Human-Centered Methods For

Designing In Healthcare

Created for:Digital Innovation & Consumer Experience

Thomas Jefferson University & Jefferson Health

Julie Guinnjulie.guinn@jefferson.edu

@julieaguinn

Copyright © 2017 DICE Group

Designing In Healthcareoverview

ABOUT THIS BOOKLET

Healthcare is still new terrain for user experience designers. This booklet is intended to help both designers and healthcare professionals promote a human-centered approach to improvement and innovation in healthcare environments, products and services.

FOR DESIGNERS

Use the Designing in Healthcare cards to help navigate healthcare-specific regulations, relationships, and environments, and avoid common pitfalls. Use the Design Technique cards to quickly explain design and innovation methods to colleagues and collaborators who are new to design.

FOR HEALTHCARE PROFESSIONALS

Use the Design Technique cards to explore essential human-centered methods and begin incorporating them into your work. Use the Designing in Healthcare cards to introduce basic healthcare regulations and protocols to colleagues and collaborators who are new to healthcare.

The information in this booklet is not intended to serve as legal advice and should not substitute for legal counsel. The information presented is not exhaustive, and readers are encouraged to seek additional guidance to supplement their knowledge and understanding.

METHODS & TOPICS

Creative Problem Solving ................................................................... 1

Designing With Patients ......................................................................3

Designing With Doctors ......................................................................5

HIPAA ......................................................................................................9

Review Boards..................................................................................... 11

Interviewing ......................................................................................... 13

Observation ......................................................................................... 15

Story Download .................................................................................. 17

Affinity Diagramming .........................................................................19

Problem Statement ............................................................................21

Brainstorm ...........................................................................................23

Brainstorming Rules ...........................................................................25

2 x 2 Matrix ..........................................................................................27

Dot Voting ........................................................................................... 29

Prototyping ..........................................................................................31

Concept Feedback .............................................................................33

Iteration ................................................................................................35

1

Creative Problem Solvingintroduction

WHAT & WHY

Creative problem solving, also referred to as design thinking, is an iterative, collaborative, human-centered approach to understanding complex challenges and developing novel and innovative solutions.

PHASES

Creative problem solving is characterized by distinct phases or problem solving ‘modes’. Use the color-coded titles at the top of each card to identify methods tailored for each of the phases below.

EMPATHIZE

Deeply understand the audience for whom you are designing, their environment, goals, motivations and physical and emotional needs.

DEFINE

Articulate the problem or design challenge you will take on based on the empathy and insights you have developed about your audience.

IDEATE

Go beyond the obvious, seek out inspiration, and explore a wide variety of solution directions for the challenge you defined.

NARROW

Develop criteria to evaluate your ideas and select the most promising ideas to develop in more detail.

PROTOTYPE

Create tangible objects and artifacts that people can interact with in order to communicate and further explore your idea.

TEST

Share your prototypes with your audience in their natural environments. Gather feedback on your idea and decide how to proceed.

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EMPATHIZE

DEFINE

IDEATE

NARROW

PROTOTYPE

TEST

DESIGN CYCLE

The phases of creative problem solving form a natural cycle of learning and refinement. A project may begin anywhere: with a problem, an opportunity, an idea, or a product already in market. Regardless of your starting point, iterating through multiple phases over multiple cycles is critical for developing successful solutions.

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Designing With Patientsdesigning in healthcare

WHAT & WHY

Designing in healthcare presents unique challenges. Common activities such as interviewing, observing and prototyping become more complicated when combined with specialized healthcare regulations, unfamiliar clinical protocols, sensitive subject matter and vulnerable participants. The guidelines below can help you anticipate and avoid common pitfalls when working in healthcare environments.

HOW

Introduce yourself to the staff. It’s essential the staff in the unit where you will be working know who you are and what you’re doing in their space. The care team is responsible for their patients and may be accordingly suspicious of strangers. Ideally, have someone they know and trust introduce you and your project in advance and accompany you on your first visit.

Get permission. Ask which patients are appropriate to approach. Most units have a central nurses’ station where the charge (head) nurse sits and can help with this information. Find out which nurses are assigned to the patients you plan to visit. Make sure they are informed about your project and that you have their permission before interacting with their patients.

Check for patient room precautions. If present, they will be posted on or directly next to the door. They indicate any special actions that must be taken before entering. Two precautions to be aware of:

• Contact precautions: indicated when a patient has harmful germs that can be spread through physical contact. Visitors should wear a gown and gloves. 

• Droplet precautions: indicated when a patient has harmful germs that can be spread through droplets from their nose or mouth, such as by coughing or sneezing. Visitors should wear a mask and eye protection.

