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Embrace Project Report: Hospital Project for Ethnic Minority
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Embrace Project Report: Hospital Project for Ethnic Minority

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    Embrace Project Report: Hospital Project for Ethnic Minority Embrace Project Report: Hospital Project for Ethnic Minority Document Transcript

    • embrace comforting patient journeyJackson CHOI // MDes Interaction Design // 2011 1
    • Content First published 2011 01:: Introduction (c) 2011 Copyright 02:: Research and Analysis Designed by Jackson CHOI Chi Kit - Pok Oi Hospital - Ethnic Minority Group - What were being done Project Tutors - Patient Journey Analysis Prof. Xin Xiang Yang Michael LAI Tequila CHAN 03:: Project Insights All right reserved. No part of this report may be reprinted 04:: Project Statement or reproduced or utilized in any form or by any electronic, 05:: Interaction Model mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information 06:: Task of Design Items storage or retrieval system, without permission in writing from the authors. 07:: System Diagram 08:: Experience Strategy 09:: Designing the programme - Concept video - Proposed Patient Journey - Digital Device User Interface MDes - Graphic Design Items Interaction Design 10:: Conclusion School of Design 11:: Self Reflection 12:: References 13:: Appendix 14:: Special Thanks2 3
    • 01:: Introduction This was a collaboration project initiated by Pok Oi Hospital under the New Territories West Cluster of Hospital Authority of Hong Kong. The project aimed to seek for opportunities of improving the service of hospital through interaction design. The executive brief was wide opened, extends from the informatics of in patient records, to navigation system of hospital, from patient services of special clinics to medical experience of ethnic minority, and even to pressure management of medical caregivers. This was also my Capstone Project for the programme MDes Interaction Design by Hong Kong Polytechnic University. It demonstrated the knowledge and various skills of interaction design acquired in this programme. This report documented the project development of the project titled “Embrace - comforting Medical Experience for Ethnic Minority”, from initial research and analysis stage, to idea generation and concept execution. By understanding the problems and difficulties faced by the target group, insights were identified and relevant solutions were suggested accordingly. It was expected that this report could serve as a proposal for further development and execution for the benefit of improving the medical care services for Ethnic Minority Group.4 5
    • PROJECT SCHEDULE Research & Rationalization Concept Development Final Presentation to POH: P6 P6 Finalized design proposals Patient Journey refinement with project video, final Primary Research design items. Interaction Model Interview with doctors, nurses and management from A&ED Experience Strategies and SOPD. Scenario Development Show Time: P5 P5 Finalized design proposals Interview with social workers with project video, final Concept Refinement design items. and programme coordinators from local NGOs. System Diagrams Final Presentation Directional Research Synthesis & Feedback & P4 P4 Rehearsal: Evaluation Final patient journey, Final Problem Statement Translation concept of digital devices and objectives Evaluation and graphic items. Patient Journey Analysis workshop in POH Concept Presentation: Infection Workshop in P3 P3 Interaction Model, Task POH Analysis, Patient Journey Secondary Research Analysis, Key interface. Interview with Scenario confirmation Good practices of other health care institutions and emerging doctors, nurses and UI Design communication technologies. management from Production of graphic A&ED and SOPD. design items: Q&A Initial Concept: poster, graphic posters P2 Analysis if existing P2 Production of project Interaction Model, Task Shadowing and Analysis, Initial concept of patient observation in video Interaction Model. SOPD and A&ED Task Analysis identifying the Medical check event activities and routines Project Proposal: P1 by SSCEM P1 Research Report, problm statement, objectives. 0 1 2 3 4 5 6 7 8 9 10 11 Schedule (week)6 7
    • 02:: Research and Analysis POK OI HOSPITAL Pok Oi Hospital was established in 1919, and has been serving as an important hospital for the local Yuen Long community for 90 years. The design of the hospital adopts the “FINE” principle: Family-based, Information Technology Driven, Networking with Community and a Green & Healing Environment. The hospital closely monitors population growth and needs of local residents, continuously update her health care services, demonstrating her spirit of 20% “We Love We Care We Serve” ETHNIC MINORITY GROUP patient population In Pok Oi Hospital, Target Audiences of this project are Pakistani and Nepalese ladies who are living with her Ethnic Minority family and children. Usually they are non English and Cantonese speaker and are closely Groups occupy attached to their own community. This means that they can only acquire information from 20% of the patient the naive community and seldom have the chance to communicate with local citizens. population. Among them, a lot of the Pakistani and Their knowledge towards local medical system comes from either the words of mouth Nepalese housewives from family and friends, or from the activities organized by NGOs and the