SOLACE
September-December 2015
COLLABORATORS
Donna Cichani Rebecca Johnson Florcy Morisset TOOLS USED Ethnographic Research Design Thinking Adobe Illustrator FINAL FORM Concept Pitch |
PROJECT SUMMARY
Our team’s original challenge was to design a product or service to improve the well-being of an under-served user group: the elderly. According to the U.S. Census’ population projections, the number of elderly Americans is going to grow significantly in the next few decades, making this under-served group more relevant than ever. My team of 4 tackled this problem under the guidance of professor Kyla Fullenwider, who is now a Presidential Innovation Fellow. We pivoted from a focus on the elderly to a focus on unpaid family caregivers after realizing the importance this crucial role has on the health and well-being of their charges. The result of our discovery research and ideation was Solace, a digital tool that connects caregivers with each other. |
Problem Definition
HOW MIGHT WE create a product or service that enables elderly citizens to fully utilize their intellectual capabilities and maintain their autonomy?
Discovery Research: The Elderly
To gain empathy for our users and understand how they could be segmented, we conducted extensive landscape research from sources such as AARP, Next Avenue, and IDEO’s Designs On: Aging. Top concerns we identified were: health care costs and difficulty navigating a complex health system, physical aging and disease, loneliness and a changing social climate, and financial insecurity.
For primary research, we visited local senior centers and interviewed family/friends who were in the elderly age group. Interview questions focused on four main areas:
Values: How do you define a good life? A successful life? A comfortable life?
Needs: Whom/What do you trust and depend on?
Identity: If you could go back to any age, which age would it be and why?
Activities of Daily Living: Are there activities you would like to do but you can’t?
Values: How do you define a good life? A successful life? A comfortable life?
Needs: Whom/What do you trust and depend on?
Identity: If you could go back to any age, which age would it be and why?
Activities of Daily Living: Are there activities you would like to do but you can’t?
Possible Areas to Explore
From that research, we created a mind map (above) to synthesize data, looking for patterns and promising ideas to see what would rise to the top for a deep dive. Here are some of the main areas we identified:
Technological savviness: How might we can incorporate pre-internet technology, or features/aspects of it, so there is a larger chance that it is inclusive for all seniors regardless of age/physiological ability?
A story-telling outlet: The elderly need an active listening outlet for their stories/rants. When you lose your fine/gross motor control and sight, there is little remaining but your ability to speak and listen. How might we create an experience that gives them an active outlet for their stories that is a productive use of time?
Caregivers: Caregivers need to be considered when we’re planning solutions for their charges. How might we also ease their burden while also delivering a delightful product/service to the elderly charges? Some seniors are losing their mental capabilities or memories and it puts a strain on their spouses, who may be afraid of communicating how dire the situation is becoming. How might we support the caretaker’s psychosocial health while they are shouldering this burden?
Housing: The independently traveling elderly may not learn about airbnb and other housing options that are comparable in price to a hostel but as nice as a hotel. How might we help them access affordable/ comfortable/ accessible housing on their budget? How might we help them to exercise their independence by helping them navigate unfamiliar cities as tourists?
Mobility challenges: Fear of falls is real. How might we prevent falls or diminish the mental or physical decline that occurs after a fall?
Technological savviness: How might we can incorporate pre-internet technology, or features/aspects of it, so there is a larger chance that it is inclusive for all seniors regardless of age/physiological ability?
A story-telling outlet: The elderly need an active listening outlet for their stories/rants. When you lose your fine/gross motor control and sight, there is little remaining but your ability to speak and listen. How might we create an experience that gives them an active outlet for their stories that is a productive use of time?
Caregivers: Caregivers need to be considered when we’re planning solutions for their charges. How might we also ease their burden while also delivering a delightful product/service to the elderly charges? Some seniors are losing their mental capabilities or memories and it puts a strain on their spouses, who may be afraid of communicating how dire the situation is becoming. How might we support the caretaker’s psychosocial health while they are shouldering this burden?
Housing: The independently traveling elderly may not learn about airbnb and other housing options that are comparable in price to a hostel but as nice as a hotel. How might we help them access affordable/ comfortable/ accessible housing on their budget? How might we help them to exercise their independence by helping them navigate unfamiliar cities as tourists?
Mobility challenges: Fear of falls is real. How might we prevent falls or diminish the mental or physical decline that occurs after a fall?
Problem Re-Definition
After this initial research, we realized that many of concerns that the elderly had were related to their dependence on others. Those with a high-quality ecosystem and access to a reliable support system were more likely to thrive. Due to this revelation, we chose to pivot our focus away from the well-being of the elderly to the well-being of the elderly caregiver.
