The Future of Home Care

Preserving Dignity and Autonomy in the Home

How will the future of home care system be redefined through services and technologies? With a rapidly increasing aging population, new technologies and services are being created to help older adults stay in their homes longer to reduce strains on healthcare systems. However, most of these new technologies are developed without the input of users in the older adult demographic and their informal and formal carers. This project explores processes for using a human-centered approach for designing products and services for the care industry.

Throughout this work, insights and reflections are given on incorporating design research techniques, service design tools, and participatory design approaches into the design process. This research suggests techniques for incorporating empathy into design teams to inform design intuition. The resulting methods are ethnography including interviewing and observation, customer journey mapping, service blueprints, stakeholder maps, low fidelity prototyping, and user testing. These learnings include additional thoughts and approaches about obtaining additional user perspectives, reframing problems, designing for different cultural contexts and extreme users, redefining focus groups, mapping processes, and understanding through the act of creating. Additional questions about design ethics, design metaphors, passive interactions, the user experience of privacy, health gamification, and creative confidence are all resulting opportunities for additional exploration.  

The world population is rapidly growing older. By 2050, the world’s population aged 60 years and older is expected to total 2 billion, up from 900 million in 2015 (WHO, 2015). Increased longevity is a significant achievement, but it presents both opportunities and challenges. Countries projecting up to half of their population out of the workforce are struggling to prepare for these additional strains on healthcare systems and social services. Total government spending on pensions, healthcare, and long-term care will increase by more than 20 percent for some countries, while expenditures for long-term care will double (Skouby et al., 2014).

How are nations around the world trying to prepare?

Managing healthcare quality and costs for this shift in demographic is one of the key focus areas in many countries at the moment. Nations around the world are preparing for the demands of an aging population with fundings aimed at this challenge.

New initiatives are directed at helping older adults implement new ways to live healthy and independent lives in order to reduce impacts on healthcare systems. Authorities advocate aging-in-place, which allows older adults to live in their own homes for as long as possible, while promoting community-based facilities and cutting social services (Swedish Institute, 2013; Ministry of Health Singapore, 2012; European Commission, 2016). Aging-in-place also aligns with older adult preferences to continue to stay in their own homes. According to the AARP, 90% of Americans surveyed say they would prefer to live at home (AARP, 2005).

However, as our population ages, we are not necessarily getting healthier, but rather spending more years in physical and cognitive decline. As longevity increases so do the risks of chronic illnesses in later life. In the U.S., 80% of the population aged 65 and older live with multiple chronic conditions (Agency for Healthcare Research and Quality, 2014). In order to support the older adults that wish to remain in their homes an increase in professional care services is required, but there is concern about the current and future supply of long-term care workers (United States General Accounting Office’s, 2001). By the year 2020, 117 million Americans are expected to need assistance, but the overall number of unpaid caregivers is projected to only reach 45 million. Greater reliance on informal care by family members has followed as a result of scarcity of affordable professional services and a greater amount of people needing care (AARP, 2016). With family members and other informal carers taking on the stresses and anxieties of caring for their loved ones there is a demand for more products and services to support them.

Many new technologies and services are being developed in order to promote healthy aging-in-place and aid informal carers.

There has been a growing business case for assistive technologies and services, which can support older adults to increase their autonomy and assist them with daily activities. The driving demand for services stems from the amount of care recipients and caregivers that need extra support and the spending power they have. Projected market revenue forecasts for 2016 - 2020 is $36.5 billion for caregiver out-of-pocket spending and $207.6 billion for the total caregiver support market (AARP, 2016). Many of the assistive technologies that are being developed fall within two major categories:

Wearables & Sensors

Portable wearable devices for healthcare applications and remote sensors will play an important role in helping older citizens live independently (Skouby et al., 2014). Wearables and sensors are two major categories within the Internet of Things, a network of devices and objects that connect to the internet, which are predicted to dominate the tech market. Gartner predicts that up to 20.8 billion connected objects will be used worldwide by 2020 (Gartner, 2016).

The impact these technologies can have on the healthcare industry is enormous. We will increasingly see the integration of medical sensors into consumer electronics to enable at home medical data gathering, which will support preventative digital health programs and remote care ( Nuviun, 2016). The ability to monitor things like eating and sleeping behaviors, GPS locations, and heart rate fluctuations over time contribute to valuable information for health professionals and consumers. Many people are already making use of fitness wearables and sensors with quantified self-health tracking devices, such as the Fitbit or the NikeFuel (Fjord, 2015), but there is a current trend towards products created for the home care industry (Wolf, 2014).

Assistive technologies can offer significant help to older adults and their carers by detecting early changes in behavior (Newcastle University Institute for Aging and Abbott, 2015). The most valuable thing about these technologies is not the device itself, but the data and the insights that are derived from that data, which can inform new level-of-care change recommendations ( Nuviun, 2016). The use of gathering insights from data can help medical professionals see shifts in behavior over time and understand early detection of disorders, while safety monitoring to detect falls, seizures, and heart attacks. The use of these technologies helps the elderly feel safer in their homes, while providing their carers a peace of mind about them living independently.

However, companies looking to serve this demographic face a lot of problems catering to this age group. Despite a growing trend towards older adults utlizing smartphones and devices (Smith, 2014a), many in need of care are unable to see the need for using these technologies. Many current safety monitoring solutions remain underused. A recent survey conducted for AARP demonstrated that while 67% of caregivers say they want to use these solutions, only 10% are currently doing so (AARP, 2016). Another problem is that a lot of these products and services lack the ability to fit seamlessly into older adults’ daily activities. In order to create technological products that can be useful to this demographic, designers must understand how their products and services can best be incorporated into the lives of the user. 

“Paternalistic technologies are often designed by very young people who often don’t understand what it’s like to be an old person.”– Natalie Kane, researcher at Changeist

Ethics of Passive Monitoring

The benefit these new technologies can provide people receiving care is considerable, but ethical questions arise out of creating technologies that surveillance older adults through data. These devices are intended as solutions for working and remote carers to see that their patient is safe and comfortable in their absence, but it is important to think about the bigger implications of using this technology. Technological solutions can only be effective when they are combined with quality care and should not replace human contact or restrict independence (Newcastle University Institute for Aging and Abbott, 2015). Carers need to strike a balance between autonomy and safety for the people receiving care. After addtional research into this topic I began to question:

• How might passive wellbeing monitoring harm the interaction between older adults and their carers?
• How might it provide a sense of false security?
• How might privacy be affected by these new technologies?

I sought to find new ways of incorporating empathy in new sensor devices and increasing agency and autonomy in older adults.

In order to develop this research I used the Double Diamond design method, which is comprised of four distinct phases, Discover, Define, Develop and Deliver (Design Council, 2005). The Double Diamond is beneficial for determining divergent and convergent stages of the design process, which gives designers constraints to move forward with the project. Defining the design process is essential in order to improve and redesign the process (Dubberly, 2004). The design process is nonlinear, but it is necessary to design a structure for the process (Stickdorn and Schneider, 2012), and to adapt it the best way for the task at hand (Design Council, 2011).

