Story Research Design Team
Research

Working alongside University Hospitals in Cleveland, our group of Masters in Human-Computer Interaction students worked for four months to navigate secondary, primary, exploratory, generative, and evaluative research to redefine our problem space and offer valuable insights.

01

Context

Before we dive into the gist of what we did and what we learned, we wish to take you on a ride to the journey of a typical patient with a surgical wound from a Mohs surgery.

Mohs surgery↗ is one of the most common treatments for high-risk skin cancers. It involves cutting away thin layers of skin until there are no signs of cancer left. Following surgery, careful treatment is required to minimize the risk of infection and avoid other problems.

Below is an initial patient journey map that we created to understand the patient's experience and emotions from the discovery stage to healing, and opportunities that may be found along the way.

02

Problem

As we continued to analyze and synthesize the data we had collected over the course of the semester it became clear that we were faced with a different problem than we had originally set out to solve: the patient’s inability to deal with unexpected situations, and the lack of easily accessible, personalized information, are the main causes of poor surgical outcomes and healthcare providers’ burden.

the patient’s inability to deal with unexpected situations

the lack of easily accessible, personalized information

We understand our problem, and we know what the benefits will look like for our different stakeholders, so what questions do we have to guide our research as we move into the summer semester? Our team developed 2 ‘how might we’ questions that we believe, at this stage of our research, address the essence of our project:

How might we help patients to put more trust and attention towards the wound-care material?

How might we ensure patients receive immediate answers and reassurance while reducing the workload for nurses?

We didn’t just pull these guiding questions out of thin air, so to better understand how we got here we will get into our three key insights.

03

Process

To answer these questions, we conducted a comprehensive research series that help us step into the world of wound care. Most excitingly, we began with a one-week empathy study to put ourselves in patients' shoes and become familiar with general wound care procedures. We also conducted site visits where we interacted with patients and healthcare providers in clinical settings to identify various touch points in this journey. Additionally, we interviewed both healthcare providers and patients to uncover pain points from both perspectives, and with speed dating sessions we showcased our ideas to explore hidden needs and potential design directions worth pursuing.

1-week

Empathy Study

6

Patient Interviews
& Site Visit

9

Expert Interviews

9

Speed Dating
& Interviews

04

Insights

01

Personalization at Home

The current wound care procedure doesn’t feel personalized beyond the clinic.

INTERVIEW

Nurses disclosed that they primarily use the wound care instruction sheet as a reference point, often tailoring the delivery of wound-care instructions based on various patient factors, including age, personality, cognitive ability, wound location, and prior experiences with wound care. They adjust aspects such as pacing, content coverage, and repetition frequency accordingly.

SITE VISIT

When back at home, patients are left to adapt generic instructions without professional guidance, relying on intuition and assumptions that are not always correct.

LITERATURE
REVIEW

Personalized care has been shown to improve patient satisfaction and outcomes. Extending personalization post-discharge, considering each patient's cognitive, health and technology literacy, and providing personalized instructional materials, whether in print or in the form of mobile-accessible content, can enhance patient confidence and treatment success.

To truly enhance wound care outcomes, it is important to extend personalization beyond the clinic setting by anticipating patients' needs during the immediate post-discharge period.

By proactively addressing these factors, patients will be more confident navigating their post-discharge care, ultimately improving outcomes and satisfaction with the wound care experience.

02

Preparedness for Unexpected Situations

Although patients show high confidence for at-home wound care, they are unprepared when unexpected situations arise.

SITE VISIT

At the clinic, when asked about their level of confidence in their ability to perform wound care at home, 100% of the patients gave themselves a perfect score of 5 out of 5.

INTERVIEW

The current procedure focuses on instilling confidence in patients before they leave the clinic. In practice this often means focusing on the main instructions patients will need to follow and not spending much time discussing possible complications and what to do when such complications arise. As one nurse shared, “I personally will only go over the first page of the instruction sheet. Most the information is on it, including what to do within the first week after surgery.”

