We focused on exploring how to support the clients with their diet and food intake and help them see a visible change in their weight, and blood sugar levels?
In near future Health navigators are expected to grow as an independent micro entrepreneur. For the same they need to develop effective and creative ways of problem finding and resolution being self-sufficient in operations and striving for sustainability at the same time.
Health navigators generally get about 20min with the clients. Currently they are spending about 12-15min on the tests, data collection and remainder of the time for counselling. Counselling being the more value add to the clients, the primary goal of the project is to improve the effective counselling time between the health navigators and the clients.
Secondly, to facilitate them making a transition from community worker to micro entrepreneurs and future proofing their sustainability.
(note to self: Somewhere talk about the subsequent site visits)
1st SITE VISIT – KICK OFF
As the first site visit to the Channapatna, Health Navigators and Srishti team (us) was introduced, given the brief of the project and were divided into 4 teams. Completing my team were: Noor, Shobha, Savita, Shaheen and me.
Then we had an informal introduction within each ground, following by an ice breaking activity where in each group to know each other better we had to talk about our interests and some other team member will draw them on a chart and cycle will continue till the last member. Finally ended our day with presenting every group’s activity.
The things we have to learn before we do them, we learn by doing them.” – Aristotle
As I see it, even if we think we know at the beginning what the product needs to be, in nearly all cases its definition changes, or is significantly refined as we progress. This may be because of insights that we gain along the way, or because the needs have changed in the interim, or both. Hence, our process must be designed to accommodate such changes.
We have two common myths at the very start of the project:
- That we know what we want at the start of a project, and
- That we know enough to start building it.
These myths lead us to the false assumptions that we can adopt a process that will take us along a straight path from intention to implementation. Yes, if we get it right, the path is optimal. But since there are always too many unknowns actually to do so, the fastest and most efficient path is never a straight line.
Setting a plan is much more than just setting timelines and adhering to your due dates. Planning should be quintessential practice, for projects, events and even day-to-day implementation to your life. Having a detailed, structured plan is what the Design Process encompasses. It is a series of steps that one follows during the project (or the formulation of a product) from start-to-finish. In short, the design process is a five-step design thinking process.
Two aspects of design:
Problem solving- How do we build this product (or formulate a concept)?
Problem setting- What is the right thing to build?
This project follows a collaborative design process. This is a non-linear process which is used to understand the context of the project and devise creative solutions leveraging on collaborative participation of all the participants during each and every phase of the project. The process involves various phases which begins with understanding the needs of the user in the context of their environment, using data to identify and analyse key moments, generating ideas, and finally developing a final solution.
The process flows from piolet field studies for building scenarios which is done by sharing experiences and storytelling to making sense of the collected data as the part of framing needs.
Moving towards the synthesis phase Clusters of information is now coming to being after the Idea generation and brain storming funnelling the data into concept. The process then moves to ideation phase. From there multiple concepts crop up. Further skimming of the concepts is done on the basis of some specific criteria. Ultimately it moves to the Final Concept stage.
2nd SITE VISIT
Well, you have to find a problem in the status quo and develop opportunities that you can capitalize upon. You must frame what you plan on creating — this phase is aptly titled. You must begin framing user needs, what goals you plan to accomplish and how you plan on positioning yourself within the process. HNs, Mayahealth and the clients being the primary stakeholders of this project, we need to understand the needs, dos, don’ts from their point of reference and their interactions. It became mandatory to get closer to their stories for the project to be in the right direction with respect to the context and dynamics within the health navigator network.
Framing the needs of the HNs / Clients in the context of their environment, by collecting data on their daily routine, experiences and feelings during their various interactions with people, objects and spaces. This phase is carried out using multiple tools and templates to bring the data together.
So we frame stories around what you understand from the situation and find the gaps within these stories.
Determining the user needs is crucial. You can develop, what you believe to be, a great product. But if the end-users don’t have a need for the product, your product will not survive.
DAY IN A LIFE
HOW: Catalogue the activities and contexts that user experience throughout an entire day.
