UXA2022 Day 1; Fiona Armstrong - How to design services in sensitive areas

Designing a service for people experiencing some form of hardship or vulnerability is challenging but the rewards are extraordinary and the best thing is how giving, sincere and collaborative people are throughout the process. There is so much more to consider when working on a topic that is sensitive. You may need to take a trauma-informed approach, draw up protocols, go through ethics, set up safety plans...it can be daunting and overwhelming. But it doesn’t mean you can't make significant reform. We’ll talk you through some case studies and specific examples on how we approach service design in sensitive areas.

Transcript

1. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. www.captionslive.com.au | captionslive@outlook.com | 0447 904 255 UX Australia UX Australia 2022 – Hybrid Conference Thursday, 25 August 2022 Captioned by: Kasey Allen & Carmel Downes
2. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. Page 74 today but also that great pushes of improving the health of all Australians. LAUREN ARGENTA: Thank you to you all for listening and we hope that we have some actionable go tos for you to take on as you move into these types of projects with these types of teams. Have a great day. PAUL MERRELL: Have fun. (APPLAUSE) STEVE BATY: Thanks, Paul and Lauren. I hope you both feel much better very soon. Thank you. Our next speaker today is coming up on stage. Please join me in welcoming Fiona Armstrong. (APPLAUSE) STEVE BATY: Thank you, very much. Over to you. FIONA ARMSTRONG: Thank you. I am delighted to be here this afternoon. It is such a pleasure to be able to be here in person and talking to everyone again. I wanted to share with you this afternoon some insights around how to design services in sensitive areas. Listening to all of the great presentations that we have heard this morning and early afternoon, it follows on nicely from a lot of the things that we have been talking about. My name is Fiona Armstrong. I work at Liquid Interactive. I wanted to share with you today some insights and learnings from my personal journey over the last 20 years of working in sensitive and complex topics. It is the first time I have pooled these together and try and distil learnings from a variety of projects, working across lots of different areas into a few principles and insights and takeaways for today. I will use some examples from areas as diverse as older Australians, mental health, bereavement
3. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. Page 75 and victims of crime to illustrate some of the points that I want to make. Let's start with what is a sensitive area? It is a bit of a strange topic title. Sensitive is a word that gets used in many context. Today we are not talking about classified information, we are not talking about the hypersensitive people. We are talking about something that has the potential to impact on your wellbeing. That is what makes it sensitive. In terms of what that actually means, it is things that predominantly will challenge your autonomy. They will take away your feeling of control, your feeling of self-determination. They often either exacerbate or create trauma and they have a vulnerability that they create as a result of that. There is often other things that come along with them, there is that sense of stigma, there is a sense of isolation that comes along which negatively impacts on trust. There is all those situations that you find yourself in that create that vulnerability in your life that we will look at today. I want to start by looking at how you approach a situation like that. Obviously, working in sensitive areas is very complicated, very complex. You are dealing with a lot of different stakeholders, you are dealing with a lot of different perceptions. Going into that, how do you prepare yourself for doing that? What does it look like? When you are starting in that area, empathy is essential and we have heard a lot about understanding peoples' journeys and experiences and empathy in today but you need to go further than that in a number of ways. You really need a very deep humility and you need to understand and really appreciate the precariousness of life. One of the things that is critical when you are working in this area is understanding that vulnerability isn't generic and it is not permanent. It really depends on your life experiences, on your health, on the circumstances that you find yourself in and the situation that you are in. I have a picture of an older lady up here, because I am sure you have all seen in the news recently that one of the things that is
4. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. Page 76 happening in Australia at the moment is there is a lot of older women in their 50s and 60s now facing homelessness for the first time. They have had very happy successful lives, great families and all the rest of it but their circumstances have changed and now they are in that situation that makes them vulnerable to homelessness. It is about that appreciation of the vulnerability of the human situation that you go into this with. In that same sort of mode, a lot of the time, particularly if you work in government, you will hear labels bandied around, cultural and linguistically diverse, great term, can never say it, you are hear about Aboriginal and Torres Strait Islander people, as a uniform block, you hear about disability, and LGBTIQ plus. Resist the temptation to put labels on people. People are not to put in boxes they are more interesting and more complicated than that. You need to see the person if you are going to work effectively, in terms of this space. Working in sensitive areas is really hard. The sorts of things that you need to do personally to prepare yourself to work in that area is really work up that sense of very finely tuned understanding of all of the different voices that you are going to hear. You need to be able to quickly grasp what you are hearing and also what you are not hearing because a lot of the time it is actually about the signals, the influences, the things that people are not saying to you that are your biggest clues as to where to go with this. You need to be able to navigate a lot of times topics that people with lived experience, passionately disagree about. That is OK. You need to be able to navigate that and synthesise that in a way that everybody feels heard, in a way that everybody feels that you have listened and they can see themselves in what you are presenting back and working with them on and finding ways to navigate when that change is where the challenge is. As part of that, there is three situations in here where I will say that
5. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. Page 77 your personal resilience is absolutely critical. The first one is as an empathetic being going into that and talking to other humans about situations that they have experienced that have been hard and challenging, it is difficult not to feel overwhelmed or upset by that sometimes. Again, the importance here is about really working in a team, supporting each other, understanding what that looks and feels like and making the time and purposely decompressing from those sorts of situations so you don't carry that with you as you move forward. There is also various safety things that you can do, particularly if you are interviewing people in their homes and in community, where you would work in pairs just to share that experience and basically provide an extra pair of ears to listen to what is being told. There is other things that happen as well, particularly if you are seen as going in as part of government. Because sometimes the people that you are working with will have had horrendous experiences that they still hold a bit of anger about or a bit of mistrust about and so sometimes what you will see in their behaviour towards you is actually that anger and that frustration really coming out and, again, it is just being able to really make sure that you don't react to that in a way that indicates that you are taking that criticism onboard in a way that is personally directed. But understanding why they have it because it is very valid. The third thing that comes up often is around the urge to help. If you listen to somebody telling you a story and you know that actually they have been given some really bad information, they have been led up the garden path, the temptation when you are listening is to actually offer advice. Please don't do it. It is really tough sometimes when you are in that situation, so if you think you are going to be in that situation, when you are designing your approach, it is always worth thinking about OK, how do I make sure that there is professional support and information
6. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. Page 78 available for people that I can hook them up with after this session so we can help get them back on the right road? Maintaining that professional distance and your own personal resilience is really important. Empathy. I mentioned before empathy is absolutely critical. It is about how you emotionally understand that other person, what they feel, what they see, see things from their point of view and imagine yourself in their place. It is absolutely critical for any sort of human centred design, however when you are working in a sensitive area, you need to go way deeper than that. You actually need to understand the person's behaviours and the unspoken concerns and deep-seated fears driving their behaviour. Without understanding their why, the solution that you create at the end of this won't go to actually creating real lasting change, it will be surface level at best. You won't actually achieve those improved outcomes that you are seeking to achieve. One example from my back catalogue of projects that I have worked on was actually listening to a group of young African male refugees one day and they were sort of - we were having a discussion about how they would settling into Australian life and we were just talking about their experiences of work and finding work and it wasn't until part of the way through the conversation - we were talking about why they were struggling to adjust and struggling to get work and when we got into it and underneath, it was actually a fundamental about their life experiences. These were guys that had grown up in refugee camps. If you can imagine growing up in a refugee camp, your sense of normal is way different to anybody who has grown up in Australia. It was actually their concept of time, so the notion that actually you got up when an alarm clock told you to get up, not when the sun got up, the notion that you needed to go to work at a particular point in time and stay there was just so foreign to their way of thinking and their way of being, that until we
7. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. Page 79 actually got through that, we weren't going to be doing anything that really actually created the outcomes that they needed to adjust to life in Australia. So the notion around designing and sensitive areas is one that does take a bit of time to do. It is not something you can do in a hurry and there is a lot of talk about human centred design and the adoption of human centred design. I would like to say it is not a sausage factory. You need to actually look at your research and engagement approach, particularly in design to fit the subject matter you are talking about. It depends on the nature of the cohort of the people you are dealing with. The diversity of the situation, the diversity of that cohort, the complexity of the needs you are dealing with as to how you go about designing your research and engagement. If it is population-guide