This is a process blog of my learnings from Stacie Rohrbach’s Learner Experience Design course taught in the School of Design at Carnegie Mellon University, Spring 2019.

January 15 — Class 1

Hi there! My name is Amrita and I’m a Master’s student in the School of Design (MA). Before Carnegie Mellon, I was working in customer support and project management at Fitbit. I’m very grateful for my work experience because it led me to Design and to CMU.

UPMC Readings — Main Takeaways

Background: Our class will be working on a project sponsored by UPMC. This project will focus on educating patients, physicians, and caregivers to reduce readmission rates at local medical facilities. At this stage, we’re currently researching the problem space.

January 17 — Class 2

  • A significant contributing factor is the misalignment of healthcare plans and healthcare systems.
  • Patients discharged to skilled nursing facilities (SNFs) represent a large part of those readmitted. There is an opportunity here to reduce both readmission rates and costs.
  • Currently, the patient discharge process is a chain that is susceptible to fragmentation, lack of coordination, and poor communication.
Source: CMU Transition Design
  • Reach out to a few friends working in healthcare for more insight (doctors, nurse practitioners, pharmacists, and community outreach coordinators).

Andrew Reading

I enjoyed diving into the mind in this chapter about Perceptual Blocks. Andrew’s relatable and humorous tone made this a fun read.

  • It’s inherent within the mind as it decreases the huge task of information processing.
  • Context is very important when it comes to memory.
  • This block leads us to solve for symptoms, rather than core issues.
  • Appropriate problem isolation is largely due to the “tendency to spend a minimum of effort on problem-definition in order to get to the important matter of solving it.”
  • How do problem-solvers then isolate problems appropriately? Problem definition seems to be a very important step.
  • This block and the previous block made me think about how important it is to frame and reframe problems with due diligence. How problem-solvers approach a problem guides what solution ends up coming out of it.
  • The broader a problem can be thought about (within reason), the more room there is for conceptualization.
  • This discussion also made me think about how complex and integrated our world is. Andrew mentions that as we continue zooming out when defining a problem, we “usually [become] involved in interdisciplinary considerations.” This is a little overwhelming to think about because every problem then becomes a wicked problem.
  • Vertical vs. lateral thinking: breakthroughs usually result from lateral thinking.
  • Based on Andrew’s description, this block is more than just information overload. It includes the inability to recall information.

January 22/24 — Classes 3/4

It was great contextualizing Andrew’s Perceptual Blocks reading through in-class “blockbusting” activities. Overall, I like the step by step process we’re taking in this class. We’re building an arsenal of theory, applying it within our own contexts, and then bridging over to the issue of UPMC readmissions. This step-by-step process is helping me expand my thinking and problem-solving abilities and start asking relevant questions.

  • Old TVs: Our prior experience influences our current perceptions. We should consider how much information is based on the present or in the past.
  • Closed refrigerators: We are used to seeing things at rest or in their static states.
  • It’s important to understand what useful information might be missing from the initial view of the problem space.
  • Moving among levels of scale, zooming out and back in, can help reframe problems.
  • This block will be especially important with the UPMC readmissions issue.
  • It’s important to consider what things we do on autopilot.
  • When thinking about UPMC, are there things that patients, nurses, doctors are doing that make the task difficult because they are glossing over necessary info? Where are UPMC rituals and where are there opportunities in the routine to intervene or tweak?
  • Sometimes, we can provide a more lasting, richer experience if use more senses.

January 28 — Class 5

During this class, we took a deep dive into Dirksen’s chapter about learning styles, discussed Bernice McCarthy’s 4MAT system, and started an activity related to the 4 quadrants.

Discussion of Dirksen’s chapter on learning styles
Source: 4MAT website

Dirksen Chapter 3

It was great to dive deeper into Dirksen’s discussion about learning goals. Defining clear, intentional, and specific learning objectives is the best course of action when designing a learning experience. This not only helps define objectives in the minds of a learner but also helps guide designers as they develop a learning experience.

  • Setting a destination
  • Determining gaps
  • Deciding the pace of learning
  • What are they actually going to do with this information?
  • How will you know if they are doing it right?
  • What does it look like if they get it wrong?