4

“Foam in, foam out”. Always sanitize your hands before you enter a patient room and again as you leave. Sanitizer dispensers are usually mounted outside the door. While you are in the room, avoid behaviors that could transfer germs, such as rubbing your eyes, nose, or mouth, coughing or sneezing, or handling objects in the room unnecessarily.

Introduce yourself to the patient. When working in healthcare facilities, it is especially important to explain your role. Patients may automatically assume you are a member of the clinical staff or care team. Make it clear up front who you are and that you are not a doctor (unless you are!)

Respect patient privacy, before, during and after. Be mindful of privacy regulations, especially when debriefing after a design session or discussing insights with team members. Review the HIPAA and IRB cards for additional guidance.

• Do not discuss patient information in public areas, such as elevators.

• Do not leave or display patient information where it might be visible to others.

• Make sure to store and dispose of data containing patient information securely, including shredding paper notes.

TIPS

Make sure your vaccinations are up to date, including for the yearly flu virus. This protects both you and patients. Though regulations vary by state, healthcare facilities increasingly require staff who interact with patients to be vaccinated against certain diseases.

Find a place to sit. Patients will usually be sitting or reclining in bed. Try to get to eye level when conducting interviews or surveys. But avoid sitting or leaning on the bed itself, as this can disturb equipment.  

Develop your bedside manner. It goes without saying to be sensitive when working in healthcare environments. Rely on your instincts for determining what’s acceptable in a given situation. Be attentive to non-verbal cues and be prepared to quickly assess situations and match your approach to suit them.

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Designing With Doctorsdesigning in healthcare

WHAT & WHY

Design and medicine have very different professional cultures. The resulting mismatches in expectations can get in the way of collaboration. In order to work effectively with physicians, it helps to understand the values that shape their profession.

• Hierarchy: Experience, measured in years of practice, is highly valued. It is common for recommendations from senior team members to be accepted without question.

• Standardization: Following proven, standardized protocols is expected. Treating patients with new or creative methods that have not been validated is considered unsafe and irresponsible.

• Accountability: Physicians are held directly accountable for their patients’ health outcomes. With their patients’ lives and their own reputation and license always on the line, they tend to be understandably averse to taking risks.

• Autonomy: In part due to the level of responsibility and accountability physicians are required to take on, they expect to be able to practice to the best of their ability without interference.

Physicians’ work environment also has implications for collaboration.

• Schedule: Physicians’ working hours can vary widely and unpredictably based on their shift, patient load and patient acuity. 12-hour shifts, seven-on/seven-off rotation schedules, working nights and weekends, or being on-call 24/7 are not uncommon.

• Location: Physicians move from room to room treating patients. They do not always have dedicated, private office space or even personal computers. They often rely on shared spaces and resources in their limited downtime.

• Accessibility: Physicians spend much of their day interacting face to face with patients and other providers, often while standing or moving between locations. Opportunities to check and respond to emails and other communication is limited and often relegated to personal time.

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HOW

Engage the right sponsors. Physicians’ culture of autonomy combined with the siloed yet interdependent nature of most health systems means projects often need multiple supporters in order to succeed. Specifically, you’ll need at least:

• A clinical champion: a respected, practicing physican or nurse who can influence clinical staff at your site.

• An executive sponsor: a senior administrator, ideally with a clinical background, who can align resources and remove obstacles.

• An operational driver: a staff member with the time, familiarity and access to wrangle clinical staff, data and permissions at your site.

Tell the right story. Physicians care about patients and data. To gain their support, frame your project in terms of how it will impact patients’ wellbeing or the physicians’ ability to care for them, and provide hard numbers whenever possible.

Work on their terms. Physicians are expected to focus on caring for patients and typically have very little time allocated for non-clinical activities. When they meet with you, it will often be on their personal time. Use your time with them wisely and be prepared to be flexible about when and where you meet.

TIPS

Be visible and accessible. When working in a new unit or practice, make it easy for potential collaborators to discover and approach you. Plan to spend time in their space, present at a staff meeting or weekly conference and leave behind contact and project information—and be patient!

Let doctors talk to doctors. Working as a designer in healthcare requires humility. Often, the best way to ensure a project is successful is for physicians themselves to feel a sense of ownership over it. Invite them to help shape your approach and to present it to their peers.

Keep it low risk. Lean in to risk aversion by breaking projects into smaller phases. Frame interventions as temporary, short-term learning opportunities. Use early phases to collect data that will build the confidence to move forward with later phases and larger interventions.

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WHO

You may work with medical students and doctors at many different stages in their training and career. Below are some of the most common roles you may encounter.

