Moments of Mediation

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Background :

This is the output of 10+ deep interviews done by me and Neelam Shetye on how/where might we disrupt healthcare. It's a part of a larger framework on disrupting healthcare consisting of 4 major conceptual "shifts" .

One of key shifts is that we think of a healthcare system as a living ecosystem in dynamic balance. The second shift is that disruption requires specific grammar that makes the problem discussable.

Here we introduce two new grammar elements: Moment of Mediation and Changing the Script. Both are currently in the process of being trademarked.

This document documents 13 separate journeys the patient or caregivers took and 60 different "moments of mediation" where they felt helpless or powerless.

Each moment can in principle become an intervention in itself, when coupled with a (service) design driven approach.

We're currently testing this approach with entrepreneurs.

--

Please reach out to rana.chakrabarti@sap.com or neelam.shetye@sap.com for more information.

Rana

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Moments of Mediation

  1. 1. patient experience MOMENTS OF MEDIATION
  2. 2. moment of mediation™ | ˈmōmənt of ˌmēdēˈā sh ən | noun The moment of unmediated interaction between the user and “the system”, which leaves the user feeling drained and or powerless. e.g. The moment when the caregiver has to explain the entire medical history of the patient from memory or via a bundle of documents to the doctor from the first incident to the current incident, including drugs given, doctors visited, procedures done, side effects if any, leaving the caregiver stressed and exhausted worrying if she has left any critical detail out. e.g. The moment when the caregiver wants to create a full picture of the patient to the brusque junior doctor or nursing staff in order to evoke empathy and better but finds herself unable to re-create it leading either to request, pleading or an escalation. e.g. The moment when the patient and the caregiver are distressed by the news given to them by the doctor and without having an option to instantly get a second opinion, or counseling to work through the distressing news, succumb to the stress.
  3. 3. change the script™ | ch ānj the skript | verb The act of envisioning the future conversation with technology mediation, empowering the end-user and changing the outcome in her favor e.g. The caregiver looks up the app which gives the entire case history of her patient to the doctor, who checks the details, call the previous doctors for confirmations and hands it back to the caregiver, satisfied. e.g. The caregiver shows the irate doctor or nursing staff a photo log of the best moments in the patients life, filled with vitality, evoking empathy when they see the current person who is a shadow of their former self. e.g. The family looks up the most highly rated second opinion, calls him, or is guided to the counselor who helps them understand the consequences of the choices before them and helps them cope.
  4. 4. the unexpected HOME HOSPITAL Symptom Event Emergency Care Transit
  5. 5. I am at a classmate’s place in a new city. My stomach starts hurting, and I am in a lot of pain. But I don’t know him or this city too well. Who do I talk to? “ ” 1
  6. 6. My friend had a splitting headache and fell unconscious. I need to decide which hospital to go to. “ ” 2
  7. 7. My grandma has had a cardiac arrest. My father is not here. Which hospital do I take her to? “ ” 3
  8. 8. My nani just had a heart attack. I have to pack for her. But I don’t know for how long and what is needed. What should I pack? “ ” 4
  9. 9. My nani just had a heart attack. I am busy arranging for her hospital trip and the ambulance driver calls up asking for directions to the house. Why can’t they take care of these things? “ ” 5
  10. 10. My friend has suddenly gone unconscious. We take him to the nearest hospital. They say they cannot treat him, and ask us to take him to another hospital. Why can’t they just take over from here? “ ” 6
  11. 11. I go in for a minor accident, expecting it to be a small thing; but get told that I need an emergency surgery. How do I get it all arranged? “ ” 7
  12. 12. at the doctor’s CLINIC / HOSPITAL Waiting Treatment Screening Diagnosis
