UX Design, UX ResearcH | Johnson & johnson | AXURE | 2020
The project identified potential interventions for a problem that is unfortunately all too common, that of a missed opportunity for bonding between new parents and baby due to health complications. It was a learning experience (to say the least) to work on such an emotionally-sensitive topic, with a vulnerable population. From an outsider's perspective, it can very difficult to fully understand the parent experience.
Empathy was paramount to arriving at a solution that met parents needs, while accommodating for the healthcare team's workflow.
Connecting new parents to their baby in the NICU through an online digital care platform.
The first weeks of life are critical to a newborn's social development, as this is when initial bonding between parent and newborn happens. Life isn't put on hold, so a parent might be unable to be present with their baby.
When a baby is admitted to the NICU, the opportunity for bonding is greatly impacted, as parents are typically unable to touch or hold their children.
I led this project with the support of the design team at Johnson & Johnson initially, then continued to refine on my own after the initial research phase. I was solely responsible for understanding and defining the user group and their needs, leading creative brainstorm sessions, designing wireframes and mock ups for user testing and refinement, and ultimately the end results that you see here.
How might we promote bonding between parents and newborn, when the newborn is in the NICU?
I began diving into the problem space to gain a broad understanding of the stakeholders and procedures of the NICU by referencing academic research, established stressor scales, and browsing support groups and forums. This provided a solid basis from which to develop more in-depth research methods, like semi-structured interviews, site observations, and several contextual inquiry sessions.
Resources like the Psychological Stressor Scale: NICU (PSS:NICU), online forums, and support groups established the basis of my initial understanding of the ongoings of the NICU.
A newborn's auditory system is fully developed at birth, yet its vision is still underdeveloped - this means that they are able to recognize their parent's voice, but not their faces
Unsurprisingly, parents are usually confused and scared, as they have little preparation for what is to come
The first time parents see their newborn is when they generally feel most concerned
Parents will acclimate to the NICU over the course of the care journey, becoming more comfortable with the ongoings and environment as time goes on
I interviewed 4 parents and 2 NICU nurses. Participants were encouraged to discuss their experience in the NICU, and directed to speak about how they remained involved with their child throughout the care journey.
" I felt helpless. I wanted to hold him, but I couldn't... It was frightening to see him hooked up to so much stuff. Then I began to think, 'what did I do wrong? "
" This isn't a normal environment. It's really its own world with its own rules. . . when parents first come here they don't know what to expect. "
Parents were generally apprehensive to interact with their babies, but wanted to help as much as possible. Nurses remained objective, tried to keep parents informed, and sometimes had to intervene if parents were too involved.
I visited 2 NICUs at separate instances with the intention of seeing firsthand how the NICU operates. I was able to have informal conversations with nurses and staff, and learned how the NICU operates on a relatively fixed routine.
Everything in the NICU operates on a routine after admission, with the care cycle taking place every 3 to 4 hours. After enough time, parents will acclimate and can begin to contribute to care responsibilities.
I had a unique opportunity to join 2 simulation events for NICU nurses. While taking an observer's role, I was able to capture how nurses keep parents informed and calm during these times.
Typically, the baby will have a team of nurses dedicated to its care. Parents will become familiar with the nurses, and often develop a relationship with them over the care journey.
Nurses operate in a team during emergency situations, but during routine care (after the baby is stabilized) they each adopt a role.
A large part of the nurse's work is keeping the parent a proper level of informed.
I performed an affinity model to synthesize the mountains of qualitative data that came from the initial research.
Parents want more communication, but nurses need to find a balance so as to not overwhelm them nor keep them in the dark
Nurses don't mind giving care responsibilities to parents if they feel the parent is capable
Sometimes, the most difficult part of a nurse's job is managing expectations
Parents don't always know what is happening when
Face-time with a HCP is more valued than other means of communication
The initial research resulted in mountains of rich qualitative data that needed to be synthesized. I affinitized the findings of research by converting the discoveries to notes and performing an affinity model. High level findings are captured below.