HOW MIGHT WE create a product, tool or service for caregivers to decrease their level of concern for senior member(s) of their family?
HOW MIGHT WE create a product, tool or service for caregivers to decrease their level of concern for senior member(s) of their family?
Discovery Research: Caregivers
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We learned that 34.2 million American adults have served as an unpaid caregiver to someone aged 50 or older in the past 12 months (American Association of Retired Persons).
The economic impact of this burden is huge because the caregiving demands often force people to miss work or retire early, resulting in forfeited wages or loss of productivity due to absenteeism.
The economic impact of this burden is huge because the caregiving demands often force people to miss work or retire early, resulting in forfeited wages or loss of productivity due to absenteeism.
We also took advantage of the national focus on caregivers from companies like AARP and Johns Hopkins Hospital to increase our understanding of caregiver needs.
We sat in on a virtual AARP caregiver fair to observe what resources were available and what attendees were asking. The major insight from this experience was that attendees were less interested in the more organized resources and instead drawn to the chat room where everyone was sharing stories, swapping hacks, or posing 'Is it just me, or...' questions. Very few questions were posed to the "experts," because caregivers considered each other to be the experts.
We sat in on a virtual AARP caregiver fair to observe what resources were available and what attendees were asking. The major insight from this experience was that attendees were less interested in the more organized resources and instead drawn to the chat room where everyone was sharing stories, swapping hacks, or posing 'Is it just me, or...' questions. Very few questions were posed to the "experts," because caregivers considered each other to be the experts.
We also contacted Johns Hopkins Hospital’s Panagis Galiatsatos, a Pulmonary Physician and director of the ‘Called to Care’ Initiative, to observe the launch of the campaign. During this event, a room in the Bayview hospital was set up with pamphlets, a curated library of resources for caregivers, and medical professionals on hand to answer questions.
Similar to the AARP Caregiver fair, however, the caregivers who attended did not spend time browsing resources, but instead sought out people, such as the chaplain or other attendees, to seek comfort or share their experiences.
In both cases, the attendees were lured under the promise of resources, but they stayed not for the experts, but for the peer-to-peer support. These two experiences, in addition to our interviews, led to the big insight that there is ample existing information for caregivers, but it won't be absorbed and accessed unless there is a human element to its delivery.
Similar to the AARP Caregiver fair, however, the caregivers who attended did not spend time browsing resources, but instead sought out people, such as the chaplain or other attendees, to seek comfort or share their experiences.
In both cases, the attendees were lured under the promise of resources, but they stayed not for the experts, but for the peer-to-peer support. These two experiences, in addition to our interviews, led to the big insight that there is ample existing information for caregivers, but it won't be absorbed and accessed unless there is a human element to its delivery.
Through our interviews, the main areas of concern and need we identified were:
1) Guilt. Many caregivers expressed guilt over wanting their time or money back, yet also guilt when they did take time for themselves.
2) Shame. Caregivers admitted to unkind feelings or thoughts about the caree.
3) Resistance to identifying as a caregiver. Most people were not fond of this word because it implied that it was their job, whereas to them it was just something they were going to do, no question.
4) Resentment for family. Many expressed resentment that they had stepped up to take on the caregiver burden when other family members stayed less involved.
5) A need for validation. When we interviewed caregivers in a group, they often searched for and gave validation to others that feelings of guilt or shame were normal.
6) A fear of being incompetent. Caregivers felt stressed that they were responsible for activities and roles that they had not been trained in, such as medication dispensing, lifting, and overseeing other activities of daily living.
Ideation
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Using what we had learned from discovery research, we were ready to ideate. We structured our ideation session by using Brian Hurt's article 'Five Levers for Social Change' as a direction for five distinct, insight-driven ideas.
While we built out five concepts, I lack the space to explain them all here so I will deep dive into one (which we did not incorporate into our final concept). For the policy change approach, we tackled an oft-heard challenge for caregivers: How do I talk to my elderly loved one about surrendering their drivers license?
We found through both our caregiver and elderly interviews that when effects of aging change the dynamic of relationships, especially parent-child, it is often met with resistance or denial by the older party. Suddenly the child finds themselves in a position of power over their parent, especially regarding legal decisions or decisions related to the parents' well-being. This can be jarring to the parent, who is used to being not only autonomous, but in the position of having to care for the child. The upset in decision-making power is readily seen through the tough conversation about when the parent is no longer safe to drive.
We gained empathy for the elderly for their fear of losing control, but we also found it interesting that the caregivers in these situations were so sure that they would not be so resistant to surrendering their licenses when their time came. Our human response is to expect that our decision-making processes will be more logical when we are put in the same position.