Discover

The first part of the process is comprised of understanding and unpacking the problem. This phase is divergent and exploratory with an emphasis on searching for new questions and opportunities.

Market research, User research

Define

The second part of the Double Diamond represents defining the problem. It is crucial to go back and reframe the problem based on the insights gathered in the Discover phase.

Synthesizing, 5 Whys, Ideation, Service Design Tools (Service Blueprint, Customer Journey Mapping)

Develop

After redefining the problem it is essential to diverge again on ideas and think abstractly about opportunities and themes. Ideating and quickly testing out ideas through sketching and prototyping is critical to this process.

Ideation, Prototyping, Sketches

Deliver

The last phase of the Double Diamond comes into play with creating, iterating, and refining ideas. It is valuable to get real market and quantitative feedback during this stage.

Iterating, Refining Prototypes, User Testing

The first part of the design process is all about exploring. Designers seek inspiration through noticing new things with fresh perspectives and gathering insights or develop opinions on what is new and interesting. This process includes user research and market research (Design Council, 2011). After identifying my interest in building technology that delivers more agency to older adults, I began collecting information from a number of different sources through literary reviews and interviews about new assistive technology and challenges.

Cultural Differences

I have collected qualitative and quantitative data from different sources around the world. This was done in order to make comparisons through different contexts as this is a challenge facing both the Western and Eastern world. Most of my initial qualitative data was taken in the United States and later, while working in Singapore, I was able to collect additional qualitative information. It is important to understand how products and services need to adjust according to their cultural context. We can find out how services and products will fit into our user’s lives by defining their thresholds (Chipchase and Steinhardt, 2013).

Understanding different thresholds and cultural contexts is crucial to identify how services and technologies can adapt to different consumer needs. Observing behaviors of people from diverse backgrounds allow designers to discern motivations that drive human behavior. In order to find solutions that are valuable to multiple contexts it is necessary to test with different user groups from various upbringings.

Western vs Eastern Families

Families rooted in Eastern and Western cultures vary in both the home, care, and attitudes towards elderly (Diamond, 2013a). Eastern family values are centered around family and community, while Western values are more about individualism. Households in Asia tend to be made up of sandwiched generations, often having older adult parents move in with their adult children when they cannot take care of themselves any longer (Tan, 2016). It is much more common in Western families to live away from parents and for parents to live in retirement homes (Jacobs, 2013). Asian families often have different impressions of intergenerational dependencies, as being older and “independent” doesn’t necessarily relate to living alone or denying functional or material support from their children (Nassir, Leong, and Robertson, 2015). Considering these thresholds is essential when designing technology that is meant to be incorporated into these contexts.

Stakeholder Map

In order to identify industries and major players within the digital health and home care industry I created a Stakeholder Map. The purpose of a Stakeholder Map is to highlight issues concerning relationships between anyone with a vested interest in an industry or service. It can help discern shared and varied interests between stakeholders and understand importance and influence (Stickdorn and Schneider, 2012). I mapped everyone from the consumer, the relationships around the consumer, the businesses and startups that benefit from these technologies, and the investors. After analysing all relationships, I was able to identify problems and opportunities in the digital health and home care industry.

Learnings

Digital health and home care is a conglomeration of many different industries and involves a variety of different stakeholders with various goals and motivations. The main category of investors are companies that can be grouped into three categories: Strategic, Governmental, and Financial, which I conveyed in the Stakeholder Map using different colors. The Governmental category includes social services and programs, which often have an indirect relationship to the person receiving care. Venture capitalist investors make up the Financial category and are a very significant relationship to companies within the industry. Within the Strategic category there are subset divisions including: telecommunications, medical technology companies, pharmaceutical companies, insurance companies, and fitness companies.

One of the problems I identified was that older adults receiving care directly interact with a lot of different stakeholders. This is a challenge when they become mentally or physically incapable of doing this independently. The responsibility will then fall on their spouse, a family member, or a social worker provided to help care for them.

Another potential problem is that many investors in different industries place a lot of pressure on health and care companies. It is important to understand a stakeholder’s main objective in order to align with it. This can be tricky within this industry, because the value of these sensor technologies can extend beyond the technology and onto the data and insights gathered. Data offers benefits to both the individual, but also potential value to investors, depending on their incentives. This can lead to products and services that are not user-centered, but rather data-centered.

Interviews

**Names have been changed to ensure anonymity for participants**

Interviewing Users (65+)

In order to obtain insights on problems and opportunities in digital health and home care, it was important for me to learn the behaviors and motivations of the target audience I had defined, which was older adults over 65 years old. I defined my demographic as over 65, because I thought this age group could and would want to take control of their own care if they were able to use assistive technology themselves, without the interference of a family member or care worker. Interviews are really valuable ways of gathering qualitative data and can be very inspiring for the Discover phase of the project (IDEO.org, 2015). They are an ideal way to develop empathy for users, create mental models of the way users see the world, and understand the true needs and priorities of customers (Hall and Zeldman, 2013). I did this initial research in the United States with a range of men and women aged 61 to 86. To recruit 6 older adults I used friends and family members to help find people that fit within the demographics I was looking for. They had a range of health obstacles and differed on technological capabilities. I spent over an hour with participants in their homes and asked them questions about their lifestyle, aspirations, and made note of how they were currently using technological devices. Interviewing people in their home allows the participant to feel more comfortable and for the researcher to see them in their natural context to develop a better mental model of their lives (Hall and Zeldman, 2013).

Extreme User

A range of outliers or extreme users can give researchers and designers additional insights and perceptions, which are valuable for arriving at solutions that can work for everyone (IDEO.org, 2015). Tom was the only participant that was under 65 and not retired. He was planning to retire in 4 years and was currently working as a pediatric transplant surgeon. Not only was Tom out of the demographic range, but in his spare time he competed in triathlons, so he was also physically an anomaly from traditional older adults. Speaking with Tom was beneficial to compare and contrast how his needs and behaviors differed from other participants.

Group Interview

Design Researchers tend to stay away from working with focus groups. As Erika Hall states, “Focus groups are the antithesis of ethnography” (Hall and Zeldman, 2013). Traditional focus groups have been found to give misleading qualitative data, because when interviewing people in a group they often change their answers based on what other participants say. However, if you can find a way to engage everyone, get diverse opinions, and are strategic about group makeup (IDEO.org, 2015) then you can gain some interesting qualitative data. My group interview took place at a living community retirement in Stoughton, Wisconsin. There were 8 people with variances in physical and mental health, technological capabilities, and aspirations. Despite having the same schedule in their retirement community, there was a wide range of activities and hobbies that participants engaged in, so their agenda was surprisingly disparate. Retaining insights from a large mix of people in the same room with extremely diverse needs and behaviors helped me understand how technological solutions would need to be adapted and customized depending on the person using it.

Technological Capabilities

I wanted to grasp the participants’ ability to use technology as most new assistive devices require the use of smartphones or tablet devices. Some of my participants already were active users, “I use my tablet everyday to read the news” —Susan

while others had never used or owned a smartphone or tablet. I had various questions about the technological goals and behaviors this age group had and administered some exercises to obtain supplementary insights.

