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Please read the Mass General PATA Instructions Doc (Questions) and then read the whole MGHs PATA pdf and prepare answers accordingly using the given templates.  Please follow the Rubric when answering the questions. 1. Clearly define the main problem and list all sub problems 2. Make a direct connection between major sub problems and the main problem. Use a Fish Bone diagram. 3. Identify all stakeholders by title and association (i.e. department, outpatient etc.) and connect them to the main problem or a sub problem. Use the stakeholder template and the Problem template. 4. Which Elicitation tools would you use to gather additional information and gain a better understanding of the problem (List two 2). Give specific examples. (For instance if you are using ethnography which stakeholders will you observe (at least two), and what you are looking for. If you are using an Interview provide the stakeholders (at least two) you will interview and sample questions) 5. Include a Glossary of all specialty terms 6. You do not need to solve the problem or propose solutions Stakeholder Title Affiliation/Position Related Problem Authority or Influence Patient Health Care customer Long inefficient screening procedure Strong since the patient can choose another hospital Element Description The problem of Describe the problem Affects... Identify stakeholders affected by the problem And results in... Describe the impact of this problem on the stakeholders and business activity Rubric Detail   A rubric lists grading criteria that instructors use to evaluate student work. Your instructor linked a rubric to this item and made it available to you. Select Grid View or List View to change the rubrics layout. Content Top of Form Name: PATA Analysis Exercise · Grid View · List View   Advanced Proficient Competent Novice Needs Improvement All Instructions followed correctly Points: 25 (5.00\%) Points: 22.5 (4.50\%) Points: 21.25 (4.25\%) Points: 17.5 (3.50\%) Points: 0 (0.00\%) 0 instructions followed Main Problem and Sub Problems are listed and clearly explained Points: 125 (25.00\%) Main Problem is present, complete and connects to the list of sub-Problems Points: 112.5 (22.50\%) Main Problem is present, and mostly complete and connects to the list of sub-Problems Points: 106.25 (21.25\%) Main Problem is present, partially complete, and only connects to some of the sub-Problems Points: 87.5 (17.50\%) Main Problem is present, not complete, and only connects to few of the sub-Problems Points: 0 (0.00\%) Not Present Fish Bone relates completely to the Problem definition Points: 75 (15.00\%) Fish bone is present, complete and connects to the Problem statement Points: 67.5 (13.50\%) Fish bone is present, and mostly complete and connects partially to the list of sub problems Points: 63.75 (12.75\%) Fish bone is present but does not connect completely to problem, and connects partially to the list of sub problems Points: 52.5 (10.50\%) Fish bone is present, and not complete and missing connections to the Problem statement Points: 0 (0.00\%) Fish Bone not present Stakeholder template completed with all Stakeholders listed Points: 125 (25.00\%) All stakeholders are listed and correctly connected to a problem Points: 112.5 (22.50\%) Most stakeholders are listed and correctly connected to a problem Points: 106.25 (21.25\%) Some stakeholders are listed and correctly connected to a problem Points: 87.5 (17.50\%) Few stakeholders are listed and correctly connected to a problem Points: 0 (0.00\%) Template is missing Problem Template is present, complete and connects with the previous documents Points: 50 (10.00\%) Problem Template is present, complete and connects with all the previous documents Points: 45 (9.00\%) Problem Template is present, partially complete and connects with most the previous documents Points: 42.5 (8.50\%) Problem Template is present, partially complete and connects with some the previous documents Points: 35 (7.00\%) Problem Template is present, not complete and/or does not connect with the previous documents Points: 0 (0.00\%) Template is missing Elicitation Techniques are present and complete with questions and procedure included Points: 75 (15.00\%) 2 Elicitation Techniques present with 2 stakeholders for each. Questions or procedure are included Points: 67.5 (13.50\%) 2 Elicitation Techniques present with less than 2 stakeholders for each. Questions or procedure are included Points: 63.75 (12.75\%) 1 Elicitation Technique present with only 1 or 2 stakeholders listed. Questions or procedure are not all included Points: 52.5 (10.50\%) Questions or procedure are included Points: 0 (0.00\%) Elicitation Technique is missing Glossary Points: 25 (5.00\%) Glossary is present and complete Points: 22.5 (4.50\%) Glossary is present and partially complete Points: 21.25 (4.25\%) Glossary is present but missing some terms Points: 17.5 (3.50\%) Glossary is present but missing many terms Points: 0 (0.00\%) Glossary is missing Name:PATA Analysis Exercise Bottom of Form Exit This case was prepared by Kelsey McCarty, MBA Class of 2010, Jérémie Gallien, Associate Professor of Management Science and Operations, London Business School, and Retsef Levi, Associate Professor of Management, MIT Sloan School of Management. Copyright © 2012, Kelsey McCarty, Jérémie Gallien, and Retsef Levi. This work is licensed under the Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 Unported License. To view a copy of this license visit http://creativecommons.org/licenses/by-nc-nd/3.0/ or send a letter to Creative Commons, 171 Second Street, Suite 300, San Francisco, California, 94105, USA. 11-116 January 3, 2012 Massachusetts General Hospital’s Pre-Admission Testing Area (PATA) Kelsey McCarty, Jérémie Gallien, Retsef Levi Five anxious faces looked up at Dr. Jeanine Wiener-Kronish, chief of anesthesia at Massachusetts General Hospital (MGH), as she entered the conference room. It was June 2009, and the group before her was the task force for the Pre-Admission Testing Area (PATA). PATA had been struggling with inefficiencies and long patient wait times for over two years. Despite the group’s best efforts to fix these problems, a letter forwarded from the president’s office that morning highlighted that conditions in PATA were not getting better. Dr. Wiener-Kronish took a seat and read the letter aloud: Last week I brought my mother into the Pre-Admission Testing Area. We live almost 3 hours away and had to make a special trip for this appointment, which her oncologist, Dr. Paul Schneider, said was necessary to ensure a safe and successful surgery. When we arrived at the clinic, the waiting room was so full, it was five minutes before my mother and I could get two seats together. We sat there for a full half-hour before they sent us back to get her blood pressure reading. We then waited back in the waiting room for another 45 minutes before being moved to an exam room. It was 20 minutes before a nurse finally came in and she mostly just asked questions I had already answered on a form provided by the front desk. After the nurse left, it was almost another half-hour before the doctor finally came in and he also asked many of the same questions. The providers were very nice and apologetic, but of the almost 4 hours we spent in the clinic, only 1½ hours of that was actually face time with anyone! Even more aggravating, while my mother was in surgery this morning, two families in the waiting room said their relatives never even had to have a PATA appointment. One even had the same condition as my mother so I’m not sure why our PATA visit was even necessary. MASSACHUSETTS