MedApps Resident Guide Journey
According to the Lean Enterprise, 66% of business ideas produce a neutral or negative effect. CIO.com.au reports that 37% of IT projects fail due to a lack of communication or poor communication. In the United States, design-driven companies outperformed the S&P 500* by 228% (Microsoft and DMI).
Design-driven projects have an emphasis on communication and customer value and are also centred in User Experience (UX) and Design Thinking!
*The Standard & Poor’s 500 is considered to be the best indicator of how U.S. stocks are performing on a day-to-day basis.
In this blog, we are going to discuss how MedApps used the UX principles to redesign the Resident Guide Experience, solved a big problem in hospitals and tripled their team size in the process. We will set the scene with context, deliver the simplicity of their approach, link this blog to previous research done for the HISA UX Community of Practice (COP) and finally share lessons learned from the CEO and Founder himself – Dr Rob Pearlman. The lessons learned span far beyond UX and is a must-read for every clinician wanting to do the same.
Many organisations have difficulty creating products and services with good UX, so it is great to have worked with MedApps and have seen how much they have done with so little. They have taken the UX principles and used them effectively.
The author wants to share one particular thing before we begin. Dr Rob taught himself coding. This accomplishment is a significant feat as coding is not an easy thing to learn and was done while working in hospitals. Dr Rob still does to this day. The knowledge of coding (or development), the process, what it takes to accomplish a task along with realistic estimations, I believe, was of significant advantage.
There were significant motivations behind the creation of Resident Guide (RG). Being a JMO (Junior Medical Officer) in a new hospital with new people, new patients and lots to remember is no easy feat. It is a demanding gig, and often things move sideways. The right information not only facilitates quick responses, but it also facilitates the right response. Here are some statistics that were part of the driving force behind Resident Guide.
- 1 in 4 doctors have had suicidal thoughts
- 1 in 5 doctors have been diagnosed with or treated with depression
- 1 in 50 doctors have attempted suicide
Resident Guide aims to be the one-stop-shop and currently manages the ‘how to book’ at your hospital:
- Imaging protocols
- Consultant Guides
- Ward Protocols
- Intern Orientation Manuals/Guides
- Phone Directory
- Education & Engagement
Rather than creating another phone app, it is worth noting that RG integrates with hospital systems, processes and procedures.
- Rosters & Rotation Schedule
- Admin and HR Information
- Consults & Referrals
- Diagnostic Tests
- Handbooks and Orientation
- Personal Well being
The UX process we followed for the redesign of the current RG experience was quite simple. Here’s what we did:
- Discussed learnings from the app to date
- Initiated a UX workshop with the team, clinicians and newbies
- Identified critical components required to discover the right experience – the why, user, problem, journey, environments, features and success metrics
- Identified the insights to create the right UX
- As a group sketched the possible solutions
- Distilled the possible solutions to a single team-agreed solution
- We used three showcases/review cycles to design wireframes
- We handed over the design to MedApps to execute
Here’s what the author believes to be the critical success factors required to work collaboratively as a team and produce great user experiences.
- A need for speed
- A need to succeed
- A need for equality, democracy, respect and trust
- A need for 5-8 people from the team and ideal user base (minimum)
- A need for open and honest communication
- A need to answer probing questions to unearth insights
- The basic UX methods like affinity diagramming, voting, personas, user journey and sketching.
Working together in workshops is not the sort of thing most organisations do. It is not the usual way to work. It can be quite uncomfortable. The Resident Guide team, however, said working collaboratively in workshops:
We conducted some research earlier in the year for HISA and asked a group of colleagues from leading organisations across various levels of UX (designer to executive) to tell us what the top ten things they thought were required to create great user experiences. Then we asked of those ten, what there number one was and why? Here were the top five (notice how many are people related):
- Methods (21) – persona, journey, prototypes/wireframes, ideation, co-design, user touch points, system intersections)
- Right Team (18) – Right people, collaboration, engagement, getting developers on board, tech feasibility, empowered the cross-functional team, relationships, UX co-ordination
- Research (14) – Understand users through observation, customer needs vs wants, what and how to prototype, the need for user validation, relevant user data and divergent thinking.
- Users (11) – User support, user validation, journey maps, understanding user motivations, user feedback, prototype and test with real users.
