Getting from Vision to Reality: How Ethnography and Prototyping Can Solve Late‐Stage Design Challenges

In 2014, Kaiser Permanente began implementing a next‐generation medical office model that reimagines the outpatient care experience, combining new architecture, workflow, and technology to create a more convenient experience for patients and a connected, efficient experience for staff and care teams. As the first next‐gen facilities were being built, challenges emerged as teams across a variety of disciplines attempted to translate the model's vision into reality. Teams were making design and operational decisions in parallel, without the ability to see how their decisions impacted the overall user experience. To resolve these challenges, our innovation team at Kaiser Permanente used a hybrid make‐and‐observe method of prototyping and ethnography. Employing a co‐creation mindset (Bødker and Grønbaek 1991), we engaged staff and patients to help us bring the future state of these next‐gen clinics to life in a minimally viable way. We created a full‐scale prototype experience at an existing clinic during working hours that included functional proxies of the future space; iterative techniques that simulated automation, i.e., Wizard of Oz‐ing (Kelley 1984); rewritten workflows; and recast staff roles. With this model we were able to mock up the future user experience, test assumptions in the field, surface latent needs, and resolve unanticipated conflicts. This case study provides an example of how ethnography, in combination with working prototypes of the future, can be essential tools for clarifying radical changes to new services. Using these methods, we were able to provide leaders with tangible evidence of why some elements of the initial vision needed to change in order to ensure a better user experience. Here we outline lessons learned and discuss limitations to our approach.