Accord
A mobile solution to be used as a communication tool for clinicians, patients and families in the Intensive Care Unit.
The Basics
Company
Northwestern Medicine
Team
5 people
Time
12 months
My Role
Product Designer
The Problem
Over 5,000,000 people are admitted to an intensive care unit every year in the united states, and 30% of them lose their ability to communicate. 1 in 3 older adults over 65 years old is admitted to ICU and receives intrusive care before death. However, 80% of them reported a preference to avoid these painful treatments but to prioritize quality and comfort at this stage of life. The complex, sociotechnical system of ICU imposes great challenge in making the patient’s own values heard and shared among people who are key decision-makers and stakeholders involved providing care to them.
Accord is designed to bridge the communication between ICU clinicians and patient’s families (surrogates) to deliver care that is aligned with patient’s own values of life.
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Source: Guttormson JL, Bremer KL & Jones RM (2015); Fried TR, Bradley EH, Towle VR & Allore H. (2002); Teno JM, Gozalo PL, Bynum JPW, et al. (2009).
Usere & Audience
The target users of Accord are ICU clinicians and patients' family members who act the patients' surrogates who take great responsibility in making critical decisions to provide patients with the best care while also honoring the patients' own values of life.
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The unique and biggest challenge for these people is that patients in ICU normally need to go through mechanical ventilation and other intrusive treatment thus they lose their ability to speak for themselves. However, as ICU clinicians know little about the patients' personal life, their families don't have much confidence to represent their loved ones either. Like most of us, they have never explicitly asked their loved ones about their values and goals
Team & Role
Working as the Product Designer/Owner of this project, I worked closely with the research team at Northwestern Medicine from navigating the problem space to delivering prototypes for the final solution.
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I coordinated and led all facets of design including: design research, creating design frameworks, iterative prototyping and user testing, interactions and visual designs.
Process
In order to clearly define the problem scope and identify potential design opportunities, I started out by taking a rigorous Design Research process to first construct a holistic perspective on the complex ICU functional structure and the current shared-decision-making process.
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I conducted 10+ stakeholder talks with various roles of clinicians on the ICU care team, interviewed volunteered patients and their families about their ICU experience, virtually shadowed ICU physicians doing morning rounds via Zoom, and dug into previous studies on relevant topics.​
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After synthesizing what I learned from the design research process, I created multiple frameworks to visualize my research insights. Utilizing my frameworks, I was able to identify the key pain points of my target users and clearly communicate them to my team members.
Key Insight #1
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A typical ICU journey is a nerve-racking experience. Families' anxiety level remains high because they have no clue about what might happen over time, especially what the best case they can expect and what the worst case they should be prepared for.
Key Insight #2
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The complex, sociotechnical system of ICU imposes great challenge in coordinating and keeping everyone on the same page. Families need to collect different pieces of information from different people but their fears and concerns are usually not communicated well among the care providers.
To move forward, I decided to narrow down the scope and focalize on the communicational challenges during care meetings, when doctors needed to discuss their prognosis with patients’ families and make agreement on treatment plans.
The Challenge
Moving into the ideation phase, a huge challenge for me is to balance the interests of different kinds of stakeholders, especially between ICU clinicians and patient’s families.
the biggest problem I encountered was to conceptualize a solution that would help families better understand what the treatment outcome might be. Even though I had learned from my research that families would desire clear information about what might happen to their loved one, ICU physicians were normally hesitant to be overly explicit on their prognosis. They did’t want to “pin a point” because situation could change fast.
The Solution
I generated prototypes for various concepts and conducted 2 rounds of usability testing with my target users, including clinicians and patients' families, to gauge their perspectives, gain better understanding of their needs in order to find the accordant goal underneath their seemingly conflicting demands.
With the help of the low-fidelity prototypes, I nailed down the core idea of the final solution ----
Help clinicians better explain the uncertainties and set up realistic expectations for the families.
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With the core concept established, the next milestone was to translate the insights into meaningful user interfaces and interactions. The ultimate solution was validated by dozens of prototypes and tests, from mid-fidelity to hi-fidelity.