Card Sorting

Card Sorting can be an effective way to gain additional qualitative data and insights. It can spark new conversations by showing participants images or words that inspire them (IDEO.org, 2015). To obtain insights on their technological usage, I wrote down 14 words that could ignite the potential for participants to share their past experiences with technology. Participants would speak aloud and comment on specific times they felt “anxious” or “connected” with technology, which helped me gain some specific details on any issues they have had using technology.

Learnings

Participants responded positively to the exercise, and I was able to retrieve supplementary qualitative information about their past experiences using technological devices. There was an overall sentiment that because they did not grow up with technology it was not intuitive or built with them in mind. Many described their longing for the “on and off” switch and 3 participants mentioned a desire to look up technological issues in a manual. After acknowledging they understood that the information they were looking for was online, they explained that they did not know how to find it. “Google is great, but you need to know how to use it.” — Fran

I did not see abundant crossover between participants’ answers about technology and in reflection, wish I would have chosen less abstract words and devices. Defining “technology” could also have been beneficial to this exercise. Typically you want to avoid “leading” questions at all costs (Hall and Zeldman, 2013), so I left this term open in order for participants to share their own concepts and ideas about objects that they considered “technology”. Some of the definitions ranged from the obvious, smartphones and tablets, to more obscure, including telephones and GPS systems in cars. Leaving this definition open made it difficult for me to identify which technologies they described as “usable” or “fun”. Some participants noted that words like “isolating” and “connection” could be linked to the same technology, so it would have been helpful to come up with a way for participants to give more specific answers. Most of the time this actually helped me remember to ask them to identify what technology they were talking about, but this depended on how much time was allotted left in the interview.

Show Not Tell

Some of the participants demonstrated specific apps they used on their devices, which was very helpful for me to gain more insight into their capabilities. There is a big gap between what users say and what they actually do (Raijmakers, 2001), so it is better to observe them. It is one thing for a participant to tell you how proficient or incapable they are with using technological devices, but it’s another thing to witness it. Showing rather than telling can also give insights into their behaviors, such as the examples below:

Joy took me over to her computer and pulled out a spiral notebook listing all of the things she hasn’t been able to accomplish, ranging from her inability to add a contact on Gmail to just resizing the window, which made it impossible for her to view the send button and send an email.

William, in my group interview, asked me to help him download the Podcast app on his iPad, so he could listen to the TED Radio Hour podcast. The Podcast app comes automatically with the iPad, and when he opened his app, he was already subscribed to the TED Radio Hour podcast.

During user research it is really valuable to watch how people use their devices to understand how they develop mental models of the technologies they use. It is also easier to understand someone’s goals with technology by witnessing it rather than asking them (Hall and Zeldman, 2013) and to gain empathy through observation.

Expert Interviews

Geriatric Physical Therapist

I interviewed Deb, a geriatric physical therapist about the journey and goals of a patient’s care in her facility. I thought the goals of a geriatric physical therapist would be straight forward, but quickly found out how the goals of her job depend on a variety of different factors with the patient’s health, home, and relationships with both family members and social workers. The biggest challenge she faces is “weaving her way through all the different relationships” in order to find a solution that can best suit the patient. She described how important and difficult it was for the children of her patients to take initiative in their parent’s well-being. She had strong opinions on technology in her profession and described how she uses empathy to motivate individuals with their health. She felt that technology detracts from the ability for therapists to empathize with patients and provide a barrier. This helped to start me thinking that technology may not necessarily be the right solution, but it could be a means to help facilitate the very complex web of different relationships.

Telemonitoring Employee

I spoke to Julia, who works in telehealth monitoring about the future possibilities and capabilities with telemonitoring and sensor technologies. She spoke to me about the benefits, as well as any challenges medical professionals face with relying on these technologies and urging older adults to accept and use them. The telemonitoring system that her hospital is using is manned by health professionals and they have found that by using technologies and data algorithms they can cut down on manpower considerably and access specialists more easily. Currently creating usable technology for older citizens to use autonomously is presenting a challenge and most telehealth technologies are still in the early stages, but the potential for life-saving intervention as well as the capability for keeping patients in their homes longer is considerable.

Defining the problems and opportunities is a very important part of the process, but it can pivot the designer in many different directions based on the insights gained. This convergent part of the Double Diamond can help define goals and challenges through analyzing the data collected from the Discover phase (Design Council, 2011). This portion of the process involves synthesizing all qualitative data collected and identifying a focal challenge.

Synthesis

I re-listened to all recordings of all the interviews and took notes on Post-its of insights I obtained that pertained to each interview. After I had written all the insights down, I grouped them under larger themes and topics I had asked the participants about. Needs and behaviors were varied among users, but there were also a lot of commonalities from these user interviews. Synthesizing all of the data is a good way to reveal what is most interesting or important at a given time. By clustering and finding themes designers are able to develop frameworks to understand the context of the problem (IDEO.org, 2015). The goal of synthesizing is to continue to find commonalities between participant needs and behaviors.

Under the larger themes some smaller themes started to emerge:

Connection

Most of the older adults spoke in length about their desire to keep in touch with old friends and family members that live far away. Most of them use their devices primarily for this reason and some have even adopted Facebook as a daily habit. Texting was a common use of connecting to kids and grandchildren, while Facetime and Skype were only used by some. “Facetime is just a novelty. It’s too difficult to have a real conversation that way” —George

Learning and Lifestyle Choices

There is often a sentiment that older adults are bored and unhappy with the monotony of life after retirement. However, many of the people I spoke to were happy with the time they had off to go travel and spend time with grandchildren. Most of them had some aspirations to learn new skills, adopt new habits, and continue hobbies, such as gardening or even participating in triathlons in Tom's case.

The Switch

There is an unusual switch, which happens when people become older and physically or mentally less capable and abruptly need support from their children. However, many of the participants I spoke to were very worried about their children’s future, and not their own. At the same time they felt uncomfortable asking for their children’s help or support. They were often afraid of “bothering” them, which they described often as the reason they learned how to use text messaging in the first place.“Texting is the best way to contact my kids, so I feel like I’m not bothering them.” — Joanne

What is Independence?

Older adults feel and consider themselves independent no matter what state their physical or mental health and wellbeing they are in. There was a common sentiment amongst participants that they did not like the fact they were getting older, but they did not feel like they are losing independence. Certain things involving mental or physical acuity were merely becoming more difficult.

Learnings

Many of my initial thoughts around independence, learning, and aspirations were very misguided towards the elderly demographic. Older adults do not feel helpless or like they are losing independence. In fact, most of them worry more about their children and grandchildren’s lives more than their own. Technological capabilities were varied and many participants had difficulties with general tasks such as using email, but this shifted in slightly younger participants.