Medical School Students. Medical school in the U.S. is 4 years. The first two years are typically a mixture of classroom and lab time. The last two years focus on gaining clinical experience. Students are not referred to as doctors until they graduate, obtaining their M.D. or D.O. degree.

• First- & Second-Years: Students in their 1st or 2nd year of medical school, sometimes referred to as MS- (medical student) 1s and 2s.

• Third- & Fourth-Years: Students in their 3rd or 4th year of medical school. During these years, students complete clinical “rotations” in various disciplines, such as cardiology, surgery and internal medicine.

Post-Graduate Training. In the U.S., doctors are required to have additional training beyond medical school in order to obtain a license.

• Interns. Doctors in their first year of post-graduate training. (Not to be confused with Internists, who are internal medicine doctors). Doctors take the final step of the medical licensing exam at the end of their intern year.

• Residents. Doctors who have completed their internship and obtained their medical license, who are pursuing additional training in a specialty. Residency programs vary from 3-7 years depending on the specialty.

• Fellows. Doctors who have completed their residency and have elected to gain additional training in a specialty or sub-specialty.

Attending. A doctor who has completed their training in full and is working independently in their specialty. In a teaching facility, attendings may oversee medical students, interns and residents.

Chair. A doctor who oversees all the doctors in a department, such as cardiology.

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Licensing Exams. In the U.S., doctors must be licensed by the states in which they wish to practice. The United States Medical Licensing Exam (USMLE) is taken in three stages or ‘steps’:

• Step 1 is taken after the 2nd year of medical school.

• Step 2 is taken after the 3rd year.

• Step 3 is taken after the intern year.

Board Certification. An additional application and test completed after residency that certifies a doctor has expertise in a specialty. Though not required to practice in a specialty, board certification is increasingly common and expected.

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HIPAAdesigning in healthcare

WHAT & WHY

HIPAA, the Health Insurance Portability and Accountability Act of 1996, is a set of federal statutes intended to improve the functioning of the U.S. healthcare system. The Act is comprised of sections, called Titles, which regulate a range of healthcare-related subjects, from group health plans to provider IDs. However, when people talk about complying with HIPAA, they are usually referring to the Privacy and Security rules under Title II.

The Privacy and Security rules establish national standards for:

• Use and disclosure of certain health information (called protected health information or PHI) by certain organizations (called covered entities).

• Individuals’ rights to understand and control how their health information is used.

• Physical, technical and administrative safeguarding of PHI.

PHI is defined as information related to an individual’s health, the provision of healthcare, or payment for healthcare, that identifies the individual or could be used to identify them. PHI may be in any form or media: paper, verbal or electronic.

The Rules apply to health plans, healthcare clearinghouses, and most healthcare providers, collectively referred to as ‘covered entities’. They also regulate the non-employee ‘businesses associates’ of covered entities (e.g., software vendors) that handle PHI on their behalf.

Understanding what is and isn’t PHI and the regulations regarding how you may use it and how you must protect it is critical when conducting design activities in healthcare settings. HIPAA violations can result in substantial fines, sanctions and even loss of license.

HOW

Get trained. HIPAA training is readily available online and is one of the easiest ways to become familiar with the regulations. Consult HSS.gov or your organization’s Privacy Officer for more information.

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Consult an expert. Even with training, it may not always be clear how the regulations apply in a given scenario. Additionally, organizational policies can vary. It is critical to reach out to your Office of Human Research (OHR) or Privacy Officer for clarification and guidance when planning design projects that involve patient data.

Plan ahead. If you can design your project so that it does not involve PHI, you can avoid concerns about HIPAA entirely. If you must use or disclose PHI, always limit it to the minimum amount needed to accomplish your project goals.

Get appropriate authorization. You are permitted to use PHI for research purposes if you obtain the signed permission of the individual, called an authorization. Without an authorization, you may only use PHI for research purposes under certain limited conditions, including if you:

• Obtain a waiver of the authorization requirement from your institutional review board, or

• Use only data that has been de-identified according to HIPAA standards. (HIPAA specifies 18 types and categories of identifying information, such as names, medical record numbers and IP addresses).

Contact your OHR for guidance and copies of the appropriate forms.

TIPS

The Privacy Rule does not require an authorization or an IRB waiver to use PHI as part of ‘healthcare operations activities’, sometimes referred to as quality improvement activities. A study that is conducted to assess or improve local care delivery may be considered an operations activity rather than research if the primary purpose of the activity is not to develop generalizable knowledge. Your OHR can help determine whether your design project falls into this category.