WHY: This is useful way to reveal unanticipated issues inherent in the routines and circumstances people daily.
Learn from what people….
This process is generally accomplished by plotting the activities which the subject performs, people he/she meets, places visited, and objects to which he/she interacted with on a timeline from the start of the day till when they go to sleep at night.
On the 2nd visit to structure the context in which the HN operates on a daily basis, the day in a life was conducted with the HNs. After a brief discussion about hows and whys about this process, we began. I though HNs would be reluctant a bit to began with it but it was not the case at all. Noor started narrating her activities from 7 in the morning. As we know this exercise is not about narration, its about journaling by sketching the events of the day.
When I asked them to draw, it got them a little hesitant. It was understood that they were not in touch with drawing for a long time, so I had to bring up to the momentum where they can ate least start with some basic icons or stick figures. I drew couple of icons for some daily chores activities they perform, male female drawings, icons for the instruments they use on their daily client visits.
After this they mustard some confidence and started taking initiative in sketching the Day I life. If not sketching the other HNs were prompting how to draw certain things to help Noor draw. I did the initial few sets and after that Savitha, Shobha and Noor took turns to complete the process.
It was amazing to observe such enthusiasm among them.
When we suggested sketching as a visual thinking tool to the HN, we often heard that “I’m not an artist” or “I can’t draw.” While I understand the hesitation, we were there to tell them that the artistic quality of the sketches is not the point. The real goal of sketching is functional. It’s about generating ideas, solving problems, and communicating ideas more effectively with others. I rationalised it to them how sketches will take a little more time in the beginning but with time it’ll be easy and fast.
As there is diversity in language among HNs too, so sketching is a level ground for everyone to understand the scenarios easily when drawn in icons or few panels of situation as compare to a full length paragraph which might not be in the same language which the reader can read. It has been observed that sketching leads to longer data retention and also to bring about the nuances of the scenario that is being sketched.
Experience mapping is another collaborative method to collect data in term of Experiences and feeling. Its an iterative process for synthesizing and visualizing the holistic experience of the HN and the client. The activity of experience mapping results in an artefact – an experience map. This experience map is another building block on top of the Day in a life map where the participant sketches the experiences in a day with respect to people they interact with, spaces they visit or living in and around, objects they use regularly and then map their experiences using terms like happy, sad, concern, satisfied etc.
Human experience is complex, and mostly intangible. Yet the challenge of experience mapping is to uncover, little by little, critical information about clients and HNs experiences through trial and error.
With this repository of information we can identify different pain and pleasure points, High and low points, areas of possible intervention.
It took a while for HNs to understand the purpose of this process and also they needed a little more time to get used to how to execute this leg of the design process. So I had to do it for them in the first place.
STUDIO TIME 1: TEMPLATE DESIGN
The whole purpose of the project is to scaffold design thinking capabilities in the HNs and ultimately self-sustainable micro entrepreneurs and for that to happen the key objective was to introduce the design process such that they should be able to carry forward the process on their own facilitating themselves and the future generations of HN.
This is the time to start ideating of the templates for Day in a life and experience mapping.
Feedback from Naveen: Each template should be easy enough to understand and should open and not constrained and rigid with too many parameters and guidelines which could be a possible hindrance.
After the feedback we 6 as group came up with these templates for day in a life and experience map.
Day in a life template has a very simple layout with dotted lines represents an hour passed in a day.
Similarly Experience map is simple enough to understand with the sheet divided into 3 columns. 1st and 3rd columns are the HN’s home and the Client’s home respectively as the primary space for both of them and the centre column is used to sketch the objects (like their phones, auto to travel etc.), feelings and other places they visited.
Both the templates are provided with some basic icons comprised of some icons for HN or client, icon for home, their equipment etc. accompanied with a few instruction points as a cheat sheet for the HNs to see and draw from that set.