Parent involvement is along a continuum, from hyper-involved to minimally involved
Some parents like to remain hyper involved, absorbing very bit of information they can and asking a million questions to the nursing staff. Others, for various reasons, are less involved and may not be present unless required.
The NICU operates on a routine, and parents will eventually be asked to contribute to care responsibilites
Following admission and stabilization of the baby, the care journey activities become routine and repetitive. At this point, parents will have the greatest opportunity to contribute to their baby's care.
Nurses try to keep parents at the "right level of informed"
Nurses have the delicate task of providing parents with enough, but not too much information. Too little information and they risk leaving the parent concerned or asking many questions. Too much information and they risk overwhelming the parent.
The baby will have a team of nurses dedicated to its care
Parents will get to know nurses on a personal level, and will develop relationships over the course of the care journey. Typically, parents will save questions for specific nurses, and learn the nurse's schedule. Further, nurses will typically update the parents on their baby's progress in-person, at the start or end of each care round.
A newborn's auditory system is fully developed at birth, but it's eyesight is not
Newborn's show a preference for their mother's voice, yet cannot recognize her face. This opens opportunities for unique design solutions to simulate bonding.
On average, a newborn will be in the NICU for 13.2 days
According to accepted research, a newborn can be admitted to the NICU for anywhere from 1 day to several months, with the average duration being 13.2 days.
After synthesizing the initial qualitative research, I began to hone in on the various stakeholders that would be affected by any design solution. The design solution would likely impact many different people in many different ways, so it was necessary to define the roles and any potential conflicts to be aware of.
B1. A way to receive auditory or tactile stimulation
B2. Regular social stimulation
B3. A way to hear parents, remotely
P1. To remotely interface with newborn
P2. To see newborn
P3. Knowledge of newborns' vitals
P4. Knowledge of procedures
P5. Way to schedule visits
P6. Way to schedule conversations
P7. Way to remember what had been said
Nurses and staff
N1. Remain uninhibited in their workflow
N2. Provide parents with the "right amount" of info
N3. Let parents know when they cannot visit
N4. Inform parents of what to expect
N5. Remain in control of their work and environment
N6. Ability to control or limit parental interactions
Different users with unique needs
Parent involvement comes in many different forms. Some are available to be present with their baby, some have work obligations but have a flexible schedule, others don't. However, they all want to be as close their baby as possible. All have different needs, captured below.
PARENT NEED STATEMENTS
As a parent that works full time, I need to see my baby on my own schedule.
My life doesn't allow me to stay in the same place for long stretches of time. To see my baby, I need a flexible platform.
It feels like I have no control, I feel the need to help my baby in some way.
I need to stay in the loop of my baby's care journey.
NURSE NEED STATEMENTS
I understand that parents want to be around their baby, but I need to remain in charge of my work.
I need parents to understand that sometimes I can't respond immediately.
I need ways to limit unwanted or distracting people.
I mapped out stakeholder relationships as a way to put the pieces together, and as an asset to drive conversation around the various direct and indirect influences that one might experience in the NICU.
The relationship map proved to be a valuable asset to drive conversation around the complex relationships inside and outside of the NICU.
All of the previous research and mapping exercise went into generating a comprehensive journey map, which revealed touch points between stakeholders during the care journey. Ultimately, this resulted in a valuable asset for conversation, and identified the best points in the care journey for intervention.
The care routine was discovered to be the best point for intervention based on the learnings of the core research, and the derived user needs. At this point, the baby is relatively stabilized and on a predictable schedule.
Parents are welcome to visit in person during scheduled hours at this point, mitigating loss of bonding between them and the baby. Design solutions will be fit into this part of the care cycle, so as to not interrupt the established protocols and existing care infrastructure.
Working Assumptions & Design Implications
Based on what I learned from the core research activities and desktop research, a few design implications and assumptions were derived that would inform the initial idea generation and future product requirement. These are summarized in the list below.
The average length of stay in the NICU is 2 weeks, so we can expect that users will not interact with the system over a long duration.