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Review Boardsdesigning in healthcare

WHAT & WHY

An Institutional Review Board (IRB) is an administrative body established by an organization to review proposals for research that involve human subjects. IRBs have authority to approve, disapprove or require modifications to research activities. Their purpose is to protect the rights and welfare of subjects by ensuring research is conducted in accordance with federal, institutional and ethical guidelines.

The U.S. Department of Health and Human Services (HHS) requires human research that receives federal funding, or is used in FDA submissions, to undergo institutional review. The Code of Federal Regulations (Title 45 CFR Part 46) establishes the structure and responsibilities of IRBs and the criteria they must use to evaluate research. The regulations are sometimes referred to as the Common Rule. Though HHS regulations only apply to federally funded research, most institutions voluntarily apply them to all human research.

Design activities frequently involve human participants. Depending on your organization’s policies and the intent and characteristics of your project, it may require IRB review.

HOW

Do your homework. Familiarize yourself with the definition and regulation of human subjects research. A few basic terms are defined below. Consult HSS.gov or your organization’s Office of Human Research (OHR) for more information.

• Human subject: a living individual about whom an investigator conducting research obtains data through intervention or interaction with an individual, or identifiable private information.

• Research: a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalizable knowledge.

• Generalizable knowledge: knowledge that is drawn from systematic qualitative or quantitative investigation that may be applied outside of the investigation from which it was derived.

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Consult an expert. The federal definition of human subjects research is broad (see above) and organizational interpretations and policies vary. It is critical to reach out to your local OHR for clarification and guidance.

Apply good judgment. Even if your study does not qualify as human subjects research or does not require IRB review, you should strive to respect the rights and welfare of your participants. At a minimum, have a senior team member review your protocol to ensure that risks to participants are minimal and appropriate privacy precautions are in place.

TIPS

Certain lower risk human research activities, such as surveys, interviews and some observations may qualify for exemption from IRB review. Additionally, IRB regulations do not apply to so-called ‘operations’ or ‘quality improvement’ activities. These activities focus exclusively on:

• Implementing a practice to improve the quality of patient care.

• Collecting patient or provider data regarding the implementation of a practice for clinical, practical, or administrative purposes.

• Measuring and reporting provider performance data for clinical, practical, or administrative uses.

Service and experience design activities often fall into the above categories. Nevertheless, IRB review may still be required if your project involves the characteristics below.* Contact your OHR for guidance.

• It seeks to develop or test new knowledge beyond current science and experience, such as new treatments.

• It randomizes patients into different intervention groups.

• It follows a fixed protocol, with a rigid goal, methodology, population, time period, or other rigid attributes.

• It involves substantial participation by researchers who have no ongoing commitment to the improvement of the local care situation. 

• It is funded by outside organizations, such as the NIH, or ones with a commercial interest in the results.

• It requires an intentional delay in the implementation of results.

• It involves risks to participants that are greater than minimal.

* Based on The Hastings Center Report: The Ethics of Using QI Methods to Improve Health Care Quality and Safety

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Interviewingempathy technique #1

WHAT & WHY

Engaging people in a structured, purposeful conversation is one of the most valuable and versatile techniques in a human-centered designer’s toolkit. It can be used throughout the design process to develop empathy, refine problem understanding, inspire solutions, gather concept feedback and test hypotheses.

HOW

1. Create a guide. Define the topics you want to cover and list key questions for each. The list should serve as a reference and reminder during the interview, not a rigid script. It should be flexible enough to be rearranged on the fly and accommodate unexpected lines of inquiry.

2. Assemble a team. Aim for a team of 2 to 3 people. It’s difficult to take notes and pick up subtle details when interviewing alone. But bringing too many people can intimidate the participant and over-crowd the space.

3. Assign roles. Each team member should have a role, for example interviewer, note-taker or photographer. The interviewer leads the discussion and creates opportunities for others to ask questions.

4. Set expectations. Introduce yourself and the goal and overall format of the interview. If you want to record or take photos, ask for permission.

5. Build rapport. Start out with broad, basic questions and ease into more specific or emotionally-charged topics.

6. Record what they say. Keep your notes as objective as possible. Capture the participant’s actual language and separate any personal interpretation or commentary.

7. Be polite. Respect the participant’s time by starting and ending on schedule. Regardless of the outcome, thank them and emphasize that their feedback is valuable.

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TIPS

• Phrase questions neutrally. “What do you think about buying gifts for your spouse?” is a better phrasing than “Do you like shopping?” because the first question doesn’t imply a “right” answer.

• Avoid yes/no answers and generalizations. You want to encourage a conversation by eliciting rich stories and real examples. Ask about specific instances and occurrences, such as “Tell me about the last time you…”

• Don’t suggest the answer. Even if a participant pauses before answering, don’t help them by suggesting an answer. This can unintentionally encourage participants to conform to your expectations.

