Understanding the Problem First

Tempting as it may be to only think about solutions, sometimes you have to dig in and understand the problem more deeply. This thinking framework helps identify opportunities for improvement across the whole end-to-end user experience of a system; this helps the design team avoid thinking too narrowly about what needs to be done.

The technique is to tell a story about how people interact with the system today, step by step. Breaking the story into steps is a crucial point; it helps separate out the problems that are revealed so they can be clarified and communicated one by one. Then, once the problem space is defined rigorously, we can move on into addressing the problems individually and in groups using Scenarios of the Solution.

This sounds simple, maybe even obvious, but it is truly amazing how much discipline is required for creative people NOT to go into solutioning before they understand the full breadth of the problems people are having. Once that discipline is maintained, this framework for thinking is tremendously helpful in assuring completeness and coherence in our solutions.

Understanding what is going on now helps us find opportunities to improve. In the problem scenario below, I found that people may forget or misremember information between the time they talk to the patient and the time they enter data into the system. Could this be an opportunity to make things better, perhaps by giving them a way to capture data while they are assessing the situation?

Problem Scenario

Scenario of the Problem in Visual Form

Step Solution Insights
1 Ellen Smith (5 yo female) was playing on the couch and slipped, striking the arm of the couch with her face. Her cheek got slightly perforated by her teeth. A nurse has put on a bandage to stabilize the situation until Jane, the PA on duty in the FastCare section, can assess and treat Ellen. With electronic charting, it can be challenging to remember who’s who without the old-style benefit of just referring to them by bed number, then grabbing that chart out of its little basket. People must transition to a new way of working when they go electronic charting. They lose the comfort of a piece of paper.
2 Jane just arrived and orients herself with the Tracking Board. She starts to leave the station to visit the patient, who is the most urgent case of three. She has to turn around and check because she can’t remember the name. Electronic charting adds cognitive load if the care provider cannot carry the data with them wherever they go.
3 There are some tablet PCs in the ED, but they are reserved for the doctors. Even when she can use a tablet, the FastCare beds don’t have anywhere to set them down while examining the patients. Jane doesn’t like rolling a whole computer cart into the rather cramped quarters at this older ED. Therefore, she has to remember most of the assessment in her head and type it in later. Any time people have to remember data in a potentially distracting environment, there is an increased chance of error.
4 Jane is not sure, upon looking at the application, where she is currently or how to proceed. As she struggles to remember where to find documentation items for her patient, she finds multiple relevant-looking paths, along with at least as many irrelevant ones. She’s not sure which path is best, and ends up documenting the injury three times. The application does not offer a lot of orientation (where am I?) cues.
5 Jane stitches up the injury and returns to document the procedure. The system has logged her out. She checks her pockets for her login cheat sheet; the username and password she was assigned are so obscure that she is having a lot of trouble memorizing them. She finally finds the sheet on the shelf behind the computer, where it has been all the time. She logs in and realizes that her most recent bit of documentation has been flushed from the system. The obscurity of the login information encourages abuse. The piece of paper was sitting there the whole time, available for anyone to use. People HATE to lose data. The single-tier login is fairly extreme; why can’t the machine remember at least the username, for a while at least?

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