Chiahan Hsiao - Expectation Cards

Expectation Cards is a tool that helps patients and nurses enhance their conversation during the remote healthcare service.
This concept is based on the research topic called “Dealing with the dark side of digital monitoring”, which is one of the Perspectives Learning Labs that focuses on Service Ecosystem Design in Norwegian Healthcare.

Here we not only dive into the dark side of remote healthcare but also bring up the awareness of hidden social structures. This project duration is 7 weeks.

Partners: Sunnaas, Siemens, CGI

Our Approach

Our approach includes interviews with relevant professionals, desktop research, and workshop with external partners.

Illustration by Chia-Han Hsiao

We conducted 6 in-depth interviews, who are a nurse & manager, medical doctor, former patient, physiotherapist, wound nurse, a technology strategist and a developer.

Illustration by Chia-Han Hsiao

Research & Findings

Throughout the interviews, we realized that the usage of the term “Monitor” gave the interviewees negative associations and didn’t reflect good enough how the patients and the nurses perceived digital service.
The aim of digital healthcare service is to support the patients rather than collect their personal data, so we decided to actively say "support" instead of "monitor".

Our overall finding throughout the interviews and research phase was that digital support is the future in health care, but not everyone can use it. Digital support can solve the issues with the aging population and lack of health personnel, but as it is structured today it sets requirements only a few patient groups can fulfill.

The story about Tom

The way we have chosen to do is through a story about Tom.

Here we want to highlight the different challenges that patients might stumble upon when using digital support services. Everything that is being conveyed throughout the story is based on the conducted interviews and desktop research.

Story illustration by Kristin Brudeseth

Findings from Tom's Journey

In our interview, a healthcare professional said that, “Some are not really pleased that we don’t work during the weekend. Because they feel unsafe that we are not controlling. They don’t get a phone call if they get something wrong. But that’s the part of the responsibility.”

The issue between Tom and the nurse is something we have chosen to frame as the invisible line of responsibility. There is an issue regarding responsibility. It's not a defined line, who is responsible for what, and everyone has their own interpretation of where that line goes.

The reason for why this invisible line exist, is because there is a shift in the social structure when digital support services are being introduced. This shift and the responsibilities that comes with it, needs to be addressed more than it is today.

Because as our findings states the patient is expected to take responsibility for their own health.

We also discovered that digital support can enhance loneliness for some patients.

A health care professional said, for some patients, the visits that they have from the homecare nurses might be their only social network. When they transfer into digital service, the homecare nurses don't visit the patient at home anymore. This can make some patients more lonely.

We also had an initial finding: Digital support is not for patients that are too ill, too well, or lacks motivation.
One of the healthcare professionals said when a patient isn't answering the questions and responds by saying “Because I'm not bothered to do it every day”. The healthcare professional felt like "I can use my time on the patients who really need it”.

After speaking with partners, we discovered that motivation is not the right word to use for these patients. It is a stereotype that labels the patients as “unmotivated”, in fact, it has nothing to do with motivation, it is because the patient feels overloaded.

This provided us a new perspective. We saw an opportunity in making the transition into digital support easier and providing something to make the patients feel less overloaded.

The reason why we need to address this is that it has a huge impact on how patients perceive digital support services. By being aware of it, and facilitate around it, we could make it possible for more patients to enjoy the use of digital support. If we don't address this there will be patient groups, like Tom, they will be excluded in this service system, even though they could have.

By bringing the line of responsibility to the surface, we can make it easier for the patients to affect their own life by benefiting from the use of digital support.

Our Proposal - Expectation Cards

Expectation cards is a tool to help facilitate an open dialogue around concerns, hopes, or personal matters with the patient, before starting the digital support. The goal is to make the nurse and patient on the same page before starting the digital support, which can make the transition from hospital to home care better for people, like Tom, and also make the line of responsibility more clear.

There are 3 types of card:

Concerns - to address the concerns he might have.

Hopes - to address all the positive aspects of digital support and the opportunities it can provide.

Myself - to address more personal things that might be difficult to talk about.

Illustration by Kristin Brudeseth

How does it work

The patient will receive the cards from the nurse while be introduced to digital support. After bringing the cards back home, the patient can choose the card that is related to his or her situation. Then the nurse will go through the chosen statements and questions when next time they meet.

Patients can mark on the line as to how much they agree with the statement.

The questions give them the opportunity to write down their thoughts, or to get more information about them from the nurse. Patients also can write some thoughts on the card.

So with our proposal, Tom and the nurse will have a good conversation about the topics which Tom has chosen. Now the nurse has the opportunity to address all of Tom's hopes and concerns before going into digital support.

They talk about Tom's expectation, he'd like to have the same amount of follow-up. The nurse explains to Tom that they will have less contact, but he is still in good hands and taken care of.

When they talk about these issues, the line of responsibility becomes more clear. Tom knows what he can expect of the nurse, and the nurse also knows what to expect of Tom.

If Tom has issues coming up during the digital support, he can use the digital version of the expectation cards. Before having a video consultation or phone call with the nurse, Tom can select the topics he wants to talk about, and send them to the nurse.

Reflection

Concerns

1/ Some of the questions or statements formulate could make people hesitate to go into digital support. But with more research and testing, it could find more mindful questions or statements to implement.

2/ The solution does not necessarily need to be the card. It can take on other forms as well - it's the conversation happening that is important that needs to be highlighted.

Advantages

1/ By engage patients and healthcare providers to talk about the “dark sides”, they can get on the same page. The invisible line of responsibility can become more visible.

2/ By providing the patients with tools to communicate, it might be easier for them to talk about sensitive matters and help remove the stigma.

Text content co-edited by Chia-Han Hsiao, Kristin Brudeseth and Sofie Berggraf