GENERAL HOSPITAL’S PRE-ADMISSION TESTING AREA (PATA) Kelsey McCarty, Jérémie Gallien, Retsef Levi January 3, 2012 2 I brought my mom from out-of-state because we were told that Mass General provides the best care in all of New England, maybe even the country, but that’s not at all what we experienced. I sincerely hope that we can expect more from our next visit to MGH. Dr. Slavin, president of MGH, had a dedicated department to process letters from patients, families, and friends. The majority of these letters were filled with overflowing gratitude for the quality of care delivered by the hospital and its employees. Therefore, when letters like this came across his desk, they were not taken lightly. Dr. Wiener-Kronish knew she needed to correct the problems in PATA quickly. Anesthesia at MGH Dr. Jeanine Wiener-Kronish began her career in anesthesia as a resident at the University of California at San Francisco (UCSF) and went on to become a skilled attending physician,1 researcher, and director of the Pre-Operative Program. In 1999, she achieved great renown for discovering a vaccine for an infection associated with prolonged ventilator usage. This infection was the leading cause of death in the intensive care unit (ICU). In 2008, ready for her next challenge, Dr. Wiener- Kronish accepted the position of anesthetist-in-chief at MGH, becoming only the fourth person to hold the prestigious position in the 70-year history of the Department of Anesthesia, Critical Care and Pain Medicine (DACCPM). Located in Boston, Massachusetts, MGH was founded in 1811, making it the third oldest hospital in the United States. With 907 patient beds across a 4.6 million square-foot campus and almost 23,000 employees, it was one of the largest hospitals in the country and Boston’s largest private employer. U.S. News & World Report consistently ranked MGH as one of the top five hospitals in the nation, and patients traveled from all over the country to receive treatment there. It was also home to the Ether Dome, an amphitheater that served as MGH’s first operating room (OR) and became the birthplace of anesthesia when ether was first publicly administered there as a surgical anesthetic in 1846.2 The DACCPM received its official charter in 1938 and since then has maintained its position as a leader in innovative anesthesiology research. The DACCPM was one of the largest clinical departments in the hospital with 278 physicians and 198 nurses, researchers and administrative personnel. This large work force was needed to support all stages of the perioperative3 patient flow: pre-operative assessment, intra-operative monitoring and care, and post-operative recovery. Due to the nature of the specialty, the DACCPM was also charged with administrative oversight in the ORs, the Post-Anesthesia Care Unit (PACU), the Pain Medicine Center, and the Surgical Intensive Care Unit (SICU). The department’s achievements across many areas of MGH, however, were being overshadowed by the persistent challenges in PATA. 1 Attending physicians have hospital admitting priveleges (the authority to provide patient care) and are primarily responsible for patient care. In contrast, interns, residents, and fellows are physicians in training and must receive attending approval for major patient care decisions. 2 Prior to the discovery of ether, surgeons had their patients drink whiskey or coat the surgical area with snow to numb the pain, even for amputations, which were common in the 1800s. 3 Pertaining to any aspects of a patientt care provided before, during, or after, and in connection to, surgery. MASSACHUSETTS GENERAL HOSPITAL’S PRE-ADMISSION TESTING AREA (PATA) Kelsey McCarty, Jérémie Gallien, Retsef Levi January 3, 2012 3 The PATA Mission The risk of administering anesthesia had decreased significantly since the early 1990s due to major strides in research and technology. Risks were still present, however, and complications could result in permanent disability or death. Doctors, therefore, needed to know before surgery that a patient’s system was strong enough to endure anesthesia. All surgery patients were therefore required to have a “pre-admission work-up”. The PATA clinic was responsible for completing work-ups for all out- patients,4 which accounted for 43\% of all surgical patients. Challenges in PATA PATA was an outpatient clinic with 12 exam rooms, a lab, and a waiting room. (See Figure 1.) Patients typically spent about 80-90 minutes of face time with providers in PATA, but even in the best-case scenario, appointments lasted at least two hours. The average appointment was two-and-a- half hours and many patients spent over four hours in PATA. Long waiting times were particularly troubling due to the goal of high quality patient- and family-focused care that MGH espoused. Many surgical patients at MGH came from outside referrals. PATA, therefore, played a big role in a patient’s first impression of the hospital. If referring physicians received enough complaints, they might start referring patients elsewhere. Figure 1 4 Out-patients (aka ambulatory patients) arrive from home to receive their care in contrast with in-patients, which are hospitalized. In-patients requiring surgery had their pre-admission work-ups completed on the hospital floor. MASSACHUSETTS GENERAL HOSPITAL’S PRE-ADMISSION TESTING AREA (PATA) Kelsey McCarty, Jérémie Gallien, Retsef Levi January 3, 2012 4 PATA providers were equally upset. Not only were they concerned by the long wait times endured by their patients, but they also experienced direct impact. Both registered nurses (RNs) and medical doctors (MDs) were salaried with the expectation that they worked from 7:00am to 5:00pm every day; appointments, however, were rarely ever completed by that time. Staying until 6:00pm had become routine and sometimes providers were there as late as 7:00pm or even 8:00pm. Tensions were growing as waiting room patient pile-ups and long days persisted. Surgeons were the final stakeholders affected by the problems in PATA. They diagnosed the patient’s medical condition and determined exactly what type of surgery was needed. They were also responsible for booking their patients’ PATA appointments, which were required within 30 days of the scheduled surgery. Because of the limited capacity, there was a common understanding that the most complex cases had priority. The cases that fell into this category, however, were not well defined. This lack of clear guidelines plus variability in surgeon assessments often resulted in sick patients not being sent to PATA while young and healthy patients were scheduled. While there was both an RN and an MD who jointly oversaw clinic activities, ownership for the clinic was shared between several departments. In addition, the clinic did not bring in any revenue,5 which also made it even harder to justify additional resources. The problems associated with pre-operative assessment were not unique to MGH. There were many publications in medical journals dedicated to the topic, but these mostly focused on best practices or cautions for various parts of the process. None offered systemic solutions to fix the problems as a whole. Despite the operational challenges in PATA, the quality of care and concern for patient safety was very high. While it would have been easy to take short cuts under the pressures of decentralization, long wait times, OR delays, and grumpy patients and providers, the MGH staff remained committed to thorough pre-admission work-ups to ensure a safe and uneventful surgery. The Impact of PATA on the OR Due to limited capacity, the PATA clinic was only able to see about 65\% of all out-patients. PATA, therefore, prioritized visits for patients with co-morbidities, long medical histories, or other potential complications (e.g., elderly, diabetic, or cancer patients). The remaining, typically healthier patients (i.e., a 30-year old who needed an ACL6 repair) received their work-ups in the OR on the day of surgery. The work-ups had the same requirements and were performed with the same degree of quality of care regardless of whether performed in PATA or the OR. The latter was not ideal, however, because performing work-ups in the OR often led to delayed surgery start times. There was, therefore, a clear desire to see all patients before the day of surgery. 