(ADD PHOTOS OF THE TEMPLATES with HNS sketches)
3rd Site Visit
This was the testing phase for our pilot template designs. We are visiting the clients for the first time with the HNs. Me along with Noor, Shobha, Savitha visited our first client for the day “Zakeera Banu”. They are family of 5 with 4 daughters out of which one is married. She has BP, sugar and recently diagnosed with some chest pain. Noor introduced me and stated my intent of visit to them. This family is very content with the work of all the HNs and they communicated the same to me. Noor initiated their protocol of the meeting with the small talks and proceeded with regular weight, BP and sugar check-up routine.
Following this I instigated her to start asking questions relevant to the day in a life and experience maps and start sketching simultaneously along with Shobha and Savitha. As they would draw on the template I was sketching along with them on my notebook and helping them with if they get stuck with something.
We continued the process with one more client and we were done for the day.
Though it’s not something happened in my group but it was important for the project. It lead to some changes the template.
This is not a potty…
4th SITE VISIT: SCENARIO BUILDING
All the data collected from former processes was recorded in the studio time and studied, where we decided to dig deeper into the narratives and find out nuances, crack those high low points to build that required scenario which will be the prerequisite for the further ideation, clustering of data and ultimately to the concept development and final concept stage.
During this visit we sat with HNs again to nudge more stories around and leaving no stone unturned. The HNs know the channels of communication better to dig for more interesting facts and connections which we might have missed before which could be an important lead for an intervention.
From this day’s work we were able to collect couple of narratives, interesting stories and most importantly we were able to extract 4 insights as below:
- There is a mismatch between the information provided, the aim of the HN and need of the client.
- Client wants to see the observable changes in their health themselves like weight loss. Whereas metabolic changes like BP and sugar can be observe only by a machine.
- HNs usually go out of their way to help their clients financially which with time will be a burden on them. Moreover, this mode of help is not sustainable
- Some HNs are not valued in their own family. They don’t receive the trust from their immediate family circle. Even with these odds these HNs contribute significant amount of their time with MAYA healthcare. This throws light upon their level of dedication.
4th SITE VISIT
From Narratives we collected in the 3rd visit and the insights we extracted and the feedbacks from the first seminar we now have to pick one insight and use that insight as a scope to look that particular issue more closely and consolidate all those narratives into one comprehensive story which will be our test bench for our forthcoming activities further surfacing int
Insight our group picked to work on is:
Client wants to see the observable changes in their health themselves like weight loss. Whereas metabolic changes like BP and sugar can be observe only by a machine.
Also suggested by Naveen that it’s a very unique issue to tackle hence working forward with the same in the 4th visit.
This time Noor was not present but Shaheen was so I took advantage of her experience and the stories of about 230 plus of her clients to check the validity of this insight along with Shobha and Savitha who have now starting doing their own client meetings. Getting down those stories in detail was the objective from the both HNs and client’s point of reference.
Secondly, while recording and sketching the data simultaneously we have to mark instances, nuances, situations, some dialogue which are something good to keep and something we can back on with GREEN (pleasure points) and similarly RED (pain points) clearly highlighting the high and low points both physical and psychological
With all the stories consolidated, we divided it into two storylines and this studio was about putting these stories on a template. We figured a very basic film pre-production style template for the storyboard with rectangular panels to draw and write about the different scenes of the story with the addition of the RED & GREEN demarcation for pain and pleasure points respectively.
We began this step after the storyboards were prepared. Recognizing issues were based on certain criteria, namely hierarchy of the issue with respect to other issues, frequency of the issue or if the issue presents a unique or interesting opportunity.
Your brain generates Ideas from the information that it holds – the Experiences you have had and the Knowledge you have gained. Experience and Knowledge are different and both are valuable inputs to idea creation. Even if the issues we found are strong enough but if the ideation process is not done properly then we might be sitting with concepts which are not feasible or not effective as we want them to be.
As Brainstorming and other traditional activities might not be ineffective and inefficient. They generate ideas that are either unrealistic or pulled from existing idea lists. Further, creative facilitators often encourage participants to ignore the very real barriers and constraints that must be overcome for new ideas to succeed.
