 Today I'd like to talk to you about using design thinking to discover user needs and guide innovation and in tele-audiology and this is a different way of approaching research and innovation that we've really embraced over the past couple of years at now. So tele-audiology, so the overall problem that tele-audiology solves is that people with hearing difficulties can't always access quality hearing services in the way that they would like to and they have different needs and preferences. So for example they may live far away from the nearest hearing centre, they may have mobility issues or busy daytime schedules or as in recent times maybe they're shouting at home or the hearing centre is closed. So the challenge we ask ourselves is how might we leverage technology to provide alternatives or improvements to traditional hearing health delivery. Now this is a pretty big challenge with a broad scope when we consider all the different types of clients and the different stages they may be along their hearing journey and what we really want to find out is where should we focus, where should we invest our time and resources and where are the main opportunities. So we decided to take a design thinking approach. So we pulled together a multidisciplinary team of researchers at now. So we heard in our team engineers, speech pathologists, statistician and research audiologist and we embarked on a design thinking sprint. So design thinking is a human-centred approach to innovation and it focuses on the needs of people. So instead in the past where we may have come up with a brilliant idea in the lab, dived in and developed it and then tried to convince users to use it, instead here we want to keep the user at the heart of the process along the full journey and that way we can create something that we know benefits the user and has a greater chance of being successful. So the five stages of design thinking are here. So firstly, empathize where we set aside our assumptions and try to gain an understanding of the user. Then we define the user needs. We think of what are their pain points, what are their barriers, what do they want to gain or what would make a positive difference to them. Then we go into the ideate phase and this is the fun part where we come up with a lot of wild solutions, get our creative juices going to try and think of things to solve those problems. And then we'll choose a few of those ideas to go on and prototype and test and this is an iterative process where we continually learn, get feedback from the user and improve our solution. So in this talk I'll talk about the first two phases of the process. So firstly empathize. So the aim here is to try and understand the experiences of our users and these are mainly clients, clinicians and others in the hearing industry and what are their attitudes towards telling the audiology. So we used three main methods. So firstly ethnographic observation. So in this case we went out and observed actual clinical appointments. So maybe assessment appointments, fittings or follow-ups. Also tele appointments where the client was at a remote location. The idea here was we could keep a, we wanted to keep a curious mindset. We would keep asking ourselves why, why are they doing it in that way? How are the people interacting with each other? And having a diverse team really helped with keeping that fresh perspective and seeing with new eyes. We also used surveys to gather insights and surveys are a great way to get information from a large number of people. So in this case we collected 175 survey responses. But the problem with surveys is that you can't really truly get someone's emotion from a brief written response or you can misinterpret their real emotional context. So we also conducted interviews and these were semi-structured with a lot of open-ended questions where we could let people tell their story, really delve in to get the details and understand their point of view. So the spread of responses were over people with hearing loss, audiologists, managers of hearing clinics and also device manufacturers. So in all good design thinking we used a lot of post-it notes and this is really helpful to visualise and map out all this data that we were collecting. On one board we had a client journey map where we arranged the problems as they related to different stages of the client journey. We also looked at different user groups that could benefit from tele-audiology and their different needs. So maybe they lived in remote area, maybe they're tech savvy and they really like new technologies and we looked at what solutions would suit them well. On the second board we sorted findings into things and we ranked them by importance and we identified over 20 different problems that our users experienced. So I'd like to share with you the top three problems we discovered as well as a few interesting insights. So problem number one related to access to services. This is the most obvious advantage of tele-audiology, benefiting people that live in remote or regional areas. And in these areas, services are quite infrequent. There may be a lack of specialists available and there's a long, constant time associated with long distance travel, particularly in a big country like Australia. So we had one audiologist who was very experienced say to us, basically to me it was just a sense of equity. It wasn't fair that people out there were getting really substandard care and she was really passionate. You could feel her frustration and her desire to better serve her clients. But access doesn't just affect people who live far away from a herring centre. People in urban areas also experience a lot of access issues as well. So things like having to wait a long time for the appointment after booking or the hassle with travelling to appointments. People talk about fighting city traffic and having to pay for parking. Also inconvenient open hours. A lot of clinics aren't open late night or in the weekend, so it's difficult for people who go to school or work to attend their appointments. We had one client who attends over three appointments a year say the commute is terrible. Two hours round trip commute for an appointment that generally lasts less than 30 minutes. So you could really hear his frustration at the hassle of getting to appointments. He wanted more easier and convenient access. OK, so the second problem was about monitoring and follow up. Again, this is a strong issue for those in remote areas