So, once again, yeah share, definitely feel free to share in the Slack or in, kinda your name, your name, your role, title, organization, anything that would be helpful for us to get to know you. Okay, and then I'm not going to, Karan did a very good job of introduce. So I'm not gonna go through, just to share a little bit where I'm at now, I'm at CalMHSA as the Medical Director of Innovation and Design Transformation. I came through that role through my other job, previously at IDEO and thinking about how you can leverage human-centered design to build really cohesive and seamless experiences. And that spans everything from health products to services to system design. Now, at CalMHSA, it's a joint, I don't know, if you're familiar with the organization, but it's a joint power authority. We sit between Medi-Cal counties and the California DHCS and we think about how we can take some of the efforts around improving mental and behavioral health across the state through either its technologies, helping organizations implement different ideas, and then state policies. And then just a little bit about myself, I love playing tennis, I eat a lot of avocados, and I have two very, very rowdy boys, so I try to keep up with them. All right. So today, we're gonna be focusing on how we might be able to use some of the design research, especially around analogous and sacrificial concepts, as a way to both uncover where those needs but then also think about how we can actually implement them or, sorry, be able to test them and really get quick feedback about whether or not you're even going in the right direction and you're really addressing the need. So, we'll be talking, this a little breakdown of the hour, here for us. All right, so we're gonna just get, I know, how many of you guys are familiar with design thinking? You can raise your hand, you can come off mute, you can say, no, yes, lots of experience. Just so we kind of center ourselves. Anyone new to design thinking? The concept? Okay. Oh, Brian. Yes?

- [Brian] Yes.

- Okay, we're just gonna go a little bit through design thinking just to center ourselves. So, I think a lot of things are interesting about design thinking. You know, a lot of times people say, "I do some of this at my work when I'm doing QI," but just to share a little bit. So design thinking has its roots really from industrial design, but it really can be applied across all industries. And the reason being is design thinking is just a way for us to explore and understand and deepen our understanding about different ways in which we can problem-solve. So I just want to say that it's really a way to problem-solve. It is one of the tools in the toolkit to be able to take something that you're like, "I don't really understand it, it's pretty fuzzy, "then how do I better understand it?" And the goal is to really take it from a human-centered approach. So really starting with the user in the middle and try to understand what their needs are first before, like, such other pain points, the challenges, the workarounds, and then what they would consider as success to then drive how you build the innovation. And, you know, really when you're at the sweet spot, I think a lot of times people, okay, say okay, I have what the user needs are. But where design thinking really also plays is thinking about, as you take into account the technology, can you make it viable and feasible? 'Cause if you build something, you have this great idea but you can't actually build it, then that's gonna be a problem. But then, and then the last one is whether it's desirable, whether you can make it, and when I say business, I mean like, is it something that you can actually, like, you can't make something without any kind of, usually some way of either paying it or even getting people to motivate to use it, right? And so that's like the business prop, right? Like, what is the proposition there? And you need to kind of have all three of these and sit in that sweet spot in the middle right here to be able to build something that is really centered around the user's needs. So that's a little bit what design thinking is here, and I think, you know, a lot of times people are like, "Well, where does this healthcare fly into this?" So just to share a little bit of that background. You know, I think healthcare really evolves around us building relationships with other human beings and it's really around a relationship about caring and being cared for, and that's really critical when it comes to healthcare. So it goes both ways, whether it's between patients, between clinicians, and where we wanna see like sustainable change is really thinking about how do we respect all these members of these relationships between patient providers, families, staff members who are impacted by the ecosystem of care. The second thing we think about is how we can achieve and maintain these like health, whether they're these behavioral changes you're hoping for and how do we sustain them over time? I have no doubt, I mean, I have worn many a Fitbit, tracked my health in different ways, but really at the end of the day is, how do we keep people engaged and continue to help people sustain that behavior even after perhaps your intervention ends? So when you think about good design, it's really about enabling the engagement and then simplifying something that is really complex to something that end user can understand. And then I think the third thing is, you know, without that human-centered lens, what tends to happen, and we do see very often, especially in QI projects, is that the system will try to take change that is best for the organization rather than for the people that work for it, like are working within the system. And so, where I feel like human-centered design can be really helpful is like you're like, "Man, this idea that I've been trying to implement "across the system is not taking on." So then where you bring in design thinking is