CommuniCare

Reconceptualizing how medical communication boards can improve the treatment and outcome of critical care patients who are unable to "speak" for themselves

CommuniCare-Hero-Image

TIMELINE

January – April 2019 (Research)
January – February 2021 (Product)

PLATFORM

iOS Tablet Application

ROLES

Research, Product Strategy, UI & UX Design, Branding

TEAM

Amanda Perez - Student at Fairfield University & RN at Yale New Haven Health

Badges-19

Gold Award - Digital Tools and Utilities
Silver Award - Innovative Use of Mobile Technology
Bronze Award - UX, Interface & Navigation
Bronze Award - Mobile App
Bronze Award - Mobile Interaction & Experience

OVERVIEW

Imagine suddenly waking up surrounded by the unfamiliar sights and sounds of an intensive care unit. You try to speak, but a tube placed down your throat makes this impossible. Scared, confused, and disoriented, you try using hand gestures to ask the nurse "what happened?", but your message becomes lost in translation.

The inspiration for this concept was born out of a research paper I wrote on the evolution of emojis as a language for communication. I was amazed to learn that while we have re-written Moby Dick using emojis alone, we have not yet designed a way for these pictorial images to serve those who are most vulnerable. Recognizing this as a problem space to explore, I embarked on a mission to understand and improve the current communication practices of verbally compromised patients in a critical care setting.

THE PROBLEM

"2.7 million patients are hospitalized in ICUs each year in the US, with many of these patients unable to speak due to assisted medical ventilation."

Current methods of care provider-patient communication—such as laminated medical communication boards—are outdated, and frankly dangerous. Patients are often reduced to rudimentary physical gestures, resulting in miscommunication and misinterpretation. Research shows that patients with altered airways experience challenges in communicating due to physical, cognitive, and environmental barriers leading to feelings of anxiety, panic, fear, frustration, and anger. Further studies have shown that communication barriers lead to extended sedation exposure, higher risk for an adverse event, prolonged stay within the ICU, as well as an increase in the cost of healthcare.

Feizi, Aram, et al. “The Effect of Using Communication Boards on Ease of Communication and Anxiety in Mechanically Ventilated Conscious Patients Admitted to Intensive Care Units.”
Iranian Journal of Nursing and Midwifery Research, vol. 23, no. 5, 2018, pp. 358–362., doi:10.4103/ijnmr.ijnmr_68_17.

DESIGN CHALLENGE

How might we improve communication practices between patients and care providers in a critical care setting so that patients' can express how they feel—physically and emotionally—to help them regain control of their lives?

THE SOLUTION

A Comprehensive Communication Solution to Humanize & Advance Patient Care in a Digital Age

CommuniCare is a modernized approach to the design of medical communication boards to help critical care patients who are unable to speak, such as those who require medical ventilation, to properly communicate with their care practitioners. By harnessing the power of design and technology, CommuniCare facilitates intuitive and customized dialogue specific to the individual needs of each patient to bridge gaps between patient–care provider communication and to reduce adverse outcomes in an ICU setting. 

ROLE & RESPONSIBILITIES

Working Alongside Specialists & Experts to Tackle a Complex Problem Space

The initial research phase of this project was conducted by myself between January to April 2019 under the guidance of Paul Sych as part of an academic assignment. During this phase of the project my work consisted of: Secondary Research, Interviews, Questionnaire Survey, and an early prototype version of the product; as well as the overall Brand Design, including typography, iconography, color palette, and logo design.

In January 2021 I pursued an opportunity to revisit the project in collaboration with Amanda Perez, a student at Fairfield University and Registered Nurse in the Surgical-Trauma Intensive Care Unit at Yale New Haven Health. Amanda's expertise and insight helped to guide and inform the Photo Study, Stakeholder Map, User Journeys, and Storyboard scenarios.

Together, with guidance from medical professionals at the Yale University Center for Biomedical Innovation and Technology, we worked together to determine the overall product strategy for how CommuniCare could work as a sustainable product in the healthcare market to provide value for patients, care providers, and the overall institution.

PROJECT SCOPE & TIMELINE

Creating a Game Plan to Build Momentum Towards an MVP Solution

When we revisited the project in early 2021, a general scope and timeline were created to optimize workflow efficiencies between Amanda and myself. This process was iterative throughout the project which ultimately helped to bring clarity to the key requirements and deliverables needed to reach an MVP solution.