Design Implication: The product must not require extensive training or learning, as the window for use will likely not be more than two weeks. Features and functionality must be readily apparent, discoverable, and intuitive. Further, this suggests that the product will be used mostly as a tool to facilitate bringing the newborn closer to the parent, and not something that the user will continue to use past its primary intended purpose.
The parents that use this product want to be as a close as possible to their baby and take an active role in the baby's care journey.
Design Implication: While the initial research indicated that there are parents who are less active in their baby's care journey than others, those parents likely won't make use of this product. Therefore, the product will be designed to appeal to those parents who want to take an active role in their baby's care journey. In turn, the product should include features and functionality that bring the parent as close as possible to the baby, as if they were actually in the NICU. This means including more functionality than just visualization, such as the ability to see any health information (e.g. vitals) that they would have access to if present in the NICU.
A newborn bonds through physical touch and auditory stimulation, not vision. However, parents are most assured of their baby's wellbeing if they can see them.
Design Implication: The product should prioritize features that promote parent-baby bonding, like auditory communication, but must also consider features that support the parent's wellbeing, whether or not it has a direct link to improving bonding between the two.
Nurses have the right to privacy for certain aspects of their work.
Design Implication: The product should provide admin privileges to the nurses, by providing capability of limiting or suspending access to the platform for reasons of privacy and security. Further, it should be communicated to the parents that the system being "offline" is entirely normal and expected, so as to reduce cause for concern.
Nurses and others on the healthcare team cannot be expected to immediately respond to an inquiry.
Design Implication: The communication functionality must not indicate that a reply should be expected instantly. The user must be informed that delayed responses should be expected, as nurses or others on the healthcare team will do their best to respond routinely. To mitigate any frustrations or concerns that arise due to delayed communication, certain aspects should be included to facilitate communication. This might include a scheduling option.
I looked to other industries for inspiration after defining the target user, which include industries like pet care. The most influential findings are tabled below. Mood boards established the vision of the product, both in terms of styling, language, and feeling evoked when interacting with it.
Analogous Market Audit
The idea of a comprehensive system that promotes communication between two involved stakeholders is not a new idea; however, existing market options are typically concerned with client-business relationships.
Do pet owners have similar needs to new parents? Well, it turns out they do. Somewhat.
Mood Board (Product Vision)
At this point, idea was beginning to take shape. To better illustrate the vision of the product, I developed two mood boards. The product could invoke a range of feelings, from that of the "friend," which would bring about softer forms and colors, to that of the "guardian," which would take on a more serious tone with harder edges and a bolder color scheme.
Mood boards established the vision of the product from here on.
"Friend" is a welcoming face in an unfamiliar place.
A benevolent servant, this system will offer a helping hand throughout the parent's journey with their baby, and serve as a constant reminder that everything is being done to protect the little one.
Muted, comfort colors pair with soft forms to portray a sense of calm and well-being.
"Guardian" is quiet reassurance of the people and technologies within its environment.
The stoic vigilante. This system is prepared to protect loved ones from harm and is a quiet reassurance in the capabilities of the people in the baby's care team.
Contrastful, minimal color scheme works with harder edges and highlights to deliver a serious undertone of competence.
I hosted a brainstorm with the idea of generating ideas based on the user needs. Participants were encouraged to build upon a skeleton framework that support parent-child, and parent-nurse communication, and were provided the working assumptions and design implications as a jumping off points. The results have been digitized and are shown below.
Leading with communication
The brainstorm resulted in many different feature ideas and unique concepts. I visualized the leading concepts in storyboard form, which I felt best targeted the user needs. These are shown to the side. Leading concepts centered around a remote platform that enabled parents to reach both their newborn and the NICU staff.
The brainstorm resulted in many different ideas, which I analyzed based on how well they suited the user needs. One recurring theme was a common point of communication, which I explored as a starting point in the form of an online portal.
Initial Information Architecture
I self-filtered many of the system and feature ideas that came from the brainstorm, and identified several features that would best suit the needs of the various stakeholders.
Potential features and functionality were selected based on how well they met the user needs.
The best way to reassure parents their baby is doing okay is to let them actually see their baby in real time.
