Communities of Care - Strategic Social Interaction Design in the Healthcare


Published on

Social Interaction Design is not web design. It's not interaction design. It's about designing complex ecosystems that support conversation, collaboration, intimacy -- in short, community. Problem is, many people - even in the IxD world - don't understand what conversation is, or how to create engaging communities.

Many healthcare providers and startups are rushing to deliver on the promise of creating supportive online communities for people while simultaneously trumpeting personal health records and electronic health records at the same time creating potential privacy and trust issues.

To design Communities of Care, you must commit to writing a narrative of human behavior mediated through time and space. While great strides have been made over the last 40 years drawing on a rich history of Cybernetics and Human-Computer Interaction, those models of interaction are limited in explaining social and psychological modalities of social interaction in physical space and particularly in mediated online spaces which is becoming more the norm for collective and collaborative group social interactions in the healthcare industry.

Published in: Design
  • Be the first to comment

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

  • But first....
  • But first....

  • A participant (think patient, family member, care provider) has a goal, in this case their goal is to engage in social activities with other people around health & wellness - like cronic conditions
  • The participant chooses a context - and this is very important - just like when your boss calls you into his office and closes the door - that frames the kind of possible conversations that might happen.

    Same thing when dealing with health related communities. If the context is an online community for parents of children with autism - that frames the expectations, kinds of conversation, types of interactions that happen.

  • The participants must negotiate a shared language. Right now clinicians define the language - it’s not patient-centric - in a language that patients would understand - it needs to be a language that is human.

  • Participants begin to the exchange of symbols - in the offline word those can be body language, but in mediated space, we lose all of that, so we develop a semiotics of conversation best suited to the environment.

  • ♣Context

  • ♣Context

  • agreement or understanding may be reached, or the transaction of some value may occur - like
    “Wow, your hot, lets go back to my place for a nightcap”

  • In Social Experience Design - we have 7 key attributes that shape the design of online communities - each community is different and features/functions must map to these attributes.

  • Community: Online and Local Live Connectors
    Organizational (The System): Digital access to caregivers, health coordinators, health coaches, nutritionists, nurses
    Interpersonal: Support tools for family and friends, weaving them into the experience, interventions
    Individual: Goal setting and tracking (where they are – SMS, iPhone, etc), personalized program and messaging, health games, health journals, HRAs, PHRs, messages to myself.
  • Baseline data is being gathered and the people are helping each other.
    Can the system:
    Help the user to notice and track the positive
    Reinforce the positive in order to promote repetition
    Provide guidance, include support team and introduce professionals at certain points
    Track behaviors through and integrate with native communication channels: email, text messages, instant messages, twitter, facebook

    Take pictures of your food – nutrition and portion size analyzed for feedback
    Take pictures of your walk – it get’s reflected back to you
    Personalized outreach messages, communication plan to yourself

  • Dr. and patients can log in to review lab results and xrays, via screenshare or live appointment
    Log in to take a pre-visit questionnaire, fill out forms, and create questions for your doctor
    View doctor’s notes from visit, (OpenNotes) and follow up care plan, track against it
    Dr. access to your health journal
    Ongoing dialogue with Dr: check in to review progress, leave notes, system can escalate, interventions
    Connect with Dr. online via email, instant chat, SMS, online visit

  • College kids don’t want to water-down their conversations because their mom is now their friend on Facebook - multiple contexts have collided as people are connecting to their family, children, coworkers - there is no delineation, no semi-private space. For Communities of Care to be truly engaging, the context has to be clearly defined so people feel comfortable discussing personal, often emotionally charged topics.

  • My participation in online social media is informed by my sense of self and self image
    I actively create, maintain, tweak, and monitor my online Persona
    I have a self-interest in seeing my online presence acknowledged and reflected back to me
    I use social media as an extension of myself, often telling about and narrating biographical details and reflecting how I would like to be seen
    In the health & wellness space, I may be very sensitive to self image, self perception, acknowledgment, status, position, success

  • People gather around shared interests, passions, goals - this forms the context for sharing. This is not goal or activity centered design - because there is no end-state for engagement.

  • Know when I am online. Know when others are as well, and the degree to which they are willing to engage.

  • Social ties are complex. People want to gather around cronic conditions, around shared interests as well - the community of care must allow for sub-groups to develop organically. For groups around cronic conditions, this is where the care team can/should/must contribute.