In this design process, the ideation stage takes inspiration from the work of Eva Brandt Camilla Grunnet at The Interactive Studio, Sweden. Their work with the design process using props and dramatization helps the designer to have a better understanding of the situation than if the designer were to just look at it from a third person perspective.
We picked up the Dream Tools props described in the paper and set up the props for a Magic Show.
WHY MAGIC SHOW?
Your brain can be thought of as an Idea workshop where you build Ideas the way we build with building blocks. Imagine for a moment that you’re a child at play. You are playing with building blocks of which you have a wide variety of colours, shapes, sizes, and even systems. The connectors don’t all match because they are from different systems, but that is okay; in fact it is great. You build a bridge, but it’s a normal bridge and you want a unique structure, so you switch the pieces around and create a bridge that flies, and that’s unique……
Looking into the context of the people at Channapatna and the Health Navigators, we have observed that their interaction with technology has been minimal. Albeit most of them don’t own a smart phone but they are aware of what and how a smartphone works.
Without this basic understanding of technology, many solutions may never be a practical approach in the eyes of the Health Navigator. If the question of practicality can be removed from this process for the HNs, they could come up with ideas that may be fantastic, just like a kid experimenting with the building blocks making unique sorts of bridges without thinking about the practicality of it however with technology it may be possible to make it a reality.
Hence the Magic Show.
So now for the part we need to explain them what will be the ideation process. The scene was set to give the role of the Magician to a participant. The magician had three tools, a Magic wand, a Magic ball and a Magic box. The wand according to the rules of the game could let you do anything, the ball lets you see anything and the box lets you store anything. However like every story is not perfect and with great power comes great responsibilities but with those powers there are some constraints too:
First, that they could not act as doctors and heal the patients
Second, they could not play change a person’s free will. Which we represented with a handcuff.
All in mind, participant will be given a story and a pain point in that story. Keeping that pain point as a intervention area, participant has to come up with as many ideas as he/she can no matter how practical is the idea or how farfetched it is, may be it is possible in next 2 years or not because, NO IDEA IS A BAD IDEA. This is the most essential thing part of this exercise. They can change something using the magic wand, they can see what will happen after 5years in the magic ball or they can store anything in the magic box. Everybody participated.
Though the HNs were excited and participated with brilliance and vigour, the HNs were partial to using only the magic wand and the magic ball and box were left untouched. Several things point to the reason for this.
- The HNs are not familiar with these props being related to a magic show.
- The concept of storage is generally related to physical items such as food, stationary, money etc. The idea of storing something virtual like data does not fall into their understanding.
However the activity was a success since there were roughly ten unique issues identified and four solutions on average was received for each.
In this stage we pick up one issue among those collected in the group and develop concepts to attend to them. The method we used for this phase is Enactment.
Enactment is a mode of dramatizing the situation in order to drive the concept development with the ground realities intact. There are several ways in which concepts are arrived at. Many of them are verbal deductions, some through brainstorming, through idea elimination, algorithms etc. However these methods tend to look at the technical aspect of the outcome.
In the context of the project, the people that are concerned and their related feelings and experiences are indispensable for a functional concept. Enactment lets you feel the fit of the shoe that you are designing for your client along with the change in experiences with the change in settings. Here, enactment helps us see and feel like the HNs and the Clients do and thereby design concepts that fit better into their lives. It helps us put the concept in perspective of the stakeholders.
The enactment took three tries to perfect. On the first try, the emphasis was to capture the story and make a short movie out of it. The stress on finding pain points and enacting the concepts was drowned in the effort to work around the unscripted enactment with the HNs.
The second try was a bit more structured. While one of the groups enacted the narrative, the other three groups would ideate on the issues and concepts. This however failed to stay time bound and the enactment took on paths that fizzled out the essence of concept development.
Third time was indeed the charm. The idea was to arrive at a tension point in order to give time for rapid prototyping. We created a narrative that was scripted to be short and simple with two to three tension points. Along with the HNs we made few changes to it and enacted. The enactment was stopped at the tension point – “How to know what the client is eating through his/her day?” The other three groups began making for this and in the end had four concepts were arrived at.