like, how do you bring that human-centered approach to be the necessary corrective change that you need in order to better serve the people that work within or rely on the system. So usually for me that's the missing piece, when people come to me with either a product or their service, they're trying to really push across a system, but where they have failed, perhaps, is having a lack of understanding of like, well what is the motivation's desire of the end user? And that's where design thinking really plays a good, a helpful method of trying to untease that. Okay. So I don't know if you guys have seen kind of this, these curves, they're very commonly seen in design process, where it's really iterative as you go through the work. And so you'll see moments where, you know, you're really trying to get very divergent of how you are thinking so you can get as many different ideas and generate many different possibilities. And then you go through these three phases of inspiration, ideation, and execution. And there is a method to the madness, I think because a lot of times people come into design process, it feels kind of messy, but the goal is you wanna try to at times come together and come with all the different ideas, but then convergent thinking is the process of really finding concrete and familiar solutions to the problem. And where you're converging is that you're looking for patterns and articulating problem, the priorities, to help you narrow down the options and make good choices. Today we're sitting here, and we are trying to think about how do we take different ideas that we have, look to outside the industry, get more ideas, but then also how do we use prototyping or sacrificial concepts to narrow. I think sometimes that can be hard for folks to kind of think through like, "I have all these great ideas, "like how do I decide which one?" And that's where these, these two techniques that we're gonna talk about today can be really helpful. I'm gonna acknowledge that while this is really pretty as a graph, this process does, like I said, can sometimes feel messy and this is kind of the mess that you might feel. And mainly when you feel that divergence, because we are asking you guys to really explore beyond just what you typically see on a day to day, but also think about how you might want to look outside your industry to be able to help you get good ideas. And that's where it sometimes starts to get messy because you have a lot of good ideas and then you'll need to figure out where you're gonna go. Okay, so I share this first one here. We're gonna talk about, there's... The way I think about like, before we jump into analogous, there's four ways of thinking about the understanding of the people that we're designing for. I'm not gonna go in a lot of details 'cause I think that you guys have gotten some of this background. I saw that you guys previously had a talk around needs finding. So, we're gonna, I'm not gonna spend a lot of time talking about needs finding, I'm assuming there may be a talk that was similar to that, but I will just kind of share with you kind of the way I think about inspiration. Actually, it happens all over wherever we are, day in, day out where you're in the hospital or even at home, where you're hearing about different people's encounters with health. But when you think about engagement, you think about the ask, right? What are people asking? So, definitely go around, talk to people. I think a lot of times people fear, like if I ask them I get like criticism, and actually criticism, or critique, I would say, is a time you have to get the most wealth of information of like what is not working, why is there a gap? How come people, why is there a barrier to people, you know, taking on this change? The next thing is observation, so spending not just like hearing what they're saying but really spending time with their environments to understand what the intuitives do and work around. This is like one of the classic ideal pictures is this woman, she was arthritic, really gnarly hands and she was like, "Oh yeah, I can open my meds "and take them regularly." And it wasn't until... Until they, the team walked in and they saw that she was taking a meat cleaver to cut off the top of her pill bottles. And it's just like classic where it's like, yeah, she's telling you she's taking her meds, she's able to open her meds, she's able to like, and she is, but the workaround for her was using a meat cleaver, which I would say is not the best way to open your pill bottles. The other thing is like immersion. So like, you know, try out things for yourself so that you can see firsthand what that experience is like. And the last one like we're gonna focus on today is around inspiration, is to look outside of your immediate problem today to learn from other industries. There's a lot of times that we will be like, hey, this is how it's been done in medicine forever. But if you really think about it, there may be other ways to do it, but we just need to look outside. The other thing that we're gonna talk to you guys today is around ideation. So, this idea of like how do we take like all the problems, needs that we have, and then how do we build from there? So you can definitely do brainstorming, you can do concept generation, which is the idea of like, you know, drawing out on a little sketch, which we're gonna talk a little bit today. There's looking at opportunity areas where it's about how do we take these different ideas and look for kind of the bigger boxes that we can play in. And the last one is prototyping. So we're gonna talk a little about those today. I'm gonna first jump into, before I stop, any questions or thoughts here, because I know I just talked a lot, so I'm gonna take a little pause. Kim, do you wanna share a little bit? I see a little commentary about human-centered design. I'd love to kind of, if you share a little bit what you wrote here, if you don't mind coming off.