• Don’t be afraid of silence. You may feel an urge to ask another question when there is a pause. If you allow silence, participants can reflect on what they’ve just said and may reveal something deeper.

• Ask why. Even when you think you know the answer or it seems obvious or self-evident, ask participants why they do or say things. The answers will sometimes surprise you.

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Observationempathy technique #2

WHAT & WHY

Watching people, activities and environments without interrupting them allows you to see how people actually behave and to uncover unexpected social and environmental factors that may impact your solution. In surveys and interviews, participants may misremember or fit their answer to what they think is normal or expected. Direct observation can help compensate for these issues.

HOW

Structure and focus are critical aspects of observational research—they make the difference between simply watching something and actually studying it. Use the four techniques below to help focus on important aspects and activities rather than trying to capture everything.

1. Timing. Use a stop watch or log book to establish the length and relative timing of tasks and events.

2. Counting. Use a simple tally sheet to objectively measure and compare the prevalence of different types of people, things or activities in a space.

3. Mapping & Diagramming. Use floor plans and flow charts to record how people, objects and information move through space and reveal meaningful patterns in complex interactions.

4. Taxonomies & Frameworks. Use standardized categories to organize field notes and ensure you don’t overlook things. Frameworks also make it easier to compare and combine notes across team members. Choose one of the frameworks below or create your own:

AEIOU: activity, environment, interaction, object, user

CATPOET: context, actor, task, process, object, explain, trigger

NOABS: need, objective, activity, breakdown, solution

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TIPS

• Don’t judge. Just observe and engage users without the influence of value judgments about their actions, circumstances, decisions, or “issues.”

• Be truly curious. Strive to assume a posture of wonder and curiosity, especially in circumstances that seem either overly familiar or uncomfortable.

• Note what’s missing. Make sure to take note of things that are not there as well as the things that are. Sometimes, things you expect to see but don’t lead to deeper insights.

• Be patient. Observing can feel dull. Give it enough time for patterns to emerge. It’s worth it.

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Story Downloaddefinition technique #1

WHAT & WHY

A technique for building shared knowledge across your team and beginning to process research observations. Sharing stories allows team members to come up to speed about what others saw and heard in the field. By listening to one another, probing for more information, and providing alternate recollections or interpretations, team members can draw out more insight and meaning from their individual experiences.

HOW

1. Unpack. Individually, review your notes for each research participant or session. On sticky notes, capture anything that stands out to you—observations, quotes, inferences, surprises. Headline one item per note with a thick marker.

Capturing items on individual notes makes it easy to shuffle and sort them later. Using a thick marker ensures items are legible from a distance.

2. As a team, one by one, share and discuss the research sessions you attended. It may help for the team to focus on one participant or session at a time.

3. When it’s your turn, describe where you went, who you met and what you did, and then talk through your notes about things that stood out to you.

4. When it’s not your turn, listen closely to your teammates’ stories, learnings and hunches. If you attended the research session with them, chime in with additional observations. If you did not attend, ask questions to draw out more detail and clarify things you don’t understand.

5. As team members share their stories, place the related notes on a whiteboard. If the discussion triggers additional stories, make sure to capture and add them as well.

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TIPS

• This process is best done the day of an interview or after a day in the field. Share stories while your experiences and perceptions are fresh.

• If you have a large team or many sessions to cover, try having team members share just their top 3 to 5 observations to start.

• Using a unique sticky note color for each research participant or session will make it easier to identify patterns across sessions and weed out duplicate notes.

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Affinity Diagrammingdefinition technique #2

WHAT & WHY

A technique for organizing and analyzing large sets of data. In essence, it consists simply of grouping similar items together to illuminate latent patterns and relationships. The technique supports innovation because categories emerge organically from the data. The process of discussing and agreeing upon categories also builds shared understanding among team members.

HOW

1. Gather the items you want to diagram. Items can be virtually anything—observations, quotes, images. Each item must be represented individually, for example on sticky notes.

2. Distribute items among your team members. As a team, one by one, share and discuss each item and place it on a whiteboard.

3. Items that are obviously similar should be placed in close proximity. However, at this stage, focus on discussing and posting the items, don’t get bogged down trying to find siblings for every item.

4. Once all items have been placed, have a smaller team of 2 to 3 people reorganize them into “affinity groups”—groups of items that “go together” or are similar or related in some way. This may involve adding to, dismantling, or combining nascent groups created earlier.