Project-Scope

DESIGN PROCESS FRAMEWORK

How We Approached the Problem to Identify a Solution

We used the Stanford University d.school model to provide a solution-based approach to tackle this complex problem we aimed to solve. This allowed us to systematize our research based on both user and market insights, re-frame the problem in a human-centric way, then translate our findings into a robust prototype for usability testing and iteration.

Design-Framework

TOOLKIT

A Selection of Tools to Collaborate Easier & Design Faster

As part of my process I always enjoy testing out new tools for capturing insights as quickly and efficiently as possible. The selection of tools used for this project include the following:

Tools-06
Empathize-04

Empathize

The foundation of a human-centered design process through observation, engagement, and immersion.

SECONDARY RESEARCH

Using Secondary Research to Gain an Understanding of the Problem Space

Before we could jump into designing, it was important to define who is most affected, where and why communication barriers occur, and what the outcomes are based on current practices.

Insights collected from medical journals and media publications revealed that medical patients in hospital intensive care units (ICUs) are the most vulnerable when it comes to communication barriers. This is often due to miscommunication or misinterpretation as a result of language barriers or unclear physical gestures.

Further to this, environmental impediments are also problematic, with research showing that ICU patients encounter challenges when trying to use the call button to initiate communication of basic needs.

TECHNICAL BARRIERS

70%

of ICU patients ask for items not indicated on the communication board

Hoorn, S. Ten, et al. “Communicating with Conscious and Mechanically Ventilated Critically Ill Patients: a Systematic Review.” Critical Care, vol. 20, no. 1, 19 Oct. 2016, doi:10.1186/s13054-016-1483-2.

ADVERSE OUTCOMES

65%

of reported sentinel events in ICUs were caused by communication errors

Cheung, Karen M. “Whiteboards Key to Improved Communication.” HealthLeaders Media, 6 May 2010, www.healthleadersmedia.com/clinical-care/whiteboards-key-improved-communication

EMOTIONAL TURMOIL

62%

of ventilated patients reported a high level of frustration in communicating their needs

Happ, M. B., et al. “Nurse-Patient Communication Interactions in the Intensive Care Unit.” American Journal of Critical Care, vol. 20, no. 2, 2011, doi:10.4037/ajcc2011433.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222584/

LANGUAGE BARRIERS

48%

of hospitals in the US encounter patients with limited English skills daily

“Hospital Picture Boards Break Language Barriers.” NBCNews.com, NBCUniversal News Group, 4 Sept. 2007, www.nbcnews.com/id/20588960/ns/health-health_care/t/hospital-picture-boards-break-language-barriers/#.Xo5JJG57lYg

MISCOMMUNICATION ERRORS

37.7%

of exchanges between nurses and non-vocal ICU patients about pain are unsuccessful

Happ, M. B., et al. “Nurse-Patient Communication Interactions in the Intensive Care Unit.” American Journal of Critical Care, vol. 20, no. 2, 2011, doi:10.4037/ajcc2011433.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222584/

ENVIRONMENTAL BARRIERS

33%

of conscious patients in ICUs are unable to use the conventional call systems

Happ, Mary Beth, et al. “Overcoming Speech and Language Disorders in Acute and Critical Care: 40 Years Later.” Geriatric Nursing, 13 Apr. 2020, doi:10.1016/j.gerinurse.2020.04.008. 

FINANCIAL BURDEN

$6.8 Billion

could be saved annually by reducing communication barriers that could lead to an adverse event.

Hurtig, Richard R., et al. “The Cost of Not Addressing the Communication Barriers Faced by Hospitalized Patients.” Perspectives of the ASHA Special Interest Groups, vol. 3, no. 12, Jan. 2018, pp. 99–112., doi:10.1044/persp3.sig12.99.

QUESTIONNAIRE SURVEY

Collecting Information to Understand the Experience & Opportunities for Improvement    

Once I understood the problem space better, I used a questionnaire survey to dig deeper into three core areas of interest:

  1. assessing patients’ level of frustration with communication and their perception of communicating interventions used by health care practitioners;
  2. identifying patients’ perceived communication needs and what they perceived as barriers and facilitators to effective communication; and
  3. retrospectively evaluating the perceived helpfulness, use, and content of a communication board.

