Healthcare service for the marginalised
The project was done as a part of the Student Service Design Competition 2020 in collaboration with IBM Design and Philips Design.
Online Exhibition: https://exhibition.servicedesignchallenge.com/casemenu
Winner announcement: https://servicedesignchallenge.com/winner-announcement-2020
Teammates: Bohan Sun, Jooeun Park, Qianfei Gu, Zhengshuang Han
Mentors: Frank Kolkman, Nuria Solsona, Robin Auer
Research methods: Cultural Probes and Expert Interviews
Service design tools used: Customer Journey Mapping, Prioritization Grid, Business Model Design, Service Design Blueprint, Figma prototype
My role: Cultural Probes, Field Research, Research Synthesis, User Flow for Ro+
Duration: 5 months
Project background 🇪🇺 🏥
How can we improve the access to care for people in Europe that are ‘invisible’, neglected, underserved, forgotten or overlooked?
There seems to be a split in society whereby the most disadvantaged (the jobless, homeless, poor, uneducated, etc.) do not receive the health services they require whereas the more advantaged do. In the EU however, one of the defining principles of its health care systems is equity of access according to need. This means that no matter who you are or where you come from you deserve to be treated to the same standards as anyone else. How can we improve the access to care for people in Europe that are ‘invisible’, neglected, underserved, forgotten or overlooked?
Project brief:
To take a human-centred approach to design a service, product or product-service combination to an existing, worrying situation - that attempts to narrow the health gap by improving the heart health of people who are currently ‘invisible’, underserved or forgotten by healthcare providers and not part of healthcare systems.
Solution Summary 🧑🏽🤝🧑🏽 ℹ️
Our team explored the healthcare experience for the marginalised Roma people in Finland. Roma people have a hard time getting adequate access to healthcare due to a lack of strong identification methods, lack of trust in authorities and low literacy rates. We searched for a solution to help the Roma community get better access to healthcare while generating trust in the system and leading healthier lifestyles.
The service concept RO+ creates a hassle-free journey for Roma people. On the platform Roma, healthcare providers and social service workers can access information in one place and coordinate with each other on referrals, appointments and the status of temporary ID. The service can solve Roma’s problems, including language barriers, by simplifying the processes.
Design process 📝 💡
PHASE 1 : IDENTIFY AND EXPLORE 🔍
Target audience
Roma people are the largest ethnic minority in Europe. However, according to a 2003 report by the World Bank, many of them live in conditions below even the most minimal for survival. Besides, many homeless women experience unwanted pregnancy due to the lack of education. Homeless Roma people sleep in a park, under the bridge, on a bench or in a tent even when it's -27°C in winter.
There are approximately 10 000 Finnish Roma residing in Finland. However, according to a 2003 report by the World Bank (UNICEF 2007), the East European Roma are “almost entirely marginalized” and many “live in conditions below even the most minimal for survival”.
“Employment authorities’ data showed that 70% of the Roma job seekers only had finished primary education or not finished their primary education.” “estimated that there are currently close to 200 homeless Roma in Helsinki. ” (Lähteenmäki-Smith, 2011)
Characteristics of Roma
Relation between Roma's lifestyle and heart health
Expert interview
Borislav, the director of Hirundo, mentioned health services mostly provided for emergencies but not for chronic disease which heart diseases usually are, so until the situation is really bad, they will help, as he said: "There was a man who was about to die because of high blood pressure." Roma also won’t take it seriously so don’t go to hospitals because they think the current situation is still ok, which was said by Raili.
Free drugs can be bought from pharmacy stores when they get special prescriptions from doctors who are volunteering to work here if the situation is not serious but if it is, then Roma will be sent to health stations or hospitals depending on the situation. Borislav and Raili said many Roma can’t read or write, especially for women, because many didn’t receive much education and they know little about their health, not mention to take care of their heart. So Borislav used pictures like the education board made by him to teach them health knowledge.
Interview with Borislav Borisov, Unit director of Hirundo day care center
Interview with Raili Bäckström, Volunteering nurse in Hirundo
PHASE 2: EMPATHIZE AND DISCOVER 💜
In this phase, our goal was to dive Deeper into the life of Rome and gain an understanding of the related stakeholders such as Hirundo, the emergency center; Global Clinic, the Weekly Volunteer run Clinic; Kalasatama health center, a multi-specialty hospital with special provision to undocumented people.
Cultural Probes
The biggest challenge of Collaborating with Roma was the language barrier between us and their lack of trust towards Outsiders. So we worked with the social service worker Delia Manea who works at Hirundo. Her education background with Sociology and fluency in Romanian and Bulgarian language helped us in simplifying the cultural Probes to Engage Roma people. Instead of using text, we numbered the options to be chosen to fill the worksheets, to keep the communication simple, yet effective.