  • Patients that are sharing their personal information need to know it won’t be traded upon. This trust only develops over time - and it only takes 1 time to destroy it. Trust is not transferrable and is completely dependent on context.

  • People make mistakes - reputation system & mechanisms to save face and repair a tarnished reputation.
    One of the mechanisms we designed into Gather was the ability to earn points based on positive contributions to the community. Those points are redeemable for prizes, gift cards, and cash. has a sophisticated reputation system for rewarding good behavior, as does eBay. A means of introducing feedback loops into the system.

  • Any community has it’s own sense of time, and conversations have a tempo, velocity, and flow.

    Design for conversations - understand how they work, the mechanisms, the value.

  • People have boundries. Patients & people need to be able to have different types of conversations based on their closeness with other people in social media.

  • People need to have granular control over what their connections can see - this includes profile information, but also Who I follow, who follows me, what conversations I am engaged in. Patients managing their persona & conversations in the context of cronic conditions must trust the system is designed for this.

  • A grammar - set of rules - and community managers or high-trust people to oversee the conversation - make sure people are behaving - people are engaging in a positive way

  • surface compelling, active or high velocity discussions allows more rapid engagement

    surface people that share interests so people can serendipitously connect.

  • Communities of Care - Strategic Social Interaction Design in the Healthcare

    1. 1. Designing Communities of Care Strategic Social Interaction Design in Healthcare Amy Cueva Chief Experience Officer Map*Pow Will Evans Director, Experience Design Semantic Foundry
    2. 2. Who are these folks? @amycueva @semanticwill © 2008 Will Evans Evans & AmyFoundry, LLC © 2010 Will | Semantic Cueva
    3. 3. We wonʼt talk about... © 2010 Will Evans & Amy Cueva
    4. 4. Definition ‣ Social Interaction Design (SxD) is the conceptualization, research, strategy, and production of dynamic ecosystems that support community, conversation & collaboration ‣ me, 2008 © 2010 Will Evans & Amy Cueva
    5. 5. Social Interaction Design ‣ Social Interaction Design (SxD) is not web design ‣ SxD is about complex, dynamic ecosystem design ‣ The User Interface is the Social Interface ‣ The content is the conversation © 2010 Will Evans & Amy Cueva
    6. 6. Social Experience Design So, if the user interface is the social interface and If the content is the conversation then We need a model of conversation © 2010 Will Evans & Amy Cueva
    7. 7. Social Experience Design People like to talk about conversation... about authenticity... What, exactly, is it? and How do you design a community of care to facilitate that? © 2010 Will Evans & Amy Cueva
    8. 8. Socio-Cybernetic Model Text © 2010 Will Evans & Amy Cueva
    9. 9. a participant has a goal Text © 2010 Will Evans & Amy Cueva
    10. 10. chooses a context Text © 2010 Will Evans & Amy Cueva
    11. 11. negotiates a language Text © 2010 Will Evans & Amy Cueva
    12. 12. begin an exchange of symbols Text © 2010 Will Evans & Amy Cueva
    13. 13. causes a reaction Text © 2010 Will Evans & Amy Cueva
    14. 14. that evokes a response Text © 2010 Will Evans & Amy Cueva
    15. 15. agreement may be reached Text © 2010 Will Evans & Amy Cueva
    16. 16. Social Media Design Basics Basics ‣ You can’t design the conversation ‣ But the interface can mediate, guide, inform the conversation ‣ The interface can encourage or discourage certain types of behavior - through identity, reputation systems, game mechanics... © 2010 Will Evans & Amy Cueva
    17. 17. Why Community? ‣ Start with the high-level strategic goals and objectives for the site – ‣ then answer: why community? ‣ What kinds of engagement do you want to encourage on your site? ‣ What is the desired outcome? ‣ There is no end-state! ‣ This will help map out your strategic direction. © 2010 Will Evans & Amy Cueva
    18. 18. Participation vision ‣ Rather than pursue Social Media strategies based on fashion, as designers we need to think about how we want the site to engage with people — who want to engage with each other ‣ and create architectures, features, and functionalities that creates a path for participation ‣ Ask: where is the community going to go? © 2010 Will Evans & Amy Cueva