  13. 13. My wife had a fall. We went to the hospital and they asked us to get an X-ray. We are waiting for a really long time, but are not getting called. What’s wrong? Can’t they see she is in pain? “ ” 8
  14. 14. I am sitting with the doctor; he has only a few minutes. But I have so many silly questions, and I don’t want to impose. How can I ask my questions? “ ” 9
  15. 15. I have carefully observed my symptoms and read up about them. But the doctor is not paying any attention to what I am saying. Why can’t she just hear me out? “ ” 10
  16. 16. My family doctor knows me since childhood, and always treats me accordingly. Why can’t other doctors do the same? “ ” 11
  17. 17. The doctor is careless while handling the tongue depressor, and hurts my 7-month-old daughter. Why can’t she be a little more gentle? “ ” 12
  18. 18. I went in battling a severe asthma attack. The doctor was very brusque, and made me walk for 5 minutes to the treatment room. Didn’t I deserve a little sympathy? “ ” 13
  19. 19. HOSPITAL the big D Diagnosis HOME Self inform Understand Decide
  20. 20. The doctor just recommended that our 20-year-old daughter get a lump in her breast removed. I am afraid how it will affect her marriage prospects. Who do I talk to to know that it will turn out fine? “ ” 14
  21. 21. The doctor just told us that our 8-year-old daughter needs an appendix surgery. We really don’t want her to go through it. Is there any chance he is wrong? “ ” 15
  22. 22. I am scheduled for an eye surgery. I look up details online and scare myself completely. How do I feel reassured? “ ” 16
  23. 23. I have read up a lot about my condition on the Internet – both success and horror stories. Why can’t someone make sense of it all for me? “ ” 17
  24. 24. I have been having 105 fever for 4 months. A lot of GPs have given me a lot of medicines. But nothing has worked. What is wrong with me? “ ” 18
  25. 25. going under the knife HOSPITAL Surgery Procedure Preparation
  26. 26. I am in for an elbow surgery. The nurse asks me to get my entire body shaved and fully undress for the surgery, as part of the standard operating procedure. I don’t think it is needed. How do I double check? “ ” 19
  27. 27. I was put through the painful and embarrassing rituals of surgery. I was expected to be as passive as possible. How do I have a voice through it all? “ ” 20
  28. 28. I have checked into hospital. I have been rushed to the OT table, and asked to undress in the presence of a man. How do I not feel ashamed? Helpless? “ ” 21
  29. 29. They rushed me into the operation theater. I just got a hurried glimpse of my mother. Why can’t I take a few minutes to be with them before I enter? “ ” 22
  30. 30. My nani is undergoing surgery for 4 hours. I have no clue what is happening with her. How do I know that she is fine? “ ” 23
  31. 31. Tense & Intense(ive) HOSPITAL The ICU Caregivers outside ICU
  32. 32. My mother was in the ICU with liver cirrhosis. Right till the end, the hospital kept saying that she will be fine. We never really knew how serious her condition was. Why couldn’t they just tell us what was happening with her? “ ” 24
  33. 33. My mother was in the ICU for 6 days before she passed away. All I got was the mandatory, 2 minute robotic update by the doctor. Why can’t they just talk to us? “ ” 25
  34. 34. The doctor came back and told me ‘your mum is on the ventilator’. I didn’t realize he meant she is not going to be back. Why can’t someone tell me what it means? “ ” 26
  35. 35. I am in the ICU after surgery. My doctor has asked me to be back in the room by 2 pm. But the ICU nurse refuses to let me go. How do I get out of here? “ ” 27
  36. 36. My nani is in the ICU. She tells me that she is not being taken care of properly. The nurse says she is fine. How do I ensure she feels cared for like at home? “ ” 28
  37. 37. I wanted to feed my mum-in-law in the ICU myself. The nurse refused. She passed away soon after. I really really regret I couldn’t. “ ” 29
  38. 38. My mother was in the ICU. I asked the hospital staff if I could go home for a shower and change. They told me to go…and I missed her by 10 minutes. I wish I didn’t have to leave… “ ” 30
  39. 39. My father is 71 years old, and is attending to his wife outside the ICU. He is required to be there 24x7, but has no place to rest and sleep. Why doesn’t anyone think about the caregiver? “ ” 31