With the help of Delia we connected to three Roma people, Maria from Romania, Lazar from Bulgaria and Romania, and Lonica from Romania . They volunteered to take part as participants in filling out the cultural Probes for 5 days and Engage in conversations with our team to gain a perspective into their lives.
Cultural Probes handed to our stakeholder
Archetypes developed from Cultural probes
An archetype of Roma’s Sickness Journey
An archetype of Roma’s eating habits
Insights
Insight 1: Preventive Healthcare is not a solution for Roma
• Due to the mobile lifestyle of Roma and insufficient income, it would be unrealistic to expect Roma to take preventive measures to save themselves from the risks of developing heart problems.
Insight 2: Bridging the communication gap to strengthen the network is crucial
• It is crucial to revise the roles and responsibilities of different departments within Kalasatama hospital to avoid a chaotic experience in the need of urgent attention.
• Parallely, it is important to also strengthen the communication between Kalasatama members working for Roma and members at Hirundo, so that they are familiar with the concerned person.
Insight 3: Building an approachable atmosphere
• Due to the high number of patients visiting the Kalasatama hospital and the lack of knowledge on the challenges of Roma life, the front desk staff of the hospital comes across as unapproachable. It is important to build a sense of culture.
• Since there is a small team of Hirundo who is working for the upliftment of Roma, it could be easy for the smooth functioning of the entire system if the people involved in both organizations are familiar with each other.
The relational map showcases the most important stakeholders involved in Roma's hospitalization, including Roma themselves, Kalasatama health center and Global Clinic, Collaborating with Hirundo.
PHASE 3: FRAME AND DEFINE 📝
In this phase, we defined three opportunities areas, that is, problems which we want to work on in the next round. For one, a service gap exists between Hirundo and Kalasatama health centers. Also, Roma people often miss the appointments with the Doctors of Kalasatama and translators Hired by Kalasatama which causes a big loss to Kalasatama and Hirundo. Last but not least, Roma people have difficulties in communicating with Doctors even with the help of translators.
The
Generating themes of challenges
We translated the findings from challenges faced by different stakeholders and clustered them into four themes:
1. Mixed information
2. Educational background
3. Communication
4. Trust
Themes of challenges between different stakeholder
Defining opportunities by building How Might Wes and translating them into What Ifs
By defining themes we identified overlapping pain points that challenged Roma patients and caregivers. Then we transformed these insight statements to ‘How Might We’ to turn challenges into opportunities. To further narrow down the opportunity statement, we answered How Might We questions with ‘What If’, to speculate the potential solution. The process is depicted in the graphics below:
Analysing the strongest What If by using SWOT matrix
SWOT analysis
PHASE 4: IDEATE AND DEVELOP 💡
We created a platform RO + , where Roma people, healthcare providers and social service workers can access information in one place and coordinate with each other on referrals, appointments and the status of temporary ID to ease Roma People's sickness journey.
Final Concept
Service Blueprint and Business Model
In the solution, the main front stage channels are Hirundo social service workers, Global Clinic nurses and Kalasatama info desk.Coordination between these stakeholders is crucial for the system to be efficient as a whole.We defined our service scope from 'learning how to use RO + application at Hirundo 'to' taking the prescribed medicine from the pharmacy '.
We have three user journeys with similar digital touchpoints in the front stage. First of all, our target users will choose the available time for the appointment and get a voice reminder one day before the appointment. Secondly, they will show the referral with the QR code at Kalasatama info desk and the info desk staff will scan it. Last but not least, we help our target users not to miss the due date to take the prescribed medicines within the valid period by prompting a reminder message.
Reflections
Working on the project has been the most enriching experience of my service design career. The project did not only solidify my foundation in the design process but also in design research and service design. The project's object stands out from the popular image of design being a service for the rich and the privileged. I was so happy to gain the opportunity to design healthcare accessibility for the invisible population of Finland. Even though I was quite sceptical about designing something so customised for a small stakeholder group such as around 300 Romas in Finland. However, we realised through our research that other immigrant populations such as those from the Middle East can also benefit from such an organisational change.
Furthermore, as we gained more systems understanding on this topic, our team would further recommend or like the opportunity to take this research forward with government organisations such as Migri, Kela for providing humanitarian residence permit to the travelling population and them equal members of the society.
Furthermore, as we gained more systems understanding on this topic, our team would further recommend or like the opportunity to take this research forward with government organisations such as Migri, Kela for providing humanitarian residence permit to the travelling population and them equal members of the society.
