NYU LANGONE HEALTH
UX DESIGN / UX RESEARCH / SERVICE DESIGN
Ker Chen, Yen-Yi Huang, Mingjing Jiang, and Vasu Kuram.
Client – Future Practice Lab at NYU Langone Health
The Future Practice Lab is a team of clinicians, designers, engineers, and researchers focused on improving the healthcare experience at NYU Langone Health, one of the nation’s premier academic medical centers. The lab partnered with the Integrated Design & Media graduate program at NYU Tandon School of Engineering to invite student teams to work as consultants and engage with the following design question:
How might NYU Langone Health improve its patient experience to be more inclusive, supportive, and positive for people who are transgender, nonbinary, and gender queer?
We had 5 weeks to research, ideate, prototype, refine, and present our solution. Luckily, I was able to collaborate with a wonderful team of UX practitioners working across research and design! Since we were a small team of designers, we shared research responsibilities. However, I took lead as a service designer and helped guide our overall product vision.
Conducting user interviews (Shared)
Compiling a literature review (Shared)
Creating a survey for exploratory research (Shared)
Synthesizing all of our research and ideas into a robust, sustainable, and service-minded solution
Sketching user journeys and low-fidelity prototypes
Creating a high-fidelity prototype of the public facing provider website
Definition of Gender Expansive
According to PFLAG, gender expansive is "an umbrella term sometimes used to describe people who expand notions of gender expression and identity beyond perceived or expected societal gender norms. Some gender-expansive individuals identify as a mix of genders, some identify more binarily as a man or a woman, and some identify as no gender."
We conducted five user interviews to develop an understanding of both our target users and the existing patient infrastructure at NYU Langone Health. We were able to sit down with clinicians, gender expansive patients, and administrative staff.
I interviewed the LGBTQ+ Patient Liason at NYU Langone Health. They are responsible for directly addressing patient concerns and coordinating the LGBTQ+ Patient Relations Team. Overall, they expressed feeling overwhelmed and poorly supported by Langone's larger Patient Relations Team.
Other insights we collected include:
Doctors on boarded 10+ years ago have missed training on gender issues
Medical language can feel stigmatizing or unfriendly
Transgender patients often face gender affirmation surgery alone and can experience severe mental and physical struggles throughout recovery without a support network.
Gender expansive patients tend to rely on online communities for medical advice due to fear of discrimination, but this leaves them at risk of receiving incorrect and harmful advice.
We surveyed academic and industry sources to supplement our understanding and identify gaps in knowledge, pain points, and opportunities in the field.
There were three common themes throughout all the sources we explored.
Gender expansive patients have a deep distrust of medical institutions due to high rates of harassment and a history of poor, often life-threatening, treatment.
Medical providers lack training on queer health practices and many patients report having to teach their providers about their healthcare.
Gender minorities face high barriers to accessing healthcare due to structural issues, hesitancy to disclose information, incompetent providers, and a lack of culturally appropriate harm reduction services.
We designed and distributed an anonymous survey to learn about healthcare experiences within the gender expansive community.
We identified three main takeaways from the survey results.
Patients often distrust and fear certain providers which prevents them from reporting mistreatment.
Bias and discrimination impact their quality of care.
Patients are often misgendered due to the structure of medical intake forms.
After completing our research, we each spent time individually ideating before coming together to develop a final solution.
I chose to focus on the following pain points:
Gender expansive patients feel disempowered by the medical community due to fear of harassment and discrimination.
Hospital administration has no efficient way to manage or address patient feedback, hold providers accountable, or track the organization's progress towards being a more inclusive space.
I was primarily interested in addressing the lack of trust between gender expansive patients and the healthcare industry. In order to make Langone more inclusive, we must first contend with a history of unequal, violent, and life-threatening experiences that they have had to face within the larger system. Through my initial research, I discovered that one aspect of the hospital experience that perpetuates patient fear is the unequal power dynamic between patients and providers. Often, patients are reluctant to speak up for themselves or voice discomfort in front of their healthcare provider which can lead to serious problems.
Thus, I identified two design opportunities:
How might we create a neutral meeting point between patient and provider?
How might we build a sense of community for gender expansive patients within the hospital network?
These opportunities work hand in hand to empower gender expansive patients and create a more supportive institutional culture at Langone.
Working off of these two questions, I designed a holistic solution that could be packaged as a hospital-wide campaign. The campaign would include a completely redesigned patient feedback system, a gender expansive speaker series, and queer friendly branding. The speaker series would include a mechanism for input and organizing from patients themselves. Trust is built through listening and active engagement, so the hospital should look to empower its patients.
