Master of Design Thesis

In Their Shoes is an interactive resource for development and innovation in nursing homes. This resource is available for use by anyone who is working in or with the homes, from administrators, to consultants, to policy makers. The intention is to highlight and preserve the experiences and perspectives of the employees in the homes. When the project started, I was looking for reasons why small, daily tasks get forgotten and slip through the cracks.

The solution, of course, was obvious, just close the cracks. But through observations in the homes, I found out what the cracks were made of, and then addressed what was underneath. To explore the interactive resource, scroll to the bottom of this page. 

 
 

Seeing what's really there

I shadowed four different nursing home employees: three nurses and a nursing assistant. They each worked a day shift during the week. This totaled 31.5 hours of observation, which I combined with other interviews to create the information you see below. It took much longer than expected to schedule the interviews, so I took extensive notes of what they were doing. These notes changed the way I looked at the work and included a huge amount of depth and detail. 

 

Resident Relationships

While I was in the homes I got the chance to talk with a few of them, and hear their stories. I also read extensive interviews with residents in 47 different homes in Oslo. Simply put, the residents rely on the staff for more than medical needs.

The residents with enough cognitive ability rely on the staff for social fulfillment as well. In fact, one resident I spoke with, Pamela, cut our meeting "short" after an hour and a half to meet with her former physiotherapist. She spent so much time with the staff in her last place the now the therapist was visiting her on a social basis at the new home. She now requests special meals so she can eat in her room as opposed to the common dining room. Another resident told me "You always feel like you’re interrupting them when you need something. ‘Oh, this guy again'". He felt the staff was too busy, always running by, and he had trouble catching them. By addressing the systems and keeping the staff relevant as a resource for future work, this project tries to preserve time and energy for the staff to engage meaningfully with the residents. A more supported staff means a more comfortable home. 

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Getting into details

From my notes, I was able to show exactly what the shifts look like, what they were doing, when they were interrupted, etc. I paid special attention to the interruptions. If I was looking at why tasks fall into the cracks, surely these were some of the cracks. It's no wonder things are forgotten when they are constantly having to change what they are doing.

 

 

Main Frustrations

At the end of each shift, I asked each employee if it was a normal day, if they'd done anything differently. Then I asked what the best part of the job was. They all said "people", either the residents, or their coworkers. Then I asked what the frustrations were. Listed above are the responses they gave me. The last one was the most interesting to me. It was something I'd often heard in large organizations. At the time, I didn't think I could address it. But after hearing the project groups response to my findings I realized it was not just relevant, but critical. 

 

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An Impossible Job Posting

During one of my interviews, an employee said:

In order to work in a nursing home, you need a cold brain, strong hands, warm heart, and strong legs. 

I thought this was quite a beautiful way of showing the variety of skills needed. After I finished the observations, however, I realized that they need a few other skills as well. They also work as much more than just their one job title. They fill so many different roles, and require impossible skills to get their work done. 

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Surprising Findings & confirmed Suspicions

 
 

The information I pulled from my notes was able to confirm certain suspicions they'd had before. Everyone knows that the staff is busy, but no one knew just how busy. There were also surprising findings about where the staff spends their time and why the homes seem understaffed to the residents. When I presented these findings back to the project group, I assumed we'd identify one direction and move forward with development and testing new ideas. Instead, they talked about how this could affect lots of different projects that were in progress. That's when I remembered something a nurse had told me. 

 
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Changing Strategies

I decided to focus on the findings themselves and what I could do to help the staff feel heard. I wanted to compile my findings into a resource for current and future projects. I hoped that this would help keep the employees' experience as a relevant resource for anyone making changes. The nurse with the quote above was upset because a governmental audit group had released a report saying nursing home employees were "not effective enough". When I said "They should just do what I'm doing, follow you all day and really see.", she was very excited at the thought. Though that isn't really feasible, I hoped to make a resource that could at least communicate the realities of working in a home. 

 
 

Deciding on form

I knew it should contain more than the synthesis document I originally made for them. That document had a good balance of text to images, but the information was in very big pieces, and might be hard for someone who wasn't familiar with my work. I wanted it to be easy to use, but not just something to scroll through quickly. I decided to make an interactive PDF. This way, it would be easily shared between team members. The file size ended up at just 3.5MB. It also lets a project team comment or bookmark relevant pages. 

 

 

Providing a Foundation

Patterns started to emerge during synthesis, even when though I wasn't particularly looking for them. When I was making the final resource, I wanted the employees' voices in there, as literally as possible. I added in quotes, and showed very specific findings, but there was something missing. These patterns kept repeating, and seemed heavier, bigger, somehow. I decided to include them as "Foundations". They're not really principles because they're requests, not rules. I put them in the voice of the employees so they stay on the top of everyone's minds. They are obvious, and perhaps a bit dumb. But these are the things that get forgotten when changes are made to how the homes run. These foundations are simple, but critical. 

 
 

The Final Resource

Above you can see several different screens from the resource. I provided some background information about the methods I used to gather the information. There are also pages that give more detailed information about different types of projects. I divided the findings into three themes: organizational, cultural, and technological. Within each of these themes, I also provided outlined information about projects under these themes, which has the highest risk, or longest potential timeline. I drew on my knowledge from previous work experience and added tips for which people you may want on a project team, general project phases, and key questions to ask for each theme. 

 

 

Changing Mindsets

When we started the project, it was about small things getting forgotten. It was assumed that we would make a reminder system, and likely a digital one. I knew there were probably organizational issues at the root of this. I believe technology is a means, not an end. It's a tool that isn't necessarily appropriate for every problem. I was glad that the findings I shared led allowed the project team to reach the same conclusions. Adding an app or screens on top of this busy world would likely cause more stress in the end. 

 
 

The Full Resource

If you have made it all the way to the bottom and want to see the actual resource for yourself, follow the link below. 

It's best used in full screen view, or, at the very least, full page view. Resist the urge to scroll at first and just click your way through. 

Full resource found here.

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