hospital. They cannot speak English spend most of their time on house works and love watching TV drama and movies. or Cantonese. Difficulties that Ethnic Minorities face in Hong Kong From a research done by local social service organization, Social Service Centre for Ethnic Minority SSCEM, language is one of the most important components in building up relationships, as Cantonese is the main spoken language in Hong Kong but due to the main language spoken at Pakistanis home is Urdu, not many of them are fluent in speak Cantonese. This also further relates to difficulties to access service provided and may lead to isolation as a result they stay with their own people as a group and hinder their integration. Extensive interviews, observation and survey had been conducted in the research process so as to collect opinion and views towards medical experience of EM patients in different perspectives: the medical care professionals from the hospital, social workers and programme coordinators from NGOs and EM patients in the real hospital environment.8 9
    • Interviews with practitioners focused on investigating daily routine of health care services provided by POH, what challenges were faced by the hospital and what were being done to improve it. Patients did not understand the local standard health care process which led to misunderstanding, misuse and even abuse of current medical system. Frontline care givers usually did not understand language such as Urdu and Hindi, that in many time made communication impossible. ” Interview with social workers from NGOs gathered information about the difficulties of patients in the channels of communication and how they can acquire useful medical care information. NGOs had done a lot facilitating smooth experience with collaboration with hospital, such as hospital visits and health care seminars. However language is still a big problem and barrier during actual patient journey. Observation and shadowing of EM patients are conducted in both Accident and Emergency Department (A&ED) and Special Out Patient Department (SOPD). Totally 12 patients were shadowed in their patient journey and interviewed afterward. Important incidents were observed, and useful views were collected. Basically they were satisfied with the overall medical experience, but communication barrier seemed to be a common concern of them all. Findings and quotes were listed below for quick references:“ (Top) Social worker and programme coordinators from a local NGO, SSCEM. (Middle) Health care Seminar organized by SSCEM in “For effectiveness, activities with interaction will be collaboration with better because there is direct response and effect United Christian Nethersole on their understanding. Even a talk in Urdu may Community Health not sound related to them. But for activities, they Service on topic Cervical Cancer. can associate to their health issue and daily life.” (Bottom) Health Check activity organized by SSCEM Patient’s emotion: Nervous, frustration, stress, for Pakistani and Nepalese ladies. uneasy, no patient. Sometimes this is caused by not understanding the system. Sometimes it is a general sense of discrimination derived from other occasions.10 11
    • “Interpreters are in charge of the conversation. If they are family member, they answer to the questions of doctors without asking the patient! They may think that they know the patient’s condition well enough. It is doubted if they will translate all conversation to the patient.”“ “Doctor may assume that EM patient couldn’t understand and then cut off some of the relevant information.” “Communication can raise the tolerance of patient.” “Someone who can speak URDU should be employed ” in hospital to do occasion translation.” (Top) Shadowing of EM patient, father accompanying “In hospital , is always waiting and waiting. I have his sick child in the triage station. brought newspaper to kill time.” (Middle) Shadowing and observing the EM patient, father “EM ladies love TV drama and movies. If you can accompanying his sick daughter in make video by Khalid Khan, your work will be very doctor consultation popular.” room. (Bottom) Evaluation focus group with medical care givers discussing “How can service providers comfort the patient if they the project concept cannot voice out their needs and feelings?” and design items. “Without interpreter, they cannot explain themselves fully, and have phobia, and prefer not go to the hospital.”12 13
    • DIFFICULTIES Ethnic minorities are facing various difficulties in terms of language, cultural, and emotional issues in medical service in POH. Language Filipino kagipitan Pakistani ‫یماگنہ‬ Indonesian darurat Hong Kong emergency / 急症 Cultural Names – different system, names are difficult to pronounce Food – some foods are forbidden for certain religions, eg. Alcohol Religions – perception & belief, and the ways seeing diseases Festivals and special dates “How can medical Customs – nudity is strictly prohibited caregivers comfort the Emotional Being ignored in the process patient if they cannot Sense of Discrimination by lacking the ability to communicate in local language Stressed and lost - not knowing what is happening in the journey and what voice out their needs and others are talking about their own health feelings?”14 15