5 Reimbursement for work-ups were bundled with surgery and anesthesia payments so PATA did not bill separately for its services. 6 A torn anterior cruciate ligament (ACL) is a common injury among athletes. MASSACHUSETTS GENERAL HOSPITAL’S PRE-ADMISSION TESTING AREA (PATA) Kelsey McCarty, Jérémie Gallien, Retsef Levi January 3, 2012 5 Each day at the MGH, it took hundreds of employees to undertake the formidable task of simultaneously coordinating 135 surgeries (34,000 surgeries per year) across MGH’s 52 operating rooms. Having to perform pre-admission work-ups in the OR put additional strain on the already overloaded surgical staff and resources. Incomplete and missing work-ups often led to delayed surgery starts. As everyone who worked in the OR was well aware, if the first cases were delayed, there would be an avalanche of problems and delays throughout the day. The OR director frequently had to make a tough call: go into overtime or cancel surgeries. Running the ORs into overtime was very costly but the impact on the staff was an even bigger problem. OR teams were asked much too frequently to cancel evening plans and stay late. On the other hand, cancelling surgeries upset patients and families who often came from long distances and had prepared many arrangements (transportation, time off from work, home nursing care, etc). There was also the physical component of having to fast for at least eight hours prior to surgery and the emotional component of mentally preparing for it. Asking a patient to go home (or stay an extra night in the hospital) and come back to the OR the next day was therefore not a favorable option. Fewer surgeries also meant less revenue. The OR director estimated that OR delays contributed to 57,000 minutes of lost productivity every year. The hospital could simply not sustain these losses. The PATA Task Force Many valiant efforts were made by the OR director and the DACCPM executive director to improve the pre-operative assessment process. DACCPM Executive Director Susan Moss was the most senior administrator in the DACCPM and she worked closely with Dr. Wiener-Kronish to manage the department (these types of relationships were sometimes referred to as “suits and scrubs”). In 2005, Moss, the OR director and other hospital leaders put together a proposal to build an additional PATA clinic. Space was available at the Mass General West (MG West) satellite hospital in Waltham, Massachusetts and market research showed this would be a preferred location for a significant proportion of PATA patients. Building a second clinic here would enable the hospital to see 100\% of surgical outpatients and provide the freedom to try a new practice design without disrupting MGH culture. Despite the robustness of the proposal, PATA was still a cost center and ultimately the MG West site was allocated to another (revenue generating) department at MGH that also asked for the site. The group then moved to trying to include PATA fixes in larger projects aimed at improving the overall perioperative process. These broader-scope projects had insurmountable fiscal, political, and cultural hurdles of their own, however, and as a result never came to fruition. In 2008, because of her deep concern about the challenges in PATA and her experience as the director of the Pre-Operative Program at UCSF, one of Dr. Wiener-Kronish’s first actions as the new chief was to form an official PATA Task Force. Moss was asked to lead the team, which included Dr. Wiener-Kronish, the MASSACHUSETTS GENERAL HOSPITAL’S PRE-ADMISSION TESTING AREA (PATA) Kelsey McCarty, Jérémie Gallien, Retsef Levi January 3, 2012 6 associate chief nurse of Patient Care Services, the PATA nursing director, the PATA medical director, and the OR medical director. Building on their lessons learned from past attempts, the task force focused only on solutions that would require changes internal to PATA. They considered improving triaging,7 providing online rather than in-clinic patient education about what to expect on the day of surgery, and switching from paper to electronic medical records. However, additional funding, personnel, and space would have been required to execute these ideas. In addition, while it was recognized that all of these efforts would certainly help, the task force knew they would not target the major source of the problems in PATA. Despite these obstacles, the task force continued to think creatively about ways to improve PATA. In May 2009, Moss added a seventh member to the task force, an MBA intern from the MIT Sloan School of Management who had been hired to conduct a current state assessment of PATA’s processes and performance. The clinic was run almost entirely on manual systems so data collection required several weeks of interviewing staff, shadowing patients and providers, conducting time studies, and mapping workflows. The data confirmed that most patients spent more time waiting than they did with an actual provider. (See Figure 2.) More broadly, the data revealed a complex system with significant variability, but also some hope for the future of PATA. 7 The process of prioritizing patients based on their medical needs. MASSACHUSETTS GENERAL HOSPITAL’S PRE-ADMISSION TESTING AREA (PATA) Kelsey McCarty, Jérémie Gallien, Retsef Levi January 3, 2012 7 Figure 2a PATA Patient Visit Detail, July 13, 2009 Patient # Time In Appointment Time Time Out Length of Visit Service Exam Room # 1st Provider 2nd Provider 1 6:59 7:00 8:40 1:41 ORTH 7 RN1 MD4 2 6:59 7:00 9:10 2:11 ORTH 9 RN2 MD5 3 6:59 7:00 8:40 1:41 NEUR 5 RN1 MD2 4 7:15 7:30 9:37 2:22 ORTH 6 RN4 MD6 5 7:15 7:30 9:18 2:03 ORTH 4 RN5 MD1 6 7:15 7:30 8:30 1:15 ORTH 3 RN2 MD6 7 7:23 7:00 10:23 3:00 ORTH 12 RN3 MD2 8 7:45 8:00 9:37 1:52 ORTH 11 RN5 MD4 9 7:45 8:00 9:33 1:48 CARD 1 RN1 MD7 10 7:45 8:00 10:24 2:39 UROL 8 RN5 MD8 11 7:55 8:00 10:29 2:34 GYN 7 RN4 MD4 12 8:15 8:30 10:45 2:30 SONC 5 RN2 MD3 13 8:15 8:30 10:40 2:25 ORTH 10 RN1 MD7 14 8:15 8:30 10:32 2:17 UROL 4 RN2 MD6 15 8:15 8:30 10:02 1:47 SONC 3 RN3 MD3 16 8:47 9:00 10:23 1:36 GYN 9 RN5 MD5 17 9:10 9:00 13:01 3:51 NEUR 11 RN4 MD8 18 9:15 9:30 10:47 1:32 ORTH 2 RN3 MD7 19 9:15 9:30 11:20 2:05 UROL 3 RN5 MD2 20 9:17 9:00 11:29 2:12 CARD 1 RN1 MD1 21 9:27 9:30 11:29 2:02 GYN 6 RN5 MD6 22 9:45 10:00 11:53 2:08 OMF 9 RN4 MD5 23 10:04 10:00 14:18 4:14 GENS 7 RN1 MD4 24 10:07 10:00 12:14 2:07 UROL 8 RN2 MD7 25 10:15 10:30 12:59 2:44 GENS 3 RN5 MD3 26 10:15 10:30 13:56 3:41 TRNS 5 RN1 MD7 27 10:16 10:30 12:35 2:19 UROL 10 RN2 MD1 28 10:45 11:00 12:26 1:41 THOR 2 RN5 MD6 29 10:45 11:00 14:05 3:20 NEUR 12 RN4 MD4 30 10:45 11:00 13:15 2:30 SONC 6 RN3 MD5 31 11:04 10:30 13:45 2:41 OMF 4 RN1 MD3 32 11:04 11:00 14:16 3:12 GENS 9 RN2 MD8 33 11:15 11:30 14:34 3:19 UROL 5 RN3 MD2 34 11:15 11:30 13:37 2:22 OMF 1 RN2 MD2 35 11:30 11:30 13:42 2:12 UROL 10 RN3 MD7 36 11:48 add-on 15:27 3:39 SONC 11 RN5 MD6 37 11:49 11:30 14:10 2:21 GYN 2 RN5 MD6 38 11:51 12:00 14:14 2:23 NEUR 8 RN4 MD4 39 11:55 12:00 16:30 4:35 SONC 10 RN1 MD8 40 12:15 12:30 