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STILL IN CONTROL - healthcare, conversations, dying

Still in control

 
 

Short description: 

Imagine that one day you are not able to speak for yourself. Who would you trust to speak for you? “Still in control” is a project exploring the benefits of elderly patients and their families having conversations about quality of life, to overcome future changes and challenges. The goal of the project was to empower elderly patients to be able to take an active part in their own treatment and to focus on what's important in the final stages of life.

We handed over the project during a roadmapping session where we discusses possible steps of implementation with involved stakeholders. The concept was developed for Akershus University Hospital (Ahus) to support the early stages of the establishment of the Center for Elderly Medicine.

Concept developed by: Alice Smejkalova, Frøya Thue and Paulina Buvinić

AHO works nomination for Service Design and Complexity and Holistic Approach
Presented in DOGA during Design Works #02: Integrerte designlaboratorier :
https://doga.no/kalender/designworks-02/
Going to be presented in Halogen during Change by Design 2018: Design for life – and death

This project is in first stage of implementation and pilot testing in the AHUS hospital.

 

Background of the project: 

Between January and March 2018, the C3 Design lab was established Akershus University Hospital (Ahus) by students and supervisors from the Service Design 2 Master from The Oslo School of Architecture and Design (AHO), to support the early stages of the establishment of the Centre for Elderly Medicine. Using service design and associated process, the C3 Design Lab helped to explore future visions for the Centre for Elderly Medicine.

Main approach: embedded design lab

During the entire duration of the project we worked inside of the hospital. We got our own space in the hospital complex, where we hosted all of the workshops, presentations, most of the interviews. We found this approach very helpful with explaining the project during the process and also an inspiring environment of the project.

 
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Still in Control

Still in Control

The goal

Empower patients and their families to plan ahead for better quality of life. Help families to work together to overcome changes and future challenges through conversations. 

 
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Current patient’s journey

Through our research we found that conversations about the end of life are happening in the final stage of life when it is usually too late for these conversations.

“Having conversations about the future is very important. I wish we had done it, but now it's too late. My father has dementia and now we can only guess what he wants.”
- Relative

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What if…

we could trigger and facilitate conversations earlier?

we could help patients plan ahead for quality of life in the future?

involve relatives from earlier stages?

 
 

How does it work?

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1. Discharge

The service is introduced in the hospital after patient is diagnosed with a chronic disease and while patient is being discharged to go home. Patient and doctor schedule the first follow up meeting.

 
 
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2. Follow up meeting

The first follow up meeting is held by municipality nurse in patient’s home. The nurse answers all possible questions about the new situation, introduces and describes the conversational tools.

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3. 1st activity/

present life

The first activity is to find out what's important for the patient and to do a detailed overview of patient's daily life together with the family and caretakers.

 

press to see in detail

The tools of this activity guide the participants through:

  • The question of “What do you enjoy doing?”

  • Identifying challenges

  • How to overcome these challenges

The tools that are included:

  • The folder with the different time frames

  • “Unstuck” questions

Follow up responsibility cards

 
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4. 2nd activity/

future life

The goal of the second activity is that the whole family (including the patient) shares and reflects on what quality of life means in the future.

 

The tools for the second activity guide the patient through a carefully designed path of questions about the quality of life and how to be prepared for the unexpected and possible situations.  

The tools that are included:

  • Question cards sorted in a specific order

Follow up “Keep in mind” cards

press to see in detail

5. Second follow up meeting

The last step is an optional follow up meeting with a nurse to answer any sort of questions, or get help while doubting about any of the activities.

 


The process

1.
Initial research and concept development

Big picture workshop   In the beggining of the process we started with workshop with participants from the hopital (doctors, nurses) and the municipality. The main goal was to collect as much information as possible.

Big picture workshop

In the beggining of the process we started with workshop with participants from the hopital (doctors, nurses) and the municipality. The main goal was to collect as much information as possible.

Focused interviews   To get more into details we interviewed speicalised from the hospital and the municipality. We ended this stage with findings presentation to the whole class, invited guests from the hospital and our project leader.

Focused interviews

To get more into details we interviewed speicalised from the hospital and the municipality. We ended this stage with findings presentation to the whole class, invited guests from the hospital and our project leader.

Individual concepts   After findings research we all presented an individual concepts. We then presented these concepts to stakeholders from the hospital. After this step we then found overlaps and formed new groups to start with the final concept.

Individual concepts

After findings research we all presented an individual concepts. We then presented these concepts to stakeholders from the hospital. After this step we then found overlaps and formed new groups to start with the final concept.

 

2.
Concept development

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During the final concept development we wanted to get to know more about the topic, that’s why we had more in depth interviews and we started mapping different solutions and findings.

During the final concept development we wanted to get to know more about the topic, that’s why we had more in depth interviews and we started mapping different solutions and findings.

3.
Prototyping and testing

Individual concepts   After findings research we all presented an individual concepts. We then presented these concepts to stakeholders from the hospital. After this step we then found overlaps and formed new groups to start with the final concept.
We wanted to prototype all of the aspects of the final solution including tone of voice, the design, how does it feel, etc. We prototyped in different stages, and in different scales. We then always wanted to test the prototypes. We went through one on one informal testing to testing with people in the hospital

We wanted to prototype all of the aspects of the final solution including tone of voice, the design, how does it feel, etc. We prototyped in different stages, and in different scales. We then always wanted to test the prototypes. We went through one on one informal testing to testing with people in the hospital

4.
Final development

Individual concepts   After findings research we all presented an individual concepts. We then presented these concepts to stakeholders from the hospital. After this step we then found overlaps and formed new groups to start with the final concept.
We went through different iterations of our final delivery. With our final design we went to total details in color, style, feel, tone of voice. We wanted to make sure if everything was suitable for the final target group.

We went through different iterations of our final delivery. With our final design we went to total details in color, style, feel, tone of voice. We wanted to make sure if everything was suitable for the final target group.

 
 

Next steps

Roadmapping

During the process we also paid attention to roadmapping of the implementation of this project. We had multiple workshops with the hospital workers, municipality workers, etc. to see what is going to happen after we are done as designers with this project.

We handed over the project with a clear plan of what the first steps should be for all of the actors and because we also delivered well designed tool the implementation and first testing is easier.

We are happy to announce that our project is now in the first stage of implementation at AHUS hospital.

Personal reflections

Embedded lab - working with the client in their own setting was a very valuable experience. We had the chance to see how they are working and vice versa. We had all of our work on the walls, which helped with conversations about our project.

Working in hospital environment - Working in a hospital environment was a new thing for me and it was very great experience. Working closely with people who are directly changing our lives was interesting, but also we could experience live how long of the process is to change anything in this setting.

Working with a heavy topic - We worked with the topic of death for a lot of weeks. It was hard, but also it taught me not to be afraid of working with heavy topics like this. Heavy topics are actually the most valuable ones and it is important to open the Pandora’s box.