    • SOME QUESTIONS WHAT WERE BEING DONE Questions to answer in this project may be: The hospital COME Project, Care Optimization for Minor Ethnicity How can a service provider realize the difficulties of patient? // Dialogue Book And how EM patient can get the quality of service like other patients? // Standard Response Cue Card How to let people voice out their concerns? // Translation Guidelines // Identification bracelet to include basic patient information for easy Communication problems may lead to emotional problem. But good identification, and prevent misidentification communication raises the tolerance of patients. Professional interpreters can be reserved and arranged in the expenses of the hospital Community Health Centre // Ethnic Minority Corner in with exhibition and help desk “Core information is The NGOs // Orientation programme: organized guided hospital visits and support group meetings important for sickness; // Health check activities with first hand interaction // Common and special topic seminars // Escort and interpretation services Not-so-core information may // Information dissemination influence the experience.” Ethnic Minority Group // Get information through word of mouth of Friends and Family // See doctor together with English / Cantonese speaking family members and friends // Get assistance from NGO social workers and volunteers Things have been done for the EM patients, but why they did not come through? For example the dialogue book with different languages are printed and placed in A&E Department’s consultation room. But they are not introduced to the frontline practitioners. Many of them does not aware the existence of the documents and even they know the dialogue books, they are not being used.16 17
    • Conflicts between hospital and patient Hospital Said Patient Said // They don’t show up in appointed date // Why I need to wait for 4 hours? // They don’t understand medical instructions // I get Panadol for all illnesses // They forget to bring medical reports // I need to bring along my kids to the hospital // They may use identity of someone else just to or else no one is taking care of them save money // Doctors are exaggerating my illness // Difficult to use telephone reservation system // I am lost in hospital “This is an integrated problem of medical service that requires the facilitation ”I am not familiar with medical terms, for minority group to blend in to the and always get into the middle of the mainstream medical system, and how fight about diagnosis and treatment can the system cater for special needs between doctor and patient!” of the group.”18 19
    • DESIGN CHALLENGES // To breakthrough language barrier Notes to consider Waste Analysis // To communicate effective medical Identifying waste as a part of the analysis of the current state map is important to help you assess which steps add value to the information and instruction patient process, and where waste occurs. On the current state map identify where waste occurs, what type of waste it is and consider waste related to the longest stages of the process. There // To educate EM patients coping with local are several types of waste that exist in patient journeys. medical system Value and Non Value Added Activity By identifying those activities that do not add value to the patient or have no clinical value, and by seeking to reduce or eliminate them from the patient journey, it is possible to provide a service that is more responsive to the patient and reduces waits and delays. Value adding activities are those activities that in the eyes of the patient make the service they are receiving valuable. e.g. the taking of an x-ray to enable diagnosis, closure of a wound in A&E.20 21
    • PATIENT JOURNEY ANALYSIS It is important to understand how patients proceed through the care delivery system. The best way to achieve this is through process mapping. Process maps are an effective way to identify constraints and bottlenecks, and unnecessary process steps. Process mapping is a useful diagnostic tool for determining where problems Registration Triage Doctor Follow-up Lab Tests Shroff Pharmacy lie. Understanding the process from the Consultation instruction Office patient perspective is essential if patient focussed service improvements are to be Communicate made. through provide express exchange of listen to listen to provide listen to interpreter information information information instruction instruction information instruction 1. Source of Medical Information - Incomplete & either from words of mouth of family ineffective and friends or for activities and seminars interpretation organized by NGOs. However EM patients may not get update information from local citizens, and they are not keen on reading printed materials. Professional Husband or Children Interpreter Friends 2. Accompanies during visit to hospital - always accompanied by family members or friends who can speak English and/or Cantonese. They will act as interpreters for the EM ladies. Source of They are very much relied on this indirect Medical communication which sometime may be Information Support group Word of Mouth inaccurate and misunderstanding. Seminars Referral Workshops Recommandation NGO & Hospital Printed Materials Family & Friends 3. Professional Interpreters - If time allows such as patients of Special Out EM Patient Patient Department, interpretation will be arranged in the expenses of the hospital. But this may not be available in A&ED.22 23