- Yeah, that's it, throw me right in.

- No, I love, sorry, I will throw all of you guys in. Just get used to it. Which I like to run my sessions.

- Yeah, you know, I know how we make visuals with slides, right? But when we make visuals and we think about the human-centered design and we think about the business and the technology, there's always a tension among those priorities, right? And not all priorities can be the primary priority at any given time. And where I see human-centered design fall off a lot is that the human is in the equation but they get outweighed by throwing the technology and the business needs together. And you're like all of a sudden these are heavier than the human-centered design and you've kind of lost the mission.

- Yeah.

- Of what you're designing.

- I think that is the challenge and you really hit the nail. It's like, it is hard. I think, like when we talk about human-centered design, like I said, it's one of the tools in the toolkit because it's so easy to be like, okay, I have this great idea, but once you start to throw the constraints, maybe it's like the reimbursement strategy is not great or maybe it's like you are starting to push against someone else's job, right? Then you start to get, you can get a lot of push, and I've given the example that I learned about. So, this is the cardiology space. So, interestingly, when stents were first, now stents are commonly used in any kind of like coronary artery disease, but when stents were first invented, cardiothoracic surgeons, for example, it was really pushing against both like what they practice, which is open heart surgery and also, like, pushing against like their ability to practice something that they felt like was in their wheelhouse. Right, now you have these cardiologists coming in and doing stents and that was like, and so you can imagine, now today we have stents very commonly used. But at the time when stents first came out there was a lot of pushback from cardiothoracic surgeons being like, "Now you're stepping on our toes." So it's about trying to figure out like, how do you balance all the different players? And hopefully, I mean the dream, the dream is like, you get everyone aligned because they see benefit in what you do. But if you don't understand where cardiothoracics are pushing so hard against a really great idea, then potentially that idea can get squashed, right? So, as today we see stents are less invasive, it has a lot of good potential rather than open heart surgery. But you could see in the very beginning you gotta balance kind of all those three to get the stakeholders in. Otherwise someone will come along and be like, "No, that's not gonna happen." So, definitely I do, I do see that for sure. Okay, I'm gonna just jump into analogous research to just kind of share with you guys a little bit with you. So, the reason why I love talking about this is that it is really easy to sometimes get sucked into the world of medicine and be like, "This is how we've always kind of practiced things "and, you know, we can only work with this," and especially around constraints, right? So it's like, "Well, we have these regulations," or, "The FDA is coming in and saying "you gotta have these things." And sometimes it feels like, "Oh well, that's the only way to approach it." So I do share a little bit. I put this astronaut one because actually, recently, NASA, I think it was like two or three years ago, put out this challenge because they were like, "How do we help our astronauts "be able to poop in outer space?" And they were really stumped, and really the top three winners, two of them had, actually doctors, in their teams in terms of the three top three ideas, and it was doctors that came up with, one of them was like, "I have an idea about like using the techniques "of minimally invasive surgical tools "to be able to like extract the poop." And then another one was like, "Hey, I've done a lot of work in GI, and so like "let's think about taking some of that world "and being able to like suction it out "and compartmentalize." And I thought it was so interesting because, at the end of the day, like NASA was like, we can't solve this problem. We're gonna look outside of our industry, see if they can help us answer this question. On the healthcare side, right, there was a big project that IDEO worked on. It was trying to understand like how you can improve, and I think there were several articles written on this, so it's not uncommonly known, but it's like, how do we improve the OR experience, right? And the team was working with a bunch of surgeons, they decided that they needed to solve this problem, they were like, "How do we get different ideas out there?" So they actually went to a place that's highly regulated and they went to the airline industry, 'cause they're like the airline industry both has to do with customer service but they're highly regulated. How do we improve the feeling of giving security to the flyer, which is equivalent to the patient, but also think about how do we make something so it never fails to have mistakes, right? Obviously people lose their luggage, but in general like how do you make sure that planes get on and off on time, and all the little steps in between, like fueling the plane, making sure that people's luggage gets on there, people get loaded, how do we get all those steps? And it was really interesting for the team to go and learn from the airline industry and also think about customer service in a highly stressful environment where you know people are getting lost, people are going and their flights get delayed. That same thing happens in the hospitals for ORs, right? ORs get delayed all the time. How do we improve that? And so for them, one of the solutions was built this like, just ask for help customer service, right? They're stationed in all these different places around the airport and it was like, just ask for help. Maybe you need help obviously finding your flight, maybe you find you lost your luggage, but ultimately it was also like you just wanna, you just got off the flight, you're interested in knowing what the giant score is, like for baseball, like go and ask them. They will help you answer it, right? So it's really like this building this customer service that can really cater and feel like approachable was one way that they tackled it as an example. But that's where they decide to take that, think about how they can improve that kind of like expectation setting for their patients coming into the OR so that people feel like, "Hey, I'm gonna be well taken care of." So that's an example. Okay, so we're gonna just share with you, it's kinda some of these starters. You know, you're gonna break it down for analogous when you're trying to figure out, "Where can I look?" Let's break it down, so like what are you trying to learn, and break down the problem into components. When you think about analogous examples, think about what are those examples and themes that you feel like, "Hey, that's really interesting "that they did it like that." Sometimes it helps just to like be able to relax, 'cause sometimes it feels like, oh, I don't really know if this is a one-to-one, right? The way that JetBlue delivers their services, is that the same as healthcare? I don't think you have to think of it that hard in sense of like, well it doesn't need to be one-to-one that something matches, right? But it's allowing you to see like, well, they did in a way that feels like that experience was much better than how we do it now. So maybe that's how you use analogous. And then just let yourself explore. I sometimes feel like we sometimes don't give a space when we are trying to design to just go wild, right? Like, take out all those constraints and be like, what if we were trying to deliver healthcare in, on a raft going down the Grand Canyon, right? Like, what would that look like, right? Take out, try to give yourself a little bit more room to explore. I'm just gonna share this 'cause we're gonna actually do some brainstorming right now, is these are kind of our tenets of brainstorm. It's always that you build ideas off of each other, encourage really wild ideas. Don't, please at this time, do not like defer your judgment. It's like, no, we're not gonna say, "Hey, that's not possible." But why don't we just say, "Hey, like what if? "What if, and yes, maybe we could do that, "and something else," right? Try to stay focused on the topics, be visual, have one conversation at a time and go for quantity. So these are kind of these ideas of like, "Hey, how do we, as a group together today," all 15 of us, we're gonna all brainstorm together. All right, so we're gonna get started, 'cause I like to do exercises where we can all participate. So, I hope you guys will participate with me. I went through the ACEP kind of itinerary, like your schedule, the schedule. And I saw Dr. Moulin is gonna be talking about decoding the waiting room in the emergency rooms. So, she writes here she is like, "Waiting is frustrating, demoralizing, agonizing, "aggravating, annoying, time consuming, "and incredibly expensive." And she talks about, she want, she says, "Hey, how do we take that from a business and service lens "and then managing the wait waiting room?" So I thought maybe, given that this is gonna be already a topic at your, at ACEP, it could be a nice one to play around with. So, we're gonna do, take this topic, hopefully it's an interesting one, hopefully all of us have experienced that, and it's how do we manage expectations in the waiting room? And we're gonna do some analogous research, or like examples in our own head together. So, you're gonna do one minute, I'm gonna give you one minute to do two warmups. That means one minute to write down as many ideas that you have into the chat. Our team from EMIC is gonna be adding them so we can see them as they come up, and then we're gonna just spend five minutes kind of discussing what that was like. All right, so... All right, so, the first warmup, oops, this should say one, sorry, but we're gonna start with warmup number one. So hopefully easy. "When you were growing up." So this like, we're gonna be talking about managing expectations. So when you were, first one is a warmup, I'm gonna give you a very easy one. "When you're growing up, or now if you happen to have kids, "what are some ways that you use to pass the time?" And throw them into the chat. I'll throw some of mine, myself, out there.

