When everything is possible, is there a way to stop enriching your design? What would it take to truly focus on solving the problem rather than to play with all the available technologies we have at our disposal?
— If you really want to help us, deal with the cue that forms here each morning. You manage to solve it, there will be true impact. — said the director of one of the governmental hospitals in New Delhi.
I found myself in India as a senior coach for the Impact Week — an initiative organized by Lufthansa aiming to apply the Design Thinking methodology as a tool for promoting social entrepreneurship among the students in the developing countries. The idea behind the Impact Week is great. There is a bunch of specialists who act as senior coaches and their job is to educate the junior coaches in the DT methodology, so they are able to lead the student teams during the entrepreneurship workshop. The junior coaches are both the employees of Lufthansa who get a chance to learn the DT tools on the job and also the educators from the universities who choose to join the program.
during the entrepreneurship week, the students are working on a bunch of topics that are selected by the universities. In Delhi, they ranged from agriculture, through transportation to health. The topic, I was responsible for was quality of life with Big Data, IoT and AI. And it was quality of life that led us to the local public hospital. The hospital that is daily visited by 7000 people + 1500 emergency cases. The hospital where the doctors need to handle 250 to 300 patients day in day out. And where one person spends up to 12 hours to be accommodated between registration, the diagnosis and the trip to the pharmacy. Waiting in a space with little privacy and low hygiene. Not knowing where to go. Not able to find information about the loved ones who are being treated. And shoved around by overtired staff.
Coming from a business university with the high-tech topics as the inspiration, we thought of bringing to this hospital solutions that help them manage the health records. We were stand corrected very quickly — the hospital had no network, the doctors had no computers and the administration had no money for such solutions. If we were truly trying to improve the quality of life of the patients, the space for action was somewhere else. It presented itself across the three bottlenecks: the registration, waiting for the doctoral appointment and cuing at the pharmacy. And, as the director of the hospital clearly stated, the biggest problem was the registration.
Each day patients start forming a line about 4 am, camping outside the hospital door directly on the pavement. Mums with sick children, elderly on clutches, coughing adults — they keep on waiting for hours either in the cold of the morning or in the scorching sun of the midday to get a chance to get in.
The ladies at the registration keep on working from 7 am to 2 pm non-stop to get this crowd going. There is 8 lines stretching outside a gigantic hall: three for women, three for men and two for elderly patients — one longer than the other. As there is almost no data on the patients, each registration card needs to be created from the scratch: with the name, the address and the details of the sickness. By government regulations, the registration workers have 3 minutes tops to register each patient — otherwise this crowd would never be served. In these 3 minutes they need to deal with the formalities of the visit, the guidance of what to do next and with the emotions of people who are sick and already exhausted from waiting.
Although since few years there is an obligatory primary education in India thus the illiteracy levels are significantly dropping, many patients coming to the governmental hospitals are analphabetics — after they get registered in majority of cases they get lost in the belly of the hospital unable to find their way to the doctor’s office. Ashamed they need to ask others to help them get to their destination. Or they need to come with a literate family member, crowding even more the already overpacked corridors.
You might think that online registration should solve the problem to an extent. Well, no. Although some patients register via the website, it is difficult to determine who is who. Why? The specificity of India is this: many people have the exact same first and second name, thus it is practically impossible to be sure whether the concrete data belongs to the concrete person. So, regardless of the fact that someone tried to register online, the entire registration procedure needs to be done all over again at the registration counter to avoid the mistake of assigning wrong data to the wrong person.
Is there a space for big data, IoT and IA? Or perhaps much simpler means of design intervention should be proposed to aid such a problem? This was the question we were left with after the user research phase. It was obvious that if we packed any advanced technology into our solution, the hospital would neither be able to use it at this point in time, nor afford it. We needed to think in true social impact terms — how can we create something that has a chance to become self-sustained and bring value to someone who might be willing to invest in such a solution? Because the hospital won’t.
With a lot of pain, all ideas for high-tech solutions needed to go out the window. We came up with a very simple, almost mechanical, registration kiosk where the literate patients would enter their data: name and the symptoms and the illiterate ones point at the aching places on a silhouette of a human body. This kiosk would do two things: collect the data on the patients and print a registration card together with the map of the hospital and the directions of where to go.
It would do two things with respect to facing the patients. And it would do one thing in the background: the kiosk was designed to collect all the data on the people coming to governmental hospitals to crunch it and to create the reports on the health state of the population for the Indian Ministry of Health. It was this sole reason, why we thought the Ministry might be interested to invest in such kiosks and to place them in the hospitals all around the country.
Of course, the idea was to make the kiosks technology-ready — we wanted to enable them to hook into the data management systems, hospital workflows, etc. but this was secondary. In the very first instance we have hoped to streamline the cue and create enough reason for the public institutions of India to want to invest in it. That little and that much at the same time. This was the hardest and at the end the most satisfactory part of the entire design process: stripping off all the unnecessary and leaving the core. Solving the problem in the simplest way possible. Which was not at all easy to find.
When I sit to design back in Poland, it is so easy to allow myself to go exuberant with technologies. To add this and that. To use whatever the newest high-tech fashion dictates. Since the visit in New Delhi, the words of the hospital director can’t stop ringing in my head: — It is easy to pack technologies when you have money. But what would you design if you didn’t?
What would be your answer to this question with the next project you take up? Is such a question at all relevant? I strongly believe it is. I believe that we could become better designers if we sometimes looked at what we create from the perspective of extreme scarcity rather than exuberant richness. From the perspective of solving the true problem rather than adding features to catch attention and increase conversion. Improving lives rather than cluttering them. I think…