Background/Brief

CANN-NET is a group of nephrologists (kidney specialists) who work to improve the care and outcomes for patients with chronic kidney disease (CKD). Pivot was selected based on our long-standing relationship with Dr. Mike Evans, who is known as the “Whiteboard Doctor” for his down-to-earth healthcare whiteboard videos for patients. (Some of our other projects with Dr. Evans include campaigns like MakeYourDayHarder.com and LockerRoomDoctor.com)

Dr. Evans recommended us to the leading Canadian nephrologist behind this new dialysis research, Dr. Braden Manns at the University of Calgary (UofC). This was the first time we had engaged with CANN-NET and UofC teams. The design research effort and culminating design product was a continuation of a larger academic research effort initiated by UofC through CANN-NET.

Pivot used a user-centred design (UCD) approach to create a printed piece that communicates the new guidelines in clinics across Alberta for the purposes of the UofC research effort. Additionally, we learned about the content so that, as communicators, we were better positioned to make decisions that would result in a more concise and communicative design.

In this case, the user / audience for the design includes:

1. Nephrologists (kidney specialists) who are making the recommendation to their patients about when to go on dialysis
2. Patients who are making the decision about when to go on dialysis.

Process

My specific role was to manage the project, conduct and analyze research and write and design the final outcome.

Our UCD process stayed true to the Pivot Informed Design approach (Discover - Design - Deliver) where, rather than jumping to a design solution, we spend time exploring the content and researching the users.

Our primary resources were the nephrologist experts behind the new dialysis guidelines (Dr. Braden Manns and team). The most valuable research method we used was one-on-one interviews with patients across Canada to learn about their current decision-making processes. This allowed us to see how best to fit the design into the user's way of life.

Our evidence-based process does not follow the “present three concepts and let the client choose” approach that may be typical of most design agencies. Rather, we let the research findings dictate the concept and use collaboration to develop trust with our clients, who then trust our recommendations for the direction of the design. This collaboration occurs at every step of the way. From sketches to detailed design, from research planning to analysis, there is nothing like having a real, two-way dialogue with your client. We don’t believe in the one sided ‘present and let them judge’ approach. We approach each meeting as a conversation where the clients are the experts on their current business and we are the experts in facilitating change and improvement.

For this project, the analysis of our user research allowed us to see that for patients, choosing when to go on dialysis is a highly stressful undertaking. Beyond reaching a single decision-maker, the design needed to take into consideration the fact that the patient often involves caregivers and family in their final decision.

Between the time of diagnosis to the time for decision-making, we learned that there are generally two types of patients: one who almost blindly trusts in their doctor’s recommendation more than any other factors, and one who takes it upon him or herself to research and discuss options with their loved-ones, who potentially weighs their own research and lifestyle above the recommendation of their physician. The second type of patient often experiences lower levels of anxiety and is more likely to stick to their decision.

One of our key content directions for the concept was to add additional links and resources to allow patients to do further research to reassure themselves. Working with a member of Patients Canada, we ensured the patient's voice was balanced with the physician and designer voices at the table. Though we had always talked about it, this was actually our first real project collaboration with PC. It’s always good to have members of all audiences participate in the research gathering. Especially when the primary end user is a patient, we like to work with patient advocates to compliment the user research.

As a result of insights gained through our research, we created two complementary infographics. Patients would be able to take the infographic to their provider to begin a conversation, and their provider would have the complementary infographic to be able to help provide them with the correct recommendations according to the new guidelines. We created one design geared towards nephrologists (published in the Canadian Medical Association Journal for physicians) and another geared towards patients to be posted in clinics across Alberta. The infographics were also designed to be made publicly available on the CANN-NET website with two dedicated URLs directing the two audiences to relevant information for them:

For physicians: informedkidneycare.ca

For patients: knowingkidneys.ca

As the research team behind the new guidelines for dialysis, the client was very involved in the process because our design phase was to be integrated into their larger research effort (outcomes to be published in 2017). They provided the physician voice and the initial knowledge transfer to us, the design team.

Challenges

Location was an issue when it came to our user interviews. Normally we like to conduct these one-hour sessions face-to-face, as there is much to observe from a person’s surroundings and facial expressions throughout the conversation. As our participants were located all across Canada, the budget did not allow for face-to-face conversations. Even video conferencing was not possible as many of the patients we spoke to were older and not tech savvy. Instead, the interviews were held over the phone and wherever possible, participants would share photos of their space and surroundings where relevant to the conversations.

Special Circumstance:

We would have liked to have had a more in-depth, unbiased understanding of our nephrologist audience, the dissemination of the information to this audience (published article in the CMAJ) was already decided prior to our involvement on the project. Thus, other than the visual design of the content, there was little we could learn about this audience to help decide the format of the content delivery.

The scope of the project exceeded the initial ask, which was to create a single infographic for the client. Based on the research conducted, we determined it was necessary to create two separate infographic designs, each dedicated to a specific audience, which meant designing two separate pieces. Due to our collaborative process, the client was well aware of this addition to scope and allocated additional funds to the project.

Colour contrast ratios and point size of the printed poster-size patient infographic were taken into consideration for accessibility. Printable PDF versions of the infographics were provided on the website so that people would be able to easily print the information from home. A French version was also designed for each infographic.

Result

The success of the project is currently being measured by the UofC research team. As part of a multi-year, province-wide study, administrative data for each region will be gathered via CORR/CIHI. Outcomes are set to be published in 2016/2017.

With the design of the two-part infographic, we were able to take the base content (new guidelines for dialysis) and make it relevant to two very different audiences. The physician version is designed to look more clinical and research-driven with the main message: “New dialysis guidelines: providers should consider a patient’s symptoms, rather than making a data-specific recommendation based on kidney function alone.” The patient-facing infographic mimics the three steps shown in the physician-facing infographic, but is more friendly and approachable, with more emphasis given to the links and resources at each step.

“Pivot’s informed design process allowed for us to integrate clinical practice guidelines into meaningful, effective and professionally developed infographics. Through their comprehensive process, Pivot was able to inform the development of the infographics through end-user interviews allowing for a current understanding of user needs and context of use. Pivot was able to distil the right message and present a clear outline of project deliverables within tight timelines while working with multiple partners across the country. We feel privileged to have worked with Pivot on such an important initiative”. - Braden Manns, Chair, CANN-NET

Designer Takeaways

1. When working on a project with many people, remember to keep communication lines open so that everyone is on the same page and is brought up to speed as research/design moves along
2. When using one-on-one user interviews as part of the research process, it is better to conduct the interviews personally or listen in first hand. You’re able to learn and observe more than when you read notes second hand.
3. Understanding content, no matter how complex, is critical to understanding the audience and will lead to a more cohesive and relevant design outcome.

Client Takeaways

1. All information is good information for a designer. Let your design team work with you to decide what to filter in or out of the design outcome.
2. Understand that at an individual level, all audiences are extremely varied. At the project onset, work with your design team to decide how much you want to let any one user group influence the outcome. Fringe cases are interesting but can get in the way of project success. Often we will outline our users as personas and prioritize them according to their “Impact of Use” — how important is their use to the overall design. This way it’s clear how much you want any particular audience to influence the design.
3. Every project need and user group is different and the research methods and design outcomes should be flexible enough to accommodate this. Don’t be afraid to ask questions of your design team to better understand how a research method may affect the outcome — trust in the process.

Interested in submitting a case study? Download 'Guidelines for Contributing Content' and email news@rgd.ca.