- Wow, keep them coming, this is great.

- Awesome, I see good ideas. We're gonna just throw them as they come in.

- I think, Delphine, I'm typing them in. I'm not sure if it's showing up but-

- You should be on slide 20. Hopefully you're in there. I put 20 down.

- Yeah.

- Okay.

- Perfect.

- Excellent. And then give you 30 more seconds. I ran, I did not keep track of time, but I'll give you 30 seconds. Okay, 15 more seconds. I love some of these ideas. "Listening to music, hop up and down, tapping, "running around, talking with friends. "Ride a bike, ice cream," always a winner. Okay, we're gonna switch to the next one. You're gonna hold all these thoughts down and then we're gonna do it to the next one. I'm gonna skip down, okay. I'm gonna, can you share some times when you thought that you were going to be disappointed but you were pleasantly surprised? Whether some, and then you can build on that one, or you can explore, what are some examples where you had very low expectation but the experience raised your expectations? And I'm gonna say it does not need to be a time in medicine, at all, but a restaurant, a flight, online shopping, maybe it was an encounter you had at the barista, you know, whatever it is. Go ahead and throw some stories down a little bit in like one or two sentence. Ooh, I love some of these. So we have cooking a complex receipts, Zoom. I also added to Zoom when Zoom started transcribing for me. I was like, "Oh, amazing." Oh yeah. Love that, recent chat bots. Anne, I would love for you to expand on that one. What did you say, you recently had surgery, what about it? Love to hear a little bit more what that drew for you. Okay, great, I'll give you guys like 10 more seconds. Recently, in one of the AI Dall-Es made my kid a Elsa holding a Pokemon. And so, I got to put that as a picture. Okay. All right, so I'm just gonna share a little bit just so you guys can see, take a look at the screen, you can see some of the really good experiences that people had. And I know we didn't get all the details. I'd love to hear some of these, like what that was and get more details, wanna hold onto those ideas. And then also thinking about things that are passing time. Okay. Curious, like what do these analogous ideas spark for you? How does analogous ideas help you? Let's start with the first one, so how does, what do they spark for you? If you go back to kind of the source and originally like, you know, one of the experiences like, how do we manage expectations of waiting room? So, we're not gonna jump to the emergency room yet, and that waiting room experience, but curious, what did these analogous ideas spark? What was the feeling that you guys got when you recalled these particular experiences? And please come off mute.

- [Participant 1] I think one of the ideas that I've always had about making the user experience better for patients in the waiting room is giving them an actual task to do because it kind of takes their mind off the fact that they're waiting and you can really collect a lot of interesting and useful information from them, either from getting their past medical history, getting more details of their chief complaint, or you can even, you know, ask them, you know, questions about, "Why did you choose this hospital "as opposed to another hospital?" Or, "What made you decide to come here today "versus going to an urgent care," et cetera. You can use that time to both your and the patient's benefit.

- I love that, yeah, definitely. Like, when someone is moving and doing stuff, it feels like the time may be passing faster, for example. I do that sometimes too when I'm driving on the highway and I'm like, hey, actually, even though it feels like it's gonna be the same time but I'm moving through local traffic, it feels better than just doing it and just waiting in the traffic for the whole time. Okay, anyone else? What does this spark for you?

- This is Kim.

- [Delphine] Go ahead, Kim.

- I felt like it really shifted the perspective. Like, when I read the question, it felt like I was a doctor, I was a person in healthcare, but when we did the exercise I was the person in the waiting room, and it totally shifted the perspective and it became fun and how do I make this enjoyable? And I think it really helped if I was designing me being the right place from which to make the design.

- Great, I love that.

- I also think it helps, like, and this is, I mean, it's cliche, but it's true that we get so separated when we're thinking about these things analytically from the feeling, like you mentioned, and I think getting in that mindset of, you know, thinking about waiting from other perspectives helps you remember what that feels like. Like the prompt of what did it feel like when you were a kid, when you were waiting? Like, I instantly thought of, you know, the times I was annoyed waiting for things and then what made me feel good, which, again, gets you in that like human-centered perspective.

- Yeah, that's very true. Like if there's like different ways, I mean I say someone even like saying, "Hey, tap on something or drum," and I remember I went to this place, oh, we went to Legoland, and what they did was they had a bunch of little instruments in the queue as you're like winding for like 45 minutes waiting to get on this ride, right? But they had for the kids little activities to do as you're winding through the line, so it feels less like I have to like be here and painfully watch the seconds, like each 10 people go by, and I thought it was a very interesting tactic by them. Anybody else?