14:29 2:14 GYN 3 RN2 MD7 41 12:47 13:00 16:04 3:17 NEUR 4 RN4 MD5 42 12:57 13:00 15:49 2:52 GENS 1 RN5 MD8 43 13:12 add-on 15:42 2:30 ANES 12 RN3 MD6 44 13:15 13:30 14:55 1:40 PLAS 2 RN5 MD3 45 13:28 13:30 16:10 2:42 ORTH 6 RN4 MD7 46 13:45 14:00 16:11 2:26 GENS 9 RN4 MD4 47 13:47 14:00 16:15 2:28 SONC 11 RN5 MD5 48 13:50 14:00 15:42 1:52 GYN 3 RN5 MD1 49 14:00 14:30 16:16 2:16 THOR 5 RN2 MD2 50 14:00 14:30 15:31 1:31 ORTH 7 RN4 MD6 51 14:16 14:30 16:54 2:38 ORTH 2 RN1 MD2 52 14:38 14:30 16:51 2:13 THOR 1 RN2 MD3 53 14:43 15:00 17:20 2:37 NEUR 8 RN4 MD4 54 14:52 15:00 17:13 2:21 ORTH 4 RN2 MD1 55 15:00 15:00 16:57 1:57 NEUR 7 RN3 MD5 MASSACHUSETTS GENERAL HOSPITAL’S PRE-ADMISSION TESTING AREA (PATA) Kelsey McCarty, Jérémie Gallien, Retsef Levi January 3, 2012 8 Figure 2b Definition of Surgical Services Figure 2c PATA Patient Scheduling over a 3-week Period Abbreviation Name ANES Anesthesia CARD Cardiac EMER Emergency GENS General Surgery GYN Gynecology NEUR Neurology OMF Oral and Maxillofacial ORTH Orthopedics PEDI Pediatrics PLAS Plastics RAD Radiology SONC Surgical Oncology THOR Thoracic TRNS Transplant UROL Urology VASC Vascular MGH Surgical Services Date Day # of patients scheduled # of no shows # of add-ons # of patients seen June 19, 2009 Friday 53 2 3 54 June 22, 2009 Monday 58 3 2 57 June 23, 2009 Tuesday 59 5 3 57 June 24, 2009 Wednesday 59 9 3 53 June 25, 2009 Thursday* 50 4 5 51 June 26, 2009 Friday 54 3 4 55 June 29, 2009 Monday 60 5 3 58 June 30, 2009 Tuesday 59 4 3 58 July 1, 2009 Wednesday 60 6 1 55 July 2, 2009 Thursday* 51 5 4 50 July 3, 2009 HOLIDAY -- -- -- -- July 6, 2009 Monday 59 4 3 58 July 7, 2009 Tuesday 58 6 4 56 July 8, 2009 Wednesday 58 5 3 56 July 9, 2009 Thursday* 53 4 2 51 July 10, 2009 Friday 53 5 4 52 July 13, 2009 Monday 58 5 2 55 Average 56.4 4.7 3.1 54.8 * The clinic does not op en until 9am on Thursday s to accommodate Grand Rounds and other hosp ital educational activities MASSACHUSETTS GENERAL HOSPITAL’S PRE-ADMISSION TESTING AREA (PATA) Kelsey McCarty, Jérémie Gallien, Retsef Levi January 3, 2012 9 Overview of the PATA Clinic In PATA, a laboratory technician, a nurse, and an anesthesiologist saw each patient. The lab tech was responsible for obtaining vital signs, an EKG,8 and blood samples. The nurse completed a standardized nursing assessment form. The anesthesiologist assessed the patient’s overall health and obtained the patient’s consent for anesthesia. While all aspects of the appointment were conducted to ensure patient safety and quality of care, the nursing assessment form and anesthesia consent form were also required by law and had to be completed by an RN and an MD, respectively. The required pre-admission work-up was complete when each of these three providers had completed all the necessary exams, tests, and documentation. Each day the PATA nursing director scheduled five lab technicians, five nurses, and eight anesthesiologists. Patient Scheduling Clinic hours were Monday through Friday from 7:00am to 5:00pm. Four patients were scheduled every half hour beginning at 7:00am and ending at 3:00pm, except during the lunch hours when there were only two patients scheduled at 12:00pm, 12:30pm, 1:00pm, and 1:30pm. The appointments were managed with an MGH software program that allowed surgeons’ offices to log in and schedule patients for a PATA appointment. They could select any available date and time, as long as it was within 30 days of the scheduled surgery. Each day, including add-ons and no-shows there was a fairly consistent average of 55 patients per day. Check-In There were two front desk attendants in the PATA waiting room, one of which was assigned to greet patients, locate their medical chart, document their time of arrival, and give them a form to complete. This entire process took about two minutes. The attendant would then walk the patient chart back to the lab and leave it in a holding bin, signaling to the lab technicians that a patient had arrived. Sometimes, when several patients arrived at once, multiple charts would pile up on the front desk before the attendant had a free moment to walk them back to the lab. Nevertheless, charts were typically transferred within 15 minutes of a patient’s arrival. The other attendant was assigned to answer phones, enter data, and process paperwork. Vitals and EKG The laboratory was split into two services: 1) two stations to take patient vitals and EKG at the beginning of the appointment, and 2) three stations to take patient blood samples at the end of the appointment. Providers needed the vital signs and EKG to evaluate a patient’s health, which was why this step was done first. For about 10\% of patients, the anesthesiologists needed to make amendments to the standard blood work order forms based on the patient exam. Therefore, to avoid sticking patients with a needle twice blood draws were done at the end of the appointment. A total of five lab technicians, trained to work at either station, were scheduled each day. When a lab tech saw a patient chart in the holding bin, they would call the patient back from the waiting room. They would take the patient’s vital signs first, which consisted of heart rate, blood 8 An electrocardiogram (ECG or EKG) is a diagnostic tool that monitors heart rhythms and conduction. MASSACHUSETTS GENERAL HOSPITAL’S PRE-ADMISSION TESTING AREA (PATA) Kelsey McCarty, Jérémie Gallien, Retsef Levi January 3, 2012 10 pressure, height, weight, temperature, and room air oxygen saturation. Next, the patient would be asked to lay flat while leads were placed on the patient’s chest for the EKG. The EKG recorded cardiac rhythms, which were later reviewed by the anesthesiologists for any abnormalities. The entire process took an average of ten minutes9 per patient. When the technician was done, they would record the patient’s vital signs on an index card (Figure 3) and attach the card and the EKG printout to the patient’s chart. The patient was then escorted back to the waiting room and the technician would notify the charge nurse that the patient was ready for the next provider. Figure 3 PATA Appointment Tracking Card Index Card Key: BP: Blood pressure T: Temperature P: Pulse R: Respiratory Rate O2 SAT: \% oxygen saturation of blood HT: Height WT: Weight This card was used to track a patient’s PATA visit. The front desk stamped the reverse side with the patient’s name and medical record number (MRN) and then entered the date, appointment time, and arrival time on this side. Lab techs recorded the vital signs, which were later transcribed into the patient’s medical chart by the anesthesiologist. All providers initialed next to their provider type. At the end of the appointment, before the front desk let the patient leave, they verified that all steps of the appointment had been completed and wrote in the departure time. At one point, each provider recorded the time their session with the patient started (IN) and stopped (OUT), but those fields had not been used in a while. The cards were stored for two weeks after the appointment and then discarded. The Charge Nurse The charge nurse was the director of patient flow, an essential role in PATA. This person kept track of add-ons and no-shows, assigned patients to rooms, and providers to patients. Their role was to keep the patient flow through PATA moving smoothly at all times. Each morning, a printout of the appointment schedule was taped to the back wall where the charge nurse had the best vantage point to monitor clinic activity. Next to each patient’s name were empty columns for Room #, RN, and MD. (See Figure 4.) 