    • Scenario 01: TAMANG, Parbati, bring her little son, to Special Out Patient Department SOPD ...... ....?? 35min TAMANG, Parbati accompanies by her In Nurse Station, the little son 35 minutes later, call to doctor During consultation, the son don’t little son, age of 9. confirm identity in English. consultation understand medical terms, and cannot translate ....?? What is the problem? This patient story illustrates two main problems in a typical patient journey. It is not uncommon for EM ladies to bring along with their little children to the hospital as their interpreters. However although the small children may be growing up and studying in local school, and they can speak English and even Cantonese, they are usually too small to understand medical conditions and not to mention those Holter test (ECG) instruction in Nurse explain the instruction in Little son goes to Pharmacy for complicated medical terms. This may leads to inaccurate Chinese English to the boy. Little son goes to medication translation and severe danger. Pharmacy for medication Also medical instruction is always in Chinese and sometimes in English. There is no native language instruction materials. It is very rare to have information and instructions translated in Urdu or Hindi. It would be very difficult for EM patients to remember and review those important instructions and precautions.24 25
    • Scenario 02: GURUNG, Manju, bring her husband to Accident & Emergency Department A&ED ...., ... ...., ... ... ,.... ? . ....., . Ms. GoRonge ? . ....., . . ,..... . ?? 1hr GURUNG, Manju accompanies by her In Triage Station, the husband is 1 hour later, call to doctor Husband talking to doctor as if he is husband to the registration.. doing the talking in English. consultation the patient, without asking his wife’s feedback. ? What is the problem? This patient story illustrates the fact that the adult family member to dominate the whole conversation with the doctor and nurse without asking feedbacks from the patient herself as if they knows everything about her health condition. The patient has no clue about what they are talking about her, and the frustration and confusion will Nurse treatment with instruction in Husband goes to Shroff Office and Pharmacy accumulate. English. for medication Also there is a tendency for the doctors and nurses to talk solely to the interpreter instead of the patient. There is case that when the nurse knows one family member can speak Cantonese, she will talk fully in Cantonese about the medical instruction of a lab test disregard the fact that the language level is actually quite low.26 27
    • Stress Points Different levels of communication are required during the patient journey, from quantitative to qualitative, from pronunciation of their names, to duration and dates, to expression of sickness and evaluation of pain. Stress and anxiety accumulate when the patients cannot express themselves, and could not comprehend the diagnosis about their own health, cannot read instructions, Registration Triage Doctor Follow-up Lab Tests Shroff Pharmacy Consultation instruction / Office confuse about what practitioners are treatment discussing. Patient will also feel frustrated when they Nature of provide express exchange of listen to listen to provide listen to information information information instruction instruction information instruction are not sure about what is going to happen Communication in the next step of patient journey. Symptoms Intensity Evaluation Emotion Qualitative Symptoms Emotion Expression Expression Intrusive treatment Quantitative Identity Duration Frequency Identity Identity Payment Identity certification Position Duration Procedures Procedures Schedule BP readings Family health Duration Actions Quantity history Cautions Schedule28 29
    • Wasted Time In current patient journey, nearly 2/3 of the time spent in hospital is pure waiting. Patients have to wait for preliminary examination in triage station, and then wait for doctor consultation. If they need to do lab test before diagnosis, they have to queue up for lab test and wait the result. At last they need to wait for getting their medication. The waiting could last for a few hours, in Registration Triage Doctor Follow-up Lab Tests Shroff Pharmacy extreme case a day. In between productive Consultation instruction / Office activities are nonproductive waiting hours. treatment Patients has nothing to do for their health. Steps Time Spent30 31
    • “How can we help them to overcome ? this communication barrier?” “What if both patients and caregivers could easily express themselves and understand each other?“ “How can patients make better use of this wasted time? ” “What if patients could express their concerns and acquire useful information while waiting?”32 33
    • 03:: Project Insights Insights / Quotes 1. Build confidence for EM patients and let them express. “Without interpreter, they cannot explain themselves fully, have phobia, and prefer not go to the hospital.”  ~ Ms. Samaira Rehmat, SSCEM 2. Let the patient take control of the journey. “Doctor and nurse tend to talk to interpreters instead of to EM patient” ~ from observation in shadowing. 3. Prevent inaccurate translation. “I don’t really understand those difficult medical terms. Sometimes I need to call my daddy to do further interpretation.” ~ A little Pakistani boy 4. Make use of the waiting time. “In hospital , is always waiting, waiting. I have brought newspaper to kill time.”   ~ GURUNG, Sujan 5. To create consistent contact point for adherence. “One patient to many people in various steps of the journey”34 35