- I think Willie has his hand up.

- [Delphine] Go ahead.

- Hey. I'm, I'm... Zaid, who knows me, probably knows me a little bit as a disruptor. My reaction was not how to answer this question, but why are you even asking me that? Why am I in the waiting room?

- Mm-hmm.

- This is the wrong question. There shouldn't be a waiting room, and if there is a waiting room, I should still be getting my care started in the waiting room. I shouldn't be sitting here for more than a very brief period of time. Sometimes I think in trying to address gaps in our world, and I think in any industry, we ask the wrong questions and work on the wrong questions. We try to solve things that really result in tampering with the system. If anyone's a Deming, a student of Deming, you can understand what tampering is, and not really making a true improvement. We're just tampering with the system. We are changing one thing but not actually making an improvement to... something that's going to contribute substantively to the aim. So if the aim is to make people happy in the waiting room and that's the end game, yeah sure we can do, it can make me happy in the waiting room one way, but the aim is to provide me expeditious, excellent, high value, efficient care. Making my waiting room experience better is not necessarily going to improve that.

- Yeah, yeah. I think you raised a really interesting point. Can you flip it on the head, can you change the waiting room to not be a waiting room but something moving towards care, right? So, then I would say like, what would be like in your mind moving towards care? Like, if you were to get some, like there's no nurses, doctors, but like will be moving towards care in your mind.

- Sure, so... Well first is still to address waiting room delays. So why are there, why are people in the waiting room for an unacceptable amount of time, whatever that might be, and certainly much of the major medical centers in this country have long waits in the waiting room, even many community hospitals, and so addressing that. Now, given the constraints, well, okay, let's be realistic and so what's the aim here? The aim is to get that patient care. And so if we don't have, you know, we're complaining as emergency physicians, well we can't, you know, move people through because we can't get people admitted and therefore the whole ER is backed up because we don't have enough beds. And so, well, you know, can we take care of patients in the waiting room? So one of the sites that we have, we started a provider in triage program where we have some extra triage rooms and we rotate people through those rooms. We work in a rural health system where people don't necessarily live close to all the places, so we use telehealth for that. So, when I do a telehealth triage shift, which isn't really triage, I'm actually seeing the patient, I'm geographically in a disparate location from that patient. Another is, one of our sites has a 29 bed ER and we often have 20 patients boarding, it's a rural sole community hospital, and so we see a lot of people in the waiting room. I will literally walk out to the waiting room and move a patient over to a private area, interview them, and then I'll walk them inside. We keep some chairs open and some stretchers open that we rotate people through and then put them back in the waiting room, draw their blood, even start an IV, put them back in the waiting room. Far from ideal, but it's more congruent with the aim than to just try to make somebody happy in the waiting room. I like the idea about, a couple of people talked about, ideas that engage the patient in their care and maybe make it more efficient, maybe possibly get more information from the patient with the leisure or the, not leisure, but the using that time to have the patient reflect on questions that will contribute to their care, I like that a lot.

- I like that, just capturing all these as we talk. So we're gonna use it for the next one, okay? Love these. And I think it's a great interesting idea, and definitely I think it's the idea of like how do we start your care early in different ways and mechanisms so that we are actually moving towards that is one that I think we have seen definitely different ERs do that, and then definitely thinking about how do we engage in patients so you can start to get even the questions, start to get the story down even before you really get the full history. So it could be a way to approach that. Okay, anyone else wanna share what this sparked for them? And I'm curious, how do these analogous ideas, like if you start to think about, I'm just curious to hear, right, like how does thinking outside of our industry, or different moments, help you start to understand the current problem at hand? And the reason being is like, you know, there are some industries out there, or some products out there, that have really helped with doing these, some of the things that we talked about today, help with managing expectations, managing kind of like the feeling, what is it about those particular products that felt... felt like they met what you were hoping for? So some folks talked about Zoom, somebody on here talked about, just looking, the automated hotel check-in. What about that struck for you as a really positive experience? Nigesh, maybe you wanna talk about, I just glanced at this, how the hotel check-in for you?

- [Nigesh] Yes. So, whenever we travel abroad sometimes we had to wait in line to check into hotels, and that would definitely add at least 10, 15 minutes beyond the regular frustrations of international travel. But after we got some of these new technologies with digital check-in and having some of the details already filled in made the whole check-in experience faster and smoother, right? So that kind of was definitely a time saver as well as a very pleasant experience, relatively.

- Mm-hmm. That's great. I mean I think that's interesting like a concept like, how do we think about creating a system just for purely just check in where you're like, I don't have to fill out a million forms that you probably already have in the system. How do we leverage those moments to be able to make that experience feel like you're doing more paperwork unnecessarily? And that could be something to explore, okay. I think someone on here, they talked about having to use Apple Pay. Anyone wanna share a little bit like how Apple Pay, the experience for them was really positive, and what about that?

- Yeah. That was actually me. I think, I was just skeptical when, you know, Apple Pay first started becoming a thing or any of these contactless payments, like, okay it's another place I have to fill in, you know, my card info and everything, and how much time is that really saving over, you know, pulling out my credit card that I already have in my phone case? And then using it, I mean, even the two seconds there was just something about it that's like, oh my God, this is great. And I, it's hard to even describe that, like that why that two seconds matters, 'cause like usually you're doing that and then like still waiting around for something, so it's often not just like the bottleneck but something about it still feels nice. Yeah.