9 Standard deviation for vitals and EKG time was 3 ½ minutes. MASSACHUSETTS GENERAL HOSPITAL’S PRE-ADMISSION TESTING AREA (PATA) Kelsey McCarty, Jérémie Gallien, Retsef Levi January 3, 2012 11 Figure 4 PATA Appointment Schedule and Charge Nurse Flow Sheet* *All patient information shown is fictitious data to protect patient privacy and comply with privacy regulations but is similar to actual information posted in PATA. MASSACHUSETTS GENERAL HOSPITAL’S PRE-ADMISSION TESTING AREA (PATA) Kelsey McCarty, Jérémie Gallien, Retsef Levi January 3, 2012 12 When evaluation of vital signs and the EKG were complete, the lab technician would place the patient’s chart in the charge nurse’s holding bin to signal that the patient was ready to be seen by an RN. The charge nurse would call the patient back from the waiting room and escort them to an empty exam room. She would then write the exam room number on the schedule under the “Room #” column to communicate the location of the patient. If all rooms were taken, the patient would remain in the waiting room until one became available. Regardless of appointment time, patients were seen in the order they arrived by whichever lab technician, RN, or MD was first available. After a patient was escorted to an exam room, the charge nurse would find an available RN to assign to the patient and then enter that provider’s initials under the “RN” column. When the RN had completed the exam, their initials would be immediately crossed out. This signaled that the RN step was complete and the patient was ready to see an anesthesiologist. The charge nurse would then find an available anesthesiologist and write their initials on the schedule under the “MD” column. Similar to the RN, when the anesthesiologist was done, their initials would be crossed out to signal that the exam was complete. The charge nurse would then highlight the … MAIN PROBLEM PROBLEM PROBLEM PROBLEM FISHBONE DIAGRAM sub problem Sub problem Sub problem Sub problem Sub problem Sub problem Sub problem Sub problem 1 Source https://templates.office.com/en-us/cause-and-effect-diagram-tm06082737 Brainstorming Brainstorming Used to generate and refine ideas Explore edges of ‘the box’ refine system definition Idea Generation Idea Organization/ Synthesis 2 Brainstorming To invent new way of doing things or when much is unknown When there are few or too many ideas Early on in a project particularly when: Terrain is uncertain There is little expertise for the type of applications Innovation is important (e.g., novel system) 3 Brainstorming Two main activities: The Storm: Generating as many ideas as possible (quantity, not quality) – wild is good! 4 Brainstorming Two main activities: The Calm: Filtering out of ideas (combine, clarify, prioritize, improve…) to keep the best one(s) – may require some voting strategy Roles: scribe, moderator (may also provoke), participants 5 Brainstorming – Objectives Hear ideas from everyone, especially unconventional ideas Keep the tone informal and non-judgemental Keep the number of participants “reasonable“ – if too many, consider a “playoff “-type filtering and invite back the most creative to multiple sessions 6 Brainstorming – Objectives Encourage creativity Choose good, provocative project name. Choose good, provocative problem statement 7 Brainstorming – Objectives Encourage creativity Get a room without distractions, but with good acoustics, whiteboards, coloured pens, provide coffee/donuts/pizza Provide appropriate props/mock-ups 8 Brainstorming – Roles Scribe Write down all ideas (may also contribute) May ask clarifying questions during first phase but without criticizing 9 Brainstorming – Roles Moderator/Leader Cannot be the scribe Two schools of thought: traffic cop or agent provocateur Traffic cop – enforces rules of order, but does not throw his/her weight around otherwise 10 Brainstorming – Roles Moderator/Leader Agent provocateur – traffic cop plus more of a leadership role, comes prepared with wild ideas and throws them out as discussion wanes May also explicitly look for variations and combinations of other suggestions 11 Brainstorming – Participants Virtually any stakeholder, e.g. Developers Domain experts End-users Clients 12 Brainstorming – Participants Virtually any stakeholder, e.g. “Ideas-people” – a company may have a special team of people Chair or participate in brainstorming sessions Not necessarily further involved with the project 13 Brainstorming – The Storm Goal is to generate as many ideas as possible Quantity, not quality, is the goal at this stage Look to combine or vary ideas already suggested No criticism or debate is permitted – do not want to inhibit participants 14 Brainstorming – The Storm Participants understand nothing they say will be held against them later on Scribe writes down all ideas where everyone can see e.g., whiteboard, paper taped to wall Ideas do not leave the room 15 Brainstorming – The Storm Wild is good Feel free to be gloriously wrong Participants should NOT censor themselves or take too long to consider whether an idea is practical or not – let yourself go! 16 Brainstorming – The Calm Go over the list of ideas and explain them more clearly Categorize into maybe and no by pre-agreed consensus method Informal consensus 50\% + 1 vote vs. “clear majority” Does anyone have veto power? 17 Brainstorming – The Calm Be careful about time and people Meetings (especially if creative or technical in nature) tend to lose focus after 90 to 120 minutes – take breaks or reconvene later Be careful not to offend participants 18 Brainstorming – The Calm Review, consolidate, combine, clarify, improve Rank the list by priority somehow Choose the winning idea(s) 19 Brainstorming – Eliminating Ideas There are some common ways to eliminate some ideas Blending ideas Unify similar ideas but be aware not to force fit everything into one idea Give each participant $100 to spend on the ideas 20 Brainstorming – Eliminating Ideas Apply acceptance criteria prepared prior to meeting Eliminate the ideas that do not meet the criteria 21 Brainstorming – Eliminating Ideas Apply acceptance criteria prepared prior to meeting Various ranking or scoring methods Assign points for criteria met, possibly use a weighted formula 22 Brainstorming – Eliminating Ideas Apply acceptance criteria prepared prior to meeting Vote with threshold or campaign speeches Possibly select top k for voting treatment 23 Brainstorming – Voting on Ideas Voting with threshold Each person is allowed to vote up to n times Keep those ideas with more than m votes Have multiple rounds with smaller n and m 24 Brainstorming – Voting on Ideas Voting with campaign speeches Each person is allowed to vote up to j < n times Keep those ideas with at least one vote Have someone who did not vote for an idea defend it for the next round Have multiple rounds with smaller j 25 Brainstorming – Tool Support With many good ideas, some outrageous and even farfetched, brainstorming can be really fun! Creates a great environment that stimulates people and motivates them to perform well! 26 Brainstorming – Tool Support Can be done by email, but a good moderator/leader is needed to Prevent flamers to come into play Prevent race conditions due to the asynchronous communication medium Be careful not to go into too much detail 27 Brainstorming – Tool Support Collaboration tools are also possible TWiki and many other more appropriate tools such as BrainStorm and IdeaFisher 28 Brainstorming Advantages: Ideas generated anonymously Eliminates typical group dynamics Everyone has equal opportunity to contribute ideas Encourages speaking in group settings Large quantities of ideas generated in short timeframe 29 Brainstorming: General Guidelines: Clearly stated questions How can we