OBSERVATION

As we delved into the call log data, we discovered that a significant (42%) percentage of the calls were related to complications, ranging from concerns about wound reopening to symptoms like itching and the appearance of white spots.

Accordingly, rather than focusing primarly on making patients feel confident, we also want them to also appreciate that uncertainty is a natural part of the wound healing process. We want them to understand that potential complications may arise and prepare them to deal with them if they arise. By better preparing them, we aim to reduce anxiety and empower them to more effectively navigate challenges should they arise during their recovery journey.

03

Need for Reassurance

Patients seek constant reassurance from direct conversations with trusted healthcare providers.

INTERVIEW

During interviews with subject-matter experts, 7 out of 9 people highlighted the importance of reassurance in patient interactions. One nurse mentioned, “It’s important to reassure them because people might easily forget or feel nervous.” Similarly, another nurse said, “I always encourage patients, especially those living alone with challenging wound locations, to call me for feedback, reassurance, or further counseling.”

SPEED
DATING

The literature indicates that patients are reassured when they know that nurses are nearby or easy to reach. At the Cleveland Clinic, phone calls are the primary way patients seek reassurance. In speed dating sessions, 14 out of 16 patients said they would first call nurses or doctors if they encountered problems. Many patients expressed discomfort with chatbots or mobile apps, preferring direct interaction with medical personnel.

SPEED
DATING

Patients rely on calls due to their trust in healthcare providers' expertise. Patient 1 said, “If they tell me I can shower, I shower.” Patient 8 echoed this sentiment, “The doctor knows me, so I’d trust him. Right now, he is the expert.”

Our solution aims to balance the need for patients to be reassured without imposing unnecessary burden on medical personnel. It does so by providing patients with more relevant, personalized instructions, including information about potential complications and how to deal with them. This includes instructions for when to seek help from medical personnel. In addition, we also introduce a proposal for a chatbot solution for those patients who are comfortable using such technology. The chatbot would need to be thoroughly vetted and include appropriate guardrails to ensure it can safely be deployed in such a context.

Empathy Study

In a clinical demo in the kickoff meeting, we were each given a wound to take care of, offering us a hands-on understanding of the challenges a patient might face as they recover during post-op recovery at home.

WHAT WE DID

Armed with wound care kits and at-home care procedures, we embraced the responsibility of maintaining the initial dressings for the first 48 hours and changing our bandages daily for the next four days. During this brief wound-care simulation, each of us shared our daily thoughts and reflections with each other, highlighting challenges and certain experiences woven into our daily lives.

WHAT WE LEARNED

From navigating instructions to facing changed perceptions of facial expressions and social interactions, this experience became a profound exploration of both physical and emotional dimensions. Adapting to new routines, confronting societal misunderstandings, and managing persistent itchiness exposed us to some experiences that a patient would face during the post-operative recovery stage. The final day brought a mix of relief and reflection, and we were able to connect even further with our project.

Site Visit & Patient Interviews

On the morning of February 7th, we headed to Cleveland for a site visit, armed with interview guides, worksheets and above all, our enthusiasm.

PURPOSE / GOAL

Our intent with the site visit was to immerse ourselves in the client’s environment and see for ourselves what was taking place at the clinic.

Patient Facing

1. To discover patients’ experiences towards at-home wound care, including preferred ways of learning, pain points, and goals

2. To discover patients’ attitude towards at-home wound care

3. To understand how patients communicate with healthcare providers , e.g. questions that they ask the healthcare providers

4. To understand support network when recuperating at home post-op, and how does this influence the success of at-home wound care

5. To discover various potential barriers patients of different demographics have towards at-home wound care

Clinical Facing

1. To understand the sequence of events during wound care treatment

2. To understand how healthcare providers communicate with patients, e.g. instructions they give to the patients, questions that they received from patients

3. To discover healthcare providers’ barriers to communicating with patients

4. To discover the pain points healthcare providers have about helping patients practice wound care procedure at home

WHAT WE DID

AEIOU stands for ‘Activities, Environments, Interactions, Objects, and Users’ and is a design thinking tool used to explore and make sense of the experiences of users. For us this space was the waiting room of the clinic as we saw this as an opportunity to empathize with patients’ experience beyond what happens in the appointment room. To conduct this activity we each went out, one at a time, into the waiting room for approximately 10 minutes and observed a different AEIOU element. We did this each once in the morning, and once in the afternoon.