- So taking something that's like a mundane action but making it really simple.

- [Participant 2] To add on to Karan's point with online ordering with contactless payments, that would have been awesome. Contactless in the sense of me not putting my address every single time. That was an amazing experience.

- Mm-hmm, mm-hmm. No, I think it's really interesting to like think about how you can try to try, anybody else? Otherwise, we'll move on to the next one. I want you to hold onto these different ideas that you have. How other moments in your time, like in your life where you feel like, hey, I was able to like kind of use those opportunities to become a little bit more streamlined, efficient, hold onto them. But if anybody wants to share theirs, 'cause I might have missed. Okay, I'm gonna keep going, 'cause I know we're like short on time. Okay, so we're gonna talk about sacrificial concepts. So, now you're starting to percolate all these different ideas where you're like, okay, there are different ways to solve this problem in different ways, right? You know, whether or not it is even taking waiting out of the waiting room. Is it thinking about like how do we make that moment feel a little bit more enjoyable or a little more seamless, right? So, then you start to have these ideas, but then you're like, well, what is the, how do you think people are going to react to this? And so, a lot of times what I'll see is folks who are like, be like, okay, I gotta like build all this out, right? But when I talk about sacrificial concepts, the concept of sacrificial being what it truly is, it's sacrificial. You come up with these ideas and you are not gonna hold onto them. They might be really great ideas but until you really test them out with people who are gonna be the potential users downstream, you don't really know, right? But I also would hate for you guys to spend a lot of time building something beautiful and fancy only to realize that that is not gonna work, right, for whatever different reasons. So, one of the things that I highly recommend is building sacrificial concepts. And so this idea where you can then take something that's really abstract, use it as a hypothesis and then de-risk. We use it a lot in terms of research to get people talking. When we have something in front of people, it's much easier to have that conversation with them. So I do this all the time at work today when we're talking about actually things very mundane. Like, hey, how do we fill out this, like, we had to do this treatment form plan for our inpatient psychiatric patients, and it's a form, but ultimately how do we go from a place where it feels like it's a regulatory form to something that feels like it's collaborative? Because a bunch of team members are gonna be putting their information on this treatment plan, okay? And then you try to get some quality feedback, and really at the end of the day, you are using these concepts to also generate response. Like, now they might be like a totally negative response, and we definitely will build sacrificial concepts to really push the edges so that we can hear really why do you really hate, we already know that we are not gonna build it, but we wanna understand the reason why somebody really does not like something. So you can even build sacrificial concepts that actually push toward the negative side, not just the positive side. So you can kind of get a gamut of reactions. So you can see here, we have a couple drawings here, things like that we might have. Here's, actually, they were building, I think this is for an airline, the airline seating. So they had to build out, "Hey, I'm gonna build out "how far the seats are from each other "so we can really get a sense how squishy it is "or how much room we can play with." And then why do we use prototyping? Because we really wanna learn and be able to test and refine our ideas. And so these prototypes are to make a question feel very tangible. And so, I would push you guys to feel like, hey, actually I should build some kind of physical, visual aid as you guys are building some kind of idea out. And I just wanna share like, to me, the way I think about prototypes versus the full idea. Prototype is like the icing on top, or maybe it's the like filling in the middle, right? So that's what you're really testing. It can be small, it can be distinct. Then over here, the MVP, which is the like, you know, this viable, is it, is like what if, what if your cake do you need to prove in order to actually have a full functioning product, right? And then, lastly, is the full experience, right? And so this is kind of how I think about these, and really your prototypes should be narrowed in the sense of the question you're trying to answer. It does not have to be the full fledge. I wanna share this project. So this is a project of how PillPack came. So I don't know, as you know, PillPack is a billion dollar company that Amazon bought. This is a project that IDEO, or we worked on, so basically, initially when we first started, it was like how do we, like, the first question was like, oh, people really need a way to take their meds, get their meds, right? So it was like, okay, we're gonna like focus on getting their meds delivered on time. But when they did the research, right? And so, you know, we started off with just some simple drawings, right? And I think a sketch on the next page, is a sketch storyboarding, right, to get people's feelings, so that this is all that that was. Then over time, as it got narrow, they would just actually put like a fake webpage on to see what it would feel like of like, what would it mean to have your meds delivered? And started hearing from folks, actually, really going back to the story about that woman with arthritis, right? The issue was like, well, all this packaging shows up, and then how am I supposed to open it? So it moved from something of a delivery service to like, hey, actually, it's about the packaging itself. How do we make it a lot easier for people to both remember their meds, right, and also open them, so they move to more of a smaller packaging, 'cause people are like, "I don't wanna be environmentally wasteful," right? So you start to move from there, and it's