When it was time for our group to make while the other groups acted, there was a clear distinction between the ideas generated by the Srishti part of the group and the HNs. The ideas that came from the HNs were more grounded and close to the existing context. Albeit technology was not their forte I was surprised to see Noor being aware of different technology to measure BP on the go which was the pain point with one of the groups. I had a little doubt about HNs taking the initiative in my group but once again I was proved wrong by Noor when she took the driving seat in the ideation stage and Swagath who helping her in the technological aspect of the concept. At that point participatory mechanism was in full swing. HNs were slightly reluctant to present their ideas in front of the class but that was just because of the language barrier.
One of the overarching goals of this project is to facilitate the incorporation of design thinking into the Health Navigator’s work culture so that they can identify and resolve issues on their own. For this reason a Learning Kit was envisioned to serve as a blueprint for the HNs to put to use in a different context.
Several things had to be kept in mind while conceptualizing this Learning Kit. First on the list was to keep it as unstructured as possible to get the HNs to work out a pace and affinity to the process on their own.
Secondly visual literacy was a concern since most of the work was to be done in sketches. This led to the question of how we might inspire the HNs to start a sketching habit.
Finally the Learning Kit must serve as a guide not only to the HNs who worked with us but also to the new HNs also to take to.
After the initial Day in a Life and Experience Map activities, we collected the artifacts from the field at Channapatna and brought it back to the Studio at Srishti.
The sketches made by HNs were scanned and analyzed. From the data collected, we brought together a list of icons that was a loosely fitted most of the activities, people, objects and spaces that the HNs interact with. The icons were then imported from Flaticons.com. A loosely structured template was built out of this for both the Day in a Life as well as Experience Map.
The Experience Map was created in an innovative way where the sketching would happen on the template but mapping the experiences would happen on a gateway sheet attached to the template. This helped keep the sketches clean of lines crisscrossing over them.
From the observations of how the HNs took to this template, few changes were made. All the icons were changed to hand drawn icons. They were drawn by hand, scanned and vectorised. The template was then recreated with fewer lines of instructions and space for the same instructions in Kannada.
The templates for Storyboarding (Synthesis phase), Issue Listing (Synthesis phase) and Ideation (Creative Ideation phase using props) were also created using the loosely structured format. At the same time emphasizing the importance of sketching at each step.
To provide continuum and context to these templates, we were guided to think of Method Cards that would help them connect the activity to the issue at hand. Use of images with minimum text was advised. Yet this created a disconnect between the template and the method card as an HN who is new to the process may not be able to understand how to go about it.
For this reason an Example Card was proposed. This would provide the necessary connection between a method card (illustration and short description) and the template. The Example card would have an image of the HNs during the corresponding activity, examples of the type of question or conversation they would be conducting and a detailed instruction of how to go about doing the activity.
To create a process overview that would show these activities from beginning to end, an Index card was created. Hand drawn illustrations were used in all of the cards. A red flag was also part of the learning kit that served as a STOP signal during the enactment activity to point out tension points and begin rapid prototyping.
Copies of this Learning Kit was given to the HNs to use it in one of their other projects and give us feedback on how it worked and what needed changing.
- CURRENT STAGE
At this point, we are waiting for feedback from the HNs after using the Learning Kit on another project.
Few of the issues that were found that has to be worked upon are:
- Few sets of icons are still digital. These have to been hand drawn and digitized.
- Some imagery (magic props) might still need to be reassessed as they did not work as well as expected during the activity with the HNs. However we are eager to know how they adapted to it in their own settings.
- Instructions have become too verbose. A right balance between giving the exact information and using crisp minimal language has to be found.
- Instructions are currently in English. This has to be translated into Kannada and Hindi.
- For some of the activities, it might be necessary to add images that suggest there is more than one way to do the activity. This would help the HNs to adapt as best as they can to the process.