improve…? What are the problems or issues with … ? Begin after each group member understands the question Designated group facilitator 30 Brainstorming: General Guidelines: Timed brainstorming Usually limited to 45-60 minutes NO TALKING during timed session Not even to clarify; field questions Provide “sticky notes” (ideal), index cards, or cuts of paper 31 Brainstorming: General Guidelines: One idea per sticky Rule :: one verb & one noun minimum per sticky EX: fire boss schedule more vacation days increase wage Group sticky or notes on a large surface blackboard ……… walls 32 Brainstorming: General Guidelines: Organize and re-organize “like ideas” into areas Discussion permitted during organizing process Themes of “like ideas” emerge Become headings or labels for columns 33 Storyboards Pictures ... imagery To show/describe users walking through a ‘to-be’ process Passive storyboards tell a story Active storyboards show a moving vision 34 Storyboards Pictures ... imagery Interactive storyboards help the user experience the system High cost/benefit ratio – Don’t invest too much Interactive is best 35 Storyboards: Options Passive Active Interactive Screen shots Slideshow Live demo Business rules Animation Interactive presentation Prototyping Output reports Simulation Complexity and Cost Seeking: WHO acts WHAT happens HOW it happens 36 ! ! ! ! ! ! Requirements validation Concerned with demonstrating that the requirements define the system that the customer really wants. Requirements error costs are high so validation is very important Fixing a requirements error after delivery may cost up to 100 times the cost of fixing an implementation error. Requirements checking Validity. Does the system provide the functions which best support the customer’s needs? Consistency. Are there any requirements conflicts? Completeness. Are all functions required by the customer included? Requirements checking Realism. Can the requirements be implemented given available budget and technology Verifiability. Can the requirements be checked? Traceable. Elicitation Goals Requirements Specification Clear Concise Consistent Correct Unambiguous Agreement Documentation Analysis Elicitation Refer to Chapter 7 page 121 of Software requirements Also, Chapter 4 page 63 of the BABOK Guide Comparison of Data-Gathering Techniques1 Technique Good for Kind of data Plus Minus Questionnaires Answering specific questions Quantitative and qualitative data Can reach many people with low resource The design is crucial. Response rate may be low. Responses may not be what you want Interviews Exploring issues Some quantitative but mostly qualitative data Interviewer can guide interviewee. Encourages contact between developers and users Time consuming. Artificial environment may intimidate interviewee 6 Comparison of Data-Gathering Techniques1 Technique Good for Kind of data Plus Minus Focus groups and workshops Collecting multiple viewpoints Some quantitative but mostly qualitative data Highlights areas of consensus and conflict. Encourages contact between developers and users Possibility of dominant characters Naturalistic observation Understanding context of user activity Qualitative Observing actual work gives insight that other techniques cannot give Very time consuming. Huge amounts of data Studying documentation Learning about procedures, regulations, and standards Quantitative No time commitment from users required Day-to-day work will differ from documented procedures 7 Analysis of Existing Systems (1) Useful when building a new improved version of an existing system Important to know: What is used, not used, or missing What works well, what does not work How the system is used (with frequency and importance) and it was supposed to be used, and how we would like to use it 8 Analysis of Existing Systems (2) Why analyze an existing system? Users may become disillusioned with new system or do not like the new system if it is too different or does not do what they want (risk of nostalgia for old system) To appropriately take into account real usage patterns, human issues, common activities, relative importance of tasks/features 9 Analysis of Existing Systems (2) Why analyze an existing system? To catch obvious possible improvements (features that are missing or do not currently work well) To find out which legacy features can/cannot be left out 10 Review Available Documentation Start with reading available documentation User documents (manual, guides…) Development documents Requirements documents Internal memos Change histories 11 Review Available Documentation Of course, often these are out of date, poorly written, wrong, etc., but its a good starting point 12 Requirements Elicitation Domain Subject Matter Expert Domain Subject Matter Expert: provides supporting materials as well as guidance about which other sources of business analysis information to consult. May also help to arrange research, experiments, and facilitated elicitation. 13 Questionnaires Have Down-sides Low response rates Low density of responses per questionnaire Lose face-to-face dynamics Questionnaires Have Down-sides Signature on form increases credibility, raises inhibitions Good ones require …. Extensive planning Format considerations Pilot-testing and revision Workshops Gather all key stakeholders together Short Focused Preparation Good, “safe” environment Provide warm-up, background, materials Plan an agenda and process 16 Workshops Outside facilitator can help Consensus/team-building skills essential Personable, well-respected Can chair a ‘challenging’ meeting 17 Elicitation Obstacles to Overcome: Pathological Syndromes “Yes, but….” syndrome “If only…” .. Conceptualization of potential vs. reality Of, relating to, or manifesting behavior that is habitual, maladaptive, and compulsive Def: Elicitation Obstacles to Overcome: Pathological Syndromes “Undiscovered ruins syndrome Perfect information about a system is not possible Need to stop on phase and at least momentarily move on Elicitation Obstacles to Overcome: Pathological Syndromes “The User vs. the Developer syndrome “Us” / “Them” thinking Tribe paradigm EX: Requirements Workshop Agenda Time Agenda Description 8:00-8:30 Introduction Review agenda, facilities, rules 8:30-10:00 Context Present project status, result of user interviews 10:00-12:00 Brainstorming Seeking features 12:00-1:00 Lunch Working lunch to keep momentum 1:00-2:00 Brainstorming continues 2:00-3:00 Feature definition Write short definitions 3:00-4:00 Idea reduction; prioritization Order set of features 4:00-5:00 Wrap-up Summarize; assign action items Ethnography (Observation) A social scientist spends a considerable time observing and analysing how people actually work. People do not have to explain or articulate their work. Ethnography, simply stated, is the study of people in their own environment through the use of methods such as participant observation and face-to-face interviewing. ... 1 Ethnography (Observation) Social and organisational factors of importance may be observed. Ethnographic studies have shown that work is usually richer and more complex than suggested by simple system models. Ethnography, simply stated, is the study of people in their own environment through the use of methods such as participant observation and face-to-face interviewing. ... 