really, this was just a simple piece, like a photo, that we just put on to see people's reactions, right? There's no product behind it yet. You can also build a wireframe of what the screen might look like. And then, lastly, play around with something like this, where it's like, well, what if we were to put your schedule, what the meds you're supposed to take on here, and the time and the date, to really help people remember. But before we even, this is before you even built the 3D tangible product. It's just like, here's a set of pictures to help people feel what it might feel like to help them understand. This is another example about prescription behavior. Literally, as you can see, this is just like, like the worst drawing, but it's like just a quick drawing to help people understand, well what is the, how do I pick up my meds? How do I get them? And as you can see, this is supposed to be a telephone. It's school drawings at the best. I'm gonna share this story from you for treatment plans for mental health providers. So we, I referenced this one because when you, when we were trying to build this product, and everyone would come to us and say, "Hey, we need to have this treatment plan because, you know, "the regulations of the state say "we have to have a treatment plan, "you've gotta fill out all these text boxes." But when you ask anybody what is a treatment plan, like truly, what is the goal of treatment plan? They'll say the goal is, it's a big collaborative tool where people can share all their ideas about how they're gonna take care of this patient, and it's like that information is disseminated across the entire treatment team. That's a really different sentiment than someone saying, "Hey, we need to have a frequency, "we need to have a responsible role spelled out "and we need to have an intervention." But by understanding, hey this tool is supposed to be collaborative and it's supposed to be one where you can come in and edit it based on what your coworker did last week. That, by having something like this, which is a conversation starter, this helps us as a researcher understand, well, how do we change something that feels very much regulated than a form to something that perhaps is a lot less regulated, or a lot less, lot less, like more enjoyable to fill out. I'm gonna show these other ones. This is Willow, which is a, so this is, sorry, this is, as we talked about 2D, 3D, so just giving some examples. This is the Willow, which is a breast pump that didn't have any wires, and you can see the millions of different ways in which they tested and built prototypes before they got the final one. This is an example of a surgical tool, and it was a surgeon that came up with this idea. He just like grabbed three things, the eraser, the marker, and this clip, and was like, "This is how I like to hold my surgical tools." But it wasn't until somebody made it that it made it more tangible what they're trying to accomplish. And I know we're running out of time, so I won't go into it, but there is a really good video about service design and how you can build the space. So this was at CHOP at Philadelphia, of how do we make the patient's room for someone who's very sick, a child that's very sick, a little bit more like home. And the way that they built it was like these 3D models of like they took just a, like a warehouse that looked like a hospital room and they built the beds, the tables, and then allowed hospital staff to walk through, change things around, move things around, so you can start to get a feel of like, well, actually, this is really hard to work on this computer because I'm turning my back on the patient, right? And so I don't want the computer screen to be facing that way because of whatever reason, right? So, but until you build and people get to be in a space, it's really hard to understand what the experience can be like. Yeah, and there's a really great story, right? For example, like kids are really scared of going in the MRI museum... it was a machine, and so, I forget which hospital did this, but they painted the entire MRI with like being in the scene in the ocean, right? And so, that feeling of being like you're now a scuba diver going in and coming into this machine, into your boat, and building out this whole story and scenario to make the MRI machine be less scary, right? So there's a lot of different ways to do it. I'm not gonna go through the video today 'cause we're out of time, how they show it some, to folks. But sharing with you a little bit here is just like a really quick like how does prototype, the different types of ways of prototyping, sacrificial concepts, are really just like a rough sketch, just get some responses. A prototype is much more tangible, an experiment is like, the one I just showed you, where in CHOP, they're gonna test it with end users, and then pilings where, hey, we're gonna get a larger population of end users. So just giving you kind of the gamut of ways that you can test. I'm gonna just skip us onto the exercises here 'cause I want you guys to go and try this out as a group. Hopefully, you have a paper in front of you. These are kind of the ideas that you had of how to, how do we manage expectations in the waiting room, just kind of capture them as we were talking. And what I would love for you to do, and we only have a little bit of time, so I'm just gonna have you guys draw one idea. Why don't you guys all take a moment to draw a sacrificial concept of how you might want to like take one of your ideas that you like, have been perfectly managing expectations. and let's spend two minutes drawing. If you have a piece of paper, if you don't have a piece of paper, you can just describe it in words, but I'm gonna ask a few folks to share it if you can. Everyone understand the instructions? You're gonna be drawing an idea that you had about managing expectations in the waiting room. Draw it, stick figures are totally acceptable, and then we're gonna share the idea to the group. I'll give you guys two minutes. I wish I had some music, but I don't. I'm gonna go back to your ideas here, so that you guys can see some of them here. Thanks, Willie. If you can even get two ideas, that's great, you have one more minute.