February 4–Class 6

Stakeholder mapping
  • Personalized care
  • Patient support system (friends, family, case managers)
  • Fragmentation and miscommunication between points of the care process

February 6 — Class 7

Defining Stakeholder States and Bridging Gaps Activity
  • What are the bad or problematic things that can happen if these issues are not addressed?
  • Skills: Learning takes practice. Learners are not given ample time to practice skills or use the information given. They need to move to active learning.
  • Motivation: Learners lack motivation (extrinsic/intrinsic). A good question to ask is how can you get people on board?
  • Environment: The space or context may not be conducive to a learning experience. Even if it’s good, the amount of time spent in the space may not be enough. As an example, it’s common for nurses and doctors to have expert bias with information, running through it quickly during the discharge process. A patient, however, may need more time to process this information.
  • Communication: A central question is how are going to frame information or choreograph the experience in a way that makes sense to a learner? There is a big design component here/form matters.
  • Is it a fast/slow skill (pace learning)? This refers to the amount of time necessary to acquire skills. Changing a mindset or views, ones that may be ingrained over time is difficult. How do we begin to help people to make this shift? How do we address slow skills? Pace layering is important here. Mental models are helpful for pace layering. If we can help learners see the snowball effect of learning, that’s good. At this stage, we begin to break things into chunks and get a sense of the bigger picture. But, this requires reinforcement.
  • How sophisticated must the learners understanding be (Bloom)? Refers to the action words associated with each type of learning. What do you want people to do? How do you know they are beginning to grasp everything you are trying to teach them? How do you measure?
  • Sufficient: Do people have enough to complete the task. Which prior experiences can you pull?
  • Appropriate: Is it appropriate to the task? Does it call up the right prior experience learners can actually leverage?
  • Accurate: About debunking misconceptions. This is where you get into slow skills. What you can pull from past experience and how can you do it in a way that helps people move past misconceptions (misconception about physicals, communication among doctors)?

February 12 — Class 8

This class session was fun-filled. We played musical chairs and discussed the intersection between game theory and learning.

Pre-game: coming up with a system // Mid-game: buy-in achieved + End-game: maintaining rules & expanding imagination
  • Through a process of trial, error, and discussion, we developed a system.
  • Comradery built as we played the game.
  • Buy-in increased when we saw the game successfully unfold within the framework we had created.
  • When it came down to two people, the fairness of the game was called into question. We could have either chosen to maintain our existing rules or modify based on context. Although we choose to maintain our rules, it was interesting to this resistance develop.
  • Feedback: What do rules constitute?
  • Immersive: The game takes you to an immersive, encompassing space.
  • Imaginary: builds the imagination. This is where designing the space comes into play.

Ambrose reading

Value-Expectancy Model (Ambrose)
  • Intrinsic: The internal desire to participate.
  • Instrumental: extrinsic motivation.
  • Expectancy-positive/negative: what are the variables and their range between positive/negative?

12/14 — Class 9

We started this class by finishing up the magic circle activity from last class.

Magic circle exercise

Dirksen Chapter 5

Key points from Dirksen’s chapter on attention:

  • Add surprise: Give unexpected rewards that learners don’t know are coming. Remember surprise can also be scary. Create a dissonance. This occurs when you have two competing mental models the create disparate ideas. This reconciliation can be turned into a teachable moment in a person’s/learner’s mind.
  • Show shiny things: pique curiosity with the novel, the mysterious, or the visually compelling. This is also connected to the idea of dissonance. Also, connects to rhetorical question in which learners should be shown instead of told. Rhetorical questions that will cause learners to think critically.
  • Peer pressure: not in a negative way, but in a way that leverages collaboration or low stakes competition.
  • Leverage habits: Creating a learning experience that integrates well into habits or previous experiences. Problems occur when people have to adapt to completely new ways of living. How can we help scaffold important changes?

12/19 — Class 10

During this class, we first debriefed about our Ambrose chapter 2 and Dirksen chapter 4.