A total of 34 participants  comprised of 12 patients and 22 care providers with experience using medical communication boards were recruited via LinkedIn, SurveySwap, SurveyCircle, and various Reddit groups to participate in a 10 question survey. Four major themes were revealed:

  1. communication facilitation;
  2. comparison with other communication tools/devices;
  3. patient/device considerations; and
  4. modifications.

Participants identified the “easy” touch screen, free drawing, key phrases and the pain figure as features that facilitates timely and accurate communication. Several participants suggested that board customization in terms of adding or removing words and phrases would improve the product, along with

Questionnaire-Responses-17

STAKEHOLDER INTERVIEWS

Conversations With Experts Provides Insights Towards a Solution

Prior to teaming up with Amanda, I used LinkedIn to reach out to personal contacts and various individuals my research pointed to as being key stakeholders and users of medical communication boards to set up interviews with via Zoom. My goal was to learn more about the experience of using medical communication boards from a care providers perspective. A total of three semi-structured interviews took place which revealed insights about different features they felt could be added or improved upon, various challenges and constraints each expert encounts in their field, as well as who the key competitors are in the market today.

Quote-1-Amanda
Quote-2-Diann
Quote-3-Rebecca

PHOTO STUDY

Visual Insights Provide an Empathy-Driven Glimpse Into the Critical Care Experience

As Amanda and myself began to dive into the problem space, stories from her experience as an ICU nurse helped to paint a picture of the first-hand challenges care providers and patients experience that had not been revealed from the research. We decided to use a modified photo study to delve deeper into the qualitative significance of the issue surrounding communication practices in a critical care setting. While most of the images were captured by Amanda to document specific moments throughout her day, other images were gathered from Google to accurately depict issues that were not photographed due to the sensitive nature of the environment. This approach helped to capture insights that would otherwise be difficult to observe, and also helped to contextualize and acknowledge gaps between the research and what is represented in the photos.


Photo-Study-16

MARKET RESEARCH

Using Ratings & Reactions to Discover How People Feel About Existing Products

To illustrate the competitive landscape, we used G2's Competitive Matrix Grid as a tool to visualize how the products mentioned during the interview phase stack up in terms of functionality and desirability. AppFigures was used to retreive insights for each product based on AppStore feedback which was then plotted on the grid based on the total number of reviews (Market Presence) against the overall rating (Customer Satisfaction). Overall, each product received fairly positive ratings which showed us that people covet a digitized communication tool; however, there was room for improvement which was shown when we started to dig a bit deeper to read what users had to say. Patterns started to emerge, indicating both accessibility issues and technical barriers.

Market-Research_Reviews

COMPETITOR ANALYSIS

Evaluating the Competition to Gain Insights into How the Problem is Currently Being Approached

To round off research findings, a high-level competitive analysis was carried out to evaluate products indicated during the interview phase as common tools used in clinical settings today. This helped us recognize which features are standard across a range of products, where new features are beginning to enter the market (such as head and eye tracking), and to also reveal gaps and opportunities we could possibly tap into in an effort to stand out in an already competitive marketspace.

Competitive-Analysis-11
Define-07

Define

Empathy findings are unpacked and synthesized into compelling needs and insights.

AFFINITY DIAGRAM

Drawing Connections & Organizing Information to Develop Deeper Insights

From analysis to synthesis

PERSONAS

Putting a Face on 'Who' the Product is Being Designed For

To get aligned about who the product is for, we decided to personify a primary, secondary, and tertiery stakeholder into three personas. 

Ideate

Ideate

A focus on idea generation and how people might navigate the product.

MOOD BOARD

Visualizing Ideas & Inspiration to Shape the Artistic Direction of the Product

Mood boards are one of my favorite contributions to the design process. They allow us to communicate the pictures we have in our minds, transfer the right mood, and bring the emotions expected from a product to life. When considering the target audience for this product, our goal was to create a design that feels friendly, evokes feelings of trust and tranquility, while placing value on simplicity and accessibility.

Mood-Board
Prototype

Prototype

Building quickly to think and learn.

HIGH-FIDELITY PROTOTYPE

Bringing Ideas to Life: Translating Concepts into Tangible Prototypes

The next step in the process was translating the Brand Concept into something tangible.

Test

Test

A chance to refine and improve the solution.