CARDIAC REHABILITATION product
Background
Cardiac rehab helps patients get back to as full a life as possible after a cardiac event such as a heart attack, heart surgery or stent procedure. It is a vital part of long-term recovery – as important as taking medication.
Cardiac rehab is an individualised programme run by healthcare professionals (HCPs) and is made up of exercise, education sessions and emotional support. Many cardiac rehab centres run two sessions a week for up to 12 weeks in a hospital or community setting such as a leisure centre.
The brief
To develop a digital product to support patients who cannot attend their cardiac rehab programme. The aim is to help keep patients safe and out of hospital by keeping them informed and motivated, and to support them in maintaining a self-care routine.
I formed part of a working group consisting of a Product Manager and members of the Healthcare Innovation team including clinical and patient representatives.
Empathy mapping
To begin with, I facilitated remote exercises in empathy mapping using Miro in order to capture the team’s combined customer knowledge and map out user attitudes, behaviours, needs and paint points. Following the session, the facilitators grouped the sticky notes into categories to help identify emerging themes.
“The workshops provided an excellent approach to gathering insight across multiple teams with varying experience of cardiac rehab delivery. The sessions were facilitated extremely well and everyone felt listened to and that their views were valued. Miro provided a great visual! It gave a face-to-face interactive feel to the workshop even though it was delivered remotely. We could really see the product starting to take shape through the eyes of our personas.” — Health Services Engagement team
Persona 1: Patient looking to start cardiac rehab having had a recent heart event
Persona 2: Patient who has started cardiac rehab and is looking to maintain
Persona 3: HCP involved in the delivery of and signposting to cardiac rehab
Personas
The empathy mapping exercise above was used to inform our three key persona profiles. These profiles will be used as a reference at every stage of the project.
Persona 1: Patient looking to start cardiac rehab after having a heart event
NAME: JOHN
AGE: 61
JOB: plumber
LOCATION: LEICESTER
BHF FAMILIARITY: LOW
“I don’t fully understand my condition or what cardiac rehab means for me and my family.”
BIO
John works as a full-time plumber. He’s a committed family man who lives with his wife and two teenage daughters. Two months ago he suffered a heart attack and was provided with a lot of health information from his cardiac nurse. He’s now figuring out what to do next.
BEHAVIOURS
John and his family have started reading through the information supplied by the cardiac nurse, as well as doing some online research. He knows he will have to make some changes to his daily routine but hasn’t started yet.
PAINS
Is worried about not being able to support his family emotionally and financially as he did before the heart attack
Is overwhelmed by information and is scared about the future state of his health
GAINS
Would like to involve his family members in his recovery journey
Would like to access emotional support for himself and his family members
Would like support in understanding cardiac rehab, medication and side-effects, as well as practical information including managing a condition whilst working
Persona 2: Patient who has started cardiac rehab and is looking to maintain
NAME: AMANDA
AGE: 66
JOB: RETIRED
LOCATION: Birmingham
BHF FAMILIARITY: MEDIUM
“I’m struggling to maintain a new routine since the heart attack.”
BIO
Amanda is retired and stays active with her husband and wide friendship group. Six months ago she suffered a heart attack and has started attending cardiac rehab sessions in her local leisure centre.
BEHAVIOURS
Amanda has started making small changes to her diet and exercise routine. She understands the importance of cardiac rehab but needs some help maintaining her ‘new normal’.
PAINS
Is struggling to stay motivated around her busy schedule
One-on-one time with the cardiac nurse is limited and sometimes her questions are not addressed
GAINS
Would like support around goal setting, stay motivated and maintaining a healthy lifestyle
Has started to feel part of a wider community as a result of attending her cardiac rehab classes
Persona 3: HCP involved in the delivery of and signposting to cardiac rehab
NAME: Erica
AGE: 32
JOB: cardiac nurse
LOCATION: NEWCASTLE
BHF FAMILIARITY: high
“Limited time and resources means I can’t fully explain and promote cardiac rehab to my patients.”
BIO
Erica is a cardiac nurse at Newcastle Freeman Hospital, and a big advocate of cardiac rehab.
BEHAVIOURS
Before her patients leave the cardiac ward, she signposts them to cardiac rehab information. She understands how important cardiac rehab is for the long-term recovery of her patients and aims to promote it the best she can.
PAINS
Her patients often dismiss cardiac rehab – they may not see it as important and just want to get back to the life they had before their heart event
Limited resources (print and digital) make it difficult for Erica to fully explain and promote cardiac rehab to her patients
Limited time (on average 10-15 minutes per patient) means that Erica can’t spend as much time talking through the benefits of cardiac rehab as she would like
GAINS
There’s a strong network of healthcare professionals that advocate cardiac rehab which makes Erica feels part of a wider community
She feels motivated hearing from patients who have an improved quality of life due to cardiac rehab
Competitor analysis
I investigated fourteen competitor health apps and websites and presented the findings back to the working group. These included Macmillan Cancer Support, Babylon Health and Headspace Inc.