Behavioral Archetypes

Because informants differed in more than 20 years, some were more physically or mentally dependent, while others’ capabilities and aspirations varied no matter what age they were. Generalizing the behaviors and goals for this age group is extremely difficult because of this variance. Commonly designers develop personas to define a target market and develop a proxy with stakeholders (Pruitt, 2014). While personas can be useful at times, there are many problems with developing personas for a large target market with varying needs and behaviors. Stereotypes including, cultural, gender, socioeconomic will often be used to explain predictable sets of behaviors and attitudes after personas are identified (Turner and Turner, 2011). Stereotypes hinder the design process and exploration by prejudicing our understanding of behaviors and reactions of generalizations of user groups.

Based on the differences in participants I decided to graph users on a chart and make Behavioral Archetypes rather than Personas. Behavioral Archetypes are the best ways of identifying different needs, because demographics and characteristics do not necessarily coincide with each other (Ben-Menachem, 2016).  In the real world segments are not so well-defined and many people take on different behavioral archetypes at different times throughout their lifetime. It is important for developers and designers to understand which Behavioral Archetypes dominate the market and how to develop products and services that can appeal to multiple archetypes (TandemSeven, 2013).

I split archetypes into overarching themes based on their needs and behaviors. By identifying main themes, such as independence, learning, connection, hobbies, and aspirations I was able to map out different goals and needs for participants. I placed needs I had identified on a 2x2 matrix, with the y-axis set as their reaction to change and the y-axis set as the source of their motivations, either from individual goals to community-based goals. This helped me to define them in 6 different archetypes.

Learnings

It was more difficult to come up with archetypes from behaviors rather than demographics, but in the end it was helpful for thinking about possible solutions that pertain to the wide variety of different participants. The 2x2 framework was helpful to identify different factors that affected their motivations. After mapping out all behaviors I could later compare solutions to these Behavioral Archetypes.

Identifying Problems

After reflecting on behaviors and motivations of these participants I began to identify the main problems in the home care industry. Using timed brainstorms I wrote down obstacles I had uncovered around health, independence, older adults, informal and professional caregivers, and technology. In order to create solutions it is important to define a specific problem to create a framework (IDEO.org, 2015). After identifying problems I picked two that I felt I could tackle with the design brief. I determined that the most important problems encompassed the communication between informal caregivers (family members) and older adults.

5 Whys

The 5 Whys are a simple but powerful tool designers use to find the causal root of a problem. Recurrent problems are often symptoms of deeper issues, so while “quick fix” or “band-aid” solutions can be helpful, they are only temporary solutions to a larger issue (Mind Tools, 2015). It works best for simplifying and gaining a quick understanding of complex issues and explaining common problems (Stickdorn and Schneider, 2012). Asking the question  “Why?” five times helps to establish links between root causes and surface problems. I attempted a few different scenarios with two of the problem statements I had identified.

Problems

1. Older adults don’t know how to ask support
2. Family members often don’t know how to support or help their aging parents

Learnings

Some of the causal roots to the problems I identified were very complex issues. It led me to question how I could possibly begin to tackle deep-seated problems, such as the fear of death? How do I challenge emotions and issues caused by family dynamics, such as guilt, anger, and jealousy? Some of the problems were too complex for me to affect. In reflection, this may have been due to the specific problems I chose to run this exercise with, because starting with the “right question” is essential for using this tool correctly (Seiter, 2014). The 5 Whys can be a beneficial tool to identify solutions for underlying problems, but in this case I found it served to help me understand that there are bigger challenges facing me with this subject that I need to be mindful of.

Goals

Since I was not able to identify a causal problem I felt was solvable with the 5 Whys exercise I decided to focus on specific goals that I wanted to accomplish with my solution. By using some of the of the causal questions I found with the 5 Whys, but not necessarily the root of the problem, I determined some goals I wanted to achieve.

1. To empower and maintain control for the older adult
2. To preserve autonomy for the older adult
3. To incorporate more interaction between family members and older adults

Developing a “How Might We…?”

By using the goals I had made for my project I came up with a HMW (“How Might We…?”) question. The goal of a HMW is to fall out of designer’s point-of-view statements and to generate seeds of inspiration for ideation. It is very valuable tool for creating a seed that is broad enough for a wide variety of solutions but narrow enough that there are some constraints and boundaries (IDEO.org, 2015). Reframing problems as generative questions is a crucial element to developing solutions. The HMW is a good complement to the 5 Whys tools, and can be developed after finding a causal root, but I found that would lead me to begin to tackle too complex of a subject. I came up with a “How Might We” statement based on my goals and insights around older adults’ care needs. I felt there should be a bigger emphasis placed on making older adult care more patient-centered and more support could be given from their families and other caregivers.

HMW inspire more interaction and support between older adults and their family members within the care system?

Ideation

Ideation is the next crucial step in the design process towards finding implementable solutions. I used my HMW statement as a starting-off point for brainstorming. I had to consider that there was more than one type of user that would use the product or service, so I began to question how to connect older adults that needed care, informal family member caregivers, and other care professionals. The most challenging part about brainstorming independently is to stop filtering yourself.

When ideating, it’s important to promote creativity over immediate feasibility (IDEO.org, 2015). I encouraged this mindset by approaching a brainstorm of exploring the “Worst Possible Ideas”. This exercise works by intentionally coming up with bad ideas and then flipping them into good ones (Sturgeon, 2014). This can help relax a team and help them feel more comfortable when sharing ideas, but I found it also worked for me when I worked independently. After thinking of the “worst” solutions such as “moon shoes” and “bunk beds” I was able to become less judgemental of my creative techniques, and put more humor into my process.

After my “Worst Possible Idea” brainstorm I spent some time ideating on different products and services that could connect children, parents, and social workers together. I came up with some ideas on products that could act as messaging apps. From my interviews I found that the majority of the participants were already using technology platforms for connecting with friends and family members. I thought a good way to build more interaction with the sensor technologies, would be to allow additional agency to the older adult with the care they receive. This idea seemed to fit well in the framework I had defined for the problem, but I felt like my target audience had shifted to incorporate other users. To obtain insights into the informal and professional carers motivations and behaviors I prepared supplementary interviews.

Secondary Interviews

Adult Child - ‘The Decision Maker’

I interviewed a child of an older adult, who spoke to me about the amount of work that goes into caring for his mother. Older adults have varying needs, so it was really interesting to hear his perspective on how he manages his mother’s health. While it is common for care responsibilities to fall to the spouse of the care receiver many times one of the children will need to take on more authority, especially as the spouse begins to develop health issues themselves. He took me through the whole process of becoming the “spokesperson” or “decision maker” for his mother’s well-being, which began after his mother was put in the hospital for a surgery. He explained how he manages the brunt of the responsibility and how he delegates tasks to his father, his wife, and his sisters. After interviewing him I learned what challenges he faces with his own family dynamics, comprehending medical terminology, trusting health professionals, and advocating for his mother’s needs. He also showed me the current apps he was using to manage his mother’s health for messaging and note-taking, which instilled confidence that my solution could be of value to someone in his position.  