  • It’s important to help build mental models. How do we address the space between a current mental model and a preferred mental model?
  • If we provide multiple learning structures within an experience we can promote flexibility for learners with different styles. The more options we give them, the more engaged they will be with the process.
  • Conscious incompetence: start to know what you don’t know
  • Unconscious incompetence: you’re a novice, you don’t know what you don’t know
  • Unconscious competence: expert knowledge (One issue here is “expert blind spot.” Experts may have issues working with novices.)
Ideation / Prototype

2/21 — Class 11

We had two guest lectures, Laura and Suzanne. Both are working on a study that involves elderly patients facing chronic heart conditions. The shared insights from their literature review, but could not share specific findings from their research. A few main takeaways:

  • Elderly patients may live alone and have to deal with the administrative complexities of post-care. These complexities include transportation, medical appointments, and filling medications.
  • The presence of misinformation on the internet contributes to declining patient health. If an elderly patient reads about treatment without checking in with their PCP, this may cause complications/decline in health.

2/26 — Class 12

We began this class by discussing readmission problem statements provided by UPMC. As we start to work on the readmission issue, it’s important to start framing the problem-space with a little more focus.

  • Memory
  • Knowledge acquisition
  • Understanding the purpose/relevance of directions. This relates back to 4MAT structure where the why is being skipped over straight to into the what. Patients may be receiving information, but do not understand it’s purpose.
  • Issues with planning and organizing (shelves from Dirksen). 1) How information needs to be linked to things you’ve learned before and 2) how do you connect new information to things you’ve done before.
  • Competence and confidence
  • Expert vs. novice
  • Unconscious competence / conscious competence
  • Attention and motivation
  1. Interpret: storytelling and how it translates or connects to something
  2. Apply: use knowledge in some way — active learning / can apply knowledge to specific situations
  3. Perspective: understand points of view / critical
  4. Empathy: grasp someone else’s perspective. Relate to another perspective
  5. Self-knowledge: knowing what you do and don’t know (conscious competence)
  • Understand this in the broader context of their lives. For example, how this care routine will help them transition back to more normal lives.
  1. Your doctor gives you a dietary guideline, but then you apply that within the context of your grocery store or when you visit a restaurant.
  1. Patient: Understanding why they should communicate with their support system / decreasing guilty they may feel post-discharge for burdening their support system
  2. Understand doctors perspective: Goes hand in hand with understanding purpose — if you better understand the rationale behind why you’re taking certain meds you’re more inclined to take them. Doctors have different perspectives so giving patient’s visibility into that.
  1. Patient having more empathy for a doctor — could lead to a patient understanding rationale behind certain meds or med routine and how that will lead to a better lifestyle change long-term
  2. Patient community: giving a patient a point of reference and understanding that they are not the exception. Getting them to see other people’s stories provides greater context/visibility and perhaps motivation to take care of themselves.
  1. What is their competency/ability to implement their process or control themselves? For example, avoid bad habits that contribute to declining health (e.g., smoking)
  • How do we gauge where they are as learners?
  • How can we facilitate personalized feedback based on our knowledge about where they are?

2/28 — Class 12

We began class by discussing our readings. The main takeaway from this discussion/readings is the idea of directed practice and feedback. We can give opportunities to learners that allow them to try things out and get some sort of feedback. Ambrose talks about targeted, goal-oriented feedback.

  • Formative: more progress/growth based
  • Feedback should be linked to what, where, and how

3/5 — Class 13

During this class, we explored UPMC’s readmission issue individually and with partners.