I shared the findings in an article written for The Brand Blog, titled 5 ways that charities can use gamification for good. The blog supports charities by sharing expertise from across the industry.
MVP landing page in response to coronavirus
Many cardiac rehab classes across the country have been cancelled due to coronavirus. Using what we understand about our audiences so far, I was briefed to design an MVP ‘Cardiac rehabilitation at home’ hub that links to new and existing heart health information. Insights gathered from this page will be used to inform the long-term cardiac rehab product.
Sketching for MVP
UI designs for MVP
ONE MONTH REVIEW (05/05/20)
Since going live on 02/04/20, the cardiac rehab landing page has had 6,064 page views and 4,146 unique page views. 58% are returning visitors suggesting they’re coming back as they find the content useful or want to understand more. The exercise videos page is more popular with 8,905 page views and 5,963 unique page views. 63% are returning visitors.
“We have been using the British Heart Foundation website whilst we have not been able to undertake cardiac rehabilitation face-to-face. The resources are fantastic and we have had good feedback from our patients.” — Cardiac Specialist Nurse, Surrey & Sussex Healthcare NHS Trust
Online survey with MVP users
I then set up and analysed results from a Qualaroo user survey that launched on the MVP landing page and surrounding pages on desktop and mobile.
826 users participated in the survey. The feedback is being used to ensure we're providing the most useful and relevant information for our users now and in the long-term.
Quantitative feedback
Qualitative feedback
The following themes emerged in response to the question ‘Can't find what you're looking for? Please let us know what information was missing from this page’:
Assessments
Condition information
Exercise information
Exercise videos
Speaking to someone directly
Most commonly, users stated that they would like to be able to speak to a healthcare professional directly, questioned how they could get a cardiac rehab assessment and requested more exercise videos with accompanying instructions on how often to do them.
TWO MONTH REVIEW (30/06/20)
The above feedback has been incorporated to ensure that the MVP pages better fit the needs of our users. In June, I ran a follow-up survey to measure confidence. 98% of 247 users said the provided information made them feel more confident about doing cardiac rehab at home, an increase of 11% since April.
Research insights summary
Following a major heart event, 58% of patients are sad or depressed
Patient insights
PersonalisATION
Cardiac rehab often lacks the personalisation required to meet the needs of different age groups, conditions, abilities, lifestyles and family/work commitments.
ReframING rehab
Many patients don't want to do cardiac rehab. They don’t understand its importance or think it's for them. There is a need for it to be reframed to make it more appealing, approachable and engaging.
Emotional support
Patients experience a huge range of emotions after a major heart event. 58% are sad or depressed and feel uncertain about the future (Recovery & Support HSE Position Paper). As such, emotional support is vital to their recovery and ongoing wellbeing. This was also highlighted as a key benefit of cardiac rehab by the British Heart Foundation’s Patient Panel.
MotivaTION
Many patients will drop out of cardiac rehab after just one class. Involving family may help improve attendance, and lifestyle adjustments should be realistic and achievable to keep patients motivated.
There is currently a ~50% uptake of cardiac rehab services
Market insights
Too structured/inflexible
Overly structured programmes with too much focus on medicalisation can lead to the patient having to fit around the programme, rather than the other way round (Recovery & Support HSE Position Paper).
Appeal
There is currently a ~50% uptake of cardiac rehab services. In order to reach the target of 85% by 2028, the model will fundamentally have to change (Recovery & Support HSE Position Paper).
Inequality in the current system
Cardiac rehab is a postcode lottery. Some people with pre-existing mental health conditions may not be able to access classes. Plus those with mobility issues and those whose driver’s licences have been taken away after a heart event may not be able to physically get to the class.
Impact of coronavirus
The impact of coronavirus on service changes and closures are expected to impact both HCPs and people affected by HCD for up to a year (British Heart Foundation covid-19 Insights).
Creating a wider sense of community can help people feel more connected to others
Competitor insights
Personalisation
Many health and wellbeing products tailor their service to the specific needs of their audience. They allow users to set interests and help them maintain routines through personalised checklists, schedules and reminders. They enable users to add appointments to their calendar and use push notifications to help keep them on track.
Community
Creating a wider sense of community can help people feel more connected to others. Some competitors display how many people are using their product right now. And others promote adding friends to support the user and help them achieve their goals.
LOGGING AND TRACKING
Allowing users to track progress over time can help them maintain a routine, help visualise their progress, and seek support in areas in which they’re struggling. One app acknowledges that people express themselves in different ways by offering multiple ways to track mood and activity.
ACHIEVEMENTS AND REWARDS
Unlocking achievements and rewards can make for a fun experience and add a competitive element.