Adult Child - Supporter

Secondly I interviewed Carolyn, who as the wife of someone that has a “decision maker” role, acts as supplementary support and takes on less responsibility, but still needs to stay informed. I thought it would be important for me to understand the caregiving process from her perspective as someone that provides support to the “decision maker”. She spoke about the importance of lending emotional support on top of the functional support she provides to both the “decision maker” and to his elderly parents. From her perspective, it is challenging for both her husband and her husband’s parents to accept the switch in roles between the parent-child relationship. She felt strongly about encouraging conversations and decision-making with her husband’s parents about the future of their care and that they should start making decisions now. It was really valuable to perceive her motivations as a support role to both the “decision maker” and his elderly parents.

Social Worker Interviews

After learning about responsibilities of both a “decision maker” and a “support” role I needed the perspective of a care specialist. I interviewed two different medical social workers in Singapore about their day-to-day activities and relationships with patients, families, and other care professionals. Both described the challenges they face with managing countless relationships with various stakeholders and understanding the best way to support a person receiving care. They are very concerned about their patients and the support they get when they are at home. At one point Sara described, “That’s when my antenna goes up. I see that the older adult doesn’t come escorted to their next appointment and they look unclean.” Often medical social workers must intervene in their patient’s care if they do not have adequate support at home. It was useful to gain the perspective of the social workers as they are fundamental to the caregiving process.

After these two interviews I synthesized the qualitative data I collected from the interviews and gathered major insights that could be incorporated into a product to help “decision makers”, “supporters”, and “professional caregivers” interact and align with the care goals of the person receiving care. I determined which features were most important to be incorporated into a product.

1. A holistic view of the patient’s health
2. Ability to communicate with health and care professionals
3. An overview of available resources
4. One person to delegate tasks
5. Inclusion of the rest of the family
6. Layman’s health terms

Service Design Tools

After gaining perspectives from the person receiving care, the family members, and the social workers, I felt I needed to understand the care industry further. I found in my interviews that the amount of different stakeholders and relationships complicate the caregiving process for everyone involved and I sought to make sense of it. In order for me to learn how and where I could connect these three different types of users I needed to map out the care system. Currently agencies and other middlemen connect people in need of care with professional caregivers and other services, but often their fees inflate costs (AARP, 2016).

Through my research I found a few services that are seeking to disrupt the care industry by removing middlemen and providing customizable care for older adults. These services help connect care specialists with people needing care and their family members. I reached out to some of these services as a way to understand this industry better and connected with a company called Elfy. Elfy is a service launching in the UK that connects care specialists to people in need of care. I offered to act as service designer to Elfy and help map out processes and streamline their service in exchange for obtaining additional insights into the care industry.

There are a variety of different methods and tools for gaining insights in the creation of services, but the most important aspect for a service designer is to help facilitate a smooth interaction between stakeholders. The service designer’s role is to help facilitate an environment to generate different ideas within independent stakeholder groups and to help them gain an understanding of the holistic perspective (Stickdorn and Schneider, 2012).

I identified a few different service design tools that would be most helpful to Elfy based on initial conversations I had with them. I foresaw some gaps in the design of the service so I facilitated exercises in the hopes of filling these gaps and helping gain a holistic perspective of the care industry. Because they are in 3 different countries, I employed online tools in order to accomplish a virtual workshop. By using an online app called Mural (mural.ly) I was able to collaborate with the entire team online. The app Mural allows for collaboration “murals” (as shown above), which allow the team to share inspiration and ideas through images, text, and Post-it notes. I made a Mural for each service design tool I wanted to facilitate with the team and underlaid graphics and a framework. Blank canvases can be very intimidating so it was important to have some work done, but not so complete that the team felt like they could not contribute. I filled in the frameworks with blank Post-its, images, and idea seeds. After an introduction and short exercise in helping the team acclimate to the Mural app I facilitated three different service design tools that I felt could contribute best to the service design process.

Stakeholder Map

Previously, I mapped out stakeholders in the digital home care industry for my initial research, but I thought this would be a good exercise to begin collaboration in the workshop. Because I was focused on sensor technologies in the care industry, while their service focused exclusively on the care industry I knew their map would be different enough from mine to provide me with new insights into the care system. I had created a blank “bull’s eye” diagram in the Stakeholder map “mural” as a starting out point and left a few blank Post-it notes. Timing exercises is an important constraint needed for facilitation and to increase engagement. I explained to the team how Stakeholder Maps work and asked the them to write down all the stakeholders that were directly related to the main user and that were indirectly related to the user. During the exercise, I maintained engagement by writing examples of additional stakeholders on Post-its and added question marks. After 15 minutes was up, I asked them to identify relationships by providing arrows between stakeholders.

We then moved onto the next exercise and I later put post-it notes (in red) where I thought there were potential gaps.

Learnings

I found that collaborating in a workshop online can be very challenging. Everyone seemed to understand how to use the app and participated in the initial exercise, but only two to three people were actively engaged in this exercise out of the entire team of 6. I thought this tool was less useful to the team, but it was helpful for me to gain a better understanding of care in the UK. It also introduced me to some ideas that I had not thought of before. For example, one person had put “pets”, which I thought was a joke at first. After later reflection, I remembered that the geriatric physical therapist told me that if someone receiving care has a pet, then a social worker will also need to be arranged for the care of that pet.

Customer Journey Mapping

Customer Journey Mapping is a useful tool for understanding every touch point customers have when they interact with a product or service. It provides an overview of different factors that influence a user experience (Stickdorn and Schneider, 2012) and is beneficial to highlight gaps, pain points, and opportunities through the perspective of the user. The process itself can also be a good way for the design team and other stakeholders to build empathy for the person they are designing for. In the workshop I had the team map out a professional caretaker’s journey, while interviewing one over the phone. I created a blank framework in Mural and facilitated this process by interviewing the professional care worker and writing down stages of her journey on Post-it notes with the team. Using this framework can also help the interviewer to remember to ask specific questions on how the participant thought or felt during a stage in the process, which is best for identifying pain points. I asked her questions about her day-to-day schedule and the current care system’s processes and observed moments that were pain points in her journey.

After this exercise, I organized the journey map and took note of any gaps (red Post-its) in the process and where Elfy can address pain points (purple Post-its) in the current care industry’s process. Identifying specific problems along the journey can help designers solve smaller issues to create a more enjoyable user experience.

Learnings

The Customer Journey Map exercise was a really helpful way for the team and I to analyse different pain points in a care professional’s journey. I obtained extra insights on care professionals’ goals and behaviors as well as the interaction they have with family members and other stakeholders. The care specialist we spoke to was very good at identifying specific examples when I asked her to. Details and specifics are beneficial to the team for gaining a better understanding of pain points and issues (Hall and Zeldman, 2013). The team at Elfy thought this tool was a constructive way to view the service from the caregiver’s perspective and for understanding problems. They had interviewed this caretaker before, but had never mapped out the entire process. Employing service design tools like the Customer Journey Map will be helpful for them to identify how the caretaker, family member, and person receiving care thinks and feels at each stage in their care service. Diagnosing specific pain points can help the team begin to incorporate solutions and opportunities to improve the overall experience and solve for specific problems. For example:

The care specialist described how the people receiving care would often get annoyed at explaining things to her, such as how to use the cooker, after they had already went through the same process with another caretaker.