    • 04:: Project Statement “Let em patients This project aims to provide Ethnic Minority patients with comforting Medical Experience. It empowers them with effective tools to communicate their own health condition without relying on interpreters. communicate embrace is an innovative communication system consists of digital devices, keyword Q&A aids and graphic posters that allow users to communicate their own health condition without relying on interpreters. The objectives are to overcome language barrier, build confidence for EM patients to express and take control of the journey, to their own health communicate accurate medical information and instruction, to make use of the waiting time, and to create consistent contact point for adherence. condition without relying on e = ethnic interpreters.” m = minority ii =36 37
    • 05:: Interaction Model patient journey Registration Triage Doctor Treatment & Lab Tests Shroff Office Pharmacy Consultation instruction embrace system provide identify express understand execute provide understand document medical health instruction instruction information instruction Interactive communication condition problem tools, voice translation, info videos and graphic keyword Q&A posters watch video and Interactive Information while waiting external source of medical information support group word of mouth seminars & workshops friends’ referral printed materials recommendation NGO & Hospital Family & Friends EM Patient38 39
    • 06:: Task of Design Items Registration Triage Doctor Treatment & Lab Tests Shroff Office Pharmacy Consultation instruction Confirm CMS Database Doctor Device Ask Symptoms Symptoms Give Consultation Data instruction Confirm Print-out Print-out Treatment Instruction Instruction Voice Voice Voice Translation Translation Translation Patient Device Input symptoms Family Health History Return Device and health Allergy id descriptions FAQ Questions Alert & Notification (queue time) Useful Information Q&A Poster Keywords Poster (Point & Answer, Point and Ask) Lobby Poster Show compassion of hospital. Introduction to Embrace system40 41
    • 07:: System Diagram 01: embrace patient device user interface design is written with patients’ native language. The interface uses metaphor of a patient journey that guide users along the way and input necessary health information. id 02: embrace doctor device user interface. Input of patient is translated automatically into English for the care-givers. Text speech and voice interpretation function is also available for in-depth diagnosis. Patient Device Doctor Device 03: Q&A poster consists of keywords of lab-test, allergy, pain scale, numbers, duration and body figure diagrams for basic exchange of health information. 04: Graphic posters present quotes from patients about their concerns and difficulties in their medical experience. This shows the compassion of a caring medical service provider. Q&A Poster Graphic Posters42 43
    • 08:: Experience Strategy embrace system aims to create a comforting medical experience for ethnic minority patients. From my project analysis, the keys are to create a platform and interface so that all users can communicate with their own languages but yet the information can be transferred and translated. Also patients can make go use of their waiting time for preparing themselves for consultation and treatments. } { Experience Strategies Design Objectives 1. I want to express my sickness 1. Graphic and digital Q&A tools 2. Guide me, don’t test me 2. Short learning curve & easy to use 3. I have the control 3. Simple task and information flow 4. Help me learn the system 4. Embed with useful information44 45
    • 09:: Designing the System46 47
    • Proposed patient journey ... ,.... . ,..... . wait wait embrace id id id GURUNG, Manju goes to hospital by While waiting, Manju explores In Triage Station, nurse checks input of Manju. While waiting for the consultation, Manju herself. In Registration, She receives the device and starts to input and they try to communicate with the help of follows the guide of device and inputs more an embrace device as patient ID. info. keywords on Q&A poster. Voice translation health info and check useful info while function is available in needs. waiting. ...., .... ...., .... 1hr . ....., .....,.... ,. ... . . ....., .....,.... ,. ... . id id 1 hour later, id device notifies her to In Consultation Room, input of Manju shows up In Nurse Station, nurse explains instruction Id device is returned after use. doctor consultation on doctor’s device facilitating further consultation. to patient with help of embrace tools. Final Manju answers doctors questions with Q&A poster. instruction is printed. Id device is returned. Voice translation is available on device in needs.48 49
    • Concept Video Storyboard In Pok Oi Hospital, Ethnic Minority Groups occupy 20% of Among them, a lot of the Pakistani and Nepalese Their knowledge towards local medical system comes the patient population. housewives cannot speak English or Cantonese. from either the words of mouth from family and friends, or from the activities organized by NGOs and the hospital. So what are the problems? Every time EM patients come to hospital, they need to However adult family members always dominate the be accompanied by friends, family and even their small conversation with health care professionals without children as their interpreters. actually asking for feedback from the patients. (Isolation)50 51