CHALLENGES AND GOAL SETTING
Setting challenges with achievable, realistic goals can create a sense of satisfaction and keep users returning to the product. One app allows friends and family members to send the patient motivators such as vouchers to keep them on track and feeling supported.
Journey mapping
Next, I facilitated a remote journey mapping exercise using Miro to identify the stages of the end-to-end patient experience. We used sticky notes to map ideas that could support our audiences at each of these stages.
‘The pre-workshop communication and task introductions ensured that participants were coming informed and prepared to engage fully in the session. Having a swift turnaround of the workshop materials added to the experience: having sight of the finished visual so you could formulate thoughts and reflect was so beneficial.’ — Health Services Engagement team, British Heart Foundation
Journey 1: Patient with good intentions
“I want to be proactive in managing my health and preventing the same happening in the future.”
The patient may want to take proactive steps but doesn’t know where to start
They may be motivated to recover for their family
They may not understand the benefits of cardiac rehab
They may have identified their own recovery plan
Journey 2: Patient who is lacking motivation
“I’m scared and overwhelmed by what’s happened – I don’t see a way out of this.”
The patient may be feeling helpless, anxious or depressed
They may not be aware of the benefits of cardiac rehab
Cardiac rehab does not sound appealing to them – they do not identify with the people that attend it
They may identify barriers to attending e.g. work, family commitments and accessibility issues
SAPS model of motivation
I then mapped our patient and HCP personas against the SAPS model of motivation. The goal of the framework is to identify rewards (status, access, power and stuff) that could help keep users motivated and engaged.
Patient looking to start cardiac rehab after having a heart event or patient who has started cardiac rehab and is looking to maintain
Status
Number of physical activities completed
Number of personal goals complete
Number of videos watched
Number of posts on patient forum
Wall of fame
Cardiac rehab programme complete
Case study feature on BHF social channels and in cardiac rehab-related emails
Access
Access to bespoke, expert support including articles, videos, podcasts, FAQs and print materials
Access to a wide network of cardiac rehab patients for community support
Ability to allow family to access progress (support, motivation)
Access to personal data/progress
Access to cardiac rehab email journey
Access to family support
Power
Power over when and where to participate in cardiac rehab programme (flexibility)
Ability to set personal goals and log progress (self-assessment)
Ability to link with relevant apps e.g. Strava
Choice over personal preferences e.g. push notifications, reminders
Ability to provide feedback to the BHF to improve service for themselves and other patients
Ability to save and share support information
Stuff
Digital badges/medals to celebrate progress (rewards)
Certificate on completion of the programme (digital, printed or both)
Relevant BHF-branded merchandise for example, exercise mats and resistance bands
HCP involved in the delivery of and signposting to cardiac rehab
Status
Number of patients helped
Number of resources shared with patients
Number of talks/podcasts given
Number of mentions in the news
Leaderboards based on constituency or hospital
BHF-approved title/status
Access
Access to a wide network of HCPs including nurses, physios, dieticians, pharmacists, physical activity specialists and occupational therapists
Access to learning materials including articles, videos, conferences and podcasts
Access to patient information in order to provide personalised support
Access to patient feedback (learning and development opportunity)
Access to exclusive professional development events including group sessions and talks
Support in getting papers published
Journal membership/subscription
Access to mentors
Power
Power to help patients in a more accessible way – online/remote support
Choice of materials that can be self-selected, curated in a list and shared with patients
Ability to provide feedback to improve service for themselves and their patients
Stuff
Promotion on BHF social channels (LinkedIn)
Promotion in Heart Matters magazine
BHF-approved badge (digital, physical or both)
Certificate from the BHF based on number of patients helped/resources shared
Annual magazine membership (health, science and research)
Vouchers for their hospital/surgery e.g. for equipment
Ideation exercise
The facilitators took the ideas from our journey mapping and SAPS exercises and categorised them in FunRetro by:
Quick wins
Achievable within three months from now
Achievable within a year from now
We shared the link via Microsoft Teams, explained how voting works and encouraged the working group to elaborate on ideas using the comments feature. We then asked them to vote for their top three favourite ideas in terms of what would benefit our audience the most in each column.
Value/effort matrix
Following the FunRetro exercise, the facilitators input all the voted ideas into Miro. We then reviewed and plotted them on a value/effort matrix to determine the feasibility of each idea and identify those that required further investigation.
Article on remote collaboration
Following the workshops, I co-wrote an article for BSC, The Chartered Institute for IT titled Remote working: how to drive innovation and collaborate effectively. We discuss our experience of running virtual workshops using collaboration tools.
“A respectful and inclusive guide about how to utilise online collaboration tools and workshopping techniques to foster an inclusive culture that nurtures the ideas of team members – of all pay grades – while working remotely.” — Johanna Hamilton, Commissioning Editor at BCS, The Chartered Institute for IT