Opportunity: There could be a standard in the app for the initial care professional to write notes about preferences and directions for caring for the individual. This can be updated by every care professional or even family members to avoid frustration between the person receiving care and the professional care worker.

An important insight we obtained from speaking to the care specialist was that she often felt like she had no input or support from the family members of the person she was caring for. She described how it would have been beneficial to have more input through multiple stages within her journey and how even possessing a list of phone numbers for family members could be valuable to her. The team at Elfy and I wanted to look into this problem further, because we felt like this interaction would be beneficial to all stakeholders involved in the caregiving process.

Service Blueprint

While Customer Journey Mapping can be a great way to understand the interactions a customer has with a product or service, a Service Blueprint contains the customer journey as well as all of the interactions that make the journey possible (Cooper, 2014). Service Blueprints help detail individual aspects of a holistic service through visual schematics from the perspectives of the user, service provider, and other relevant parties (Stickdorn and Schneider, 2012). They work beyond the customer’s view and are good ways of identifying how stakeholders interact with one another. I used this tool to get an overview of the current caregiving process from beyond the caregiver’s perspective. Because their app and service had not been completely defined the Service Blueprint can act as a proxy for them to identify how current caregiving processes operate and how they can be improved. This tool will be helpful to them in the future for gaining a bird's-eye view of their service and app to minimize root problems within the service. Overtime this map can act as a “living” document and the blueprint can be revised (Stickdorn and Schneider, 2012).

Designers should begin a Service Blueprint from the user’s journey and perspective, a challenge when there are multiple user categories. Within this service the person receiving care, their informal carers or family members, and the professional caregivers are three different users. The team and I used the person receiving care, because it encompassed all interactions and processes and the service will be most beneficial with their needs at the core. After mapping out the journey of the person receiving care, it is important to map out all the interactions they have with other people and processes.

The “line of interaction” represents touchpoints that happen with both the user and the service provider. In this Service Blueprint the person receiving care’s journey is mapped out with the interaction between the professional caregiver. Below the “line of interaction” are any actions that happen with the person receiving care, but are passive actions they do not engage with. The “line of visibility” represents anything that is completely invisible to the user, including all processes and interactions between stakeholders that develop in the background, such as all processes that happen within the care agencies. The “line of internal interaction” identifies internal system processes, such as the interaction between the care agency and financial or governmental organization.

After mapping out the entire system, it was easy for the team and I to identify what kind of knowledge gaps we had, such as the internal care agency processes. The “physical evidence” defines what objects are within the service. In this case an important part of the process is the “care package”, which the care specialist described as a “laminated sheet telling the carer the name of the patient and the tasks they need to accomplish that day”. I placed red Post-its by knowledge gaps and purple Post-its next to opportunities, so the team can refer to the map in the future.

Learnings

This was a beneficial tool to analyse different interactions and processes in the holistic service. It helped to identify information flows and processes that need to be incorporated in Elfy’s service as well as possible opportunities for improving them. With the Service Blueprint, the team and I were able to see precise interactions happening between professional caregivers and the people receiving care. The team and I wanted to identify where family members can have more input into their family member’s care, and this tool helped to pinpoint voids in the interaction between them and professional caregivers.

Ideation

Once the team and I had identified stages within the journey that family members could provide additional input we ideated on solutions that could improve the level of interaction between them, professional care workers, and the person receiving care. We used the Service Blueprint as a base and looked at stages within the journey where there were gaps (shown with purple Post-its). We then brainstormed on specific moments to find solutions for incorporating additional interaction within the service. By illustrating exact phases in the journey, it was easier to think of more tangible solutions rather than abstract ways of involving family members.

Some of our solutions involved incorporating video into the process, prompting family members for feedback from caregivers, and building the community with meetups with other families using Elfy’s service. These solutions will be helpful down the line, as we build out the service and app, but they will need further testing and prototyping.

Building Empathy with the Team

After talking to a careworker about the misgivings of the care system we were motivated to obtain a family member’s perspective as well. We decided that it would be helpful to do another customer journey map through the informal carer’s viewpoint. Helen had written a blog post on a blog about her poor experiences within the care system in the UK, so I reached out to her and asked if she would allow us to interview her. I led an interview with the Elfy team hoping to gain an understanding of the processes and relationships she’s had within the care system. However, instead of speaking about her process of working with care agencies she spoke in depth about the mistreatment she’s received transitioning her father from in-home care to a retirement living situation. When interviewing someone, it’s important not to lead the conversation but consider specific topics to drive the interview. In the end, this process was much more useful as a way to identify insights and opportunities rather than processes.

Learnings

Interviewing can be a great way for the team to gain more empathy for the user, which is beneficial for designing a human-centered service or product. Through the process of caring for her father, Helen felt helpless, unsupported, and guilty. By describing her pain points within the care and health system the team and I we were able to gain additional empathy for people in her situation. Obtaining empathy for the user is a really important tool for design teams to inform intuition and help make decisions. Teams that are driven by empathy don’t want to let down their users, as our brain is structured to put emotion ahead of intellect (Patnaik and Mortensen, 2009). After speaking with Helen, I had a deeper desire to help disrupt the health and home care system.

Insights and Opportunities

Family members need support. Helen is only 37, but dealing with care for her elderly father who is 77, has diabetes, multiple cancers, and is legally blind. Her friends and her partner do not have parents that need extensive care, so she does not feel like she has anyone that can offer her advice.

Opportunity:  Build more of a community for the family members within the app, such as a forum.

Lack of empathy within the care system. Helen described how terrible her experiences were with the care and health system in the UK. Specifically how social workers have made her feel guilty for not being able to care for her father and how powerless she has felt throughout this process.

Opportunity:  Distribute empathy gained throughout the organization. Design ways for the entire team at Elfy to continue to gain empathy through personas, storyboards, and continuing to interview users.

No patient differentiation. Her father is legally blind and has a number of other health ailments, but still has full mental capacity. The hospital he is currently at, due to a broken pelvis, treats him like the rest of the patients in his ward, which is full of patients with dementia. They will not ask him opinions on his health care and call him by his legal name, “Albert”, which he detests.

Opportunity:  Treat people receiving care like the individuals they are and customize their care. Incorporate ways of determining how people want to receive their care and incorporate feedback so they can change it.

In order to understand if a solution is desireable to the customer it needs to be made tangible so it can be tested. Solutions cannot be taken into the world if they are abstractions, therefore it must be prototyped (IDEO.org, 2015). Prototyping helps to get ideas out of the designer’s head and into something that can be felt, experienced, and tested. Ideas that are generated should always be tested and explored (Warfel, 2009).

Prototyping can create three different forms of value; it helps the designer make decisions and problem solve in real time. The designer is able to learn and explore what they are making and get a better understanding of their item through backtalk. The second value comes from testing it with users and evaluating the progress of the work. Through feedback designers are able to resolve what is working and what is not. The third value helps people understand what the strategy is and allow people to experience it. It explaines the story of the service to ensure its tangibility (Wildman and Durrant, 2013).