    • Even worse, due to their lack of medical knowledge, small Some patients will choose not going to the hospital if there How can we help them to overcome this communication Different levels of communication are required during the children can hardly translate difficult medical terms and is no accompany available. This could seriously jeopardize barrier? patient journey, from quantitative to qualitative, medical instruction for their parents. (Inaccuracy) the health of patient. from pronunciation of their names, to duration and dates, Stress and anxiety accumulate when the patients cannot In current patient journey, nearly 2/3 of the time spent in How can patients make better use of this wasted time? to expression of sickness and evaluation of pain. express themselves, and could not comprehend the hospital is pure waiting. diagnosis about their own health. What if patients could express their concerns and acquire What if both patients and caregivers could easily express Embrace is an innovative system that will enhance the It empowers them with effective tools communicating their useful information while waiting? themselves and understand each other? medical experiences of Ethnic Minority. own health condition, without relying on interpreters.52 53
    • Embrace consists of networked portable devices used by Patients input their health conditions and questions in Q&A posters have keywords for effective communication suggested lab tests and numeric answers. the patients and the doctors. their native language, and the input will be displayed in such as pain scale, allergy, English in the doctors’ device. Meet Satta, a Pakistani lady, goes to A&E Department for After registration, Satta gets her own portable embrace The device invites her to input her symptoms before the After a while, the device calls her to go to Triage station for the first time device showing her patient ticket number. triage calls. She expresses her fever and identifies related preliminary check up. symptoms on the list. After triage, while waiting in the lobby, she checks By then the device acquires for her health and allergy She also highlights questions she wants to ask the doctor. approximately how long she has to wait for doctor history. As the questions are in her native language, she consultation. feels confident to express herself.54 55
    • Being new to the hospital, Satta clicks into the information and various medical services provided by the hospital in In the waiting lobby, there are posters with quotes of section and learns about process of the patient journey promotion videos. She feels secured and is more prepared patient concerns in Urdu. She feels that the hospital has for coming steps. great compassion for her needs and difficulties. At this time, the device calls her to see the doctor. In consultation room, her symptoms and health history are The doctor reads her basic inputs. . Based on Satta’s condition, related questions have been already shown on doctor’s device. shortlisted Speech button is available for asking those questions in For in-depth diagnosis, voice translation in the device When the doctor asks about her headache, Satta points to The doctor then indicates suggested lab test with Q&A Urdu when needed. comes in handy. the pain scale on the Q&A poster to express the severity poster. and tell when it began.56 57
    • In the process, the doctor uses confirm buttons to confirm Then, Satta moves to nurse station, where the nurse Similar functions help Satta going through the rest of her from lab test to Pharmacy. all useful inputs to the CMS for the patient record. prints out lab-test instructions in Urdu, and explains to her journey, clearly. With embrace, Satta has better control over her patient journey, she could express her health conditions effectively, learn about important medical instructions, and she is emotionally more engaged.58 59
    • DIGITAL DEVICE USER INTERFACE Patient Digital Device information triage doctor treatment lab test shroff pharmacy Digital devices use patient journey as the metaphor for user interface design. The interface is named after information, triage, consultation, treatment, lab test, shroff and pharmacy. Interface will be in their native language. The flow of information map to the actual patient journey which help guiding the input of health information respectively. Inputs of patient will upload onto the system, and they will be displayed on doctor’s device in English. Text speech function and voice translation will be available for in-depth conversation. Doctor Digital Device patient id symptoms instruction questions translation60 61
    • GRAPHIC DESIGN ITEMS embrace lab test Symptoms Q&A poster blood test rashes radiology itching Q&A Poster gastric endoscopy diarrhoea The poster is designed to assist simple Q&A conversation between patient and caregivers. The poster is visually divided into four areas: Allergy, suggested lab tests, glucrose test Sneezing pain scale and numeric answers. The poster is bilingual with Urdu and English. Obviously Urdu words are in larger size for the use of EM patients when words in English is smaller holter test ECG running nose for frequent users such as doctors and nurses. abdominal pain Users can use it for questions and answers by simply pointing to the key words and numbers. Content can be updated easily through editing and reprinting. Posters for different departments may be different depending on the need and requirement. allergic to The poster will be placed in consultation rooms, triage station and nurse stations where peanuts conversation is conducted. egg pollen latex 0 1 2 3 4 5 6 7 8 9 10 / / / / / year / month / day / hours / minutes / / / / / / / Monday / Tuesday / Wednesday / Thursday / Friday / Saturaday / Sunday 0 1 2 3 4 5 6 7 8 9 10 11 1262 63