To fight this faulty human bias, we designed a policy change that would capture the foresight of 'I will act differently' and encase it in a legal document.
We discovered that currently in Maryland, all drivers over 40 must pass a vision test at each subsequent driver’s license renewal. Our idea was to push that further, also requiring drivers over 50 to complete a “Driving Exit Plan,” which outlines the timeline and metrics they will follow in the future to decide when to decrease driving frequency or relinquish their license altogether. These plans, which constitute legal documents, would require a co-signer who is liable for ensuring that the stipulations of the plan are followed. The co-signer must be present at the time of renewal.
This policy change would make it easier to have a conversation around license surrendering because it is something expected, mutually agreed upon, and there is a larger onus on both parties to consent. The DMV could provide coaches to help lead the conversation, using the document as an objective mandate. Or we could all just have self-driving cars in the future and this will be all for naught!
While we built out five concepts, I lack the space to explain them all here so I will deep dive into one (which we did not incorporate into our final concept). For the policy change approach, we tackled an oft-heard challenge for caregivers: How do I talk to my elderly loved one about surrendering their drivers license?
We found through both our caregiver and elderly interviews that when effects of aging change the dynamic of relationships, especially parent-child, it is often met with resistance or denial by the older party. Suddenly the child finds themselves in a position of power over their parent, especially regarding legal decisions or decisions related to the parents' well-being. This can be jarring to the parent, who is used to being not only autonomous, but in the position of having to care for the child. The upset in decision-making power is readily seen through the tough conversation about when the parent is no longer safe to drive.
We gained empathy for the elderly for their fear of losing control, but we also found it interesting that the caregivers in these situations were so sure that they would not be so resistant to surrendering their licenses when their time came. Our human response is to expect that our decision-making processes will be more logical when we are put in the same position.
To fight this faulty human bias, we designed a policy change that would capture the foresight of 'I will act differently' and encase it in a legal document.
We discovered that currently in Maryland, all drivers over 40 must pass a vision test at each subsequent driver’s license renewal. Our idea was to push that further, also requiring drivers over 50 to complete a “Driving Exit Plan,” which outlines the timeline and metrics they will follow in the future to decide when to decrease driving frequency or relinquish their license altogether. These plans, which constitute legal documents, would require a co-signer who is liable for ensuring that the stipulations of the plan are followed. The co-signer must be present at the time of renewal.
This policy change would make it easier to have a conversation around license surrendering because it is something expected, mutually agreed upon, and there is a larger onus on both parties to consent. The DMV could provide coaches to help lead the conversation, using the document as an objective mandate. Or we could all just have self-driving cars in the future and this will be all for naught!
Prototyping
![Picture](/uploads/6/0/5/9/60598659/9283538.png?558)
The idea that we chose to prototype was to create a digital tool to connect caregivers with each other through the guise of access to organizational tools and resources.
Because we sought to reach early adopters, we used Everett Rogers' 'Diffusions of Innovations' (the summary, by Les Robinson, is linked here) to help us decide what the tool would do and wouldn't do. A snapshot of our decisions, based on the 5 qualities that determine the success of an innovation, are listed below.
Relative advantage: Design the interface with bright, positive colors that convey energy (see right), unlike existing tools which are predominantly red and have strong medical undertones.
Compatibility with existing values and practices: Allow access to archived conversations for people who have specific, searchable concerns.
Simplicity and ease of use: Sync the tool with existing organizational platforms, like Google Calendar.
Trialability: Let caregivers try out the tool on a tablet or computer while they are waiting in the hospital or doctors office.
Observable results: Track caregiver mood so that they can see the correlation between their well-being and use of the tool.
We incorporated these features into our concept, then showed a paper prototype to caregivers for their reaction. Their feedback informed the development our final concept.
Because we sought to reach early adopters, we used Everett Rogers' 'Diffusions of Innovations' (the summary, by Les Robinson, is linked here) to help us decide what the tool would do and wouldn't do. A snapshot of our decisions, based on the 5 qualities that determine the success of an innovation, are listed below.
Relative advantage: Design the interface with bright, positive colors that convey energy (see right), unlike existing tools which are predominantly red and have strong medical undertones.
Compatibility with existing values and practices: Allow access to archived conversations for people who have specific, searchable concerns.
Simplicity and ease of use: Sync the tool with existing organizational platforms, like Google Calendar.
Trialability: Let caregivers try out the tool on a tablet or computer while they are waiting in the hospital or doctors office.
Observable results: Track caregiver mood so that they can see the correlation between their well-being and use of the tool.
