Monday, May 18, 2015

Totem...Taken or Not

Totem...Taken or Not

We did one of our favorite community activities...we call it the 'and' activity.  Each person in the community writes an idea on a piece of paper.  On Friday the question was "share an idea for how to identify whether or not you took your medication?"  Then we pass the paper with the idea to the right.  The person to the right adds to the idea and passes it to the person on their right.  An example:
1st person wrote: "Every time you take a daily dose of medication you have an item that inspires happy memories (like a picture or a memento) and you move that item along a game board.
2nd person wrote: "And you reward yourself when you complete a row"
3rd person wrote: "And take a picture of the item and text it to your son or daughter or whomever the item reminds you of and then they know you took your medication"
And so on....
After about 20 minutes five new stories of new ideas emerged.  We came up with ideas from coffee cups with lists of medication and indicators to matrices with a place to check off each time you took it associated to favorite TV show schedule to a log book to flipping the bottle of the taken dose over.

There were a few common patterns that were present in the ideas:

  1. Tactile and visual - every idea had a visual indicator and something you touched to move or indicate
  2. Reward - There was a reward associate with take the medication either a treat or moving along a game board or indulging in chocolate
  3. Purpose - A couple of the ideas leveraged an individual's purpose or interest to reinforce the positive habit of taking medication.  Example: taking medication so I can watch Jeopardy or so I can go golfing
  4. Place - Was important part of each idea.  Coffee table, kitchen counter, night stand.  Many had a strong association with place
  5. Order - All of the ideas had the medications already in good order, in the right place for the right times.  
Although we don't know if the next adaption of Pill Pouch will include a totem or  not it was a very helpful practice to understand the world that medication and health lives in and what are some potential barriers, obstacles and opportunities.   Until next week...


Monday, May 11, 2015

Feelings, Interests and Routines these are a few of our favorite things...

"When I wake up, if I am in a bad mood from too little or too much sleep I get out of my routine, " share Mr. Chaos also known as Mr. Don Carter.

This week it was all about routine.  We started by looking at our own daily routines and we noticed a few unique things that may help us as our design fits into and enhances a person's life, gives them control and a sense of freedom.



The patterns that we identified were: 
  • Attitude- Attitude can affect routine (too much or too little sleep, natural rhymes, bad dreams all can affect attitudes in the morning).  "Pills can add to the drag of the day and become the benchmark"
  • Feelings- Understanding how a person feels about taking their medication and their health is important
  • Interests/Motivations - Understanding a persons interests or motivation is key arrive at a shared understanding why a medication is important to allow them to be able to participate in their interests (time with family or grand kids, golfing, gardening, etc.)
  • Common Cultural Anchors - There might be a similar cultural anchor (i.e. watching Jeopardy) that can be a shared point in routine that can create strong association to taking medication.
Routines are unique and personalized.  How could our design allow each person to review and identify their own routine and how and why medications fit into their daily routine.  "Pills don't push you around you should be the pill pusher," from Christine Gloss.  A funny way of saying that the day shouldn't revolve around medication but the medication should be fit into the existing daily routine.  

Also Ed Marsh quickly put on his actor hat and played a doctor/patient conversation.  "Mr. Smith, how are you feeling about your condition and taking this medication.  Oh, you are not sure you want to take your medication?  You are a golfer right Mr. Smith.  You know taking this medication will help you more quickly get back on that golf course."  Like a professional motivational interviewing coach, Ed quickly and precisely acted out a vignette of the feeling and interests part of our discussion.  Understanding a persons feelings and their motivations are the foundations of allowing the change to fit into their existing routine and make it a sustainable change. 

The outcome of our session was that have a set of questions or principles that allows each person or their those involved in their care to recognize their routine, identify how and where medication fits into their routine, understand there feelings about the medication and understand why taking medication is an important step to continue to enjoy their interests.

These are the questions and principles we identified:
  • How are you feeling about medication?  
  • What things to you want to be able to do? 
  • Be aware of the role of mood and identify mood changing activities or behaviors
  • What is my daily routine? (What time do I wake up? when do I eat? what is the first thing I do in the more? is there anything I do every evening and where does that happen?)
  • Slow and Small - Only make one change at a time and once that change has become routine work towards the next.  
It is about living an individual and personal interest centered life not medication centered life.  

Tuesday, May 5, 2015

Change Isn't Easy

Our fun and lively community started off this week's design session with sharing our favorite DIY projects.  By the end we were talking about sledge hammers and bobcats that can rip down houses.  Starting off this way you think we might have only seen the proverbial nails, but we went way deeper.

The conversation covered all five questions that emerged from the previous week's conversation but really was rooted in the importance of routine.  Christine shared a story of her friend Frank who was recently discharged from the hospital and they told him to take a new medication at 9am and 9pm. Because they didn't ask Frank about his habits, he stays up late so he sleeps in until 11 or Noon, that would not be feasible for him. If he was asked maybe they would have suggested he take the medication when waking up and twelve hours later. This was only indicative of a greater challenge.  Here is what we discussed and learned together:
  • When taking medication and making changes these changes need to fit into existing routines in order for the changes to last  
  • Every person is unique and has a very personal routine
  • Having a way to assess and understand our own routine and how a habit or medication change fits that routine is important
  • Doctors, nurses and pharmacists could benefit from understanding a patient's routine and helping them integrate these changes into an existing routine. 
  • Finding a keystone habit like; reading the paper, making or drinking coffee, making breakfast, brushing teeth are very personal and import reinforcing habits that can create a strong association to taking medication as prescribed
  • It is about "understanding my world and how medication fits into my life" not letting this new medication control my life.  This is the control we want and need.
The question that we were left with was:
  • Is there a way for an individual or their medical professional to assess their current routine and identify a personalized way to integrate their prescriptions successfully into this routine? 
This is what we are going to explore this coming Friday.  Our personal daily routines and what patterns and process exists to identify keystone habits that can help a person have control over their medication.

