CASE STUDY: How might we provide expert care to an ageing and changing population?

Case Study 2

Context: In 2020 & 2021 a Masters study was conducted on behalf of the College of Gerontology Nursing New Zealand with the intention to research and propose solutions toward the question “What does expert care to a changing and ageing population in Aotearoa New Zealand look like?”.

Two students carried out the study, one a social worker and one a registered nurse in an older persons orthopedic ward. They were supported through this research by an academic supervisor from nursing as well as an academic supervisor on Human Centred Design.

This study gained high risks ethics approval through our institutional ethics committee.

Empathy:

The empathy stage started with a CONTEXT MAP. The context map is a tool used to help understand the context the challenge lies in. Headings are created to determine what is KNOWN about the challenge. Facts are collected and gaps are identified for further research. Secondary research is started. EMPATHY INTERVIEWING is carried out. Stakeholders are identified and an interview guide is created for each stakeholder. Interviews are recorded, and transcribed.

Define:

The data was coded in different ways.

An AFFINITY MAP was created for a small sub project but for the main project a CUSTOMER JOURNEY MAP was built. This customer journey map was created from the age 65 to end of life. Through this analysis THREE points on the journey were identified where a change occurred in someone’s life. These points changed the way people interacted socially and with support services. These points may occur at different ages but the nature of the change was similar. INSIGHTS and HOW MIGHT WE QUESTIONS were then developed within the CUSTOMER JOURNEY MAP.

PERSONAS were created to represent different user groups (and different stages). These personas are used to create a narrative to help people relate to the data. These personas are also used in further stages of the process to help ideate, and walkthrough their prototypes.

An excerpt from their thesis is as follows:

HOW MIGHT WE QUESTION

How might we address communication issues between family and staff in ARC? Related insights:

• A lot of staff and family commented that there is a lack of knowledge around Dementia and what it means for their loved one, for example the forgetfulness, increasing agitation, or increasing falls.
• Workers felt that they could never meet the family’s expectation of care for their loved one.
• Family often had feelings of guilt or anger when a loved one enters care and ARC staff have to manage that.
• Workers need more training in having difficult conversations with family members.
• Workers want to feel appreciated for the work they do and the care they provide to the residents.

This question addresses a theme we hear about all too often in health care. Workers do not feel appreciated and feel that families only see the negative things in relation to their loved one and that families have unrealistic expectations when it comes to resources in ARC.

Added to that is the lack of time in a workplace for workers to have deep and meaningful communication with families and validate their feelings.

Families feel guilt, anger, and grief in what is often an emotional time. Sometimes there is a feeling of powerlessness and loss of control as often the transition to ARC has followed an acute admission to hospital rather than a planned event where everyone has had time to adjust to this change.

For our research, this HMW question aimed to find ways to make communications easier between staff and families in ARC. This would have the benefit of finding ways to build rapport between each party so that any issues can be discussed more easily when it comes to the older person in care.

Criteria identified were as follows:

• Cost to benefit ratio.
• Innovative model of care
• Will it help to retain staff in ARC?
• How ethical is it?
• Does it enhance independence of aged persons?
• Impact on mental health and resilience
• Impact on family satisfaction
• Does it improve communication?

Prototype and User Test:

Low fidelity prototypes were created to gather feedback. Prototypes were:

• Four coloured concentric circles were created symbolising wrap around care of an aged person. The aged person was at the centre, with each ring symbolising family then a neighbourhood care team (the proposed solution) and the final ring of the formal circle which includes doctors, hospitals allied health support.
  To user test this solution, a description was given to the user and then on the empty circles people were asked to place what roles would be held here. This allowed them to identify what may be missing and if their idea could actually work.
• A mock up digital mood board was created representing the I want to engage with your idea. This board is for aged facility homes for family, the older person and the support workers to engage with and enhance connection. Testing was in the form of I like, I wish and I wonder while also having empty spots to ask what people thought could be added.

• Balloon symbols added with a service description of steps to understand the need for aged care workers to continue their careers. A professional development programme where feedback was asked for in the terms of I like, I wish and I wonder followed by in depth questioning of certain aspects with target stakeholders.
• A flowchart showing career progressions. This was a digital solution which anyone could see and engage with to give feedback.

Refinements:

Feedback was analysed and the top solution was tested against the PERSONAS created in the define stage. These helped to create a SERVICE BLUEPRINT which shows the interactions and the resources and processes needed throughout the use of their top idea.
A PRIMEFACT checklist was used to assess the idea as objectively as possible. This helps to validate the solution and identify ways the final solution could be made stronger.

This solution was then passed to the industry sponsor.