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.  


Wednesday, April 22, 2015

How To Draw Taking Meds?

Last week performed a community design activity called 'Draw Toast?'.  If you are interested in learning more check out this TEDx video.

It is a fun way to visualize each participants perspective and easily see patterns emerge.  Below is what emerged during our activity.  There were five interesting themes that we will explore more deeply.


The five themes that became more obvious once we performed this activity were:

1. Importance of Remembering Take or Not Taken

We had had a few solutions suggested during the activity like; documenting in a log or having a family member call to check in. 

2. Distractions Are Barriers


Distractions included a pet, busy schedule, how chores, and a phone call that can get us out of our routine and prohibit us from taking our medication.

3. Taking Medication Correctly Becomes Part of A Routine or Associated with an Activity


A new insight that was identified in few community members' drawings was associating medication to an activity or routine like teeth brushing or coffee making was a helpful.  

 4. Time and Information Have A Critical Relationship To Medication


Timing and other information are an important part of taking medication as prescribed.

 5. Water or A Beverage Were Always Associate With Taking Medication


It might seem obvious but taking medication is most often linked with drinking a beverage or water.  This could be something that is explored to further strengthen or create a deeper connection between the two.  

Finally, below is the summary of the nodes clustered together.  

Check out the Draw Toast website to learn more about this fun and helpful team centered activity to move your organization closer to its goals.  

Monday, April 20, 2015

Community Design A New Way To Innovation

The Pill Pouch has entered a phase.  A phase rooted in community design.  After almost 6 years from prototype to today the Pill Pouch is helping many that share a similar story to Kathi and Stella.  Just like living organisms grow, evolve and adapt so too the Pill Pouch is entering a stage of growth and evolution.  We are doing this in the context of community.

We invited mothers, fathers, sons, daughters, grandmothers, grandfathers, designers, refiners, nurses, pharmacists to work together, in community, and we asked them to share their experience, creativity and ingenuity to come up with the next adaption of the Pill Pouch.

We started by sharing stories of health stress and success. We then used these to together define the opportunities we are working toward.

 Two themes emerged.

  1. A way to talk about taboo topics with family (aging, death, living situation, driving, advance directives, making decisions, etc.) 
  2. Getting control and changing our relationship to medication

 We used these two themes, put on our designer hats and came up with ways we can use our individual experiences and talents to collectively solve these challenges.

Our journey has begun, in community, with individuals sharing their gifts and experiences together to create something new.  Now that we embarked on this journey we can't wait to experience what emerges.