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imageWith the exception of Pawn Stars, Flipping Out, Ladies of London, and Wahlburgers, I’m not a fan of reality TV. Okay, so maybe that’s a bit of a lie. I do like a little reality TV, just not the obnoxious shows. You know the ones I’m talking about, they start with a K and a R? 

Anyway, my all time favorite reality show is NY Med, a documentary-like series following ER nurses and doctors at hospitals in NYC and NJ. Unfortunately, NY Med is no longer on, but when it was, I was obsessed. I was obsessed, mostly, because of one of the show’s featured nurses, Katie Duke. I loved her energy, specifically her motto, “deal with it.” That motto stuck with me in the early days of my husband’s cancer diagnosis (I was watching the show when my husband was first diagnosed). It still does, to be honest, which is why I continue to follow Katie on social media, including her YouTube show on the Scrubs Beat channel.

Speaking of her show, on one of her recent episodes of The Katie Duke Show, Katie and her friend and former colleague discussed how nurses are assigned patients, and debated if assignments should be made based on the number of patients needing nursing care, or by acuity. Thankfully, they both agreed that the patient-nurse ratio should be based on acuity. I say thankfully because, I mean, why would it be any other way? Think about it, why should a patient who does not need a lot of care, but obviously needs some care (otherwise, would he/she be in the hospital?) be left for last (for a lack of a better way to describe this) because his or her nurse has another patient who really requires 1:1 care?  And vice versa? 

Why am I so interested in this topic? Because I’ve spent the past six months by my husband’s hospital bedside as he deals with complications from cancer and a major infection. I’ve also experienced numerous hospitalizations with other close family members over the last few years. Between the two, I’ve seen a lot. A lot that has convinced me that making nursing assignments based on acuity is the only way to make assignments, and will always be my expectation as a healthcare consumer, whether as a caretaker or a patient.

Before I go any further, let me say that my husband’s experience has been fantastic (you know, as fantastic as a six plus month stay can be). No, really. I’m not lying. Our hospital team is amazing and is very aware of their patients needs. To say we’re lucky would be an understatement. But, unfortunately, as I mentioned above, I’ve had experiences at other institutions with other family members over the last few years, and those experiences have not been nearly as positive.  

Here’s a scenario that describes why I’m for assignments based on patient acuity.

Now, I know I just said that my husband’s experience has been fantastic, and that is the truth, but for this example I’m going to use a scenario from  husband’s stay and apply it to a setting similar to what my other family members experienced at other institutions. 

Without sharing too much (but with my husband’s permission), my husband has been hospitalized since April. At first, he was critical. How critical? Well, numerous people have told us it’s a miracle he’s still with us. Today, he’s clinically well, but still has a major open wound that requires a lot of nursing care to keep it, and the skin around the wound, clean in order to keep him clinically stable. When his wound vac leaks, and believe me when I tell you it leaks a lot (not because his care team is not skilled at doing this, but because his wound is in an awkward  position and is an awkward shape.  Awkward all around), he’s laying in liquid that is extremely bad for his skin (think bile). Laying in it too long can cause his skin to break down, which could lead to an infection, and on and on and on. He’s facing another big surgery soon, so an infection is not something we’re interested in. 

In the ICU, he obviously had 1:1 care, so we never thought much about what life would be like outside the ICU with this type of wound. But when my husband was moved to the step-down unit for a few short days, things were really bad. The dressing just would not hold, and his nurse, who I will call “Charlie” from here on, was in his room at least 8 of his 12 hour shift (give or take, a bit) trying to keep him and his skin dry while we waited for his docs to come up. Charlie also had one other patient that day. If I were that patient, or a loved one of that patient, I would be concerned about the ability for a nurse to properly care for me and/or my loved one in this situation.  In fact, I was (note: my concern was not about the a lack of skill, but by the fact that Charlie only has two hands). Thankfully, because as I’ve said before, we are in a fantastic hospital, the other nurses in the unit covered for Charlie and all patients were properly cared for (I was assured). But what would have happened if this happened at a different hospital? Let’s say a different hospital that was severely understaffed? What if (again, if we were at a different hospital) my husband’s nurse had two patients just as needy (for a lack of a better word) as my husband? Would my husband lay in fluid for too long, risking infection? Would both patients suffer?

The main reason why nursing assignments are not always made based on acuity seems pretty obvious to those on the outside— it’s all about reducing overhead costs these days. But I know there’s more to it than that. With that said, though, and even when institutions claim to be invested in the “patient experience,” staffing always seems to be done on the lower end of projections. But if the patient experience is really important to an institution, then nursing assignments should always be made based on acuity. It’s the ethical way to care for the patients who are dependent on others to get them well. 

This all said, of course, from the patient/caretaker/consumer perspective, with much respect to those who make assignment decisions! Also, like teaching, nursing is an unappreciated profession. Hug a nurse today, okay?

