Improving cleanliness in the lab
STERILE FORM
Preventing the spread of germs in a lab and office environment.
OVERVIEW
Virginia Commonwealth University’s surgical pathology lab in Anatomic
Pathology tasked us with solving a problem. During daily intraoperative
consultations, they must take notes
in a bio-hazard environment (the lab),
and transfer the notes to clean areas.
They want to transfer the “dirty” notes from the lab to clean areas without contaminating the clean areas.
MY ROLE
Prototyping, Research,
User Research, User Interviews
Journey Mapping, Ideation
IN A NUTSHELL
RESEARCH
Our research focused on understanding the pathology lab process through lab visits and interviews. We analyzed the market and customer segment as well.
IDEATION
Touchpoint maps helped us pinpoint target areas for improvement. Our four ideas improved cleanliness with varying degrees of cost and implementation.
OUTCOME
Our recommended solution uses a printer in the lab to create a clean copy of the notes. The clean copy can safely be used by all of the lab staff.
IDENTIFYING THE IDEAL PROCESS
PROBLEM STATEMENT
Our original problem statement was to “Develop
a method to take notes in a dirty environment that
can be taken in to a clean environment, requires
one person, cost-efficient, repeatable multiple
times per day, and allows for transcription on to paper to attach to the requisition sheet.”
HUMAN-CENTERED DESIGN
DEFINING THE PROCESS
We followed the human-centered design approach to guide our process. This was our first time using the process so it was a challenging yet rewarding journey to learn with a real-world scenario.
Define
Empathize
Test
Prototype
Ideate
UNDERSTANDING THE LANDSCAPE
INITIAL RESEARCH
We set out to observe, engage, and immerse ourselves in the pathology lab's process. Before we visited the lab, we conducted preliminary research with an insights canvas, PESTLE analysis, and reaching out to other university labs, among other things.
INSIGHTS CANVAS
THE BIGGER PICTURE
Our insights canvas helped guide us in the early stages of our empathy research. It helped us see our problem in a greater context outside of the lab.
Our insights canvas
PESTLE ANALYSIS
ANALYZING THE LANDSCAPE
Our PESTLE analysis helped analyze the changing landscape surrounding the pathology lab, and the features that impact their performance.
Our PESTLE analysis (we omitted the last "E" for eco-environmental)
Each letter stands for an element of the external operating environment. They stand for Political, Economic, Socio-cultural, Technological, Legal, and Eco-environmental elements.
Overall, our biggest takeaways were
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If incorrectly created or procedure done can lead to malpractice lawsuits.
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Psychology is an important factor to consider in the process of note-taking.
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Note-taking is changing due to increased need for ease of access, information and storage.
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Changing guidelines can occur at any time at the hospital and impact the procedure due to retention of notes and new laws.
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Possible shift in priority due to aging population and decreased workforce.
MARKET ANALYSIS
SIZING THE MARKETS
We conducted a market, market segment, and target market analysis to look into the size of the potential markets both in volume and in value, the various customer segments, and the competition.
Market
The market for this product is laboratory spaces. There are many lab environments that value cleanliness and have to take or transport notes in multiple environments. This application could easily work in most lab environments.
Market Segment
There are a multitude of market segments in the laboratory environment. Ex: pharmaceuticals, veterinarian labs, cosmetology, microbiology, pathology and more. All of these provide a range of services with varying degree of cleanliness.
Target Segment
Our target market are pathology labs. They deal with the grossing of multiple specimens on a daily basis. People within the target market would be pathologists, pathologist assistants, residents, and lab directors.
Our market analysis
OVERVIEW
Overall, the university pathology labs fell in to one of two buckets; Johns Hopkins or Northwestern. Johns Hopkins is the most advanced lab with an entirely digital process. In contrast, Northwestern still takes physical notes but scans them for digital review.
Of the labs we interviewed, VCU had the most analog (and dated) lab note taking process.
HOW THEY RANK
Johns Hopkins University
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Entirely electronic process
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Audio dictation automatically creates digital notes
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Pathologist examines digital files for diagnosis
Northwestern University
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Notes are physically taken during grossing process
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Notes are scanned and uploaded to a database
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Pathologist examines digital files for diagnosis
Miscellaneous
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Specimen arrives directly in lab
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Notes taken on container
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Dirty notes and requisition sheet never leave the lab
A spectrum from analog to digital for plotting a university's pathology lab note-taking process.
UNIVERSITY PATHOLOGY LABS PROCESSES
SOURCING THE FIELD
We reached out to over fifteen different university anatomic pathology labs (eleven responses) to understand how they approach their process.
BUSINESS MODEL CANVAS
A HOLISTIC VIEW
The Business Model Canvas is a visual representation of current or new business models. The canvas provides a holistic view of the business and helps us understand the environment surrounding users.
Our business model canvas
The experience map helped to identify gaps in the process
EXPERIENCE MAP
VISUALIZING THE PROCESS
We created an experience map to better understand the note-taking process. It helped create a holistic view of the process from a user’s perspective.
EMPATHIZE
UNDERSTANDING OUR USERS
After our initial research, we were ready to conduct lab visits to record qualitative data. Observing the lab and interviewing users provided us with insights in to their process.