User Interface & Interaction Design
Accord is designed to bridge the communication between ICU clinicians and patient’s families (surrogates) to deliver care that is aligned with patient’s own values of life. It has 2 parts: the first part drives a family reflection on their loved ones’ own values of life and the second part features a graphic aid that doctors can use when they are meeting with families to discuss their prognosis.
Family's Portal
Guide family members to reflect on patient's lifestyle, value of life and goals of care they would receive in ICU.
Physician's Portal
A dashboard with graphic aid for doctors to guide discussions with patients families and to better deliver their prognosis.
Simple steps that help families feel more in control
1. Reflect
An ICU care team member guides the family to reflect on and talk about the patient’s normal lifestyle and health priorities
2. Articulate
Families are empowered to articulate the goals of care form the patient’s perspective.
3. Care Meeting
ICU doctors hold care meeting with families and use the graphic aid to deliver their prognosis
4. Track
Families and all clinicians can track the prognostic change and keep a holistic understanding of the patient’s clinical condition.
Family Reflect
Onboarding
An ICU care team member will introduce Accord to families during the onboarding stage, providing an overview of the four major steps they will experience with the platform. This approach helps alleviate the stress of not knowing what to expect.
Family Reflect
Patient's Lifestyle
Families are encouraged to discuss the patient's lifestyle and hobbies and input corresponding details, including new categories if desired. These granular details add a human touch and aid decision makers in providing personalized care aligned with the patient's values.
Family Reflect
Health Priorities
Families are guided to consider various quality of life attributes and evaluate their importance to their loved ones by adjusting sliders. These attributes align with topics commonly discussed by doctors when describing a patient's potential future life.
Family Reflect
Patient's Goal
Following the reflection process, families are better equipped to articulate the patient's goals of care, including best-case and worst-case scenarios. This input empowers individuals to express their hopes and concerns.
Physician's Tool
Dashboard
During care meetings, doctors utilize the graphic aid on Accord to communicate their prognosis to families, referencing their inputs from previous reflections displayed on the dashboard. This approach enables doctors to speak in terms that patients and families can understand, making the prognosis more easily digestible.
Physician's Tool
Visual Prognosis
Doctors can add a horizontal spectrum to visualize the range of possible outcomes, with one end representing the best case and the other representing the worst. Doctors can easily input prognosis by dictation.
From my research, I've learned that it's really important for doctors, and also patients and families, to NOT use hard numbers or metrics on the spectrum. It is better to keep the "Best Case" and "Worst Case" as two relatively opposite scenarios and allow doctors to describe them in a way that is more applicable and relatable to each individual patient.
Another important piece of information that families always look for is "where my loved one falls on the spectrum right now?".
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Doctors can add another component -- "Most Likely Projection" on the spectrum and adjust its position accordingly.
Physician's Tool
Track Evolution
As patient's situation changes over time, doctors will hold multiple meetings with families. Every time they regroup, they can add a new spectrum for the latest situation.
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​Being able to see the range of what is possible and how it is evolving over time helps families keep a holistic understanding and a good track of their loved one's illness.
Save and Export
At the end of both family reflection and care meeting discussion, a summary will be created and allows easily saving or export. This allows families to have a post-meeting reference to digest the information better and also keeps all stakeholders, including other clinicians, on the same page and share the same level of information.
Impact
Throughout my thesis, I've been able to interview 8 ICU clinicians from different hospitals. And Accord has received terrific feedbacks from them. In their words, this invites information transparency, it alleviates the stress from the care team and also gives families a sense a control. Different types of clinicians also find this tool helpful.
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More importantly, through this project, we proved the value of Human-centered Design in healthcare. We compiled our design process and learnings along the way into an academic paper about the applicability of Design-thinking to the critical care setting. This paper has been accepted by The Journal of Critical Care and will be published soon in the future.
Testimonials from ICU clinicians
"It really humanizes the information about patients. This will relieve stress from the care team."
---- Dr. Walter, ICU Physicians
"This invites information transparency. It really gives family a sense of control."
---- Patti, Respiratory Therapist in ICU
"This helps our social workers as well, knowing what the picture physicians are providing to the family."
---- Becky, ICU Social Worker