5. When the groups are complete, give each a descriptive name that captures the unifying characteristic or theme.

6. Review the diagram together to ensure that everyone has a shared understanding of the groups.

7. Depending on the items being analyzed and the resulting number of affinity groups, you may want to spend additional time identifying meta-categories.

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TIPS

• If there are more than 8 people, gathering around a common area may not be convenient. In this case, one person can handle all the note-placing. Simply gather notes from each participant as they read them aloud and place them on the display.

• Create a “parking lot” close to the display for ideas that don’t appear to fall into a natural category.

• Don’t get bogged down arguing over a name for a category. If there’s disagreement over which name to use, apply them all and move on.

• Redundancy is good. Don’t discard notes because they’re already represented. It’s helpful to leave repeated items posted since it may indicate something meaningful about the frequency or saliency of the content.

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Problem Statementdefinition technique #3

WHAT & WHY

A technique for narrowing a broad design challenge or problem space to a specific, actionable problem. A clearly articulated problem statement helps you align team members and ideate in a directed manner. It also serves as an artifact that can be validated with users and stakeholders.

HOW

1. Provide each team member with a copy of the problem statement template below.

2. Individually, have team members generate a problem statement by filling in the 5 phrases. Write each phrase on a separate sticky note to easily experiment with different ways of articulating the problem.

3. As a team, one by one, share the problem statements you generated. It may help to post them up side by side. Discuss and resolve any discrepancies or conflicts, especially about your user.

4. Document the problem statement you will solve for. This may be one of the statements generated earlier or a new statement that emerged from the discussion.

TEMPLATE

I amuser description

goal or outcome

problem or barrier

root cause

emotion

I am trying to

But

Because

Which makes me feel

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TIPS

• The person described in the problem statement should be vivid and unique. Try to specify at least 3 characteristics including something about their environment or context. If you find yourself using words like ‘average’ or typical’ you are being too broad.

• The root cause should not imply a solution. Try swapping out “because…” for “if I had…” If the resulting phrase makes sense, it contains an implied solution.

• A good problem statement should be true, insightful, actionable and exciting. Use these three basic questions to evaluate your problem statement:

Who says? Is the statement supported by findings from users?

What’s new? Does it frame the problem in a new way?

Who cares? Is this work worth doing? Is your team excited?

• If your team cannot come to consensus around a single problem statement, try sharing several variations with users to gain more insight into what’s important to them.

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Brainstormideation technique #1

WHAT & WHY

A technique for quickly generating new ideas and incorporating diverse perspectives by leveraging the collective creativity of a group. Conducting a brainstorm creates a distinct period of time when team members can intentionally turn up the generative part of their brain and turn down the evaluative part.

HOW

1. Provide each participant with sticky notes and a thick marker to record their ideas. Capturing ideas on individual notes makes it easy to shuffle and sort ideas later. Using a thick marker encourages headlining and ensures ideas are legible from a distance.

2. Clearly display the goal or topic of the brainstorm and present any relevant data or insights to help ground participants.

3. Review the rules of brainstorming provided on a separate card. Be ready to enforce these throughout the session.

4. Quiet ideation. To balance different thinking styles, spend 2 to 3 minutes capturing initial ideas individually. Headline one idea per sticky note, large enough for everyone to read.

5. Share. Go around the group and share your ideas out loud, placing the related note on a whiteboard. Keep explanations to a minimum—say just enough for the group to grasp your idea and move on. Long explanations sap energy. If participants have a lot of ideas to share, have everyone start with their top 3.

6. Build. As each participant presents, others should chime in with new ideas or builds inspired by the presenter. Be sure to capture these additions on individual notes as well.

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TIPS

• If you have more than 8 participants, consider breaking them into groups to generate more ideas and maintain a higher level of engagement.

• Be mindful about the space in which you conduct a brainstorm. A good rule of thumb is that all members of the group should be able to reach the whiteboard or display in two steps.

• Be thoughtful about who you invite. The last person you want in a brainstorm is someone who, instead of coming up with ideas, only talks about why the ones already mentioned won’t work. Not only does that kill creativity, but it shifts the group’s mindset from generative to evaluative.

• To re-energize a group when the stream of ideas has slowed, try:

Adding or removing constraints from your problem or solution space.

Applying analogies and metaphors: e.g., “What if our product were like [other type of product or experience]?” or “How would [company or brand x] solve our problem?”

Solving the opposite problem: e.g., “How might we increase customer churn?” Then reverse the solution ideas you generate.

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Brainstorming Rulesideation technique #1

Defer JudgmentDon’t dismiss ideas or spend time analyzing why they would or wouldn’t work. In a brainstorm, any idea is a good idea. Capture it and move on to the next one.