where there's a long time between fishing and follow up. But it was also interesting to note that many clinicians mentioned that clients sit on problems for a long time. So maybe their herring head has stopped working or they can't remember how to change programs. But instead of contacting the audiologist or finding a solution that they might wait for the next appointment, which could be months away. On the flip side, also there were clients who would book a full appointment for just a minor issue like a wax guard change. So a quote from one audiologist said, I wish we could do more to have an efficient and effective follow up and find an easy way for original clients. And then from our survey, 30% of clients said they experienced the problem that sometimes I just want to ask a question and I don't feel like I need a whole appointment. So what we were hearing is that the current system didn't really accommodate everyone's needs well. The third problem we'll mention is time and appointment. So one of the most common challenges reported by clinicians was time constraints. So short appointment times, these were usually 30 minutes and they thought it was difficult to fit all those tasks into that appointment time. They wanted to engage with their clients more, but there was insufficient time to build rapport and there was just too much task switching. They felt like they were just ticking off a lot of boxes and not providing that in-depth personalized care. So quote from experienced audiologist said, I always feel pushed for time or like I could do a better job for the client with more time allocated per appointment. And that was reflected in the client comments as well with one client saying, I want someone who takes the time to understand what my everyday life looks like before suggesting hearing aids or other devices or making adjustments. So we could see from both sides there needs to be more time to build rapport and listen to client concerns within the appointment. Now we also discovered some interesting insights for this one. We wanted to find out how willing clinicians are to perform certain tasks via teleordiology with clients of different age groups. So here we have 16 graphs and each of these graphs relates to a different task. So along the X axis, we have the client age group going from infants through to older adults. And we compare two scenarios. One where the client has an assistant which are the blue bars and the other where there's no assistant present with the client. And what we discovered was that clinicians are more willing to use teleordiology with adults than with children. They're more willing to provide information, counseling and answer questions. And they're more willing for assessment tests, hearing aid fittings for new users when there is an assistant present with the client. So that's shown by the large difference between the red and the blue bars. So what this tells us it highlights some very, very favorable opportunities for teleordiology and possibly where there are potential barriers that we might face. The second insight relates to the clinician-client relationship. And this is usually thought to be one of the things that most people are worried about with teleordiology and one of the main barriers. So we looked at how clinicians thought teleordiology affects the quality of care and the quality of relationships with new and returning clients. So along the X axis here we have from a decrease in quality with teleordiology through to an increase in quality. And what was really interesting that was that it's rather than looking at all the clinicians together, if we separated responses from those who haven't used teleordiology, which is the blue bars, and those who have used teleordiology, which are shown by the red bars, we see that clinicians who have used teleordiology thought that it would increase or have no effect on the quality of care and relationships. And this has been echoed in our other Connected Health studies, which suggests that once people try it out, it shifts their attitudes. And then also following on from this, when we look at responses on other categories from these clinicians who have used teleordiology, they also thought that teleordiology would increase client satisfaction, as well as clinician job satisfaction. And from conversations that we've had with audiologists within Hearing Australia who had just after their first tele appointment, they were really excited, even surprised at how well it went and keen to do more. And this has also reflected in the client feedback surveys. Also, many of these clinicians rated the ability to serve more clients and the ability to respond to clients' needs sooner as increasing with teleordiology. And that shows the promise of technology to solve the problems identified of access and follow-up that I previously mentioned. So to summarize, the top teleordiology needs to inspire innovation. We have to increase client access to hearing services, regardless of where they live, to enable clients to receive follow-up support and solve problems quicker, to help and to help clinicians make more effective use of time in face-to-face appointments. So if we go back to the original design thinking process, we've now got to this defined needs stage. And then we went on to do a brainstorming ideation session where we got together 20 researchers from within NAL and we came up with over 80 ideas. And then we selected two of those ideas to prototype and test. So they're exciting developments and innovations in progress at the moment. We had a really great soundbites webinar last week by Jeremy Pang, who talked about one of these projects, which is to better prepare clients for their first appointment using teleordiology in that pre-assessment time period. So to wrap up, design thinking is a human-centered approach to innovation. It's helping us maintain the focus of our direction and teleordiology on the needs of clients and clinicians. So it's an exciting way to innovate. We're constantly learning, improving our processes and learning new tools that can help us achieve this and will make sure our solutions will create real value for our users. So finally, thanks to the teleordiology sprint team, Laura Baddard, Michelle Sater-Turner, Mark Sito, Humphrey Chin and Ingrid Yngd. Also thanks to all the people who we interviewed and who responded to our survey and shared their experiences and to organisations who helped spread the word about this study.