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The Patient Experience

I’ve spent the past four months watching my husband fight for his life in the ICU of a hospital here in Boston. I’m not going to discuss the specifics of what he is dealing with here in this post. What I will tell you, though, is that this entire experience has changed my perspective on the patient experience, a topic I’ve been focused on for the last few years. As a result, I now have a more solid idea on what I ultimately want to focus my career on—the entire patient experience.

What do I mean when I say “the entire patient experience?” I mean, I’m not going to focus on solutions solely from a technology perspective anymore, but also from the human perspective. AKA, empathy.

Empathy and the patient experience. Time to start exploring.

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San Francisco, March 2015

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I had the opportunity recently to talk to the lovely ladies from the Ladies That UX Boston group about incorporating improv techniques into our work as UX designers. It was a fantastic experience that I enjoyed very much. I hope those who were attendance enjoyed the talk as well.

Because of my strong belief that UX design can benefit from improv techniques, I want to share my talk here as well, amended slightly to better fit this platform.

So, without further ado…

In March of 2014, I took my first improv class at an improv theatre in Boston. While I was very much aware of the fact that improvisation is often said to be helpful in numerous business practices at the time I signed up, that was never my intention. My intention was to cure a severe case of the winter blues. It worked. With that said, it didn’t take me long to realize that what I was learning not only could be applied to my UX design work, but most definitely should be applied to my UX design work.

Before I go any further, let me take a minute to talk about improv itself.

What is improv?

Improvisation, or improv, is a form of live theatre in which the plot, characters and dialogue of a game, scene or story are made up in the moment. [source]

When an improviser takes the stage, he/she has no idea what is going to happen. Everything is made up on the spot with a topic suggestion from the audience.

Visuals are always fun, so here is a link to one of my favorite Upright Citizens Brigade Asssscat episodes. I should warn you, though, that while this video is not raunchy, I would not considered it to be work safe.

Go ahead and watch. I’ll wait.

Now that we have a base understanding and a visual on improv, let me answer a question you may be asking yourself—what made me think that what I was learning in improv could be applied to my UX design work? The fact that the techniques used in improv promote six important skills, skills necessary to not only create fun and entertaining improv scenes, but fantastic user experiences as well, that’s what. Those six skills are:

Collaboration. Listening. Creativity. Presence. Taking Risks. Communication.

As like designing great experiences, Improv isn’t easy. To master the six necessary skills, improvisers use the ever-popular “yes, and” technique (among others, but we’ll focus on “yes, and” for now).

“Yes, And” is defined by the Upright Citizens Brigade Comedy Improvisation Manual as the following:

“Yes” refers to the idea that you should be agreeing with any information your scene partner gives you about your reality.

“And” refers to the adding of new information that relates to the previous information.

Simply said, an improviser must take everything offered by his or her scene partner as fact, and then add on to it to heighten the scene.

For example. Let’s say you’re watching two improvisers on stage who received “duck” as a suggestion. The first improviser turns to his/her scene partner and says, “these ducks are really hungry today.” His/her scene partner would say in response, “They sure are, mom. We’ve already fed them two loaves of stale bread!”

The second improviser supported his/her scene partner by accepting his/her partner’s declaration that the ducks were really hungry, and then added on to the offer by giving us more details—they’ve already fed the ducks two loaves of stale bread.

Through a series of “yes, and’s,” a scene full of fun, crazy characters, dialogue, etc. will develop.

“Yes, and” is the foundation of improv. It’s about accepting information and adding on to it so that the scene can continue. It’s the technique that allows for anything to happen. This is a proven fact, and the reason it’s a proven fact is because “yes, and” facilitates collaboration. This is why I’ve made it my mission to make “yes, and” the foundation of my UX practice.

“Great ideas come from those who accept and build upon the ideas of others.”

To incorporate “yes, and” into my UX practice effectively, I’ve been working on mastering other supporting techniques that I learned through improv. These techniques, with brief descriptions,are:

Listening: One can’t accept what is being offered if it is not first heard. This is true in improv, UX, and, well, life. To react accordingly to what is being said, we need to be present. We need to actively listen. Active listening is when we both hear and process what is being said. When we don’t actively listen, we’re allowing ourselves to miss key pieces of information in favor of forming our response to ensure our point of view is heard. Through active listening, we can open ourselves up to fully hearing the thoughts and ideas of others, thoughts and ideas that can greatly influence the task/problem that needs to be solved. In addition, when we actively listen, we’re better equipped to make sure our own point of view on the topic is spot on when it’s our turn to speak.

Make Statements: I realize what I’m about to say next might seem strange, given the fact that a big part of our jobs as experience designers is to be inquisitive, but here it goes: Sometimes, statements are going to provide you with a lot more information than questions. In improv, I learned that questions are roadblocks, creativity killers, even. Questions put the onus on a single person to carry a scene/conversation. Questions, honestly, are exhausting. After some observation, I realized the same holds true in UX. So now, if I’m facilitating a user interview and the person I’m interviewing seems nervous, uncertain on how to respond, or is simply not fully engaged, I form my question into a statement.

