myDesignThinking

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Great news!! I just accepted a research position as a student trainee with the Richard L. Roudebush Veteran’s Hospital in Indianapolis which is located on the northwest corner of the IUPUI campus. It will start in about a month. I gave up my school fellowship (see related post) and health insurance to take advantage of this fantastic opportunity to leverage my thesis research.

As a condition of being a “student trainee”, I am able to utilize the full resources of the department and part of my work hours (they call it a tour) are to be used for my thesis research. This opportunity will build upon my past professional experience, allow me to be onsite with my intended stakeholders, and actually be able to regularly engage with the senior researchers and faculty I am citing in my bibliography. In addition, I will be able to practice the skills I am learning as a Design Researcher and learn new skills to help to investigate healthcare processes, human-factors, patient-provider interactions and much more. I am so excited and I cannot wait to start.

Below is a summary of the position…

This is a Federal position in one of the few Human-Computer Interaction labs in the nation. I will be working in a research lab inside a hospital; with the work contributing directly to National-level improvements to the ways healthcare are delivered. Researchers need help translating their ideas for new systems into real designs, and those designs need to be tested on real end-users. Our lab here in Indianapolis does this for projects researching topics like stroke, exam room ergonomics, electronic medical records, patient-provider communication, and personal health records. I can expect to contribute as a full member in each project and will not be fetching coffee (unless I want to).

The position is placed in the Human-Computer Interaction (HCI) and Simulations Lab in the department of Health Services Research and Development (HSR&D) and Center of Excellence on Implementing Evidence Based Practice (CIEBP) as a student trainee. The HSR&D department is comprised of researchers (investigators) and support staff, and is funded primarily by grants. The HCI Lab supports various grants that seek to implement healthcare changes (process changes, software changes, etc). The HCI Lab provides design guidance and performs various types of data gathering on the proposed end-users of a grant’s product, especially usability testing and ethnographic observations.

I have been struggling with two different content buckets for a while now and I need to choose one. The pressure is on and it’s getting late in the semester to split my time on two different content areas. It was impossible for me to kill one, so I just keep on researching and making sketches. I was thinking that in my making I would discover a new understanding or insight yielding a clear choice. That hasn’t happen until today.

My two content babies….

- Mental models within doctor/patient interactions.
- Waiting rooms in ER or Family Medicine

So what does one do when they are stuck and fellow classmate cannot help? Go talk to the faculty of course! Christopher Vice helped to bring clarity to my struggles. I felt that the content area of Waiting Rooms was somehow weaker of the two, but I could not articulate the reasons why. He helped me to see that it was more at the level of “solving a problem” rather being an academic investigation in Design Research. It was a “WoW” moment. At that point, I understood the “waiting room” content bucket was built upon a foundation of sand! Meaning, it originally did started out as a problem or as I would like to say an opportunity. It did not have a solid foundation built upon theories; instead I took an opportunity and then sought out academic theories to fit into it. This is in contrast to the “mental models” bucket in which I wandered around in my research, allowing my interests and emerging patterns to guide me. Completely different approaches.

So say hello, to mental models with doctor/patient interactions!

For my other bucket I used the same format influenced by the challenge map, showing a scale or hierarchy of questions. The key insight about this visual is the the big blue and baby blue boxes to the right. They represent that huge visual size difference between the number of hours watching TV vs. the number of hours it took to create all of Wikipedia. Shocking isn’t it?

Now image if on the big blue box instead it stated how many hours were spent waiting in family medicine waiting room or an ER? It is an extreme example, yet it gets my point across that “waiting space” are at best missed opportunities and at worse lost resources.

Lots and lots of feedback from classmates.

In this visual I focused on my thesis question writing. Taking the best of “How Might We” questions from the 100s I created in the past weeks. I want to show different levels of scale on the questions. At the top are the higher level concepts and as I went down I unpacked those big concepts. This method was useful for it allowed me to see scale and get a sense of where the appropriate level should be.