    • Promotional Poster The posters use quotes for EM patients as the theme message. This is a gesture showing the compassion of the hospital for Ethnic Minority Group, and say we understand your feeling, your difficulties and requirements. The poster will be placed in lobby areas, waiting rooms and NGO service centres. They act as promotional items promoting the newly established embrace system. It will also be used as a means to call for contribution and ideas64 65
    • ROLLOUT SCHEDULE The system is suggested to be rollout in four phases. Phase 1 will be an introductory stage promoting the concept of mutual 1 phase 1 // Jan 2012 3 phase 3 // Jan 2013 assistance in medical care activities. Graphic posters will be posted in lobby areas demonstrating the compassion of hospital for Ethnic Minority group, Implement Q&A posters for Test run of digital devices for and acting as a bridge to invite target users to contribute to the establishment A&E Department and SOPD patient and doctors of the new initiative, such as codesign workshops and common questions in patient journey. Roll out graphic posters in Usability tests with Q&A posters will be rollout in selected departments. They can directly help hospital and NGOs for promotion stakeholders and evaluation users to accomplish simple task of expressing their own health condition. and invitation for attachment workshops Phase 2 will present information videos showcasing health care services of the hospital which serve to increase the transparency of patient journey. This is proved to be important in building up the trust and confident of users. Extensive brainstorming workshops and codesign workshop will be conducted 2 phase 2 // May 2012 4 phase 4 // May 2013 with stakeholders including patients, frontline practitioners and management. This is critical for creating a relevant system that can actually improve the Information videos showcase Rollout Digital system for all users. in hospital and on online platform communication tools for patient and doctor in connection to CMS Phase 3 will rollout beta digital devices in selected departments for test run. Braninstorming Feedback will be collected for revision and improvement. The information flow Workshops for consolidating and accuracy of communication will be monitored and evaluated carefully. medical information from Constant feedback from Usability test will be done in real location. stakeholders skateholder Phase 4 will have all items implemented for a holistic patient journey. Digital devices will play an important role in the journey. Information will be linked to the CMS for official patient record. Constant feedback will be collect and this will be a looping process for best outcome .66 67
    • 10:: Conclusion The project solutions were designed based on thorough research and study of current patient journey, and how stakeholders interact with each other in the process. Patients’ difficulties and requirements were observed and analysis in this two months project. With the contribution of frontline medical care professional and management, opportunities are opened in terms of practicality in real hospital context. Also the inputs from social workers and programme coordinators from NGOs help understanding the characteristic and behaviour of the target group. The project addressed two major opportunities enhancing the medical experience of Ethnic Minority group: 1. Help them to overcome the communication barrier 2. Patients make better use of the waiting time The project focused on providing solutions for the above design opportunities. No fictional technology was employed. User capability was taken into consideration, and the solutions ranged from low-tech graphic posters to mid-tech digital input devices, no more complicated than an ordinary ATM machine. The key features took advantage of back-end translation and voice translation that helped seamless communication. Users did not have to worry about the technology but just enjoy the benefits from it. I have confident that the proposed system can answer to the project statement: ”Providing Ethnic Minority patients with comforting Medical Experience. It empowers them with effective tools to communicate their own health condition without relying on interpreters.”68 69
    • 11:: Self Reflection 12:: References “ This was a wonderful design experience. All stakeholders were contributing all they have to the success of the project. The hospital colleagues tried their best to give green lights to my numerous request of observation and shadowing of EM patients, and also gave their time for interviews, discussion and evaluation workshops! Without their generous support, the project could not be as real and solid as it is now. Difficulties that Ethnic Minorities face in Hong Kong, SSCEM http://www.sscem.org/napalese.php?page=page_8 Translation guidelines http://ntwc.home/view.asp?pcat=CIR-NTWC-ADMINIn NTWC Intranet >Service Divisions > Administration > Policies / Manuals / Circulars & Guidelines Colleagues from NGOs spent many of their time in organizing activities wth EM Standard Response Cue Card (HAHO), http//hohbfsmc2/bssd/cuecard.html people, explaining their characteristics and introducing existing works done catering the specific needs of them. Information sheets (HAHO), Multilingual Phrase book for Emergencies (HKSAR) The project began with a bigger scope addressing both language issues as Song L, Chui WC, Lau CP, Cheung BM. , A 3-year study of