- Usability(11) – Readily usable, ease of use, intuitive, pleasing, enjoyable, targeted, adaptable, scaleable.
MedApps Learnings (Dr Rob Pearlman)
In Silicon Valley, they say ‘move quickly and break things’. Well, organisations cannot do that in health because when things get broken trust gets destroyed, and people get hurt. The MedApps approach has been to move as fast as possible making sure not to cause any breakages. It means mapping out 75-80% of the understanding of a problem, the use cases and how the logic is going to function (good Experience Design needs Clinicians, Doctors, Nurses, Allied Health and Administrators involved in the process) and then just run with it. These people have all the answers.
There’s a trend for hospitals to try and build technology. Districts spin up internal dev teams and projects which have had limited success or only last for a short period of time and would probably reflect a significant waste of scarce resources. Innovators should always be trialling new ways and experimenting, new technologies and new avenues of growth. If, however, technology is not an organisation’s niche then stick to what you are good at and partner with the technologists instead.
MedApps wanted a new Experience Design but didn’t have the skills in-house. At this junction, the obvious choice was to draw on the expertise of external consultants. Design Moshpit was invited to run Experience Design Workshops. Together we co-designed the new experience. They were instrumental in teaching us what we were going to build, how to structure all the things I wanted to get out, making sure that the process was not entirely my own and that the team owned it going forward.
Design Moshpit have also recently run our quarterly Business Strategy Workshops to identify the ‘where to now?’ These workshops identified agreed strategies for the next 18 months and subscribe the team as a whole to the future directions of MedApps.
There have been many insights along the Resident Guide journey. One worth mentioning includes Dr Rob’s fixation was on what he thought the payer would want (i.e. having the Admin & HR tab at the top left). The only strong feedback we had has been consistent – why is the tab there? JMOs do not need it, and there should be an education tab. This is a good reason as to why it is essential to have all stakeholders at each workshop. Get all insights at the one time and save time in the long run.
So, never outsource your development unless the business is prepared to run 400% over budget. Contract in when necessary but decide to be a technology company or a company awaiting usurpation. Control the means of production and have conversations to immediately change the specification of a greenfield API or the layout of a page (with the interaction between design, backend and frontend all in the space of 5 minutes). It may be a complete change from the plan and specification laid out at the start of the week and a 4 hour time difference or a language barrier will add delay and complexity to what otherwise would be a simple conversation. These remote working skills can be built and learned, but they are not for startups, they are for Fortune 500 CTO’s and VP’s of Engineering.
When Resident Guide wanted to ‘go pro’ they were fortunate to have had a two-year track record of the application in the market with revenue and 14 hospitals on board. Resident Guide had usage metrics that showed that people engaged with the platform and the engagement was continuous. That fact that Dr Rob is a user of the platform given he was (and still is) working in hospitals that did and did not have the application deployed – was beneficial. The failings of the platform, where and how it could be improved he observed daily.
It’s a good thing to solve a problem and be good at it. Sometimes it takes a long time to solve a problem. Having lots of money at early stages can be corrupting and problematic. MedApps bootstrapped for 2 and a bit years before the decision was made to look for funding and it meant a much more frugal mindset. It also meant we spent a lot less time looking at the problem space when the decision to scale arrived because they had already solved a real problem.
Resident Guide investors are all family and friends. It is a great privilege and honour to have the trust of so many friends and family with such a large sum of money. To some degree this could have been to the detriment – the fear of ‘ruining Christmas’ by blowing up the funds given to you by your nearest and dearest can be a powerful disincentive to risk. It eventually became apparent that they did not mind if we failed (although they certainly hoped we would not). They had always expected MedApps would spend the funds they had invested in a responsible manner for growth and stability.
Resident Guide has also been very fortunate on the Business Development side. The connections made as a Junior Doctor have continually shown enthusiasm for the application. Through word of mouth, we have managed to grow our network of hospitals significantly. In large this is due to the value the application drives, the massive problem that it solves and the relationships with our administrators. We are eternally grateful for their support and ongoing feedback and we work as hard as we can to integrate into improving.
Listen to everyone, but trust in one’s self. Everyone in the startup world everyone has their opinion. On many occasions, individuals have come and told us exactly what we should be doing. From simple things such as the line should slope in that direction on a pitch deck or prove the product market fit. After four years of operation and twenty-one live sites, we have proven product market fit!