I was influenced by the “challenge map” method and how I want to represent scale. Also I tried to show relating definitions, trends and key facts.

I have decided to proactively seek out a part-time professional or student work position that would help me to design and implement a more robust and in-depth thesis. Currently, I hold a fellowship position sponsored by my graduate program that is less than ideal. I do appreciate the health insurance and the monies the fellowship provides to off-set the high cost of graduate tuition, yet, answering phones in a civic art center and doing a few basic layouts 12-hours a week is not productive professionally and is taking too much time away from thesis research and interviewing stakeholders.

An ideal fellowship would have a flexible schedule. It would allow me to build professionally upon the skills taught in the graduate program. The perfect fellowship position would be within healthcare so that it could be used as a thesis resource.

If all else fails, I am seriously considering quitting my fellowship to focus on my thesis research even though it would be a large financial impact. I am committed to doing serious research and work towards a high quality thesis. There is less than a year remaining in the graduate program and I want to make the most of the time left.

What changed from Round 4:
From our small thesis group questions of my assumptions and Value Judgments emerged. What values and assumptions do I put into the follow words in quotes; “inefficient” systems, “holding” areas and “flawed” systems. How do I define these value statements?

I found within the “waiting room environments” category a more meaningful category of “reframing”. I felt an emphasis on a concept of reframing, which can be applied anywhere, rather than a waiting room which is more of context, will offer greater insight as thesis question. A focus on waiting rooms, I felt was too much like a project question.

Added sections of “framing”, “Interdisciplinary Team Facilitation”, and “Translational Designers” dropped “Transformational Leader”, “Greater System Thinking”, “Opportunity Finding”

What did I learn (reflection)?
Talking out loud to my small group is a helpful technique to conceptualize and externalize my thinking. In fact, their (mostly) silent participation as an audience allows me to safely present and articulate my thoughts is just as if not more powerful than interactive dialogue. I believe talking into a tape-recorder would be a good tool when I am without partners or small group.

Key component to effective small thesis group are a deferral of judgment, active listing, coupled with a few probing questions enables time for the speaker to talk out and conceptualize their thoughts. Also, the audience can help the speaker by capturing thoughts, ideas, feedback, and quick visuals on post-it notes.

Key Thoughts:

When viewing waiting rooms with “lacking the ability to perform effectively” (inefficient #2 definition) to “Tending to impede or delay progress” (holding #1 definition) and “to remain inactive or in a state of repose, as until something expected happens” (wait #1 definition) then that would be an incorrect observation. For that is what waiting rooms do. Waiting rooms are in fact efficient in the ability “to pause for another to catch up” (wait #2 definition) and the above two mentioned “hold” and “wait” definitions.

What if we reframe or rethink waiting rooms to “preparing rooms” or “warm up rooms”? Then they would certainly “lack the ability” to “impede or delay progress”. In fact, a warm-up or preparing room are “to make things or oneself ready” (prepare #1 definition) before a specific purpose.

Reframing opens up divergent thinking and opportunities.

Overview: Below are groups of “How might…” questions that I use to explore my thesis interests.

Note: Asterisk’s* are questions of key interest. Underlines are key concepts.

Definitions:

Inefficient (the free dictionary)
1. Wasteful of time, energy, or materials – (me- waste of thinking a cognitive resources)
2. Lacking the ability or skill to perform effectively; incompetent

Flaw (Merriam -Webster)
1. (noun) an imperfection or weakness and especially one that detracts from the whole or hinders effectiveness

Holding
- adj. (the free dictionary)
1. Tending to impede or delay progress: a holding action.
2. Designed for usually short-term storage or retention: a holding tank; a holding cell.