In one day of interviews we had the opportunity to speak with seven patients. These selfless patients allowed us to speak with them, in teams of two and three, during their visit to the clinic.

Lastly, for the nurse mockup one of our team members assumed the role of a patient, while the nurses and the doctor recreated the exact experience that a patient would go through following their surgery — dressing their wounds, listening to the at-home wound care instructions and receiving a four-page instruction sheet about what to do.

WHAT WE LEARNED

The opportunity to visit the University Hospitals clinic allowed us to delve into the experiences of both the patients and the health care providers. We prepared tailored interview questions for both, focusing on the key themes we had generated in the first phase of our research. These questions guided our conversations and helped us to uncover valuable insights.

From the patients we understood that they were leaving the clinic with very high levels of confidence. At the same time however, we were hearing from the nurses that they were receiving numerous calls from patients who seemed to be seeking reassurance once they were home. There was a clear misalignment in patients’ perceptions of their confidence, and their actual wound care proficiency.

Expert Interviews

We conducted expert interviews to understand more about wound care practices, focusing on daily patient interactions, post-op care, and at-home instructions. This involved a series of questions covering various aspects of wound care, communication channels, and patient expectations.

PURPOSE / GOAL

1. To understand why healthcare providers communicate with patients the way they do and any barriers they are experiencing

2. Understand healthcare providers’ expectations on patients’ at-home wound care behaviors

3. Understand how healthcare providers view the efficacy of the instructions they give their patients

4. To discover the pain points healthcare providers have about helping patients practice wound care procedure at home

5. Learn more about emerging technologies and lifestyle factors impacting wound healing

WHAT WE DID

Prior to interview sessions, we developed interview guides tailored for healthcare professionals to meet our objectives. Then, we recruited 6 nurses from the University Hospitals of Cleveland, along with 2 nurses and 1 dermatologist from University of Pittsburgh Medical Center. Given logistical limitations, we conducted the interviews remotely. Each session followed a semi-structured format, with one facilitator and one note-taker present, and lasted approximately 40 minutes each.

WHAT WE LEARNED

Through the expert interviews, we had new findings about communication channels, observed patient pain points, patient expectations, instructions, and emerging technology. First, we learned that primary communication is through the electronic portal, Epic, with rare patient calls and messages mainly for reassurance or infection concerns. Also, according to healthcare professionals, indicators for patient calls included anxiety, confusion, and repeated questions, with some redness considered normal in wound healing. Patients may struggle with assessing wounds at home, adhering to instructions, and accessing appropriate medication and home nursing. While patients are expected to reach out if they experience unexpected pain or significant changes in wound characteristics, healthcare professionals also commonly mentioned patients calling for reassurance. Lastly, when asked about emerging technology regarding wound care, plasma injections and stem cell therapies were brought up.

Speed Dating

Speed dating is a design method for rapidly exploring application concepts and their interactions and contextual dimensions without requiring any technology implementation. It helps identify and understand contextual risk factors and develop approaches to address them.

PURPOSE / GOAL

1. To surface more patient-facing hidden needs

2. To test out the level of riskiness of the kinds of solutions patients are comfortable with

3. To narrow down our design focus and design principles

4. To test if a more human approach / varied touch points to lead to a more successful wound care experience

WHAT WE DID
STORYBOARDS
Image 1 Image 2 Image 3 Image 4 Image 5 Image 6 Image 7 Image 8 Image 9
WHAT WE LEARNED

The speed dating sessions gave us valuable insights on patients’ ability to recall instructions, need for reassurance, handling unexpected situations, their pain points regarding their wound care experience.