2 Scope of ethnography Requirements that are derived from the way that people actually work rather than the way in which process definitions suggest that they ought to work. Scope of ethnography Requirements that are derived from cooperation and awareness of other people’s activities. Awareness of what other people are doing leads to changes in the ways in which we do things. Scope of ethnography Ethnography is effective for understanding existing processes but cannot identify new features that should be added to a system. Focused ethnography Developed in a project studying the air traffic control process Combines ethnography with prototyping Focused ethnography Prototype development results in unanswered questions which focus the ethnographic analysis. The problem with ethnography is that it studies existing practices which may have some historical basis which is no longer relevant. Observation and Related Techniques (1) Observation Get into the trenches and observe specialists “in the wild” Shadow important potential users as they do their work 8 Observation and Related Techniques (1) Observation Initially observe silently (otherwise you may get biased information) Ask user to explain everything he or she is doing Session videotaping 9 Observation and Related Techniques (1) Observation Ethnography also attempts to discover social, human, and political factors, which may also impact requirements 10 Observation and Related Techniques (2) Can be supplemented later with questionnaires Based on what you know now – the results of observation To answer questions that need comparison or corroboration (confirmation) 11 Observation and Related Techniques (2) Can be supplemented later with questionnaires To obtain some statistics from a large number of users (look for statistical significance!), e.g.: How often do you use feature X? What are the three features you would most like to see? 12 Observation and Related Techniques (2) Can be supplemented later with questionnaires Can be supplemented later with interviews After getting a better idea of what is to be done, probably some questions require more detailed answers 13 Observation and Related Techniques (2) Can be supplemented later with questionnaires Can be supplemented later with interviews You will not be wasting other peoples time or your own This is very labour intensive! 14 Ethnography – Overview (1) Comes from anthropology, literally means writing the culture Essentially seeks to explore the human factors and social organization of activities  understand work 15 Ethnography – Overview (1) Studies have shown that work is often richer and more complex than is suggested by simple models derived from interviews 16 Ethnography – Overview (1) Social scientists are trained in observation and work analysis Discoveries are made by observation and analysis, workers are not asked to explain what they do 17 Ethnography – Overview (1) Collect what is ordinary/what is it that people do (aim at making the implicit explicit) Study the context of work and watch work being done 18 Ethnography – Overview (2) Useful to discover for example What does a nuclear technician do during the day? What does his workspace look like? Less useful to explore political factors Workers are aware of the presence of an outside observer 19 Ethnography – Example (1) Sommerville et al. were involved in a project where they had to elicit the requirements of an air traffic control system They observed the air traffic controllers in action with the existing system 20 Ethnography – Example (1) Surprising observations Controllers often put aircrafts on potentially conflicting headings with the intention of fixing them later System generates an audible alarm when there is a possible conflict 21 Ethnography – Example (1) Surprising observations The controllers close the alarms because they are annoyed by the constant warnings Incorrect conclusion The controllers do not like audible alarms because they close them 22 Ethnography – Example (1) Surprising observations The controllers close the alarms because they are annoyed by the constant warnings More accurate observation The controllers do not like being treated like idiots 23 Ethnography – Example (2) Dealers at a stock exchange write tickets to record deals with old-fashioned paper/pencil method It was suggested to replace this with touch screens and headphones for efficiency and to eliminate distracting noise Source: Preece, Rogers, and Sharp “Interaction Design: Beyond human-computer interaction” 24 Ethnography – Example (2) Study found that the observation of other dealers is crucial to the way deals are done Market position was affected if deals were not continuously monitored Source: Preece, Rogers, and Sharp “Interaction Design: Beyond human-computer interaction” 25 Ethnography – Example (2) Study found that the observation of other dealers is crucial to the way deals are done Even if only peripheral monitoring takes place “Improvements would have destroyed the very means of communication among dealers Source: Preece, Rogers, and Sharp “Interaction Design: Beyond human-computer interaction” 26 Ethnography and prototyping for requirements analysis Prototyping Chapter 15 Prototyping is used to elicit and validate stakeholder needs through an iterative process that creates a model or design of requirements. It is also used to optimize user experience, to evaluate design options, and as a basis for development of the final business solution. 1 Prototyping A software requirements prototype is a mock-up or partial implementation of a software system Helps developers, users, and customers better understand system requirements Helps clarify and complete requirements Provides early response to “Ill know it when I’ll see (or won’t see) it” attitude 2 Prototyping A software requirements prototype is a mock-up or partial implementation of a software system Effective in addressing the “Yes, But” and the “Undiscovered Ruins” syndromes Helps find new functionalities, discuss usability, and establish priorities 3 Prototyping Prototyping is effective in resolving uncertainties early in the development process Focus prototype development on these uncertain parts Encourages user participation and mutual understanding 4 Prototyping – Realizations Prototypes can take many forms: Paper prototypes Prototype on index card Storyboard Screen mock-ups 5 Prototyping – Realizations Prototypes can take many forms: Interactive prototypes Using high-level languages (e.g., Visual Basic, Delphi, Prolog)‏ Using scripting languages (e.g., Perl, Python)‏ Using animation tools (e.g., Flash/Shockwave)‏ 6 Prototyping – Types Horizontal: focus on one layer – e.g., user interface Vertical: a slice of the real system 7 Prototyping – Types Evolutionary can be turned into a product incrementally, giving users a working system more quickly (begins with requirements that are more understood) 8 Prototyping – Types Throw-away: less precise, thrown away, focusing on the less well-understood aspects of the system to design, designed to elicit or validate requirements 9 Prototyping – Fidelity (1) Fidelity is the extent to which the prototype is real and (especially) reactive Fidelity may vary for throw-away prototypes 10 Prototypes don’t necessarily look like final products — they can have different fidelity. The fidelity of a prototype refers to how it conveys the look-and-feel of the final product (basically, its level of detail and realism). Fidelity can vary in the areas of: Visual design Content Interactivity There are two main types of prototypes, ranging between these two extremes: Low-Fidelity High-Fidelity Product teams choose a prototype’s fidelity based on the goals of prototyping, completeness of design, and available resources. Prototyping – Fidelity (1) High-fidelity Applications that work – you press a button and something happens Often involves programming or executable modeling languages 11 Prototyping – Fidelity (1) High-fidelity Advantages: provides an understanding of functionality, reduce