LAB VISITS
A CLOSER LOOK
Our initial visit was a crash course in the pathology lab grossing process. Megan (our project sponsor)
was incredibly helpful in walking us through the process and answering any questions we asked.
Summary
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Lack of cleanliness
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After written diagnosis, it’s unnecessary and dirty for people to bring notes, slides, requisition sheet back to personal office to call in
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Do they run this process seven days a week? (Yes, as stated in brief)
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Reorganizing lab is possible but a hassle
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Cerner is very old. Using third-party software is a pain because you have to re-enter information and they’re generally difficult to incorporate
This is where a specimen is received from a surgical room for initial processing.
Sorting trays are for the end of the process. This is where the notes are stored throughout the day.
This is where a specimen is received from a surgical room for initial processing.
From our first lab visit
Touchpoint map
Based on our initial lab visit we created a simple touchpoint map. We wanted to have a simple,
top-view of the process so that we could make it more accessible and easier to understand.
Our simplified version of a touchpoint map
Our second lab visit
Weeks after our initial lab visit, we came back with more questions and with the goal of creating a more detailed touchpoint map. We decided to take a deeper look at the process to better target areas for improvement. It helped us zoom in on different areas.
A more detailed touchpoint map helps identify gaps in the process
DEFINE
CLARIFYING OUR INSIGHTS
We used our empathy findings to identify compelling needs and insights. We made an updated problem statement focused on users, insights, and needs.
INSIGHTS
Following the initial lab visit, we began to understand the process and came to the understanding that there are different inking schemes, tight spaces, and reorganization of the lab is possible. Also, there is a time constraint that can cause anxiety. We found there was a lack of consistency in certain parts of the steps.
After our second lab visit, we discovered that some of our initial understandings of the process were incorrect. Initially, we believed there were multiple pathways to grossing, which is incorrect. Another incorrect initial insight was our understanding that audio dictation was not possible within the 20 minute timeline.
After additional interviews during the second lab visit, we realized the audio dictation with transcribers, which is the current approach, is impossible, but audio dictation with speech to text is a possibility. We also had new insights in our second lab visit such as anatomic pathology departments are incorporating new technologies like cameras and drives that we could incorporate into the solution.
NEEDS
The project brief stated the needs of it’s users. We also identified needs from lab visits. The anatomic pathology department is a fast paced environment that diagnosis serious conditions in small amounts of times during operations. The job entails coming into contact with bodily fluids and anything to limit this would be crucial for the lab employees.
The pathologist assistant needs to be able to transfer notes from a dirty lab to a clean environment, so that they can prevent contamination and ensure the health and well being of everyone around them.
ASSUMPTIONS
Based on our empathy research and insights, we created assumptions.
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Users are crunched for time
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They do not want to have to worry about sanitation
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We have to be aware that users could use a new notes process incorrectly due to lack of time or too complicated of a process
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We assume this is a specific problem to pathology labs.
DEFINE
CONVERGING THE DATA
After our initial empathy exploration we converged and gathered our notes to
create insights, needs, and assumptions.
“Develop an efficient, cost-effective, and clean note-taking process for an anatomical pathology lab.
It must be repeatable multiple times per day, require one person, and be
completed within twenty minutes.”
Our refined problem statement
IDEATE
WAYS TO IMPROVE THE PROCESS
Our insights provided a springboard for ways to improve the cleanliness of the note-taking process. We held different ideation sessions and exercises
to formulate four actionable solutions for the lab.
MIND MAPPING EXERCISE
ANOTHER WAY OF LOOKING
Mind mapping helped us ideate ways to improve the note-taking process by identifying spots for improvement. The exercise was a combination of a touchpoint map and a journey map. It helped prioritize our different concerns and stakeholders.
The mind map helped to identify solutions throughout the process
CHALLENGE BRIEF
CONSIDERING CONSTRAINTS
The challenge brief helped serve as a reminder of the stakeholders, materials, and scope of the project so that our solutions were achievable. Reiterating the details of the project helped us focus on ideas that would hit every criteria.
The challenge brief
HOW MIGHT WE SESSION
PIECES OF A SOLUTION
Our initial "how might we?" session helped us come together and strategically look at ways to improve the note-taking process.
Our five HMW questions
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How might we make it more cost efficient?
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How might we make it more clean?
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How might we make it more space efficient?
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How do we make it more accessible?
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How might we make it more time efficient?
Images from our HMW session
From our answers that we generated from this exercise we were able to find areas in which we could dive deeper into, as well as some areas that we still had some questions on. This is where we started to have some ideas about how we can put a process together. After this exercise we were able to come up with our first solutions.
Digital Dictation
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Requisition sheets created in lab
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Requisition sheet is scanned
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Notes are written/typed on tablet
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Slides are photographed
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Pathologists reviews digital notes, slides for diagnosis
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Pathologist assistant calls back
Anatomical Assistance
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An A.I. interface is next to tables
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Notes are recorded through audio dictation
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Once completed, ask A.I. to send file to pathologist
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Pathologist reviews, sends to A.I.