Wait
- Verb
1. to remain inactive or in a state of repose, as until something expected happens (often fol. by for, till, or until ): to wait for the bus to arrive. (dictionary.com)
2. to pause for another to catch up —usually used with up (Merriam-Webster)
3. to remain neglected for a time: a matter that can wait. (dictionary.com)

Waiting –noun
1. a period of waiting; pause, interval, or delay (dictaionry.com)

Prepare
1. To make things or oneself ready.(the free dictionary)
2. To make ready beforehand for a specific purpose, as for an event or occasion: ( the free dictionary)

Warm up
1: to engage in exercise or practice especially before entering a game or contest; broadly : to get ready (Merriam-Webster)

Translational Development: (translational designer)
1. Between research and practice a third discipline must be inserted, one that can translate between the abstractions of research and the practicalities of practice. We need a discipline of translational development (The Research-Practice Gap: The Need for Translational Developers by Donald A. Norman) and http://instone.org/uxrpi-update

Reframing:
7. How might we reframe or rethink waiting room experience to a warm-up or preparing room
8. * How might designers/architects/physiologist and stakeholders, redefine the waiting room experience to a “warm-up” room where it can prepare a patient in those moments before their consultation with their doctor. Ie. Prime the Patient.
9. How might reframing be utilized to generate opportunities and divergent thinking to overcome feeling of “pausing for others to catch up” and “delay”.
10. * How might the hospital, find opportunities in the downtime in waiting rooms that is often used for the purpose of distraction and entertainment with such devices as TV and magazine to devices that can communicate key information and personal concerns to their doctor even before the visit.
11. * How might designers uncover what happens in the moments before a key interaction? Then reframe it for the betterment of the interaction.

Translational Designers:
1. How might translational designers facilitate interdisciplinary collaboration for various learning styles?
2. How might translational designers bridge the gap between active research and practice?

Interdisciplinary Team Facilitation:
1. How might interdisciplinary teams that lack facilitators help each other manage individual processes to produce a cohesive group? (group decision making?)

2. How might non-makers facilitate visual sense-making for organizational learning for interdisciplinary collaboration?

Mental Models:

I left the concept of waiting spaces behind and explored more deeply into mental models and barriers of communication. How can we create a shared mental model to overcome miscommunication?
In this 2nd draft of my mental models diagram, I took feedback from small group on my 1st draft and made some changes. Even while writing about my 1st a couple of post ago I quick realized that major issue. I had not key or legend!!! I was taking lots of time explaining and writing about my 1st draft.
So in this 2nd draft I add more element and labels to make my visual more clear. In addition, I discovered a quote about constructing new mental models as part of knowledge creation. Heck, I was just trying to understanding and reveal current mental models. I am not ready to learn how to make new ones. That is a bit joke, because each of our mental models constantly change as we grow and have experiences.

What changed from Round 3:
I temporality pulled away from groups  “Doctor / Patient Interactions”, “Waiting Room Environment” and “Healthcare” to encourage me to explore other areas.   With this strategy, I discovered a new themes or patterns of “Greater System Thinking”, “Opportunity Finding” and “Pre Experience”. From Mental Models, I uncovered new category of “Framing”.  I dropped Brainstorming; it was hard to do, yet I did not see significant relationships for the theories I wish to pursue.  I can see it reemerging as a minor method of ideation during the action research phase of my thesis.  I added a new “Key Thoughts” section at the beginning to give a sense of the origin and direction to some of my thesis questions.  Finally, I added a new section to capture additional areas to explore mostly based on feedback from small team discussion.

What did I learn (reflection)?
All the theories and interesting ideas are overwhelming.  I realize I cannot make sense of all of them nor am I able summarize every finding, even though I try.   Sometimes I get “”analysis paralysis“”. Looking back to my 3 buckets of personal interest helps to limit and focus my direction.  I need to be sure I am taking control of my thesis not being completely sidetracked by external ideas.   Still, it’s hard to converge.

Overview:    Below are groups of “How might…” questions that I use to explore my thesis interests.

Note:  Asterisk’s* are questions of key interest.  Underlines are key concepts.