Encourage Wild IdeasEmbrace even the most out-of-the-box notions because they may be the key to solutions. The whole point of brainstorming is coming up with unexpected and creative ideas.

Build on IdeasNo “But…”, only “And…”. Sometimes, people say silly things but there is a nugget of inspiration in it. When you build on ideas, you might bring those silly ideas back down to earth and make them real innovations.

Stay FocusedAlways keep the discussion on target. Though a brainstorming session may seem light and fun, it requires discipline and self awareness to maintain a generative mindset focused on a single problem.

One Conversation at a TimeNo interrupting, no dismissing, no disrespect, no rudeness. Let people have their say. Avoid side conversations. If other people can’t hear your ideas, they can’t build on them.

Headline Your IdeasMake your idea simple to understand. Big bold letters allow others to see and comprehend an idea quickly. Add a sketch for impact.

Go For QuantityAim for as many new ideas as possible. In a good session, you should be able to generate 100 ideas in an hour. Crank out ideas quickly.

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FACILITATION NOTES

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2 x 2 Matrixnarrowing technique #1

WHAT & WHY

A technique for comparing and prioritizing items using defined criteria. Items are mapped along two, often competing, dimensions such as impact and ease of implementation. Team discussion around where to place each item draws out new insights and clarity, while the resulting matrix can expose hidden relationships between items and help teams balance competing priorities.

HOW

1. Gather the items you want to prioritize. Each item must be represented individually, for example on sticky notes.

2. Brainstorm the dimensions you will use for each axis. You may need to try a number of combinations to arrive at a useful, meaningful pair.

3. Draw the matrix on a whiteboard oriented so that the best outcome is located in the upper-right quadrant.

4. One by one, read each item aloud and place it on the matrix in the appropriate location on each dimension. You should have items in every quadrant. If you find items are not distributing well, you may need to try a different pair of dimensions.

5. Review the diagram as a team to ensure that everyone has a shared understanding of the meaning of the items and their placement. Select one or more items from the upper-right quadrant to pursue.

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TIPS

• If you have a large number of items, it can be helpful to plot them on one axis at a time. To make things even easier, create a reference point on the axis by first placing one item that everyone agrees on. Subsequent items can be placed relative to that reference item.

• Sometimes the upper-right quadrant will become overloaded, making it difficult to select an item to pursue. In this situation, draw another 2x2 with the same axes and re-sort just the items from the upper right.

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Dot Votingnarrowing technique #2

WHAT & WHY

A technique for understanding group preferences and converging on an agreed solution or direction. Use this technique to quickly and collaboratively narrow down virtually any set of items. The nature of the process allows all group members to have an equal voice and provides a level of anonymity for contentious decisions.

HOW

1. Display the options and ensure all participants understand them. Avoid having similar or related options as these can lead to vote-splitting. If necessary, combine similar options under a less specific heading.

2. Tell participants how many votes they can place and any other rules. For example, if they can vote more than once for an option.

3. There are no fixed rules for the number votes to allocate to each participant. You can go with the standard ‘three votes each’ or use one of the common formulas available online such as (n / 3) + 1, where n is the number of options being voted on.

4. Ask the group to cast their votes by placing a mark next to the options they prefer. You can distribute sticker dots or participants can use markers.

5. All participants cast their votes at the same time. When voting is complete, tally the marks and rearrange or re-list the options by their new rank.

6. As a group, share and discuss the results. It may be useful to review options that did not receive votes to verify that they weren’t left behind due to a misunderstanding.

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TIPS

• You can provide dots in two colors to allow both positive and negative voting. This will allow you to see which ideas have opposition.

• There can be a tendency for people to vote for their own ideas or pet topics. To avoid this, brainstorm specific criteria for participants to use when evaluating the options.

• It is not uncommon for participants to complain that they need more votes. The fact that they feel that way can be a good indication that you are truly forcing them to prioritize.

• After tallying the results, if any participant feels strongly about an option they voted for that did not win, allow them to briefly advocate for it. If group members are swayed, they may reallocate their votes.

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Prototypingoverview

WHAT & WHY

Prototyping is a powerful tool for both thinking and communicating. Translating an abstract idea into a tangible object invariably provokes new questions and ideas. At the same time, it generates artifacts that people can interact with and respond to. A prototype can be just about anything—from a wall of sticky notes to a role-playing activity to a high-fidelity model—as long as it expresses an aspect of your idea and helps you learn.

HOW

1. Reflect on your idea and what you need to learn in order to move it forward. Try breaking it down into separate, build-able, testable components. For example, if you were designing a chair, you might want to test different materials, seat heights, and so on.