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A.I. confirms receiving diagnosis
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A.I. calls O.R. regularly and continues process
SOLUTIONS
FOUR POSSIBLE WAYS
After our ideation sessions we mapped out unique processes to improve the cleanliness of the note-taking process.
Safe Scan
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Physical, dirty notes taken in lab.
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Notes and requisition sheet are scanned in lab, then printed or digitally uploaded to folder in pathologist’s office
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Notes are brought back to dirty area for temporary storage
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Additional notes can be added and scanned to existing file
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Paperwork kept in lab and discarded after 2-3 weeks
Noteable Notes
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Notes are recorded through audio dictation
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A picture is taken of the slide and/or specimen
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Notes and slides are digitally
sent to pathologist -
Diagnosis confirmed, then a confirmation message is sent
to the pathology assistants
Feedback
The feedback from our sponsor was that a combination of Digital Dictation and Notable Notes would be best. This narrowed down our solution to one idea with varying degrees
of implementation for prototyping.
REGROUP
COMBINING TWO IDEAS
We needed to regroup after receiving feedback on our four initial solutions. They were small variations of each other, and not four distinct solutions. Due to this and our sponsor's feedback, we combined Digital Dictation and Noteable Notes. It would now be one solution with different stages of implementation.
The best way to achieve the optimal solution was by implementing it over time, in stages
PROTOTYPE
MATERIALIZING THE SOLUTION
We participated in a role-playing activity and storyboarding exercise in order to prototype
our new solution.
INITIAL PROTOTYPE
THE VARIOUS STAGES OF IMPLEMENTATION
We created a touchpoint map for each iteration of the solution. Our prioritization matrix gave context to the user value and ease of implementation for the lab and staff.
We wanted to implement a solution for the lab by the end of the semester so we moved forward with prototyping Simple Scan.
ROLE-PLAYING ACTIVITY
ACTING IT OUT
We created a role-playing activity for Simple Scan in order to discover potential issues, and see what was and wasn’t working.
The following are some insights that we received from this activity
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Are the slides dirty?
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Where is requisition sheet placed during the grossing process?
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Can the requisition sheet be placed on something instead of being given by hand?
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Is it a color printer? (needs color for inking scheme on notes)
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Should we trash to original, dirty version of the notes?
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Centralized, clean phone in lab
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Designated clean space in lab
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Clear line in process where clean materials need to be handled
STORYBOARDING
DRAWING IT OUT
Storyboarding was a helpful prototyping tool because it helpsed align expectations around the process.
Storyboarding our Simple Scan was very helpful. When our team created storyboards for the same process it helped show the different views we have of the process. The difference
in perspectives allows us to think about the process in different ways, and it helps align expectations.
We always refer back to the storyboard during our development of the solution because it’s a place of convergence that helps keep us all on the same page moving forward.
TEST
FINAL TESTING IN THE LAB
For our final prototype, we tested a working prototype in the lab. We had two lab staff members run through the process.
FINAL PROTOTYPE
REACTIONS FROM THE PATHOLOGY LAB
In a previous lab visit we setup an Epson ES-300W scanner to prepare for the future prototyping session. We had Megan and one other pathologist assistant use our solution as if they were in a live note-taking process. They replicated the entire process to see how the use of the scanner would change their existing process.
We briefed them on how to use the scanner but didn’t dictate how and when they should use it. They both used the scanner at different points in the process because it was worked more easily for them. The point in time in which they used the scanner didn’t hinder their process or speed.
One issue that arised was having to setup the scanned notes to print. In an ideal world they would be able to press the button to scan and it would automatically print. This would reduce the amount of time in the process and reduce steps.
After we ran through prototyping we asked Megan and the staff how they felt about the process. On average, in terms of cleanliness, they rated the current process at 6.5 out of 10 (with 10 being the dirtiest). They rated the new process as a 1.25 out of 10. This is an 80% increase in the perceived cleanliness of the process.
So overall, in terms of cleanliness,
they felt it was an improvement.
They felt the extra steps are worth
the improvement in cleanliness.
COST ANALYSIS
THE COST OF CLEANLINESS
Our cost analysis helped communicate to our stakeholders the real-world value of implementing a new note-taking process.
FINAL RECOMMENDATIONS
MOVING FORWARD
The initial step would be to implement Simple Scan. The next step is incorporating voice-to-text note-taking styles that would still be printed. This allows the lab to follow their daily process, but with the ability to take notes without touching the them.
The ideal outcome is moving to a digital platform. The notes could be digitally uploaded and sent to the pathologist. There would be a digital signature component, and all files would be stored online. This clears space in the storage room, cuts out transcribers, and limits the movement in the process.
The "Don't Touch Me, I'm Sterile" team
Rosette Cesar, Aamna Ikram, Megan Decker (project sponsor), and me
STERILE FORM
Learning while implementing.
CONCLUSIONS
The Sterile Form project will always have a special place in my heart. It was my first time using the human-centered design process. On a bigger level, it showed me how working with a great team can drive great outcomes.
Working with Aamna, Megan, and Rosette for the semester was a great experience because we each brought something different to the table. We were always rooting for each other, and lending our help and support throughout the process.