This feature implies the integration of a camera and internet connect for live streaming. The addition of a camera into a sensitive area brings with it several UX implications, namely, nurses need a say in controlling its capabilities, providing a way to limit access to view the livestream, and potential effects on the baby's well-being.
View health status and goals
A major benefit of being present in the NICU is the ability for the parents to see their baby's health vitals. Introducing a feature that hosts the vitals in real time will mitigate some parent's stress over their baby's health.
This feature implies the ability to link health vitals monitors to an online platform. From a UX perspective, the question of how much health information should be provided to the parents so that they are not overwhelmed, yet also not kept in the dark. Further, nurses will typically update parents on their baby's progress in person. How will seeing nurse notes affect the parent's well-being?
In the interest of allowing the nurse's workflow to remain uninhibited, parents have the ability to speak to their baby through a remote speaker connected to the hardware in the baby's room. Additionally, if control is limited at a time where the parent can't speak to their baby, they have the option to send a voice message that is then played at a later time at the nurse's discretion.
This feature implies the integration of a one-way speaker system to the camera system. Many points must be considered from the nurse's perspective. How will they limit inappropriate sounds? Will there be a way to adjust volume so that the baby is the only one receiving the message? Who controls access, and how might we limit unintentional activation of the speaker system?
Ask questions or make comments
Parents cannot always remember what has been said to them, or what they want to say to the nurse or doctor. A chat function will provide an avenue of communication for the parents to connect to the healthcare team, to capture notes, and remember questions they want to ask. Messages will be sent to the nurse on duty who is on the baby's healthcare team.
This feature implies integrating a functional two-way chat between parents and healthcare team. Questions that must be addressed: Who will the message be sent to? What if that person is unavailable? How can we easily organize the chat to facilitate intuitive communication and make the message gets sent to the right person. And, perhaps most importantly, a nurse cannot be expected to immediately reply to the message. How can we establish a communication paradigm that supports delayed replies?
There are many others who are invested in the health of the baby other than the parents and healthcare team. The loved ones of parents care just as much sometimes. The ability to take and send snapshots to selected recipients can be a simple way to visualize the baby's progress.
This feature implies building in an intuitive and simple way to share snapshots of the live stream. Potential concerns include limiting access to only those the parents want receiving the images, and making sure delivery of those images is secure.
I began to consider how an online portal would be the central point of interaction between the various stakeholders, while also accommodating other components.
The online portal would host the other components of the system, and provide an avenue of communication between parents and newborn, and parents and staff.
Online Portal wireframes
Mobile app wireframe
As the project had a solid direction at this point, I began to prepare for user testing. I opted to produce interactive mid-fidelity mockups in the interest of time. While these wouldn't totally represent the final product, they would give users a better sense of the products features and capabilities.
Two wireframe concepts were selected, and their home screens translated into higher-fidelity screen mockups intended for user testing.
I quickly translated the mid-fidelity mockups into 2 interactive prototypes which would allow participants to understand the concept better than static images. These prototypes were built to be shareable and fully interactive.
The product was at a good point for user testing. Participants were sourced from the March of Dimes with the requirements that they be parents of children who were currently or recently in the NICU. The 1.5-hour session was split into two parts: first a focus group with a warmup exercise, and then a usability test that included a cognitive walk-through of two distinct portal interfaces.
Participants were initially briefed on the purpose and goals of the project, then were asked to describe their experience in the NICU as a warmup. Then, they were separated and asked to "think aloud" as they walked through the two different online portal interface concepts.
Participants first engaged in a short thought exercise, then asked to interact with the two prototypes, while instructed to "think-aloud."
Overall the concept was well-received. Participants significantly preferred Concept B over A due its to its simplicity on the "Live View" page, which made them feel there was more of a focus on their newborn. More detailed feedback is captured in the table below.
Participants were informed that features were consistent across both concepts, whether or not the screen displayed them.
Cluttered home page
Take & share images
Speak to baby
Confusion how to start call
Refined User Flow
Touching on the more technical aspects, there are many security concerns that parents have regarding who has access to this platform. This can be partially mitigated by providing a user with a unique code that they input during initial onboarding. Further, during this point, the user can be introduced to the "give access" feature, which allows trusted friends and family to log in, as well.