We incorporated these features into our concept, then showed a paper prototype to caregivers for their reaction. Their feedback informed the development our final concept.
Final Concept
Our final problem/opportunity statement:
People thrust into the unfamiliar role of caregiving often feel isolated, stressed and ill-equipped.
By providing organizational tools and a platform for caregivers to connect with each other, we can support their emotional and logistical needs.
People thrust into the unfamiliar role of caregiving often feel isolated, stressed and ill-equipped.
By providing organizational tools and a platform for caregivers to connect with each other, we can support their emotional and logistical needs.
Core Features and Page View
The core features of Solace all promote the caregiver's well-being, with the understanding that a competent and healthy caregiver will do a better job. Organizational tools would decrease logistical stress and social modules such as the live chat would encourage peer-to-peer connections. The platform can be shared among family members to keep everyone on the same page and encourage more participation.
The core features of Solace all promote the caregiver's well-being, with the understanding that a competent and healthy caregiver will do a better job. Organizational tools would decrease logistical stress and social modules such as the live chat would encourage peer-to-peer connections. The platform can be shared among family members to keep everyone on the same page and encourage more participation.
Positioning
We saw a gap in the market for caregiver tools that are dynamic and service oriented. The Johns Hopkins Called to Care Initiative and AARP already understand the economic value of investing in the caregivers. While they are well-meaning, however, they are not positioned for flexibility. Both missed the core element of what will attract AND keep caregivers engaged: an emphasis on the human factor of resource delivery. Because they will already understand the value of this venture, we will use these organizations as key partners to help promote and finance the Solace beta.
We saw a gap in the market for caregiver tools that are dynamic and service oriented. The Johns Hopkins Called to Care Initiative and AARP already understand the economic value of investing in the caregivers. While they are well-meaning, however, they are not positioned for flexibility. Both missed the core element of what will attract AND keep caregivers engaged: an emphasis on the human factor of resource delivery. Because they will already understand the value of this venture, we will use these organizations as key partners to help promote and finance the Solace beta.
Revenue Stream
Patient compliance is financially beneficial to insurance companies and health care providers. Therefore, with their financial backing, caregivers and carees can access it for free.
Patient compliance is financially beneficial to insurance companies and health care providers. Therefore, with their financial backing, caregivers and carees can access it for free.
Case for Return on Investment
Solace will be beneficial to hospitals and insurance providers because it will increase patient compliance, reducing hospital readmission. To prove the return on investment, we have used numbers from the University of Maryland Medical Center and re-admissions for patients with chronic heart conditions.
Solace will reduce the re-admissions by 40%, based on studies on effect of patient and caregivers engagement and the rate of readmission reduction for heart failure and pneumonia.
Therefore, with Solace, 30 day re-admissions will reduce from 345 to 207. Based on re-admission cost and the penalty multiplier, the readmission penalty will reduce from $1,725,000 to $1,035,000.
That results to an annual savings of $690,000 for this one hospital and this one illness.
Solace will reduce the re-admissions by 40%, based on studies on effect of patient and caregivers engagement and the rate of readmission reduction for heart failure and pneumonia.
Therefore, with Solace, 30 day re-admissions will reduce from 345 to 207. Based on re-admission cost and the penalty multiplier, the readmission penalty will reduce from $1,725,000 to $1,035,000.
That results to an annual savings of $690,000 for this one hospital and this one illness.
Challenges and Learnings
During the course of this project, I learned how important it is to have team members with different skills and knowledge areas than you. For instance, while my forte in this process was during the research and interviewing phase, my teammate Rebecca thrived during the UX and prototyping phases, Donna was the analytical superstar who came up with the revenue model, and Florcy was the team challenger- always forcing us to question our assumptions and prove how our ideas were linked back to insights. The balance of skills made this project a success and allowed us to learn from each other.
The team dynamic also proved challenging, however. We changed course and pivoted rapidly in the 8 week semester, and it was very difficult to stay on the same wavelength while so many decisions were made, especially during team meetings where not everyone could attend. It forced us to really understand and articulate why we were pursuing one idea over another so that every team member continued to feel ownership of the direction of the project. This was particularly difficult after the ideation session when there were many good options to pursue and we had to come to consensus on our final direction.
The team dynamic also proved challenging, however. We changed course and pivoted rapidly in the 8 week semester, and it was very difficult to stay on the same wavelength while so many decisions were made, especially during team meetings where not everyone could attend. It forced us to really understand and articulate why we were pursuing one idea over another so that every team member continued to feel ownership of the direction of the project. This was particularly difficult after the ideation session when there were many good options to pursue and we had to come to consensus on our final direction.