  • How to get patients to buy-in to their own personal care
  • Post-hospital care that’s personalized to a patient’s lifestyle
  • How can the hospital account for the social factors that influence a patient’s ability to take care of themselves after
  • How can we get buy-in from a patient’s support system? Or buy-in from a patient to allow their support system to be involved?
  • Can we leverage learning experiences with lifestyle coaches? Lifestyle coaches most involved with patients outside of the hospital/post-discharge.
  • Patients with an exhaustive medication list. Helping them remember their medications/reducing cognitive overload. During research, the clinical care workers asked a patient to discuss their specific medications, doses, and uses.
  • Patients that can change dietary habits?
  • Lifestyle coaches — core?
  • Support system — secondary?
  • Patients understanding the value/purpose to taking their meds post-discharge
  • Patients understanding where they can get their meds post-discharge
  • Six facets of understanding
  • Defining learning experiences and bridging gaps
  • Attracting attention
  • Stages in the development of mastery
Learning theories
  • Where: when the patient is still in hospital after care has been administered (maybe not immediately post-care).
  • Lifestyle coach intervention: providing information at this checkpoint. Having a lifestyle coach might imply that a patient is better able or more committed to post-care maintenance. This is important because one issue that came from research is that it’s really up to a patient to drive discharge care. The hospital provides/connects a patient with the resources that it can, but it can’t necessarily go beyond that (e.g., to a patient’s home to make sure that they are no longer smoking). This is why patient buy-in is very important.
Notes from partner discussion

3/7— Class 14

During this class, we spent time thinking about our project’s focus. I spent some time discussing ideas with Stacie, Chen, and a few class members.

Summarized Notes

Problem-space

Helping patients with newly diagnosed chronic but manageable illnesses manage care long-term.

Main Questions:

  • How can we create a system that supports patients with the foresight that they might fail in caring for themselves?
  • How might we create a system that boosts a patient within and outside the hospital space? How do we help people recover from setbacks?
  • How can we create a patient support system with the foresight that patients may take a few tries to integrate their new care practices/routine into their life outside of the hospital?
  • How might we help them manage care long-term?
  • How do we design a learning experience that accounts for regression? Or that has the foresight that learners may fail at something?

Who are you designing the experience for? (specific learners and/or stakeholders)

Patients in their 30–50s who are newly diagnosed with chronic but manageable illnesses.

What do you intend for them to learn (skills, knowledge)? What do you need to teach them?

Still pushing to define that “what.” The cycle of practice and feedback will be very helpful in helping define this further.

Why is it important for them to learn this? What is the value?

Can help patients better manage and feel support as they shift their lifestyle, integrate new habits, and change their behavior. It’s important that they feel supported through inevitable setbacks outside the hospital.

When do you foresee the experience taking place (doesn’t need to be specific time but rather a timeframe)?

This experience will reoccur during various points during moments within and outside the hospital (scaffolded learning, reinforcement).

  • During hospital stay
  • Discharge (touchpoints: doctors, clinical case managers, staff they encounter when checking out of hospital)
  • At home with caregivers

Where do you envision the experience taking place (describes the context, eludes to affordances, points to medium)

Within the hospital and outside the hospital

Important Methods:

Practice and feedback

Next steps:

  • Continue pushing at the “what”
  • Propose ideas that would fit into the above components perhaps within in different contexts listed.

UPMC Passavent Visit

We met with 2 clinical case managers from UPMC Insurance working in UPMC Passavant Hospital.

  • Has 9 years of experience
  • Previously worked at Mercy hospital in Shadyside
  • 5.5 years of experience
  • Previously worked at UPMC’s hospital in Shadyside
  • Primary patient at Passavant hospital is older
  • Both clinical care case managers work with patients with UPMC Insurance — so they never really see issues with insurance
  • The mentioned that things do get a bit messy for patients with Medicare or medicate
  • Both see patients in the acute phase. They only work with patients for 3–4 days, might be as short as 40 minutes right before discharge.
  • The experience for post-discharge care is very subjective:
  • Every patient is different, and clinical care managers have to meet them where they are at
  • There are many social factors that contribute to a patient’s ability to maintain post-discharge care
  • Or, for example, change has to come from the patient. If a patient has COPD/been smoking for 20 years, they won’t stop immediately even if it’s critical to the health.

Don Norman: Artifacts & People

This chapter is a chapter in Don Norman’s book Things that Make Us Smart. It deals with representation and fitting the artifact to the person.

  • Internal (hidden)
  • Can apply this to the body /(EG X-ray competent to show how much body is getting — moving abstract to more concrete — making internal more apparent)

Interaction Designer | Carnegie Mellon University, School of Design | MDes ’21

Interaction Designer | Carnegie Mellon University, School of Design | MDes ’21