1177 Vårdguiden is Sweden's entire collection point for information and services in the health and care.
1177 Vårdguiden offer free healthcare advice, information, inspiration, e-services, and is available on web and phone around the clock. The URL is 1177.se and the telephone number is 1177 for healthcare advice. 1177 Vårdguiden is operated by all Swedish counties and regions in collaboration.
I was given the mission to enhance 1177 Vårdguiden's services on both web and phone. The aim was to improve all areas in the current services and also investigate what is realizable by adding a social layer on top of the web service. Social layer means in this context a new layer of digital functionality that enable social interaction. For instance, enable care seekers and medical advisors to interact and communicate with each other in better ways than before to improve the quality of the services.
Service design is a business development method and design theory that implies to plan and organize both people, infrastructure, communications and other components on a service to enhance their purpose and value. The aim is to improve the overall customer experience of the service. By designing a service based on needs from a holistic viewpoint it becomes more user-friendly, competitive and relevant from a customer's perspective.
I used service design as a method to create two support services for 1177, one for web and one for phone. These support services were created by a variety of carefully selected design methods, as visualized in the image below.
The Design Process
Strategy and directives for the project was established early to define vision and outcomes.
Painting a picture of current service
First of all I created a document to explain the directives and strategy of the project, which include specific user-centric goals and sub goals. This document can be seen on the image above. Then I visualized the current service of 1177 as a storyboard to get something concrete to talk about, something you can point at and discuss with all stakeholders. The storyboard was created from data collected from contextual interviews with medical advisors and managers at 1177. I also went through educational materials and system documentation to get the big picture. The storyboard include identified insights, pitfalls and negative user scenarios that need to be resolved. Finally, the storyboard provided a basis for developing support services.
Wire up a context to work within
During the phase of data collection, I learned about the health care adviser's role, operating procedures, regulations, common user patterns, available technical equipment, operations of the phone system, and all things important to do a good job. I put together an affinity diagram by grouping notes of opportunities and boundaries. This became the context that I had to restrict myself to. As myself and other creative people often seem to say: "tighter boundaries propel greater results".
Participatory design with pictograms
I had two workshops with immigrant women that have lived in Sweden for maximum 3 years. Most of them have difficult to communicate in both swedish and english. Because of this I had to figure out a way to make their participation in the design process easier. Pictograms became the solution. Based on the ideas of constraints and opportunities collected in the brainstorming session I was able to design pictograms describing all things and situations (digital devices, social elements, expressions, feelings, user roles, and many more) that are accessible in touchpoints during the user journey. With arrows and pictograms I was able to draw the current user journey map of 1177. During the first workshop everyone was allowed to redraw the user journey for a better experience. Each time someone modified the user journey they had to speak out loud and explain their reasoning of change for the group. This approach invited the group to short, insightful discussions and problem solving that led to even better solutions. Everyone was able to write on notes if they found it hard to speak. The result became a better experience of the service. The modified user journey map could now act as a medium for the next workshop in which new particpants had the freedom to adjust and redesign the result of the previous groups work. The new group was able to focus more on enhancing feelings and experiences to meet their high expectations in certain situations.
Regulations and standards
During the participatory design workshop I acted as an expert. I had more knowledge about the service and it's constraints than anyone else. For instance, I learnt during the contextual interview that nurses must work according to a set of regulations. One of these regulations is the conversation process that describes how to manage phone calls in a calm and problem solving way. During and after the workshop I had to make small changes so the new support services follows these regulations.
As a service designer I'm the expert. This viewpoint puts me in a position with authority to consider a second opinion on all touchpoints to make sure that they deliver what the care seeker expects from the service. A touchpoint is defined as ‘any point of contact between a Customer and the Service Provider’. I interpreted every single step in the user journey map as its own custom touchpoint that could be adjusted and designed for user-centric needs.
Designing user-friendly and desirable touchpoints
By the book, one should look at 5 things when designing touchpoints: aestethics, interaction, functionality, construction and meaning.
