Problem – Solution Scenario Example
A Tool for Human-Centered DesignAnalysis and Synthesis
Mark Anderson
The pictures in this document are for illustration purposes. The scenarios are amalgams of multiple observations, and not necessarily related to the actual situations when the pictures were taken. Details have been changed to make the scenarios general.
Problem Scenario 1
PA juggles caring for three patients with entering documentation.
P1.1 / 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 this new 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.
P1.2 / 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.
P1.3 / 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.
P1.4 / 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.
P1.5 / 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?
ACTIVITIES are summarized above to roughly correspond with the workflow described in Problem Scenario 1.
They are color coded by activity type: GREEN = Assess, PINK = Procedures and care, BLUE = Documentation.
In later scenarios, ORANGE corresponds to order entry, management, and review of results.
The HORIZONTAL axis corresponds roughly to the relative time taken for each activity.
The VERTICAL axis corresponds roughly to the relative level of professional effort required for the activity.
Problems: Confusion, disorientation, frustration, long waits for care.
Causes:
Travel between patient and computer adds time.
Multiple pathways to similar documentation with few orientation cues lead to uncertainty about how to document.
Not supporting bedside charting means more requirements for memorizing patient data.
Problem and Solution Scenario ExamplePage 1 of 6
Solution Scenario 1
SOLUTION:Orientation Efficiency / InsightsS1.1 / 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. / Faster treatment may improve healing.
S1.2 / Jane just arrived, and orients herself with the Tracking Board. She picks up a tablet and selects Ellen to see her vitals and what has been documented so far. Ellen is indicated as the most urgent case of three, which helps Jane decide to see her first. / Coding acuity and priority helps people organize their work.
S1.3 / Jane sets the tablet on the bedside workspace. She uses a stylus to quickly document the answers to questions she asks. / Bedside charting has mixed acceptance. Some people feel it could interfere with patient interaction, and may increase the chances for cross-contamination. Others feel that it’s a signal to the patient that they are important enough to invest in this equipment.
S1.4 / The application has been simplified so that it does not include multiple paths to separate but similar screens. There may be redundant paths to screens, but not multiple different screens for the same purpose. / Users have more confidence that they chose the right method for documentation, because there aren’t so many similar ones.
S1.5 / The application’s two levels of security help avoid loss of work. It has a screen saver that kicks in after 3 minutes but only requires a password, and it does not throw away work in progress. After 60 minutes of inactivity (both timeouts are user selectable) the system logs itself all the way out. However, in this case Jane returns to the computer in 20 minutes and can log in with only her password. Next year, the hospital is going to buy biometric fingerprint readers. / Keeping the wrong people out is important, but we can also help let the right people in faster.
Goals: Less effort, less time until treatment, less time until patient is cared for and released.
Strategies: Support tablet computing so caregivers may chart in the room. Stylus use reduces cross-contamination. Increase orientation cues to help people understand where they are in the application.
Improvements: PA assessment and documentation can overlap.
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