HOW THE PROJECT STARTED

Our design team was tasked by healthcare policymakers to redesign the national end-of-life care planning program, examining strategy and touchpoint level innovations to encourage middle-aged citizens to self-initiate the process while they are still healthy.

Advance Care Planning (ACP) → is a form of end-of-life care planning that involves holding and documenting conversations with your family and Nominated Healthcare Spokesperson(s) (NHS) about your healthcare preferences, in case you are no longer able to communicate your wishes in the future.

Prior to our project, ACP discussions were largely initiated by healthcare providers when someone was already ill. Clients also had to go through a multi-step formal process, sitting down with trained facilitators multiple times to create the document.

It is estimated that a third of Singaporeans will be aged 65 and above by 2035 →. Coupled with a ballooning healthcare budget that more than doubled to $17 billion → over the last decade, this work is critical to help Singaporeans plan for their future healthcare.

WHAT I DID

As a UX Researcher and Service Designer on the project, I collaborated with teammates on generative and evaluative research, and facilitated workshops with end-users, their families, service providers, and government regulators to help them understand our insights and collaborate on co-designing solutions.

METHODS AND FRAMEWORKS OVERVIEW

GENERATIVE RESEARCH

a.k.a. the time I truly learned what holding space in a conversation meant

To map the current client journey, our team employed a combination of observations and user interviews. This approach allowed us to gain insight into the interactions between facilitators and clients, as well as understand clients' motivations, values, and pain points.

Participants were recruited through our stakeholder’s network of service providers and through our organization’s social media.

We learned 3 key things:

• The current process involves a lot of back and forth between the facilitator and the client to finalize the document.
• The facilitator has to make tradeoffs between the functional (documentation) and qualitative (discussion) goals of these sessions.
• Clients are already employing various channels to kickstart their planning - over text, Google Docs, or online workbooks.

❤️‍🩹

Participants were often emotional during our interviews, as this was a deeply personal and vulnerable topic to discuss. I grew a lot as a researcher through these conversations.

“Then I realised I don’t have anything to be counselled because I don’t have any death threatening disease. Am I mature enough to do that… I made the decision to plan simple first. So I downloaded this pdf kit.” - A participant who reflected using the available workbooks, as she did not feel ready for a facilitated discussion.

To clarify our scope, I broke down "self-initiation" into four distinct processes on a journey map. Each had their own design implications, but we focused on self-facilitation and self-documentation as these were the heaviest tasks that a facilitator currently takes on.

EVALUATIVE RESEARCH

a.k.a. the time a conversation with participant helped me process my own grief (full story in "what I learned" → section)

Before designing future artifacts, we needed to assess the current baseline ability for self-initiation. We conducted a 3-part usability test with existing materials:

“Maybe this booklet can be done directly before they fill in the [form], maybe an official procedure that you fill up the booklet and you get some score, the booklet should guide the form.” - A participant commenting on the disconnect between the workbook and form.

“Ya because, unless it’s linked, seamless, tick already here so this one will appear. Otherwise you after the fill up already then you give them the form, they will think that this one [booklet] already have the information, this one serve a purpose already, why would I need to fill up here” - A facilitator addressing the gap in the current materials.

I also independently conducted an artifact review of ACP materials from UK, US, Australia and Canada, to complement our findings from the usability tests by benchmarking and referencing international practices.

Consolidating findings from our generative and evaluative research, we distilled 4 design principles:

CO-DESIGN & PLAYTESTS

a.k.a. the time I made a room full of policy officers roleplay as family and friends

We decided to pursue two prototypes - a Convo Kit to support discussion with family members, and a Digital Documentation Tool to support self-reflection and documentation. We used provotyping and workshopping extensively to collaborate more effectively with our stakeholders and subject matter experts.

Taking the lead on the Convo Kit development, I conducted playtests with users, stakeholders and game designers, which uncovered considerations around psychological safety and distance, death education, and metrics tracking.

Consolidating the insights from the provotypes, we likewise ran workshops to co-design the new program strategy with regulatory stakeholders. This greatly strengthened their buy-in.

At first, our stakeholders thought that adding self-service tools to the existing program would be enough. It was crucial for us to demonstrate how the concerns revealed by the provotypes needed to be addressed at the program structure and success metrics level to genuinely support their vision of self-initiation.

WHAT CAME OUT OF THE PROJECT

We convinced our stakeholders to look beyond tactical changes at the touchpoint level, and adopt bolder innovation at a program strategy level.

Program leadership, comprising senior doctors, palliative care professionals, and policymakers adopted our roadmaps and strategic shifts.

For the working team that will execute the implementation, we also prepared toolkits in Google Slides and Sheets, as they were less familiar with Figma and Miro.

The Digital Documentation Tool → has been launched, with insights from our research and service design shaping the user flow and data integrations.

The documentation tool is integrated with the national digital identity system and national healthcare records, making it easy to verify identities and eligibility for self-planning.

The tool also took in insights from our research to:

• Inform the user of why they are being asked to provide certain inputs

• Scaffold reflections without influencing decisions, by providing hypothethical scenarios or asking the user to reflect on family experiences

• Provide timely counsel through popups and educational links

The ACP Convo Kit prototype is being adapted into a workbook, a physical game board, and an online experience, following a research and development roadmap that I developed and handed over to stakeholders.

WHAT I LEARNED

❤️‍🩹 Grief is love with nowhere to go

I took on this project shortly after my grandmother passed away. I had witnessed firsthand how my grandmother's long coma and the lack of clarity on her preferences led to significant family conflict. In a way, I selfishly wanted to use this project to convince other elderly members of my family to be prepared.

What I wasn't prepared for was how this project would transform my worldview on grief, caregiving, and love. With each conversation—whether with a participant, a family member, or a service provider—I gained deeper insights into what "preparing for the end" truly meant to each individual.

One particular interview stood out. Auntie A, who had cared for her father and her mother-in-law before their passing, shared her perspective on caregiving as a special journey one undertakes to learn how to express love for a family member. This interview left me weeping in a cafe after the participant left, and I still reflect on this conversation to this day. I'm grateful that this job allows me to meet and learn from so many incredible people in each project.

🤝🏻 Strategic empathy for stakeholders

As government regulators, our stakeholders were naturally cautious when approaching new ideas that differed from current policy terms. We had to find a balance between pushing for innovation and adequately addressing their very valid regulatory concerns. I learned the importance of building trust and exercising empathy for our stakeholders. Our team deliberately created safe and playful spaces for idea exploration before dialing back to more “realistic” ideas that felt more comfortable. We also delivered artifacts in formats (e.g. an updatable journey map in Excel instead of Figma) stakeholders can easily use to communicate with their management.

💪🏻 Leveraging past experience to level up

This project was a culmination of my research, analysis and stakeholder management skills, coming together in a service design context. As the only member on the team to have worked in a government Ministry, I was able to apply that contextual knowledge to help my design teammates understand and navigate the policymaking processes that our stakeholders go through. I really got to hone my qualitative research skills through this project too. It was a deeply sensitive topic, and I learned how to hold space within interviews for people’s deeply personal and emotional experiences. I also got to attend the Copenhagen Institute of Interaction Design’s service design intensive in the middle of the project, which was timely!