This article was co-authored by Geri Lynn Baumblatt & Amy Bucher.
A nurse practitioner (NP) was telling patient advocates how to help patients prepare better for appointments. She explained that many people with high blood pressure (BP) don’t track it before their appointment. So, she gives them a sheet and has them schedule another appointment to come back after they’ve tracked it. When asked if her office could proactively mail or email the BP tracker to patients when they schedule their appointment and avoid the delay in treatment and a second appointment, the NP explained, “we have no way to do that.” When asked if the admin could be trained to help with this, she said, “They don’t have that skill set.”
If you’re confused, so were the patient advocates. This is a solvable problem using existing tools. But it was clear that as frustrated as the NP was with the current situation, she wasn’t interested in thinking about how to address it. And this initial roadblock is relatively simple to overcome; it doesn’t even get to the more complex question of whether people know the right way to take their own BP and how to train them to do so.
Amy had a similar experience while designing a tool clinicians could use to train patients to take their own BP at home. After learning the right way to take BP, she noticed it wasn’t done quite right at her next physical exam: her sleeve wasn’t moved out of the way, her arm was elevated above her heart, and she definitely didn’t sit quietly for 5 minutes before it was taken — something that’s probably often hard to fit in during a short visit.
Clearly, if a medical professional doesn’t have time to take a patient’s BP correctly during an appointment, it’s unlikely they’ll have time to teach the patient to do it themselves. With these real-world challenges in mind, Amy interviewed and observed patients and clinicians and determined that easy-to-understand, visual instructions the clinician could print with a patient’s discharge paperwork after a quick verbal walkthrough would accomplish the goal and minimize time spent. She created a prototype and brought it to a primary care office to get feedback. The clinicians agreed it was well designed and easy to use. But they said they wouldn’t use it because they’d have to click out of the electronic medical record, disrupting their work flow. One clinician said, “If you can figure out a way I can cut and paste the information into the EMR, I might use it.”
Adopting and implementing any new technology or resource is a change. Even when a hurdle is low, it still takes effort to clear it. Clearly there’s a need to help people correctly take and track their BP. But demonstrating how a tool can impact patient experience or outcomes doesn’t mean it will be snapped up and utilized. Health designers often created products that reduce readmissions, create operational efficiencies, improve outcomes — but still didn’t get much adoption.
Adoption doesn’t just happen when a tool makes sense or solves a problem — it’s a complicated emotional process.
A short success story
A patient worked with researchers to create a short, pre-appointment tool. She asked her own physician to try it and give her feedback. He was skeptical, but he agreed. After just one day, he found it greatly improved his conversations with patients. His experience created real excitement to continue to use it.
Health is also social for clinicians
They want meaningful conversations and relationships. And they want to know they’re making a difference in people’s lives — you know, the reason they went into medicine. So beyond the improved metrics and operational efficiencies people say they want, how do we scale this experiential learning to reach clinicians in the social/emotional heart of what matters to them?
Clinicians sharing their experiences can be helpful. Videos can help show how a tool or resource changes a real encounter and add emotional salience. We often see this when clinician partners observe a focus group or see video clips of real people talking about an experience — it’s fundamentally different than telling them about it. Making the abstract emotional can be an effective way to motivate adoption, especially since medical professionals entered the field to help others.
How can we measure clinicians’ experiences in ways that matter to them?
Data suggests clinician burnout often follows a feeling of disconnection from patients, maybe because of a hyperfocus on data or a lack of autonomy in how to approach diagnosis and treatment. Even though effective tools help accomplish key goals, they may contribute to clinicians feeling less control over their work and less connection to their patients. But when they feel confident patients know what to do and can have better conversations – it can profoundly improve their day-to-day experience.
We need to include clinician social and emotional needs as part of human centered design and measure it. We can’t assume making tools effortless and invisible is enough to motivate adoption. Ultimately, dashboards may largely go unused if they don’t help clinicians visualize the positive impact on their patients’ outcomes and experiences. Our challenge as designers is to dig deep to design tools that help them go home at night feeling like they made a difference at work.
In retrospect, the negative feedback about the BP tool might have come from a place of resentment. The EMR already dictates too much of clinical interactions. And while a BP tool may have added almost no time, it still may have chipped away at the clinician’s ability to personalize care. Would the BP tool have been more valuable if instead of laying out step-by-step training, it facilitated a better conversation?
How might we help clinicians recognize when a tool or approach will help them build trust, relationships, and support their mission to improve people’s lives? Let’s collaborate to better understand and measure how to elevate the human, relational, and emotional experiences of both patients and clinicians.
About Amy Bucher
Amy Bucher, Ph.D., is Vice President of Behavior Change Design at Mad*Pow. Amy received her Ph.D. in organizational psychology from the University of Michigan and is the author of Engaged: Designing for Behavior Change