    19. 19. Model of Attributes Identity | a way of uniquely identifying people in the community presence Presence | a way of knowing who is online, available or otherwise nearby Relationships | a way of describing how two users are sharing relationships related (e.g. on Gather, people can be family, friends or colleagues) Conversations | a way of talking to other people within the community identity Groups | a way of forming tribes within the context of shared interests Reputation | a way of knowing the status of other people in conversations reputation the community (who's a good citizen? who can be trusted? who is a big contributer?) This may be less important. groups Sharing | a way of sharing things that are meaningful to participants (like presentations, articles, methods, design patterns, etc) © 2008 Will Evans | Semantic Foundry, LLC
    20. 20. A Roadmap ‣ Completely understand the profile of the audience ‣ Map out how users will participate - both today and tomorrow ‣ Create multiple participation points ‣ Find lightweight ways for first time creators to contribute ‣ Make it easy for Spectators to find and consume user-generated content ‣ Prepare your organization for participation in the conversation © 2010 Will Evans & Amy Cueva
    21. 21. Healthcare Considerations ‣ People: Patient, family members, primary care physician, specialist, pharmacist, nutritionist, chiropractor ‣ State of health: Healthy, symptoms, Not yet diagnosed, recently diagnosed, chronic ‣ Influencers: Emotional state, financial state, level of emotional Support, level of knowledge, access to technology, laws, level of insurance ‣ Interactions: Decision support, online visits, communications, conversations ‣ Organizations: Hospitals, pharmacies, employers, government, communities, Non-Profit orgs ‣ Objects: Medications, procedures, claims © 2010 Will Evans & Amy Cueva
    22. 22. Ideas & Opportunities © 2010 Will Evans & Amy Cueva
    23. 23. PHR + Social Media ‣ PHR data feeds profile ‣ Profile becomes matching system ‣ Rich profile attracts relevant people, objects, interactions ‣ Social media enables interactions ‣ Data makes interactions more meaningful ‣ Interactions produce data © 2010 Will Evans & Amy Cueva
    24. 24. Relationships, Frequency, & Access Track Reflect Become aware Encourage Achieve Celebrate Intervene Reach out Share Visit Inform Communicate Coordinate Escalate Obtain data © 2010 Will Evans & Amy Cueva
    25. 25. Promoting Positive Reflection © 2010 Will Evans & Amy Cueva
    26. 26. Enabling & Informing Patient/Doctor Interactions © 2010 Will Evans & Amy Cueva
    27. 27. Care Team Coordination © 2010 Will Evans & Amy Cueva
    28. 28. Influence of the system © 2010 Will Evans & Amy Cueva
    29. 29. Design Considerations © 2010 Will Evans & Amy Cueva
    30. 30. Design Considerations the shit you wish we spent the whole talk on © 2010 Will Evans & Amy Cueva
    31. 31. Design Considerations 1. Create articulated contexts © 2010 Will Evans & Amy Cueva
    32. 32. Design Considerations 2 2. Design for identity © 2010 Will Evans & Amy Cueva
    33. 33. Design Considerations 3. Interests, Passions, Goals © 2010 Will Evans & Amy Cueva
    34. 34. Design Considerations 4. Presence © 2010 Will Evans & Amy Cueva
    35. 35. Design Considerations 5 5. Groups, Tribes, Cohorts © 2010 Will Evans & Amy Cueva
    36. 36. Design Considerations 6. Trust © 2010 Will Evans & Amy Cueva
    37. 37. Design Considerations 7. Reputation © 2010 Will Evans & Amy Cueva
    38. 38. Design Considerations 8. Conversation © 2010 Will Evans & Amy Cueva
    39. 39. Design Considerations 9. Spheres of Intimacy © 2010 Will Evans & Amy Cueva
    40. 40. Design Considerations 10 10. Privacy © 2010 Will Evans & Amy Cueva
    41. 41. Design Considerations 11. Governance © 2010 Will Evans & Amy Cueva
    42. 42. Design Considerations 12. Serendipity © 2010 Will Evans & Amy Cueva
    43. 43. In the end: community members will own it ‣ Once designed, communities of care are not in the hands of those that funded, designed, built it - it must be handed over to patients and the community - letting go is the hardest thing ‣ Shift thinking from “What it does” to “What people are doing and saying” ‣ Create a system so that it can become what it will mean to each person, and as a result, service the community “The street finds it’s own uses for things” © 2010 Will Evans & Amy Cueva
    44. 44. Amy Cueva @amycueva Will Evans @semanticwill HealthcareUX on LinkedIn
    45. 45. Thanks Amy Cueva @amycueva Will Evans @semanticwill HealthcareUX on LinkedIn