  40. 40. panic attack HOSPITAL Scary Moments
  41. 41. It is 5 in the morning. My mum-in-law has had a cardiac arrest. The hospital says I need to get blood. I am alone, its dark and I am really scared to step out. Who can I reach out to? “ ” 32
  42. 42. My mother is in a lot of pain. Her doctor is not here until morning, and the duty doctor doesn’t know much about her condition. Who should I turn to for help? “ ” 33
  43. 43. to do or not to do… HOSPITAL Moments of Uncertainty
  44. 44. The hospital just told me that they will need blood, but not right now. They will inform me when. What am I supposed to do? “ ” 34
  45. 45. I am hooked to the IV. The doctor asks me to report if I get a rash. I can see a rash developing, but the nurse says it is nothing. How do I raise the alarm safely? “ ” 35
  46. 46. My wife developed an allergic reaction to anesthesia and went into coma. She is better now, and I really want to get her operated in another hospital. But the doctors here are convincing me to stay. Why can’t someone help me decide if I should stay or go? “ ” 36
  47. 47. After 2 days of inducing labor, they told me ‘we will operate on her’. They put me in a spot where I had no choice. Why couldn’t they tell me the full story earlier, so that I could take a decision? “ ” 37
  48. 48. the patient routine HOSPITAL Inside the hospital room
  49. 49. I am in for a stomach infection and have to spend about 10-12 days here at the hospital. How do I pass my time in here ? “ ” 38
  50. 50. The doctor comes in everyday, and takes an inventory of my bodily functions – how I sleep, eat, poo… Why can’t someone take an inventory of my interests and get to know me? “ ” 39
  51. 51. Every time the nurses change shifts, they mess up my medication dosage. Why can’t they just get it right? “ ” 40
  52. 52. The nurses keep coming in and doing a lot of tests. But they don’t tell me about the test results unless I ask them multiple times. Why can’t they just keep me informed? “ ” 41
  53. 53. Every time I ask the nurses about my test results or correct their mistakes, they feel I am intruding and get defensive. How do I get proper care and information? “ ” 42
  54. 54. 2000 miles away HOSPITAL Patients & Caregivers away from home
  55. 55. I am in a hospital far away from home, with my aunt attending to me. I really want to be cared for, but I don’t want to impose. Who can I be a child with? “ ” 43
  56. 56. Our son is in the ICU. The doctors say he is brain dead. We are far away from home with no family here. We don’t even understand the language. How do we get help? “ ” 44
  57. 57. Our son just passed away in the ICU. We don’t know this city and have no family here. We don’t even understand the language. How do we make arrangements? “ ” 45
  58. 58. losing the battle HOSPITAL Death at hospital
  59. 59. The doctor curtly told us that it is better we don’t see our mother in the ICU in that state. As consolation, they told us that since she was in coma, she didn’t feel any pain when her heart stopped. Why couldn’t they be a little more sensitive? “ ” 46
  60. 60. We specifically asked them to make sure my father-in-law doesn’t go hooked to the machines. In the rush to revive him, it was forgotten. We just wanted him to go in peace. “ ” 47
  61. 61. My mother just passed away in the hospital. My father is completely shattered. Is there someone who can talk to him? “ ” 48
  62. 62. the paperwork HOSPITAL Leaving the hospital
  63. 63. I am ready to be discharged, but the hospital staff says they will take time to prepare the reports, discharge summary and bills. I want to go home now! “ ” 49
  64. 64. They made a mistake in my discharge certificate because of some miscommunication between the doctors and OT staff. Why can’t they just get it right? “ ” 50
  65. 65. I am running out of time to submit my bills for insurance claim. The hospital didn’t send me the bills for a long time, and now they send me a wrong bill. Why can’t they just get it right? “ ” 51
  66. 66. no cure in sight HOME HOSPITAL Dealing with Chronic, Progressive, or Terminal Conditions
  67. 67. My mother was unwell with liver cirrhosis. We didn’t know how serious her condition really was. I wish there was someone to guide us through the disease. “ ” 52