2. Decide which components of your idea you will prototype. Though you might be tempted to mock up your entire solution, building separate prototypes that explore discrete components will give you clearer insights. Prototype the most important and least understood components first.

3. Brainstorm different ways to represent the components you want to test. Ask yourself what kinds of information you need to collect to answer your question or inform your decision. What would be the fastest way to get that information? Refer to the back of this card for inspiration.

4. At this stage, you should also start thinking about how you might gather feedback. Always prototype with your test or feedback session in mind.

5. Start building. Don’t over think or over solve. Prototyping is a rapid way to explore and learn. Ask yourself frequently, “What is the minimum I have to build to get my key idea across?”

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TYPE & PURPOSE

Prototyping encompasses such a wide range of activities that deciding what and how to create can be overwhelming. Use the categories below to explore and narrow down your options:

Intent

Prototypes can be created to serve different purposes:

• Gain Empathy: facilitate conversations with users

• De-risk Innovation: quickly and cheaply reduce ambiguity

• Explore: develop multiple solution directions

• Experiment: test hypothesis and validate assumptions

• Communicate & Inspire: make your vision tangible and concrete

• Resolve Disagreements: compare options and variations

Aspect

Prototypes can represent different high-level aspects of ideas:

• Looks Like: prototypes that primarily represent how a solution could look and feel.

• Works Like: prototypes that primarily represent how a solution could work (mechanically, technological, logistically).

• Interacts Like: prototypes that primarily represent how a solution could respond to users or environments.

Artifact

Prototypes can take many forms:

• Storyboards

• Software screen flows or click-throughs

• 2D or 3D objects

• Skits or role-playing scenarios

• Scale models, sets or dioramas

• Faux or future media: advertisements, press releases, magazine covers

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Concept Feedbacktesting technique #1

WHAT & WHY

Concept feedback sessions are a quick way to test and refine your ideas. They are an opportunity to learn more about your user and their needs as well as to learn what they like and dislike about a specific idea before you invest significant time and resources.

HOW

1. Identify session participants and locations. It’s important to get feedback from people who represent your target users. Be thoughtful about where you conduct the sessions. When possible, get feedback in the context or environment where your solution would be used.

2. Plan your feedback scenario and questions. Are you just looking for general reactions or do you want to have participants try out specific features or tasks? Write down your learning goals and any specific questions or instructions.

3. Let participants interact with your prototype. Don’t over explain or “sell” your idea. Provide the minimum information needed for participants to understand what to do, then let them explore.

4. Encourage participants to think aloud. Refer to the tips on the Interviewing card and have participants talk through their experience. Ask them: “Tell me what you are thinking as you are doing this.”

5. Actively observe. Watch how participants use your prototype. Don’t immediately correct mistakes or misperceptions as these can lead to insights about what participants want and expect. Respond to questions with more questions of your own. For example “What do you think that button would do?”

6. Follow up with questions. This is often the most valuable part of the session. Ask participants: “Show me why this wouldn’t work for you” or “Can you tell me more about how this made you feel?” and most importantly, always ask “Why?”

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TIPS

• Testing may be discouraging at times. If you feel the urge to “sell” your idea, keep in mind that failure is the fuel of successful innovation. Collecting constructive feedback is far more valuable than inviting praise.

• Physically hand your prototype over to participants. The prototype isn’t a precious object, but the insights you can gain by sharing it are.

• Give participants a choice: create two versions of the same prototype. It’s often easier for participants to tell you why they prefer one over the other than it is to tell you what they don’t like about one.

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Iterationtesting technique #2

WHAT & WHY

Integrating feedback from users is a defining characteristic of human-centered design. During the iteration phase, you draw conclusions about your idea and integrate your learnings into a new prototype. You will rarely land on the ultimate idea your first time through the design process. You may need to iterate multiple times to arrive at a meaningful solution.

HOW

1. Reflect on the feedback you’ve received. It may help to unpack your learnings using a simple feedback grid:

2. Make a decision about how to proceed. You have 3 essential options:

Pivot. Change direction significantly. Your idea did not resonate with users. Either test a new solution idea or move on to a new problem or opportunity altogether.

Persevere. Continue on your current trajectory. Your idea was well received. Move on to higher fidelity prototypes or prototypes of additional components of the idea.

Repeat. Try again with a few minor tweaks. You received mixed feedback but believe the underlying idea has potential. Create a new prototype and gather another round of feedback.

positive feedback + constructive criticism

! ideas & suggestionsunresolved questions ?

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NOTES

The Digital Innovation and Consumer Experience Group is

an internal consulting organization that implements new

technologies and digitally-enhanced experiences across the

Jefferson health system and Thomas Jefferson University.