For the phone service, I couldn't do much regarding the aesthetics because I was constrained to audio as a medium of communication. However, I was able to set rules for the speaking voice, such as friendly sentences, and the choice of voice to communicate a warm, clear and kind tone. For the web service I was able to concentrate more on usability issues for functionality, interaction and meaning. Basically I simplified the connection process as much as possible. The digital toolbox and co-browsing functionality received a framework of rules that puts the medical advisor in the position of being a host of the tools. This means that only the medical advisor can control and decide when to show, hide and use tools together with the care seeker. The reasoning for this approach is based on the medical advisor's profession as an expert and the care seeker as a novice. It's also based on best practices in usability that claims that too many things on the screen will create noise and more misunderstandings for the user.
Touchpoints can be designed in five ways to improve the user experience. Through aesthetics, interaction, functionality, construction and meaning.
Illustration: Robin Liendeborg
1177 Vårdguiden manage more than 5,5 million calls every year. The most important and striking issue for the phone service is the problem with language barriers. Care seekers and medical advisors talk different languages and there is only one number to call. During the contextual interviews I figured out that the national phone system being used by 1177 has numerous of phone queues connected to the number for no special reason. All of them can be renamed and medical advisors can join one or several of the queues. By renaming the queues so they represent languages instead of geographical locations it is possible to connect care seekers with medical advisors that talk their native language.
The only thing the care seeker have to do during waiting times on the phone is to press a specific number to the phone queue that place them in the right queue for their language. The different numbers are communicated to the care seeker by a speaking voice on the phone. All steps of voice messages and the order of how things are communicated over phone to the care seeker were redesigned to be more logical from a care seekers's perspective. Messages were redesigned with consecutive sentences without complicated words, including a more friendly and welcoming voice tone.
The support service for web resulted in a user journey that connect nurses on phone with the care seeker over internet. The medical adviser use a decision support system to investigate the care seeker's need of urgent health care. This is done by asking a set of questions and depending on the care seeker's answer the system will provide a degree of how urgent it is to receive health care. This system helps medical advisors to be objective in their assessment but it can't be used in all situations. In some cases, medical advisors are lacking information or visual feedback to make a proper decision. As it looks today, medical advisors are only able to use their hearing to make a decision over phone. As a service designer I understood that there is room for improvement - why not use their eyes too?
By allowing the medical advisor to connect to the care seeker's browser it is possible to use digital tools in the browser to make a better assessment. For instance, the medical advisor can access the care seeker's webcam and thereby be able to see blotches and rashes on the sick person. The particiapatory design workshops were an exploration of how to shape these digital tools so they become acceptable for care seeker in terms of privacy and service value. At the same time the tools must be helpful for the medical advisor. Only a few of the suggested tools matched the criterias, and these can be seen in the model below. All mismatching tools were removed from the user journey.
During the time of the project it could take up to 20-30 minutes until your call would be answered by a medical advisor. The majority of the issues are easy and quickly solved, so I was thinking that there must be a way to shorten the waiting time to offer a better experience for everyone. Therefore I designed a sophisticated queue system in combination with a chat on 1177.se to reduce waiting times. By turning callers into chatters it is possible for anyone to ask their questions directly to a dedicated nurse that only take care of the chat. The nurse will also be able to connect to your browser and show you around on 1177.se so you can read articles on your own language. Because many immigrants have never visited the website, only used the phone service. The patient groups also said that they are better in writing swedish than talking the language. So this approach was helpful and met several user needs.
The outcome was very different from the original service. What was most interesting between the old and new is that the new one focus both on positive experience (mood, feeling, carefully built sentences that show empathy and much more) together with tools that increase the quality in the medical advisor's job.
The connection process describes how the care seeker connect to the medical advisor online so they can co-browse together. This can be done during phone calls or directly through the website where the connection process is experienced in a reversed order. To connect, the medical advisor shares a temporary 4 digit password over phone that the care seeker uses to sign in to the co-browsing session. The login procedure was designed like this due to legal reasons and to make sure that no patient information is shared with other people except the patient.