group, you might want to take a iterative and qualitative approach but if it is a smaller group and you will work with them for a long period of time, you might want to take a step back and codesign your codesign process so they have that feeling and deep understanding of designing the outcome that they want and in that case you are facilitating, you are not actually leading. No matter what approach you take, the principles around ethics apply to all research and it is something that gets baked in from the start. Whether you are dealing with making sure that people have informed consent, they are really clear on why you are doing this research and how you are going to use the information that provide, privacy and video recordings, they are all about ethics. Depending on how sensitive the topic is, how big that risk is to participants, there are more advanced levels of ethics that apply. This is governed by the National Statement on Ethical Conduct in Human Research and basically what it talks about in the nutshell version is about doing the right thing in the right way and in the right spiral with
8. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. Page 80 the respect and concern for your participants at the fore. It talks about the fact that your research has to have merit and have integrity and justice and benefit to the people you are engaging with. All really strong values that underpin a lot of the research that you are doing in a sensitive area. Within those national guidelines, institutions create their own procedures for ethical reviews and it is always worth checking up-front whether or not what you are about to do is going to trigger their ethics review process because if it does, you are looking at a longer time line than you ever expected, you are looking at an add on of three to six months. It is always worth just getting that cleared up-front and not hitting it when you are about to take your project out onto the road. One recent project I have been working on which required that higher level of ethical protections was around mental health. I have a few different projects that I will share with you today. In this case, when we looked at how to create that safe responsible environment that does no harm? We chose to involve mental health counsellors in our codesign sessions so they were there actually listening and dealing with anybody who might be experiencing issues on a one-on-one basis during the sessions. We had specialist support lines for participants after the sessions in case there was anything that came through in cases of distress. Fortunately, we had our approach well designed to minimise that sort of risk and avoid triggering issues and so we didn't have to use those services but we had them on hand if they were required. We also had avoided things like making sure people didn't have to disclose any personal or health details as part of those, so we gave them that privacy and protection. There is a few other things that we had to navigate our way around on this project. The values that I was just talking about, in terms of ethical research, are also consistent with the principles of trauma informed care. Trauma informed care basically talks
9. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. Page 81 about safety, trustworthiness, transparency, collaboration, mutuality and empowerment and choice. It sits comfortably in that sort of space that we were working in here, in terms of when you are dealing with somebody's mental health, how do you create that sense of calmness and space and of positivity in a way they can engage with and move forward with that safety, calmness and productivity. This project had other challenges associated with it as well. When you talk about designing in sensitive areas, I am trying to give you a feel for the different lenses and layers you have to work through and the governance issues you will come across. The other one on this one was critical governance, we are dealing with health outcomes and medical outcomes and we had to look at the clinical governance and ensure that we had something that would create good health outcomes for people. That involved establishing governance processes and procedures that looked at clinical governance. We had reviews of the clinical appropriateness of all of the products, the tools, the content that we were preparing and publishing. We had to choose clinically validated tools to use so they had the robustness and track record associated with them as well. All of these things brought together actually created an interesting situation, because at the end of the day, what we were trying to do was understand how we supported people who might be experiencing mental health issues, whether or not they recognised them as mental health issues was the other aspect of that, to take action and look after and protect their mental health. So we had to come up with a solution that really helped and drove those outcomes at the same time as navigating our way through those sorts of procedural and frameworks I have taken you through. Different project. We talked a little bit about trauma informed design. It is an approach that actually started in physical spaces predominantly, where they were looking at how to create that safe space
10. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. Page 82 for people that were in high states of distress. It is really interesting to look at because a lot of the spaces that we send people into in those situations are challenging in themselves. This is a real picture from the project I worked on. Basically, I am really interested to point out, in terms of what it says to people. Here you are walking into this office, you see high counters and big glass screens in there. What do you think that is actually saying to customers? Do they feel welcome? Do they feel valued, respected? Are they equal to the person they are dealing with? So that is the environment that actually a lot of services are delivered in. Particularly, in rural and remote areas across Australia, there has been a habit of putting customer service into the facilities that are already in that community. A lot of cases they are in police stations, court houses, they are in transport and main roads offices and what are we trying to say to people, in terms of where we are sending them? I have heard from a lot of people that have said to me "I live in a small community and I am not walking into that courthouse for everybody and I don't want people gossiping about me and why I am in the court". It is that sense of understanding the appropriateness of the environments that we are trying to deliver services in. There is also a little bit behind this as well that goes to our culture. I did a project with a group of people who were very experienced customer service professionals and we were redesigning the physical space for one that looked like this to one that looked a lot more welcoming and inviting and appropriate. At the start of that discovery process, we were just chatting through, in terms of some of the ideas that had come up in the codesign that people were interested in and one of the things was as simple as putting self-service touch screens in so people could, if they needed evidence or proof of a utility bill while they were there, they could print it out and bring it across to complete the transaction that they were
11. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. Page 83 trying to do that day. The attitude that I was getting from the customer service staff there was "You don't want to do that" and I was like "Why not? That is helpful to the person, it saves them going home to do that and they can do it while they are here" and then "No, they will print everything out and abuse it" and it took a while to get under the surface of what was going on here. It was because these people, although they had worked in customer service for a long time, belonged to an agency in government that was a regulatory agency, so the mind set of that agency was one about upholding the law and making sure that people followed the law but it then came to a principle of the fact that everybody was out there to try and break the law. That notion that applied to printers, so it comes out in the strangest ways when you are working through some of these principles. Bringing us into solution-mode now, looking at how that goes through. We have looked at some of the approach. Let's look at solutions. I am conscious of time, so I will need to speed up. Partly, when you look at solutions, you need to see the full picture. By the full picture, I don't mean a single service, I mean the actual end to end experience of that customer. In that, good example of that one was some work we did around victims of crime. After you have been the victim of a crime, you interact with a heap of different organisations and agencies and entities from police to victim support, to courts, health, to try and get you back on your feet. You have to repeat your story a lot of times during that and that causes a sense of distress but it also keeps people locked in that horrible thing that happened to them and they can't feel that they can move on. They feel disempowered by it. What we heard through those was practical tangible examples of the outcomes of the fact that the system was disconnected and broken at points and so the peoples' experiences were that they were continuing to fall through those gaps.
12. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. Page 84 Point I want to make here is the best way to motivate people, particularly on that big system-wide perspective when you are talking about multiple organisations, is actually to become good at story telling. If you can share and amplify the voices of the people that you have been talking to and the situations that they find themselves in and the experience that they have interacting with the different entities, it is far more powerful than any argument about whether your process is efficient. If you can design from that perspective and bring people on that journey. It works a lot better. In that same space, we heard that retelling the story left them reliving that experience over again. Other things that happen in your life that cause stress and bereavement is one of them. At that point in time, things that you might have been able to cope with, duplication and repeating yourself, if you are feeling fine, it is annoying and frustrating. When you don't feel fine, it leaves you feeling quite vulnerable and very stressed. In this space here, there was a piece of work that I did and it is going back to when I was still in Scotland at this point in time and we looked at the process of what you have to do if you have a bereavement in the family, in terms of who you have to note few. The important point about this was there was a lot of people that you had to note few, but secondly, we identified that there was one key point in the process and if we designed the system around that one key point, we could make this a lot easier. I had the very strange pleasure of 10 years ago, having to go back to Scotland unexpectedly because my father-in-law died and I became the customer on the other side of the service that I had designed, which was an interesting perspective. The registrar that you have to go to see to registrar the death in Scotland, after she had finished with all the paperwork for registrar duties, was able to turn around and say "Now we can help you, we can tell your drivers licence, we can tell passport,
13. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. Page 85 pensions, we can tell tax, would you like us to do all of that for you as well?" And in that 10 minutes of just sitting there, I notified every single government agency that my father-in-law had died. 28 agencies, 10 minutes. I didn't have to repeat myself and duplicate myself. That worked really well. It was lovely to see her because she had no idea who I was so she treated me as she would treat anybody else going into that situation. It was lovely to see that what I had designed actually worked really well and they were sticking to it, that is five years after I designed it. Forward into Australia. Same concept, we are still in bereavement land but in Australia I didn't have the registrar to be able to act as that key lynch point in terms of hooking everything together because of the way the system works here. We looked at engaging funeral directors and we did but the quality and consistency of the experience wasn't uniform enough. The quality and trust in the data wasn't good enough for everybody else to accept and use. We had to take a slightly different approach, in terms of enabling people to create their own personalised check lists of people to note few and doing as much of that as possible online and as quickly as possible there. There is also the example that I just talked about from the Scottish one is an example of a proactive service where the customer still had choice and control. Those things are important in a lot of the things you will come across in this area. I won't go into this example because I am about to run out of time but we were looking at working with Queensland seniors, looking at some of the fundamentals and concerns around how they would make their money go far as they got older and whether they had enough money to continue to live well. This example was about how we got them better access to all of the range that concessions out there in a really quick, simple proactive way that still maintained that choice and control and still worked through - it is there, it saves them thousands
14. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. Page 86 a year. Final comments. UX/UI. We get into the territory of actually designing the service, so you have worked through your approach, you have worked through designing the solution and now you are designing the service. There is still lots of things that go into it. The example that I have got here is in aged care. In aged care, nobody wants to ever admit we are getting old. It is not something anybody relishes. Particularly as you start to be able to notice that you can't do the things you used to do anymore. You have that innate fear of losing your independence. Older people will go for as long as possible without admitting it and actually get to a point where it is a crisis point. We were trying to actually give them that empowerment and that control and confidence and trust to be able to proactively at an earlier point start thinking about it and planning for it so you don't end up at that crisis point. We knew because you started with that sense of resistance, and I spoke to hundreds of older people around this and that sense of resistance meant that any friction that you came across at the start of your journey, it would be like that's it, I am not doing this anymore, it is too hard. We had to make sure that we were really careful in how we created the experience that really resonated with them, that talked to them, created that frictionless environment and had lots and lots of little signals in there that gave them that incremental confidence to know that this was for me and this was OK and this was normal. As we worked through, even after we had worked through - we started by designing the look, feel tone of the experience and testing and refining that before we started to talk about functionality and delivering in navigation and content. We created the framework to start with and then started to fill it in from there. We really needed to delve into understanding what are the questions that people have that get them to the stage that they feel confident enough to actually apply for their
15. Note that this is an unedited transcript of a live event and therefore may contain errors. This transcript is the joint property of CaptionsLIVE and the authorised party responsible for payment and may not be copied or used by any other party without authorisation. Page 87 assessment? I can't get them to apply for their assessment, then we are back in the crisis situation. There were three questions that they needed to answer but to answer those questions we needed to look at that granular tactical understanding, how we normalise that situation for them and gave them the confidence that what they are experiencing was normal and importantly, we needed to make sure that they still had a sense of control. If they felt this was going to threaten their independence, that was it. That sense of control and the sense that once they embark odd this journey and applied for an assessment, they still had a sense of control. It was their decision as to what happened next. There was a lot of careful work went into refining and working through all of the different aspects of this. My final comment for today, your grandmother or grandfather is not familiar with swiping right. When you are designing in sensitive areas, you need to unlearn everything that you think is familiar in terms of UI pattern design and come at it from the perspective of the person you are designing for. Thank you. (APPLAUSE) STEVE BATY: Thank you so much. That was wonderful our next speaker is Ted who is joining us from the west coast of the USA. It is late in the evening for him and that is OK. It is about 9pm on the west coast. I was going to say he is in San Francisco but I am not convinced that is true. He is on the west coast of the country which is good. Please join me in welcoming Ted. Hello. TED DRAKE: Hello everybody. Let me go ahead and share my screen real quick. There we go. I think you should probably have me good with sound and everything, is that correct?