Lumen
How can nursing homes use technology to enhance their workflows?
Concept
UI
UX
Healthcare
Background
With falling birth rates and a growing aging population, the need for efficient nursing homes is skyrocketing.
This surge is straining care providers with rising costs, severe staffing shortages, and increasing pressure to deliver high-quality, efficient care at scale. Outdated systems add to the problem, causing care delays, unhappy residents, and staff burnout.
The Challenge
How might we improve communication and workflows in nursing homes to ensure timely care and enhance resident satisfaction?
Certified nursing assistants (CNAs) often have anywhere between 6-15 residents to look after per shift. Juggling all these responsibilities can lead to neglect and malpractice.
Streamlining today's systems can help nursing homes maximize the return from already existing resources.
The proposal
Lumen is an application that focuses on providing an extra layer of organization to the call light workflow.
The core features of this app can be broken down as follows:
01
Call lights, prioritized
Problem
In many modern nursing homes, CNAs care for multiple residents at once, often missing call lights while assisting others.
Solution
Our app notifies assigned CNAs of new call lights and prioritizes them based on order of activation, reducing mental strain and ensuring timely, efficient care.
02
Requesting help
Problem
Some nursing home tasks require multiple CNAs or RN approval, forcing staff to spend valuable time searching for available help.
Solution
The Lumen app's Request Help feature allows CNAs to quickly share call lights with colleagues, improving efficiency and patient care.
03
No resident left ignored
Problem
When call lights go unanswered for too long, residents may feel neglected and frustrated.
Solution
Lumen automatically notifies other CNAs if a call light remains unanswered for over 15 minutes. If the assigned CNA is unavailable, another team member can step in to provide care.
04
Resident profiles
Problem
CNAs that switch nursing homes often can find it challenging to quickly learn new resident preferences.
Solution
Lumen provides a resident profile for each patient at a facility with their health needs. The profile also has a section where CNAs can leave notes to inform colleagues of patient preferences and other special needs.
Deep dive
Research
Talking with CNAs revealed that most nursing homes rely on manual request tracking and face-to-face communication.
Because the main challenge is to improve efficiency, I first created a journey map of the current workflow to identify friction points in the existing process.
Prioritizing lights is difficult
Nursing assistants report difficulty knowing which lights lit up when, especially when they were not in the hallway when it lit up.
People finding is disruptive
Nursing assistants express frustration at the need to often leave tasks to track down people in order to complete call light requests.
A low-tech environment
Nursing assistants often get juggled around several facilities, and a majority of them reported that most facilities do not rely on technology despite having internet access.
Existing tech is outdated
A few facilities use pagers for call lights and walkie-talkies for communication, but can be limited in capabilities, bulky, and hard for new workers to use.
I decided to focus my designs around the most disruptive part of a CNA’s day: the call light experience.
By doing this, we aim to save the facility time by improving worker efficiency, which in turn may help save nursing homes money in the long run.
Considering the big picture
Before I dove in, I took a minute to think about how an app for CNAs would work in the nursing home ecosystem.
I focused my work around CNAs because they were the only stakeholders I was able to speak to. A solution for CNAs however would touch the workflows of many stakeholders.
Roughly, I would imagine the integration of such a service to look like this:
While this case study focuses on the service provided for the care team with a special focus on the CNAs, next steps would involve exploring the missing pieces, specifically:
1. An administrative facing service
2. The call light hardware for residents
But without further ado, let’s get into the meat of the design!
Designing the core features
A lesson in double checking my assumptions
When I started my designs, I had a made many assumptions I made about what information a CNA needed during their shift. Working closely with a small circle of CNAs disproved many of my assumptions, leading to iterations.
Assumption 01
CNAs need constant, easy access to all information.
A big chunk of understanding the app information hierarchy was thinking through how and when CNAs wanted to access certain pieces of information. I had first started with a classic, maximalist design approach: a central menu bar that allowed CNAs to access their scheduling information and any room's information at any time.
After sharing this with CNAs however, I realized just how overwhelming a day on the floor is. CNAs are constantly focused on many tasks, and have little time to think about things other than what they have to do in the moment. These discussions had me backpedaling my approach to try something else: what if I went with a more minimal, curated information architecture instead?
Sharing the two hierarchies side by side yielded a quick winner!
Assumption 02
Communication with other colleagues is essential to ALL workflows.
To help streamline communications at nursing homes, I had proposed a “Responding” button. This button served two purposes: (1) to help other CNAs understand how the statuses of their colleague’s lights were changing, and (2) to help them communicate with colleagues about who was responding to a help request.
When I talked to CNAs, however, I learned a crucial detail: call lights are turned off by hitting a button in the patient room. This meant that my proposal could potentially complicate rather than complement existing workflows, since CNAs would need to tap the app button and the actual call light button. As a result, I made the decision to remove this button.
While the responding button interrupted the CNA’s default workflows, I felt that it was still helpful for the situation where someone was responding to call lights that did not belong to them. Having this extra interaction provided a way of letting colleagues know that you were addressing their call light, or that you were coming to help.
As such, I kept the “Responding” button interaction for those use cases.
Assumption 03
CNAs made often and frequent reference to resident details.
When I conducted my initial round of interviews, I learned that CNAs often were juggled around many facilities. This lead me to my assumption that there would often be situations where CNAs would constantly need to care for new patients.
As such, my initial approach for the patient details page presented all the health information at once on the same hierarchy.
After sharing this concept however, I learned something new: CNAs actually rarely needed to reference patient details beyond vitals and notes.
Speaking with CNAs taught me that there were two patterns to CNA shifts: while some CNAs were often shuttled around different facilities, there were also a good number who stayed in facilities so long they knew all of the patients there by heart. As a result, details such as ambulatory status, mental status, and health conditions were not things these CNAs needed to look up often.
Furthermore, even new CNAs coming onboard only referenced certain pieces of patient health information at the very beginning. This information led to a more hierarchical iteration.
Reflections
Challenges of adoption
Taking a step back and reflecting back on this project as a whole, I can see a number of factors turning into potential challenges for the adoption of Lumen as a solution. A few sit at the top of my mind:
Challenge 01
Medical facilities have a lot of regulations around patient confidentiality.
Particularly in the case where CNAs use personal devices, ensuring compliance can be tricky.
Consider...
We have models that set a precedent.
Many existing services, particularly EHR applications, have similar patient confidentiality rules that apply. They can serve as a model as to how to ensure Lumen meets all necessary criteria.
Challenge 02
Adopting a new app will be costly.
As with any new technology, adoption will require time, training, and money.
Consider...
Return on investment
In the long run, Lumen will be able to streamline a currently disruptive process and boost worker productivity, resulting in higher returns for the nursing home.
Challenge 03
It may be difficult to change existing technology implementations.
While walkie talkies and pagers are outdated, they are common throughout the medical system and would be a cheaper initial investment.
Consider...
The Lumen application has advantages over walkie-talkies and pager systems:
A smaller learning curve, as the app was designed with simple hierarchy, and will be more familiar since smartphone technology is pervasive
Regular updates and new features to further enhance workflows
Ability to reference patient charts and notes
Ability to organize call lights in a more sophisticated manner
These considerations are not necessarily a magic bullet answer to the challenges, but rather a demonstration that despite barriers to adoption, there is still opportunity in the space.
Ultimately as the needs of nursing home care continues to grow, I believe that adopting a more modern solution such as Lumen can significantly boost facility productivity, leading to more efficient care and satisfied patients and families.