- This is reminding me how limited my artistic skills are, but-

- Oh, don't worry. My artistic... Very subpar.

- Showing his in the chat, nice.

- Oh, nice job, you wanna throw in the chat? That sounds really good. Okay, we're at eight seconds. Why don't we have Zaid start? Maybe you're sharing, I'm gonna stop sharing, and you can just hold it up on your screen, and you can hold it up to folks. I'll remove my pin. On the pin, okay, Zaid, why don't you walk through it, and then we're gonna take one or two people's thoughts here. Go ahead.

- [Zaid] All right, I have "Sesame Street" in the background, I apologize. But basically it's like, my thought was like, imagine expectations through a dynamic queue. Patients are always asking like where they are, when they're gonna be seen, and maybe visualizing the process on their phone or another way to see how, you know, their queue spot or their time to be seen shifts dynamically as patients with different acuity come in. So they have their spot, like an imaginary space, and it goes up or it goes down, or an emergency over here shows up, so then they see that, oh, somebody came in urgently, so your queue has been pushed down, and that's pretty much it.

- I like that, it's like you both know what you're, I had something very similar. It's like a checklist of all the things you got to get done, or like things before you, but then it's dynamically trying to build empathy that there is an emergency that came through, but everyone can see that. That's interesting. Does anybody else wanna share their ideas? Just so you know, mine was very much a sketch of like, you know, lines. Anyone wanna share? Max, I see that you came off, so I'm gonna call on you. Do you have anything you wanna share?

- I don't really have too much. I mean, I think I was just thinking about the... automated check, and I mean, I don't, I was mostly thinking about the clinic experience more than a hospital setting, where, you know, similarly to like hotel guests, you would allow people to check themselves in that already have appointments through, you know, an iPad or something like, the shared iPad or something like that. I mean, the other thing is like, I feel like it would be, like, you should know if you have my information already, so that I can like do a form or not have to do a form, kind of all of that kind of stuff. Like, in the normal cases, how can we skip, like the, like, not abnormal, but just the, you know, the cases that need more human touch. Yeah.

- No, that's great, I think there's something about that, but like filling out forms that's really tedious, and if there's a way to, if you really have it, then don't make me do it. Any last ones that people that wanna share theirs? 'Cause I know we're coming up on time.

- I think I saw Kim holding something up. And then Kathy.

- Go ahead, Kim and Min Jung, and we just, we can close on these two. I'll just share some final thoughts, but let's have you guys share your ideas.

- I live in a really rich, abundant fantasy where each of these people have a little VR pod when they come into the waiting room, they, of course, they electronically check in, but they're separated from each other, 'cause I find being in contact with other patients, having other emergencies, I think actually makes people anxious, so they all have a little pod with a little VR and they can pick their VR experience.

- Ooh, I love that, that sounds amazing. I'm gonna go to the beach for that. Okay, Min Jung, you wanna share yours? Last one?

- Yeah, hi, I am Kathy. I was trying to refrain from starting a sales pitch, but I am the founder of Siren Care and I'm doing patient intake in the emergency department. So, harnessing the waiting time to collect information. And one thing that I was thinking about, the example that I provided was the free food sample in Starbucks. And I've been thinking, you know, if the patients provide their information, what can we do for them? And part of the frustration of waiting is not knowing what to expect. So it would be great if we can inform them more about the waiting times, but it can get quite complex to, you know, predict waiting times. So I was thinking about, you know, how can we do this more simply? And I was thinking, you know, if we, if the waiting time, waiting room is confined to like a physical space. Oops, I have my blur on. Oops. So if the waiting room is confined to a physical space, if we have a person counter, whether it be like a count in and out, or whether it be a camera that just counts patients, we can have like, you know, some set some expectations. Maybe, you know, to about the average waiting time, and just capture, you know, how long they're waiting so they don't have to go to someone and ask that question, and we can set some expectations. And also if we can get that real time in a bunch of ERs, or urgent cares, in one location, we can also share multiple wait times in that location so that patients can self-divert them to places.

- Mmm. Yeah, so providing a way in which people can make kind of their own informed decision about what their, how long their wait is gonna be, that's really helpful. Okay, guys, well, I know we're up to time. I'll just share this last screen here, and obviously if you guys would like to have any of these screens, I'm happy to share them. These are some questions now, as you make your sacrificial concepts, at the end of the day, it's really open-ended questions that we should say to folks that when you're trying to probe with them, what is, what do they, what is a reaction to the sacrificial concept prototype that you're showing to them? So a lot of times we'll say like things like, "Hey, can you walk me through what you're seeing? "What is your eye most drawn to? "What are you least drawn to? "What would you use the most, or why?" You have a lot of different features. "What were you expecting to see?" So a lot of times you, they'll have this thing, and you're totally off, so you're like, "What were you expecting to see?" And they're like, "Oh, I was expecting to see "this other thing, right?" So sometimes they can help you design, and then obviously of course, asking them what is missing, right? Like what were the, were they hoping for? So these are some open-ended questions to help you guys get started as you're trying to do your research and understand, you know, whether or not you're going around the right path. Lastly, I'm gonna let Karan jump in here for a next step at ACEP and what they're planning on doing.

- Yeah, thanks so much, Delphine, this was amazing. And we're gonna build on this, so, this year, for those of you that are participating in the Hackathon, we're gonna have the chance to do this for your own, you know, your own pitches and your own ideas. The nice part about being at ACEP in person is that you're gonna have thousands of end users at the conference that you could potentially recruit to kind of give you some user research on some of these prototypes, and I think sacrificial concepts in a time compressed setting, like a Hackathon, is a great way to kind of explore some of these things. So, we'll likely have some materials for you all to create some sacrificial concepts and kind of iterate that way during the Hackathon. So, look forward to that. Again, 2D or 3D, you know, are both really helpful. Even a 2D, just like we're writing down in this session, can kind of help advance ideas. So looking forward to that at ACEP. And we have a bunch of other good sessions coming up. But thanks so much, Delphine, this has been, this has been really cool and unique.

- Thank you, everyone.

- All right, everyone, thanks for joining everybody.

- [Participant 3] Thanks, all.