The advisors and people I trust most and listen to most never tell us what to do. They listen carefully to what we are telling them then discuss how ‘Team X did Y and achieved Z result. We have observed that in market A there seems to be a tendency towards B. With those similarities, have a look at that example and how it might demonstrate how to leverage – that might be a useful insight! They do tell us things, but they nudge us in the right direction and let us make the decisions.
Awareness mirrors a preferred approach of mine. Watch and learn! Act when there seems to be enough information. Act decisively. There is so much information in the startup world, and it is sometimes hard to know when to do what.
An entrepreneur is someone who can build a business, sell it, walk away, find another problem and then solve that.
An exciting period of our development came with a small section of outsourced work. The third party was to work in two-week sprints with continuous delivery, but even before the first line of code had been written things felt wrong. The approach all along was that the project is failing then it is because of the decisions those at the top have made. So let us identify the problems and get to the solution. Fortunately, Resident Guide had spent the previous three-weeks mitigating the risk, and our resource was able to swing into position seamlessly. We subsequently delivered the project basically on-time and slightly over budget. The lesson here? That accountability always comes from the top. As CEO I am always responsible for every mistake in my organisation. If I am growing, then the organisation is too. When people do not deliver their end of the bargain, give them another chance but have the parachute ready.
Resident Guide is very lucky to have had such a vast pool of personal connections to have drawn from in the initial resourcing of MedApps. We have indeed operated a ‘KanBan’ or Just-In-Time methodology of hiring, and for the most part, this has worked well.
We were very nervous about the first few hires. Initially reaching for what was around. Resident Guide’s first hire was a housemate of almost a decade ago. He went on to do Law, and he wrote the initial contracts. When it came to the point of raising it was fortunate he was at a stage in his life when he felt he could buy the call that was on sale to see what life would be like a year down the road on Team MedApps.
There was enormous uncertainty about the necessity for any of the hires. When the first hire came on, it was sure as to whether they would be doing nothing for 50% of the time. After all, up until a few weeks ago, MedApps had been managed by Dr Rob along with a clinical workload.
Hiring our first developers was more tricky. It is fortunate things turned out well, but there was no frame of reference for how to hire, but if we are going to be sitting in a room together then they best be competent, and we would get along together.
The fourth hire did not work brilliantly but left on good terms.
People say be careful about hiring friends, but our fifth hire was a university and surf club friend of over a decade. He had product management experience in a bewilderingly diverse number of locations, and product management needed some care. It very rapidly became apparent that he was necessary and Resident Guide was able to lure him away from his dream of working for AWS/Microsoft/Google to take a bet on MedApps.
Our sixth and seventh hires (Co-CEO and Wellbeing Project Lead) were also from the friendship circle, and it has been fantastic having them onboard.
The commonality between the team has led to a very open and flat structure, and the trust between us all has easily integrated the other team members whom I have known for less time. That trust has enabled delegation since day one, and we believe that this is the only way to achieve excellent results from our people – trust them to make the right decisions, and recognise that there are no mistakes just lessons that we will try not to make again.
Searching for the best user experience and successfully creating a world-class experience for the customer is a simple process but does require some necessary inputs.
People in the form of users, Clinicians, Doctors, Nurses, Administrators is an essential ingredient. They have all the answers, and this accelerates the time it takes to achieve success.
A flat structure, openness and trust is also an essential ingredient. Trust in people is the only way to achieve excellent results.
Using the UX methods such as those found in workshops are the final of the essential ingredients.
When any combination of these ingredients are missing, the author believes that this is when teams step into the 66% of ideas that don’t add value and the 37% of IT projects that fail due to lack of, or poor communication.
About the author
Bernard Schokman is CEO and Head of Innovation Design at Design Moshpit. Design Moshpit specialises in designing and executing innovation frameworks across an organisation. The foundations of these frameworks draws their inner working from Innovation Frameworks, User Experience, Design Thinking and Agile.
For almost the last 30 years Bernard has worked in, created and led teams for various organisations across development, testing, business analysis, user experience and design thinking. While directing the User Experience of a massive CRM and leading the User Experience design for a Telco, Bernard noticed efficiencies in bringing all stakeholders together at the same time across a collaborative framework of User Experience, Design Thinking and Agile. The root foundations of innovation.