In addition to this conversation we also performed the 'How To Draw Toast" activity around how we would advise someone to 'have control of their medication' now that we have had several weeks of conversation.  Here is what emerged:

A brief, brief, brief synopsis of the picture (caution this is early in the design so some things seem a bit out there):

  • Personal rewards like doing the morning crosswords, having cup of coffee or eating piece of chocolate are self reinforcing and may help create a lasting habit.
  • A totem could be something physical like flipping over a med bottle or moving a magnet or it also could be tied to an activity (making coffee, feeding cat, etc.)
  • Establishing a personalized routine is critical in all drawings
  • As humans we are blessed with many attributes that can be stimulated by the design:
    • Visual - background contrast and the physical characteristics of the medication are important
    • Brain/Knowledge - Knowledge is confidence and knowing what each pill looks like, why it is being taken and how should it should be taken is the first step to freedom
    • Conversation - conversations with doctors, pharmacists, nurses and even friends and family are helpful and knowledge building
    • Smell - A trigger that smells like coffee could help create a positive connection to taking medication
    • Sound - An alarm that sounds like Chopin and inspires images of birds, butterflies and bees it is relaxing.

Finally, Sue shared a great tool she and her husband Andy created to keep track of all important medical information including prescribing doctor, a complete list of doctors, pharmacy contact, insurance information and allergies (see below)


Monday, April 27, 2015

Control = Freedom = Happiness

The Power of Community-led System Design

The stories that were shared last week were the complexity and stress of managing chronic conditions.  Many of our friends, family members, clients, patients,  neighbors live this struggle everyday.

This week we reviewed our 'Draw How To Take Medication' and the nodes that emerged from the activity.  

Our review of these nodes and the patterns that emerged inspired a rich dialogue that further deepened our understanding of the complexity and patterns in managing chronic conditions and the medications that are a part of this fight.

We shared laughs about the importance of place (using a different bathroom = a smell from not wearing deodorant) and a story about Moses (not to be confused with Charlton Heston/10 commandments Moses - ask Kathi to tell you the hilarious story)

We started by exploring the connection between Routine -> Place -> Remembering.  Bev told how important in her work, as an occupational therapist (OT), that she learn her client's, with traumatic brain industry, previous routine.  Because everything new needs to fit into an existing routine or else the change would be too great for the client to adopt.  

Routine (including Place) and Habit Are Critical 

We talked deeper about keystone habits, from Charles Duhigg's book, the Power of Habit, and how an association to habit is a powerful way to form new or strengthen existing habits especially taking medication as prescribed.  This included the power of place that in inextricably linked to habit.  Much like the Japanese Kanban that transformed Japanese manufacturing place and routine our powerful.  How does routine become part of this system?     

Medication History Helps at Doctors and In Emergencies

Sue discussed the importance of having medical history along with medication information. She includes; past surgeries or episodes, conditions, doctors names and phone numbers, next appointments, medical power of attorney. advance directives, DNR (Do Not Resuscitate) and ICE (in case of emergency) contacts.  There are tools out there like St. Mary Mercy's Plan In A Can  and File of Life and Advance Directives.  How would a system work that integrates medication with medical history?
Take or Not Taken = Important

Remembering whether or not we took our medication was an unanimous challenge when taking medication, vitamins or supplements.  A little bit of a stretch but we made a connection to the movie Inception, because Leonardo DiCaprio's character had a Totem to tell what world he was in. Sue has a totem to tell where or not she took one important medication she takes seperately on an empty stomach. 


After taking this critical medication, Sue turns the bottle over as the indicator that she took her pill that day.  Bev added "it could be like an airplane toilet, Occupied or Vacant".  Could we design a totem that is familiar, integrated and becomes part of a routine?

Control = Freedom = Happiness

A deep, human and emotional theme seems to be control.  If a person feels controlled by their medication, their mental health wanes (meds (can) = depression) and the physical health follows.  But if a person can gain control over their medication, condition and health they have the freedom to live life.  Our quick with a quip, Ed Marsh declared "Control Frees Us To Live Life".  Freedom is Happiness.  How does this system give people control and the ability to experience freedom?

Five Senses To Freedom



Finally, we talked about the importance of using all our senses.  Touch, Taste, Sight, Smell, Sound.  Color to indicate morning and night.  Braille or texture for low visibility.  Background color (black, blue, red) to maximize contrast with each pill.  Bracelet or Watch as a wearable accessory that goes with us everywhere.  A magnifying glass to see details on each pill.  A gumball machine with the sound and visual of the gumball rolling down.  How do we engage all our senses in the design?  

Next week we will explore these five questions.