Making something that can be experienced is worth much more than a picture, but first you need to identify what you should make. Armed with inspiration and learnings I gained from facilitating service design tools, I began to sketch out some of my initial ideas of a messaging and note-taking app during early brainstorming. I wanted the learnings from my prototype to be able to be incorporated into the Elfy app.

Making a Sketch Prototype

I developed sketches that incorporated some of my initial thoughts on a messaging product and used some of the main themes I gathered from speaking with children of people receiving care and the care specialists. I wanted the sketches to look rough as this was my first attempt to understand if this service would be beneficial to users. I made 5 different “screens” and thought about putting them in a prototyping app to allow sketches into an app format, but I decided at this stage it was best to keep them rough and approachable.

Testing a Sketched Prototype

I took my prototyped screens to the medical social workers I had spoken with and described what the different sketches and screens were. I was surprised that at this low fidelity that they were able to understand that this was an idea for an app. To promote additional feedback I began writing notes directly on the designs, as they seemed hesitant to critique what I was showing them. Some of the things they brought up were small critiques, such as they wanted the ability to see who the spouse or “decision maker” was for the person receiving care, but I also received some bigger insights that I could incorporate into my next iteration and explore further.

Feedback

Layman’s Terms. The medical social workers did not think it would be necessary to see the medical condition with the medicine, because when they see the medicinal name, they understand immediately what it is for. I had included this in the prototype because a “decision maker” described that the first thing he did when he took over responsibility for his mother’s health was find out all the different medications she was on and why. I thought giving the option to view medical information in Layman's terms would be valuable for the family of the person receiving care, but this helped me consider that the app may need to change depending if the user was a medical professional.

Social media for health. When trying to decipher what the prototype was I found that they came up with their own relatable applications. Sara asked, “How is this different than Facebook or Whatsapp?” When sketching this out I had not thought of the connection between this and a social media app. Knowing the kind of metaphors that people use is helpful to position and market the app, because metaphors help us familiarize ourselves with new technologies (Watson, 2015). For instance, Elfy describes their service as “the Uber of Elderly Care”, to help explain their service.

Passive interactions. Sara brought up the fact that this product could potentially keep the child of the older adult from ever interacting with their parent. This was a really helpful insight as this was something I wanted to avoid. I strived to incorporate more solutions within the next prototype to avoid this sentiment. I brought up some solutions to this, such as if the app will not open more than 5 times for the child without calling their elderly parent. The social worker really enjoyed being part of the ideation process and said, “Yes! Gamification! Singaporeans love gamification!” and began showing me another health app she was using to count her steps.

Learnings

Using a sketch prototype was helpful to get feedback. I was initially worried, because they were pressed for time and I thought they would get annoyed with me for showing them such a rough prototype, but they actually seemed to really enjoy giving me feedback on it and suggesting features that could change. Sharing the low fidelity prototype helped incorporate participants into the design process. Participatory design techniques are a great way to gather addtional insights and bring users into the design process. Another way to gather feedback at this low fidelity would be to cut the patient information and have the social workers arrange it by importance. Overall, the social workers were supportive that this idea would be helpful in their own jobs and for family members of their patients.

Sketch App on Marvel

For the next iteration I made new sketches and inserted them in a prototyping app called Marvel. Marvel gives designers the ability to create hotspots and set up interactions within the app. I continued to keep my sketches looking unfinished during this stage in hopes of receiving better feedback. Prototypes are not meant to be perfect and it is often better for receiving feedback, because participants feel more comfortable critiquing ideas when decisions have not all been made and set in stone (Warfel, 2009). I changed the sketches based on the feedback I received from the social workers to make them look more like a messaging app and focused on the profile of the person receiving care. I added the “decision maker” contact info as this was something the social workers mentioned as something they wanted to see immediately. In order to design a better user experience I needed to identify one specific user, so this iteration changed considerably to target family members of the person receiving care.

Testing a Sketch App

To get feedback on this prototype I needed to speak to a user that was a family member of someone receiving care, so I spoke to Bruce, who was a “decision maker” for his mother’s care. He is also a pharmacist and I wanted to ask him specific questions on the feedback I got from the social workers about whether to use Layman’s terminology. While viewing the prototype on an iPad, he shared his experiences advocating for his mother’s care and the challenges he had with his own family dynamics and his experiences with medical professionals. His insights were really valuable and encouraging to this iteration and I was able to take away some valuable insights and feedback.

Feedback

Goal Specific. He thought it would work best to familiarize the family members and care workers with a “care plan”. It would be valuable for both informal and professional carers to see an overview of problems, solutions, and the care goals. Most of the value would come from communication between informal caregivers and professional caregivers rather than healthcare professionals, because people within the health industry have their own documentation and he thought they would be unwilling to contribute to the platform. A summary of a care plan with data trends overtime would have been valuable for him when taking care of his mother, such as “Are they taking medication?” or “Are they losing or gaining weight?”

Layman’s Terms. He thought that it would be really important to have what the drug was being prescribed for from his experience as a pharmacist. He discussed some of the ways that he discusses medications with his patients and the importance of including side effect information for the informal caregiver. He gave an example that if his mother had a stomach ache, it would be helpful to search “stomach ache” in side effects to see if the cause could be medication related. He also wanted to section for questions he wanted to ask the doctor at the next appointment. Often he felt rushed during the appointment and it would be a good way to remember information. The app could even prompt the user based on the appointment in the calendar with their questions.

Family Dynamics. Bruce thought that the messaging portion of the app would be really useful, because he used texting or emails with different family members, but delegating who would be receiving different messages would be helpful. However, it also brought up an interesting power play that could be incorporated for the “Power of Attorney” or “decision maker”. He thought it would be great if he could inform his family members about decisions he made with mother’s care without the capacity for them to argue or reply. Making an announcement, rather than having a conversation about decisions he made on his mother’s behalf, would have saved him from previous grief.

Learnings

This fidelity worked well for Bruce to understand the app concept and he was able to flip through different pages of the app on his iPad. However, the hotspots and interaction I incorporated were impractical at this stage. Keeping this fidelity rough gave Bruce the agency to make suggestions on how the app should be improved and I was able to take his suggestions onto the next iteration. This low fidelity prototype was shown to be a good proof of concept, as the participant was very encouraging on the usefulness of the app.

Interactive App with Invision and Sketch

For my next iteration I created a higher fidelity app by using Sketch and InVision, two softwares used for prototyping. I incorporated 6 different pages with interactions for the user to view on an iPad. I increased fidelity by designing with graphics rather than sketches. The process of designing the app with graphics helped to increase design decisions through backtalk. This helped to understand specific opportunities and problems the app could solve and helped to define the product. 

Testing an Interactive App

I tested this next iteration with two different users that were currently caring for their mothers. The prototype raised questions and thoughts about their role as the informal caregiver for their parents. One said that as she had recently retired, her next job is to care for her mother. I had made the design for an iPad intentionally, because people in this age group are wide adopters of this device. Both participants had iPads so they understood the value in having it on an iPad app, but one participant wanted a smartphone app so she could easily take notes while at the appointment. By defining the app with a higher fidelity, I was able to get more tangible feedback from the two participants.