design risk, more precise verdicts about requirements 12 Prototyping – Fidelity (1) High-fidelity Disadvantages: takes time to build more costly to build sometimes difficult to change 13 Prototyping – Fidelity (1) High-fidelity Disadvantages: false sense of security often focuses on details rather than on the goals and important issues 14 Prototyping – Fidelity (2) Low-fidelity It is not operated – it is static Advantages: easy and quick to build cheaper to develop excellent for interfaces 15 Low-fidelity prototyping Low-fidelity (lo-fi) prototyping is a quick and easy way to translate high-level design concepts into tangible and testable artifacts. The first and most important role of lo-fi prototypes is to check and test functionality rather than the visual appearance of the product. Here are the basic characteristics of low-fidelity prototyping: Visual design: Only some of the visual attributes of the final product are presented (such as shapes of elements, basic visual hierarchy, etc.). Content: Only key elements of the content are included. Interactivity: The prototype can be simulated by a real human. During a testing session, a particular person who is familiar with design acts as a computer and manually changes the design’s state in real-time. Interactivity can also be created from wireframes, also known as “connected wireframes.” This type of prototype is basically wireframes linked to each other inside an application like PowerPoint or Keynote, or by using a special digital prototyping tool such as Adobe XD. Pros Inexpensive. The clear advantage of low-fidelity prototyping is its extremely low cost. Fast. It’s possible to create a lo-fi paper prototype in just five to ten minutes. This allows product teams to explore different ideas without too much effort. Collaborative. This type of prototyping stimulates group work. Since lo-fi prototyping doesn’t require special skills, more people can be involved in the design process. Even non-designers can play an active part in the idea-formulation process. Clarifying. Both team members and stakeholders will have a much clearer expectation about an upcoming project.hgygh Cons Uncertainty during testing. With a lo-fi prototype, it might be unclear to test participants what is supposed to work and what isn’t. A low-fidelity prototype requires a lot of imagination from the user, limiting the outcome of user testing. Limited interactivity. It’s impossible to convey complex animations or transitions using this type of prototype. Prototyping – Fidelity (2) Low-fidelity It is not operated – it is static Advantages: offers the opportunity to engage users before coding begins encourage creativity 16 Low-fidelity prototyping Low-fidelity (lo-fi) prototyping is a quick and easy way to translate high-level design concepts into tangible and testable artifacts. The first and most important role of lo-fi prototypes is to check and test functionality rather than the visual appearance of the product. Here are the basic characteristics of low-fidelity prototyping: Visual design: Only some of the visual attributes of the final product are presented (such as shapes of elements, basic visual hierarchy, etc.). Content: Only key elements of the content are included. Interactivity: The prototype can be simulated by a real human. During a testing session, a particular person who is familiar with design acts as a computer and manually changes the design’s state in real-time. Interactivity can also be created from wireframes, also known as “connected wireframes.” This type of prototype is basically wireframes linked to each other inside an application like PowerPoint or Keynote, or by using a special digital prototyping tool such as Adobe XD. Pros Inexpensive. The clear advantage of low-fidelity prototyping is its extremely low cost. Fast. It’s possible to create a lo-fi paper prototype in just five to ten minutes. This allows product teams to explore different ideas without too much effort. Collaborative. This type of prototyping stimulates group work. Since lo-fi prototyping doesn’t require special skills, more people can be involved in the design process. Even non-designers can play an active part in the idea-formulation process. Clarifying. Both team members and stakeholders will have a much clearer expectation about an upcoming project.hgygh Cons Uncertainty during testing. With a lo-fi prototype, it might be unclear to test participants what is supposed to work and what isn’t. A low-fidelity prototype requires a lot of imagination from the user, limiting the outcome of user testing. Limited interactivity. It’s impossible to convey complex animations or transitions using this type of prototype. Prototyping – Fidelity (2) Low-fidelity Disadvantages: may not cover all aspects of interfaces, are not interactive, may seem non-professional in the eyes of some stakeholders (sigh!) 17 Prototyping – Risks Prototypes that focus on user-interface tends to lose the focus of demonstrating/exploring functionality Prototypes can bring customers’ expectations about the degree of completion unrealistically up 18 Though prototyping decreases the probability of a software development project failure, this activity has its own risks. The biggest risk is that anyone who is interested in the project after facing a working prototype will decide that the final product is almost ready. ‘Wow, you seem to have already done everything!’ enthusiastically says the one you asked to evaluate the prototype. ‘It looks great. Is it possible that you will finish it quickly and give it to me?” In short, then: NO! Prototyping – Risks Do not end-up considering a throwaway prototype as part of the production system Always clearly state the purpose of each prototype before building it 19 Beware of those project stakeholders who think that the prototype is just an early version of the final product. Managing expectations is one of the key components of the success of prototyping. Everyone who sees a prototype must understand its purpose and the limits of its application. Web testing service comes in handy when you want to improve design and content of e-commerce site.  Do not let the fears associated with premature release of the product draw you away from creating a prototype. Explain to everyone that you are not going to release it as the final product. One way to control this risk is to use paper and electronic prototypes. None of those who evaluate the paper prototype will believe that the product is almost ready. Another way is to choose prototyping tools that are different from those used to develop the final product. This will help to counter those who ask to “quickly finish” and release a prototype. Moreover, beware when users start to bother you with the question: “How the user interface will look like and operate?” Working with prototypes that resemble the final product, users easily forget that at the stage of requirements specification they should basically think what they want to see in the system. Create the prototype only with those demonstrations, functions and navigation capabilities that will help you eliminate ambiguities in the requirements. Prototypes Partial implementations Best used to explore requirements Great for “Yes, But” responses Evaluate the results 20 Prototype Roles Evolutionary Usually part of an agile or rapid application development effort Part of iterative stages of code refinement Code kept Prototype Roles Throw-away Requirements gathering tool Particularly useful with interface development None of the code should be carried forward into the final product Project Interview Questions GCIS 514 Fall 2021 Questions Answer Follow-up suggestions