There is another benefit to making statements instead of asking questions, a more personal benefit that can help you grow professionally and personally, regardless of your profession. That benefit: When we make statements, we’re showing those involved in the conversation that we own what we’re saying, that we know what we’re talking about. It also shows that we’re committed to moving the conversation forward. Don’t be the person hiding behind a bunch of questions, let your point of view shine!

Respond From The Top Of Your Intelligence:This is an interesting technique that serves as more of a guiding principle when adding information. To respond from the top of your intelligence means that you should make choices based on what you know to be true about the topic and/or situation. Don’t respond with what you think your colleagues, stakeholders, and/or users want to hear. Don’t pretend to know more, and don’t pretend to know less. Simply said, make choices that best represents the reality of the situation.

Ask, if this is true, what else is true? At a high level, adding information to an offer made by your scene partner seems easy. For the most part, it is. But eventually, to keep things interesting, you’ll need to start getting creative. Again, as with the other techniques I’ve talked about, the same goes for UX. To keep a conversation moving in a meaningful way, you’ll need to start thinking outside the box. A way to do this is to ask, “what else can be true about this reality?” For example, assuming you’re your re-designing a weather app, you know that 65% of users never view forecast information for more than the three days ahead, the default view. What else can be true about the intentions of these users? They’re using it for real time weather info, and not to help with packing for their vacation? With this technique, you can start developing additional, realistic paths to take the conversation.

One last thing that I want to mention regarding “yes, and.” Does “yes, and” mean that everything, literally everything, must be agreed to? In improv, the answer is yes. In the real world, the answer is no. In brainstorming sessions, interviews, and in life-in-general, you’re going to hear things that you don’t agree with, and sometimes you’re going to hear things that are just completely wrong. According to Tina Fey (from her book, Bossypants), the purpose of “yes, and” is to “respect what your partner has created. And to at least start from an open-minded place.” “Yes, and” means being willing to see where the “yes” will lead. Sometimes, it will lead you to the perfect solution. Sometimes it will lead you to a completely different idea than the one you started with. You never know what direction you’ll end up until you start exploring through collaboration.

Everyone can incorporate improv techniques into their practice. How one designer uses the techniques will differ from another, of course. Our environments (consultants vs. employees, etc.) will dictate how we go about doing this. For example, I often start brainstorming sessions with an improv game aimed at setting a positive tone for active listening. This might not be doable if I were brainstorming with client stakeholders, users, etc. However, regardless of how it’s done, the important thing to remember is that leading by example is key. Practice “yes, and” as often as you can. You’ll soon notice that those you are conversing with are suddenly on the “yes, and” train as well.

Disclaimer: Everything written here is based on my personal experiences, and opinions. Be advised that not everything said here will work for you exactly as it has for me, or will be appropriate for your own situation.

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A few weeks ago, I put my fear of networking aside and participated in a careers panel. For those of you who know me in real life: yes, you read that right. I didn’t just attend the event (an event hosted by Ladies That UX Boston, to be specific), I participated in the featured panel, and it was fantastic! What made it so fantastic was the fact that, in addition to having the opportunity to help answer the thoughtful career-oriented questions asked by the audience, I also had the opportunity to learn from my three sister panelists (and oh did I learn a lot!). Folks, Boston is full of talented, smart designers who are extremely passionate about this craft. Don’t let anyone tell you otherwise. I’m so lucky to be here and part of this community.

Now, I won’t recap all of the advice and personal experiences that I shared at last month’s event here, but I will share with you the one piece of advice that I believe will help enhance a designer’s (female or male) career:

Take an improv class.

Once again, yes. You read that right. The best piece of advice I can give to anyone interested in enhancing their UX career is to take an improv class. I took my first class in March of 2014 and it didn’t take long for me to realize that a lot of the techniques I was learning could, and should, be applied to my UX practice. Here are two (of many) reasons why:

1. Good improv requires active listening and team work. For example, take the popular technique, “yes, and.” In improv, “yes, and” means that an offering by an improviser is always accepted and built upon by his/her partner to heighten the scene and get to the “funny.” From a UX perspective, you can use “yes, and” to build momentum during user interviews, brainstorming sessions, etc.. By using this technique, you’ll clearly hear what your users and stakeholders are saying, and then properly help to build on their idea to get to the true want/need.

2. Improv builds confidence. In addition to enforcing active listening, improv forces you to think fast. This training prepares you for any and everything. With the ability to think on your feet, you’re going to be less fearful about taking risks and exploring new opportunities, like getting out there an networking with other designers.

I could go on and on* about how improv can help enhance a designer’s career. At the same time, I understand that the thought of taking an actual improv class can be extremely intimidating for some. Don’t let that stop you from exploring improv. If taking an actual class is not an option, grab a book (there are a lot out there!) and study the art that way. You never know, that may inspire you to take an actual class!

*In fact, I’ll be talking more about this topic during an upcoming Ladies That UX Boston event.

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