  68. 68. My father-in-law has advanced cancer. The senior doctors are hopeful. But the junior doctors always come in and say he has weeks to live. Why are they constantly telling us about the worst case? “ ” 53
  69. 69. the pillar of strength HOME HOSPITAL Caregiving
  70. 70. I am 13 years old. My mother met with an accident. Now I have to be the mother and care for her. Am I the only one in such a situation? “ ” 54
  71. 71. My husband just took care of his father and now has to take care of me. I know he is very stressed. How do I give him a break from all the caregiving? “ ” 55
  72. 72. My husband just lost his father to cancer. Now I am unwell and he is afraid he will lose me. How do I reassure him? “ ” 56
  73. 73. I have been caring for my mother since I was 13. I have no constant friend with whom I can talk about my life and my feelings. Why can’t someone follow up with me? “ ” 57
  74. 74. My mother has to undergo surgery every year. Ever since I was 13, I look after her and the house really well. But at times I don’t feel like doing it. Am I selfish or does everyone feel this way? I want to know! “ ” 58
  75. 75. My mother has been ill for many years now. I take good care of her, but I feel like she is hogging all attention. I don’t feel wanted. I don’t feel recognized for my efforts. How do I deal with my conflicting emotions? “ ” 59
  76. 76. My mother had an accident and has to undergo a surgery every year. Each time, I am afraid of losing her. How do I hold on to whatever little I have? “ ” 60
  77. 77. on hospitals… EPILOGUE
  78. 78. I hate hospitals because the power is in their hands…NOT YOURS
  79. 79. They come in with a stoic face and treat you like a ROBOTIC MACHINE
  80. 80. ICU is like a BLACK BOX once your loved one goes in, there is no way you can know what is happening inside.
  81. 81. It is like you have shattered a bit and are trying to put the pieces together. But how do you put pieces together when you don’t have INFORMATION?
  82. 82. Even if you can walk, they will put you in a wheelchair and make you feel MISERABLE
  83. 83. There is always MORE to ask!
  84. 84. As a doctor, you understand the disease… But not my experience! Unless you have had cancer, Unless you have been in my shoes, you will never understand what I am going through...
  85. 85. For my mom, it was the first time in 63 years that she was hospitalized. I thank god that this was also her last time. It crushes me to think of the 6 days she spent alone in the morbid ICU.
  86. 86. Why is more care in the ICU = only medical care?
  87. 87. I have been a patient 10 years ago, and as recently as a few weeks back. But what they make you go through at the hospital has not changed at all…
  88. 88. If you are not alert, you can be there FOREVER!
  89. 89. Hospitals are places of TRANSITION. There is something to someone holding your hand and telling you – you’ll be alright, here or later…helping you make the transition.
  90. 90. You are a Patient. You need Medicine. Do Not EXPECT Love, Care and Happiness.
  91. 91. As my mother was wheeled into the ICU she sighed “I will not come out alive!” Such was her disdain for hospitals that true to her word, she came out dead…
  92. 92. First Responder by Luis Prado from The Noun Project Waiting Room by Luis Prado from The Noun Project Programmer by Hadi Davodpour from The Noun Project Scale by Veronika Karenina from The Noun Project Patient by Wilson Joseph from The Noun Project Doctor by Diego Naive from The Noun Project Surgical Scissors by Mister Pixel from The Noun Project Sad by Juan Pablo Bravo from The Noun Project Laundry by Luis Prado from The Noun Project Headache by Sebastian Langer from The Noun Project Question by Thomas Le Bas from The Noun Project icon credits Injection by Luis Prado from The Noun Project Patient by TypePlus from The Noun Project Suitcase by Diego Naive from The Noun Project House by Pham Thi Dieu Linh from The Noun Project Speech Bubble by Anna Stam from The Noun Project Wheelchair by Dmitry Mirolyubov from The Noun Project Document by Brian Gonzalez from The Noun Project Front Desk by João Miranda from The Noun Project Sitting by Nithin Viswanathan from The Noun Project Window by Juan Pablo Bravo from The Noun Project

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