Living with Diabetes

Introduction
The product of our people centred research at the Endocrinology department of Hillerød Hospital is a service design concept for people who require regular medical tests – such as diabetics. Currently all medical services such as collecting and analysing blood are located in the hospital. We propose that these services be decentralised. They could be moved out to everyday locations such as gyms, cafes, grocery or health food stores or even the S-train. These are places that are already integrated in people’s daily routines and do not carry the strain or stress of being in a serious medical environment.

Users of the system could pick from a network of such clinics and have their routine tests at a place and time convenient for them. This would be less disruptive to their daily life and would allow them to be more relaxed as well as consistent with their tests. The patient information and records would remain centralised with the hospital and this in no way eliminates the patient-doctor interaction. It only streamlines the flow of these processes so that the strain on hospitals can be reduced.

This design concept is not intended for those with extreme or critical conditions requiring intensive care. It focuses on people who are stable, well adjusted to their condition and live relatively normal lives except for the regular disruption of having to visit the hospital for routine tests.

Executing such a shift would require co-operation from the hospital, the centralised health care system, smaller health care providers and owners of appropriate businesses who could house these satellite clinics.

The Context
Diabetes care is an increasingly important issue as the condition is on a steep rise. Currently more than 220 million people worldwide have diabetes. By 2030, the number of diabetics in Denmark is expected to rise to 232,000 from 157,000 in 2000 (all statistics are from WHO) In this scenario, finding newer, better ways of helping people manage and live with their diabetes is crucial. The health care system needs to find ways to scale its services to match the needs of the growing number of patients.

At Hillerød Hospital the Endocrinology department is divided into an in-patient ward and an out-patient (amubulatorium) ward. The inpatient ward deals with severe cases in which people need intensive medical care for several days. The outpatient ward conducts scheduled appointments with doctors, many of which were routine. Over time, we came to focus on the out-patient experience as it deals with patient’s long-term needs both inside and outside the hospital. It was the fact that conditions such as diabetes are not cured but something the person adapts his or her lifestyle to that compelled us to work with this department.

A typical visit to the outpatient ward invovles coming in earlier to provide your blood etc. for testing and then returning at a scheduled time to meet with a doctor to get the results. Most people have to come for such an appointment every 3 to 6 months. Appointments are not flexible as the department is very busy and rescheduling for an alternative time is hard. At the same time, delays are inevitable with doctors and nurses having to juggle a number of responsibilities. This means that patients are taking time off on working days and often find themselves waiting for some amount of time.

The consultation with the doctor is brief. People who have had the condition for a long time are well-versed with it and there is no new information the doctor needs to share with them. For some, what is more important is the emotional aspect of getting a confirmation from the doctor that everything is okay.

Gathering User Insight
In order to gain an in-depth understanding, we conducted co-creation exercises with nurses and patients. It helped us to develop a clearer picture of roles and relationships. It became clear that as well as providing medical care, a large part of the nurses role is to provide information and to encourage patients to be proactive and positive about their healthcare.

In order to understand the life of diabetics outside the hospital, we conducted interviews with some diabetics in their homes. We mapped their journey from discovering they have diabetes to their current status, through to how they see their future. We also looked at their routine hospital visits, breaking them down to the different steps and tried to understand what aspects were important to them and what they would eliminate.

A became clear to us that diabetics do not see the condition as others looking from the outside. Two quotes stood out and encapsulate this difference. More than once we were told “I am not sick”. Diabetes is not a disease, it is just another part of the person who has it. This attitude is critical to their being proactive about their care and having a positive approach to their life with diabetes. One of our interviewees said “Everyone should eat like a diabetic.” Over time they had developed a very good understanding of their body and diabetes. They felt confident managing their medication and activities and felt in control.

Design Challenges
The design challenge we set ourselves was to make visits to the outpatient clinic a seamless part of everyday life and encourage proactive attitudes toward personal healthcare. We summarised our goals in the following 3 statements:

1- Shifting the perception of diabetes from a disease that requires treatment, to simply a factor that impacts lifestyle choices.
2- Making the necessary medical visits integrate seamlessly into the individual’s daily life.
3- Promoting preventative healthcare and encouraging a comprehensive healthy lifestyle.

Exploring the User Experience
Our design concept centres around the patient experience. Though there are definite benefits to the hospital and healthcare providers, our goal was to improve the lives of diabetics. Hence, it was important for us to tell the story from the patient perspective. Realising that the idea may seem far-fetched to those who were entrenched in the current system, we knew we would need to present the idea in a manner that demonstrated that it was not so unreasonable. Finally we chose to create a video prototype to explain the entire service experience. The video narrates the story of an average user visiting a cafe with his friend at lunch time and having his test done at the clinic attached to the cafe.

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