Key Thoughts:

• Companies like Disney and Universal Studio’s redefine the waiting in line or queuing experience as being a productive part of the future ride experience.   Foster a seamless experience from waiting to the ride. How might we apply that concept to waiting rooms for your family doctor?   For example, make it so that patients don’t feel like they are waiting), but feel like being meaningfully prepared for the doctor consultation.
• Holding areas/spaces seem to me (assumption) to be waste of cognitive and other resources.   A symptom of an inefficient greater complex system.   A place/space for overflow.    I question why do we even have waiting or holding areas? How might we find opportunities to make these areas a seamless productive part of their greater system?  What is their role in the complex system?

Greater System Thinking:

1. * How might we find opportunities to make “waiting spaces” a seamless productive part of their greater system?
2. * How might organizations find opportunities to make their “waiting spaces” or dead spaces integrate meaningfully into their greater system?  Rather than be separate from it.
3. How might designers foster greater understanding to individuals and organizations in their role and impact of greater ambiguous systems?   (too high level?)   Concept of Triple Bottom Line

Mental Models:

1. How might designers visualize mental models and their impact before and during verbal communication?  Thus to develop communicative tools to overcome them.
2. * How might mental models, show how framing and cognitive biases effect interpersonal communication?
3. How might individuals become aware of their cognitive processes and barriers that impede their experiences?
4. How might designers with stakeholders foster an environment of full self-disclosure for diagnosis that overcomes assumed mental barriers?  ie low trust, fear, embarrassing ..etc

Framing:

1. How might we frame the moments before communication?   For more effective outcomes?
2. How might designers and stakeholders, come up with a creative process to develop appropriate framing tools that inform individuals before going into important interactions.

Pre Experience:

1. * How might designers create meaning with “pre-communication” or those moments before communication?  (thinking doctor patient interactions)
2. * How might service design be used to make all the touch points and moments between touch points to prepare patients before their consultation?
3. * How might organizations design the experiences before the key experience?   Investigate and utilize those before moments.     Is it concepts of preparation, education, and/or layering?
4. * How might individuals design their own before experiences when none are created for them in preparation to the key experience?

Opportunity Finding:

1. How might designers develop a toolkit to find opportunities in any context?
2. * How might organizations find opportunities to make their “waiting spaces” or dead spaces integrate meaningfully into their greater system?  Rather than be separate from it.   (repeat from above)
3. How might organization see their unseen opportunities?
4. * How might we redefine waiting rooms experiences from being a symptom of a flawed system as an opportunity to be part of the greater system?

Transformational Leader:

1. How might leaders and workers collaboratively create a system to discover opportunities within their organizations?   – theory of the golden egg or TQM
2. * How might leaders facilitate and infuse creative behaviors?   – Daniel Pink : A whole new mind
3. How might leader s make policy without full understanding of complex and ambiguous systems?
4. How might leaders and workers develop a shared understanding of their role and impacts within a complex system?    -  concept of Triple Bottom Line
5. How might leaders facilitate creative innovation within multi-disciplinary teams?  – Lack of creative says Pink.  Theory of effective teams

Areas to Explore: (based on feedback from small group)

1. What are the histories of waiting rooms?  Is it circular?   Going back to 1on1 onsite medicine?
2. Causes of lying and studies of lying with personal interactions.
3. What are the theories and factors for the breakdowns in communication? (trust , lies, fear)
4. What are of models of good interactions?  Bad interactions?
5. What are the theories of personal and group framing?  When and how to do we use it?
6. How does our “assumptions” interact or interfere with framing?  Find theories.
7. How do innovation, pattern breaking, problem finding and opportunity finding relate? (more…)

This is the first draft of my mental models bucket or area. I am feeling pretty good about the depth of research and written content that went into this visual. I am trying to show the relationship of the interactions between the doctor and patient (green oval) while beware aware that even if its “shared interaction” our personal experiences (pink dotted line) of that interaction may not and often is not the same. Hence, the personal experience lines have vague boundaries the shape is not concrete in form. T

The rectangle bar in the center shows how communication barriers can get in the way of a share experience or interaction, but always. Since the bar does not completely run to the border of the oval.

Since mental models are hidden my sub questions try to use methods to bring them to light.