medication well as cultural concerns of EM patient. As the project developed, the focus incidents in an acute general hospital. Department of Medicine, University of was narrowed down to the actual patient journey in the hospital. This turned Hong Kong. the project from a solve-all-problems approach to a project solving a specific http://www.ncbi.nlm.nih.gov/pubmed/18315775 design problem, from a social-based project to an interaction design based project. The scope is more manageable for a two-month project, from research Understanding the Patient Journey - Process Mapping to design proposal. Also this addressed to the major issues that really affected http://www.scotland.gov.uk/Resource/Doc/141079/0036023.pdf the medical experience of Ethnic Minority group. Effects of a mobile phone short message service on antiretroviral treatment After all the hard work done for this project, I feel satisfied with the final adherence in Kenya (WelTel Kenya1): a randomised trial. ” outcome and design solutions. It is the best project I have done in this Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya. programme, and thanks for the guidance my project supervisors. http://www.ncbi.nlm.nih.gov/pubmed/21071074 Inspiring scientists to be more patient-sensitive http://www.ideo.com/work/laboratory-posters/ ~ Jackson CHOI Kobo eReader Touch Edition review -- Engadget http://www.engadget.com/2011/06/13/kobo-ereader-touch-edition-review/ Talking The Talk: Verbally Lets The Speech Disabled Communicate Using The iPad (For Free) http://techcrunch.com/ Fuji Xerox Exhibits Color Electronic Paper w/ Optical Writing System http://techon.nikkeibp.co.jp/english/NEWS_EN/20071206/143736/70 71
    • 13:: Appendix School of Design, MDES in Interaction Design Master student: Mr. Choi Chi Kit, Jackson Medical Experience of Ethnic Minority Group Aims Master programme of School of Design on Hong Kong Polytechnic University is working collaboratively with Pok Oi Hospital on an interaction design project about improving medical experience of ethnic minority group. The project requires research and analysis towards existing medical experience in target point of School of Design, MDES in Interaction Design view in order to discover opportunities of improvement. Target group of research is Nepalese and Pakistani lady who are living with their family and children. The Medical Experience of Ethnic Minority Group interview will focus on the medical experiences of target group in areas such as needs, difficulties, A collaboration project of Hong Kong Polytechnic University and Pok Oi Hospital aims at expectations and performances. improving medical experience of ethnic minority group. Questionnaire Your name: ___________________________________ Patient Journey Research 1. How many times have you use this service in Pok Oi hospital? (This or last visit) We want your health care journey to be smooth, effective, error free, well communicated and respectful of your choices. We would like to better understand your perspective on our 2. How long does it take to go through the whole patient journey? From To health services. The interview will focus on the medical experiences in areas such as needs, difficulties, expectations and performances. 3 What procedures have 4. How will you value your medical experience? you go through?  Negative Positive We will not ask or record detailed information about your medical treatment or results – Booking rather we want to know about how the health system works and communicates Registration information to you and how you feel about your experience. Participation in this project is Triage entirely your choice. Queue Doctor Consultation About Patient Privacy Lab test All information you give as part of the project will be treated in the strictest. Any information Wait for report that might identify you will not be disclosed without your consent. Steps will be taken to Diagnosis honor your privacy and autonomy. The data and its analysis will be reported to participants Confirm treatment of this collaboration project and in a design report at completion of the Project. Pharmacy Medical Instruction Payment Discharge Contact: Others Student Name: Choi Chi Kit, Jackson Project Supervisor: Prof. Xin Xiang Yang Student Number: 10612896g Mobile: 6573 0189 Mobile: 9684 9374 Email: sdxin@polyu.edu.hk Email: Jackson.choi@polyu.edu.hk72 73
    • 14:: Special Thanks Pok Oi Hospital Support Service Centre for Ethnic Dr. LEE Sun Woon, Hospital Chief Executive, Minorities (SSCEM) POH Ms. Eden Lam, Registered social worker Ms. Louisa LEUNG, Manager Q&S Division Ms. Ruth KONG, Registered social worker Ms. Yedda Li, Q&SD Ms. Samaira Rehmat, Programme Coordinator Community Health Centre POH Ms. Anam ISHTIAQ, Programme Coordinator Rita Kong Molly CHAN Christian Action Ms. Nargis Shafqat, Community Worker Special Out Patient Department POH Ms. Janice Chan Hei Man, Registered Social Worker Ms. Kitty Woo Chun Ching, Department Operation Manager Ms. Ng Sau yee Hong Kong Christian Service The Hong Kong Jockey Club Community Project Grant: Integrated Service Centre Accident & Emergency Department POH for Local South Asians (ISSA) Dr. ONG Kim-lian, Consultant Ms. LIMBU Sita, Programme Worker Dr. Lau Chu Leung, Assistant Consultant Ms. Phoebe Wong, Project Leader Mr. Wong King Pong, Manager HKSKH Lady Maclehose Centre Quality & Risk Management Division Multi-lingual Interpretation Service Ms. Ho Kim Kum, Hospital Manager Ms. Mona Mishra, Interpreter74 75
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