Feedback

Communicating Care. The participants thought that most of the value came from the common communication area, so people could bring up concerns and questions in an informal context. One participant who had taken on a big role of the caregiving for her mother wanted a way to update her family members automatically based on the notes she took. She discussed the biggest obstacle she had with her siblings was that they did not update her on her mother’s well-being after going to see her, something she did as soon as possible by emailing them after visiting their mother.

Patient-Centered. One participant mentioned the importance of keeping the patient’s needs at the center and she favored incorporating more about the patient preferences in the profile. Integrating specific suggestions on how people want to be cared for would enhance the service and give more agency to the person receiving care. She suggested it could be simple things, such as:  “Always include my wife in any instructions you have for me” or  “Make sure you always call me Bob”. This insight reminded me of Helen’s frustration at the health professionals calling her father his given name, which he despised.

Resources and Support. The prototype brought up reflections in the participants on what resources and support were valuable to them depending on the current care stage of their family member. One participant confirmed she had no access to resources until her mother went to the hospital and she was introduced to a social worker, reiterating something that Helen had said about needing support and resources made available to her. Providing some kind of forum with available resources would be valuable and could bring a community together through the app.

I had incorporated some interaction with the app, but found it was still not enough to allow participants to explore the app independently without talking them through how to use it. This was something I felt I needed to change for future iterations. While creating this iteration of higher fidelity I was able to define the messaging app idea and get better feedback on the concept. The overall positive consensus that this app would be beneficial to family members of people needing care helped solidify that this solution was worth continuing.

Through the Develop phase designers learn to “build the right thing”, while the Deliver phase is for “building the thing right” (Ries, 2011). Once the solution feels tangible, it is packaged up and taken through final testing before the product or service is launched. During the Deliver phase designers settle on an idea and execution advances the process. Real market feedback is required and bringing in additional quantifiable data is important (Design Council, 2011). Increasing user testing is necessary as multiple iterations will benefit the design and usability of the product or service.

Through the process of prototyping in the Develop stage I was able to provide a solution to inspire more interaction between older adults and their family members within the care system. After testing prototypes with five users with three different iterations, I identified that a “Care Kit” solution incorporated into a care app would benefit family members and care specialists to interact more effectively and understand goals on behalf of the patient’s well-being. According to a Nielsen and Norman study, testing with 5 users will give designers enough insights to move forward (Nielsen Norman Group, 1998), but in order to see if the idea can scale, more user research is essential. Finding an audience and building a community is important for scaling the business and identifying if the solution is valuable (Klein, 2014).

Keeping the person receiving care at the center and identifying their needs will be an important aspect of the app moving forward and additional testing with people receiving care will be crucial. Culture and context will become more important to designing for usability, so using threshold maps to define behaviors and supplementary testing in new markets is crucial. For instance, many Eastern countries have foreign working live-in household maids that become primary carers for older adults. In the app we will need to consider things like literacy and relationships between the housekeeper and other family members if we want to expand to these markets.

Through prototyping, I recognized how technology only accounts for a portion of the value. The real value progresses through how the product is placed in the overall service design. Building out the service will be valuable to identify where this solution can integrate most effectively. Mapping out the service with Service Blueprints and Customer Journey Maps will be beneficial moving forward to maintain a human-centered design. These tools also help gain empathy throughout the organization, which will help the team make more intuitive decisions in the future. When users are actively involved in creating experiences, rather than passive recipients the design will improve (Polaine, Løvlie, and Reason, 2013). Additional solutions achieved through prototyping, such as gamification, could be integrated into the app in order to improve interactions and give more agency to the user. Incorporating feedback loops into the design will help ensure that users have an active participation, and help Elfy respond and alter the service with changes when needed.

There are other ethical considerations, which I was not able to tackle with this project, but will need to be investigated further. The data created through the technological services is another layer of the experience that is passive to the user, but significant to businesses and investors. Design ethics must be considered when dealing with user’s private data. In Privacy is UX Alex Schmidt determines how privacy needs to be put in the user experience process (Schmidt, 2015). Elfy and I will need to make sure that privacy is precedent to users especially if data from sensors are incorporated into the app. In service and product design, it is important to consider the different ways in which designs can be broken or can fail. Scenario storyboarding and additional mapping will be beneficial for defining the experience (Polaine, Løvlie, and Reason, 2013) and for developing narratives (Kessler, 2012), which will be helpful for identifying in what way the designs can fail.  

Next steps

1. Designing a higher fidelity prototype to test with users
2. Determining how this feature of the product fits best into the service
3. Testing for a larger market and scaling
4. Scenario storyboarding to improve the customer experience
5. Building feedback loops into the design

The most crucial part of the design process is to reflect on how it was applied. By using the Double Diamond method and defining the process, I was able to specify tools I used for researching, ideating, making, and testing. I learned some key takeaways by using the Double Diamond process.

Lessons Learned

Framing and mapping problems is a key part of the process and will affect the solution in the end. Identifying a small problem and sticking to it would have benefitted me. My HMW statement was too broad and incorporated too many small problems. I have a tendency to look at the holistic service or design, which can lend itself well to service design tools and identifying causal root problems, but can be detrimental to the design process. Sometimes it is easier to solve for a small problem rather than not coming up with solutions for an overarching problem. I am really glad I stopped myself from tackling “The Fear of Death”.

Identifying one type of user would have been more beneficial. I started out too broadly with people over age 65. There were definitely similarities between users, but their behaviors differed dramatically. I should have focused specifically on older adults receiving care and maybe even a specific type of care they were receiving. Connected technologies claim to benefit everyone, but this specific needs case is more valuable for the people that are in declining physical and mental health. Over time, this shifted my perspective on who the user would be for the service.

Taking the time to explore through research is good, but I should have started to create prototypes earlier. I received as much value speaking to people about my prototype for 30 minutes to an hour, rather than interviewing people for hours at a time. Both are essential to the process; however, in the future, I will start incorporating prototyping and user testing earlier on. It can be difficult to ask for user feedback on what feels like a half solution, but that is when the participatory design process can come into play. Using “sacrificial concepts”, which are raw and potentially flawed concepts, can be helpful to include in the interview process and can create a response in participants. I found that participants really enjoyed being part of the design process, so in the future I would like to use additional co-creation and participatory design explorations. 

The backtalk that comes from creating and prototyping can help designers understand the solution. Building something tangible is not only valuable for testing with users, but also for the designer as we learn by making design decisions. I knew the problem(s) I was solving, but I was not sure how to identify the solution I was coming up with in my head. Through the act of creating, I was able to understand and express through a design what I wanted to create, but was not able to articulate.

Building empathy throughout the process is crucial for the outcome of the design of the product or service. Talking to users about a real problem they face was very beneficial to my design process. After speaking to adult children about their experiences taking care of their elderly parents, it became much easier for me to make design decisions. It is essential for design teams to have conversations with their users and try to gain their perspective in order to create a better designed experience. Increasing empathy for the people you are designing for can help designers see how our job can make a difference in their lives, which is the greatest reward of all.