Users' security concerns can be addressed and mitigated during the onboarding process by requiring a unique code to access the platform.
Style Guide and Branding
At this point, I honed in on the visual brand language. The color scheme is minimal, so that focus remains where it matters most. Accent and call-to-action buttons are highlighted with a blue hue, which conveys a sense of confidence, trust, and professionalism to the user.
High-level changes included re-orienting the dashboard page to include both the 'live stream' and 'health' pages, which could be activated via toggle. That page layouts also changed to incorporate the feedback from user testing. Details are shown below.
Text descriptions and button actions were made to be more direct, and discoverability of certain features (e.g. recent photos and note book) was improved.
Concept B was used as the foundation for further refinement based on the user testing session. Though participants indicated that they preferred the simpler layout of Concept B, testing revealed confusion around how to find certain pages or actions, so some functionality was reintroduced in the interest of improved usability.
Several key usability issues were discovered regarding discoverability, observability, and error recovery on different pages. Namely, difficulty accessing the "health" and "live view" pages was noted, as participants had trouble recalling how to switch between the two. This was mitigated by making this action a contextual action and placing it closer to the primary content on the home page.
Trouble identifying how to switch between "live view" and "health" pages
Uncertainty around the purpose of "Nurse Jackie" box
Unclear when "Speak to Liam" is activated
Reduced cognitive burden of remembering "Live View" and "Health" pages by introducing page toggle
Included more descriptive "Chat..." copy for chat box
Pulled "Notebook" from chat box and created new box for improved discoverability
Added "Recent Photos" section for improved discoverability and quicker share / delete actions
Confusion regarding interpretation of health gauges
"Additional Information" section not utilized, some confusion around how it relates to health stats
Green upward indicator next to weight and length misinterpreted
Notes section of "Daily Update" understood, but not immediately, request for past notes to track progress
Health gauges simplified
"Additional information" localized within health gauge card, hover over to reveal more information
Upward / downward indicators removed, numeric display only
Notes section now shows daily update, with ability to scroll to past notes
Calendar & Scheduling (previous)
"Active (selected)" day not immediately recognized
All activities shown on calendar considered overwhelming, difficult to parse
Scheduling action not immediately recognized
Want for upcoming activities and events
Calendar & Scheduling (refined)
Active day now more clearly indicated on larger calendar, paralleled with card
Routine activities (i.e. feeding) now hidden from monthly calendar to reduce confusion
Scheduling tab replacing with "+" icon and contextual actions
Activities / events section now able to be toggled between upcoming and past
Each event card now has contextual actions for improved flexibility in modifying or deleting event
See and speak to your baby in real time.
Live view shows your baby in real time, and the one-way microphone in the webcam will allow them to hear your voice. If you invite anyone to view, rest assured that you will know who is viewing and when.
Connect with your baby's healthcare team.
The chat box and video capability will let you speak with your child's healthcare team on your own time. Quick questions or in-depth conversations will no longer be forgotten.
Capture your baby's recovery journey and share with family.
Take a photo of your baby as often as you like, and quickly share their progress with your friends and family.
Easily see upcoming procedures and schedule visits.
Sometimes it can be hard to work around your baby's or healthcare team's schedule, so we make it easy. See all upcoming events and care schedules, and simply indicate if you would like to attend.
Check in on your baby in real time.
Everything you would see in the NICU, simplified and at the convenience of your laptop or mobile device.
Daily health updates keep you informed.
Updates on your baby's health, straight from your baby's healthcare team. You can see you bodies height and weight, and any notes on their behavior.
Check in wherever you are.
Embrace syncs with mobile devices, so you can check in wherever you might be, and whenever you want to.
Making the most of the space on mobile, Embrace's viewport will automatically adapt to bring what matters most into view.
Simplified UX for smaller devices.
We understand there's a lot here, so we make it easy to use the most important features, like "Live View" and "Chat" if you're on your smart phone.
Designed and built by Benton Humphreys. © 2020