Patient Feedback System
The current complaint system at Langone is only available by phone or in their office, Monday through Friday 9 AM to 5 PM. There is no email address or online interface. Furthermore, all feedback specific to the queer community is funneled to one person, the LGBTQ+ Patient Liason, who is often overwhelmed.
There are several issues with this, including:
Gender expansive patients may not be comfortable complaining through the phone or face to face with a staff member due to fear of retaliation or harassment.
Long wait times may deter them from submitting feedback.
There is no efficient way to track the outcome of complaints or hold people accountable.
The complaint system is not specific to the gender expansive community, so staff members may not know how to best respond to their complaints.
There is no option to collect positive feedback or track what the hospital does well.
The new patient feedback system would include both physical and digital touchpoints and would create an efficient hand-off system for queer and gender expansive patient feedback by partnering with Langone's existing LGBTQ+ Advisory Council. Feedback would thus feed into an internal ticketing system where the patient relations team can more easily and efficiently respond to issues. An important feature of this internal system is that, if a feedback form references a specific provider, the ticket feeds into a provider database that displays all of the tickets related to that provider. This would allow hospital administration to aggregate feedback into useful metrics and track how well (or how poorly) hospital staff is doing in terms of respecting their patients’ gender identity and providing a consistent level of comfort.
Finally, Mingjing had the idea to create a metric dashboard based on the patient feedback system that provides anonymized data to the public, so that the community can track NYU Langone’s progress. The feedback system is thus structure as a four step cycle as illustrated below.
The goal of the speaker series is to build trust and provide education for both providers and patients. This would address several pain points identified in our research, including the lack of verified and accurate resources for members of the gender expansive community, and the lack of updated training and cultural sensitivity for providers.
The speaker series would occur six times a year, leverage NYU faculty and community members, and be open to the public for free. Attendee registration would be organized through a website like eventbrite and would accept donations to be distributed to local mutual aid funds for gender expansive medical care. Three events would be practitioner facing and three events would be patient facing.
Best Practices in Mental Health Counseling for Transgender Patients, presented by Samantha Busa, PsyD
Understudied and under-reported: Fertility issues in transgender youth, presented by Leena Nahata, MD
Ethical issues in gender-affirming care for youth, presented by Laura L. Kimberley, LSW
Navigating Teen Gender Transitions, a panel presented by medical staff and mental health experts.
Understanding Hormonal Changes, presented by medical staff.
Supporting your Non-binary Child, presented by mental health experts.
The goal of the branding campaign is not only to create inclusive marketing for the speaker series and redesigned patient feedback system, but also to put patients as ease and remind them that Langone strives to be a safe space within the hospital itself. We know from research and firsthand accounts that doctor visits can be highly emotional, anxiety-inducing events, so while the branding campaign is only a minor part of the overall solution, it is an important addition that may help patients feel a little more at ease in their day-to-day.
Sketches and User Journeys
Here are the low-fidelity prototypes and user journeys I sketched out for the patient feedback system.
We created personas for all the stakeholders in our system, including patients, providers, and administrative staff.
These prototypes were created in Figma. I created the prototype for the public facing website, while Mingjing and Vasu created the ticketing system prototype, Ker created the physical collection box, and Yen-Yi created the feedback forms and email notification mock-ups.
IMPACT / REFLECTION
We received the following feedback from our client:
Our service design closes the communication gap between patients, providers, hospital administration, and the greater gender expansive community.
It would be easy to implement using existing infrastructure and Zendesk services.
The branding and speaker series would help publicize Langone’s gender inclusivity.
They said the solution felt holistic, realistic, and feasible.
Some future improvements I would like to make include:
Develop a rollout plan and change management strategy for the patient feedback system.
Expand on the marketing and branding campaign.
Develop a community forum space.
As this project was completed as part of my graduate program, our professor had every team member submit anonymous feedback for each other midway through the project and at the end.
Here is some of the feedback I received from my team:
"Sarah is super intelligent and knows what she is doing. She put so much efforts into the project and her ideas are great."
"Sarah is passionate and has a lot of thoughts on this topic. She expresses her ideas in a way that's easy to involve others in the plan."
"Sarah always has something great to add to the conversation, and has helped generate some really cool ideas. She's also passionate about this project and a great resource for group members to bounce ideas off."
"Sarah is so reliable and detail driven. She always has a clear mind about what we are doing and what we are missing. We couldn't have done such great project without Sarah!"
"Sarah has helped keep our team focused, and been so good at generating ideas that take our project to the next level. She's assertive with her ideas, but is also willing to compromise when necessary."
Read more about this project on Medium: @sarah.aj.tahir