Current Work

  • The WrapApp

    • Description:

      We are working with the Wraparound Project, a hospital-based violence intervention program (HVIP) that provides resources, mentorship, and case management to victims of violence. HVIPs are essential to reducing violent re-injury in the community through constant communication and follow-up between high-risk clients and culturally competent case managers. During activities in the Inspiration phase, we identified that this constant high-touch support and guidance required by dedicated case managers increased their risk of vicarious trauma and burnout. In the Ideation and Prototyping phases, we developed and tested "The WrapApp”, a mobile platform intended to enhance communication and planning between case managers and clients to prevent the likelihood of future violent injury. We plan to implement this app with the Wraparound Project at San Francisco General Hospital.

    • Research Publications:

      Inspiration Phase - Designing an Information and Communications Technology Tool With and for Victims of Violence and Their Case Managers in San Francisco: Human-Centered Design Study

      Ideation Phase - forthcoming

      Implementation Phase - forthcoming

    • Funding Mechanism: CalVIP

    • Project Lead: Marianna Salvatori

    • Research and Community Partners: The Wraparound Project at ZSFGH, Code Tenderloin, Alternova

    Wraparound Project + DCYF Youth Violence Prevention Bridge Program

    • Description:

      Youth violence has been increasing in San Francisco. We are currently in the Inspiration phase of this project, researching how we might link the Wraparound Project with the Department of Children, Youth, and Their Families (DCYF) on the School Crisis Support Initiative (SCSI). SCSI aims to address and prevent violence involving students from the San Francisco Unified School District (SFUSD) through a comprehensive, collaborative, and community-centric approach. The initiative works to reduce the number of students involved in violent or serious conflicts both on and off campus, especially gun-related incidents, by coordinating rapid response de-escalation and violence prevention support for specific school sites designated by SFUSD. The goal of the Ideation and Implementation phase is to prototype and implement a solution that will provide transparency between violent injuries that matriculate to ZSFGH and the San Francisco school system to protect our city’s youth better.

    • Research Publications:

      Inspiration Phase - forthcoming

      Ideation Phase -forthcoming

      Implementation Phase -forthcoming

    • Funding Mechanism: The Department of Children, Youth, and their Families (DCYF)

    • Project Lead: Jennifer Reid, MD

    • Research and Community Partners: The Wraparound Project at ZSFGH, DCYF

    Data Management for Hospital-Based Violence Intervention Programs

    • Description:

      In hospital-based violence intervention programs (HVIPs), there are wide variations in how data is collected and what is recorded. During the Inspiration phase of this project, we explored how to create a database that captures the complex stories of our patients who have experienced violence and supports efforts of fidelity in the field. In the Ideation phase, we designed and tested different solutions, ultimately deciding that integrating this database into the hospital's Electronic Health Record (EHR) would be the best approach. We are now in the Implementation phase, where we are piloting and refining this solution, which is currently being used by the Wraparound Project.

    • Research Publications:

      Inspiration Phase - forthcoming

      Ideation Phase - forthcoming

      Implementation Phase - forthcoming

    • Funding Mechanism: CalVIP

    • Project Lead: Caitlin Collins, MD MPH

    • Research and Community Partners: The Wraparound Project at ZSFGH, The San Francisco Department of Public Health

  • Disparities in Well-being Outcomes Among Medical Students: The Impact of Disabilities

    • Description: Medical students have diverse identities, some of which put them at higher risk for poor mental well-being and severe distress (i.e. disability). We used human-centered design (HCD) qualitative research methods in the Inspiration phase to better understand disability and its relation to medicalstudents. In the Ideation phase, we are comparing well-being, protective and risk factors, and the interaction of modifiable variables between medical student cohorts with and without the identity of disability.

    • Research Publications:

      Inspiration Phase - forthcoming

      Ideation Phase - forthcoming

      Implementation Phase - forthcoming

    • Funding Mechanism: Internal UCSF Funds

    • Project Lead: Henry Seaborne

    • Research and Community Partners: N/A

    Mental Health Screening in Surgical After Care Clinic

    • Description: Using HCD methodologies, we uncovered during the Inspiration and Ideation phases that there is a need to improve equitable access, efficiency, experience, and quality of care for trauma patients at the ZSFGH surgery clinic. During the Implementation phase, we collaborated with the Division of Trauma Recovery Services to screen all victims of violence for mental health disorders, such as PTSD and depression, with subsequent referrals and care coordination. This effort, along with other quality improvement projects by the Division of Surgery to address the unmet needs of surgical patients, will ultimately lead to improved patient outcomes and cost optimization.

    • Research Publications:

      Inspiration Phase - forthcoming

      Ideation Phase - forthcoming

      Implementation Phase -forthcoming

    • Funding: CPG SURF 5.0 Grant 

    • Project Lead: Jennifer Reid, MD

    • Research and Community Partners: UCSF Trauma Recovery Center

  • End of Life Care for Patients with Advanced Dementia

    • Description:

      Providing end-of-life care for patients with advanced dementia can be complex, often leading to high-intensity and potentially unwanted treatments (i.e. mechanical ventilation, ICU admission, and resuscitation at the end of life). We applied a human-centered design lens through the Inspiration and Ideation phases to identify key insights from the clinician perspective, test hospital-based solutions, and redesign care delivery for patients with advanced dementia.

    • Research Publications:

      Inspiration Phase - forthcoming

      Ideation Phase - forthcoming

      Implementation Phase - forthcoming

    • Funding Mechanism: California Healthcare Foundation

    • Project Lead: Lara Chehab, MPH

    • Research and Community Partners: Reset Health

  • Hand Infection Care at ZSFGH

    • Description:

      If not cared for appropriately, hand infections can become infected and be a significant source of disability for patients. These infections are more common among vulnerable populations; however, no specific studies have assessed ways to improve care for this diagnosis in these groups. In the Inspiration phase, we identified key challenges providers and patients face in delivering proper care for hand infections. In the Ideation phase, we brainstormed and tested potential solutions with patients and providers. We co-designed and devised a discharge toolkit, and we plan to pilot it at ZSFGH with inpatients admitted for hand infections during the Implementation phase.

    • Research Publications:

      Abstracts Presented -

      Inspiration Phase - forthcoming

      Ideation Phase - forthcoming

      Implementation Phase - forthcoming

    • Funding Mechanism: Internal funding from the UCSF Division of Plastic & Reconstructive Surgery

    • Project Lead: Alap U. Patel, MD

    • Research and Community Partners: Mica Rosser, MD, Scott L. Hansen, MD

  • Surgical Oncology 'Patient Navigator' Position

    • Description:

      Cancer patients, especially those needing treatment, surgery, and other tests, often struggle with navigating the complex scheduling and referrals across different departments involved in their care. To address this, we are collaborating with Dr. Ajay Maker and the UCSF Department of Surgical Oncology to create a 'Patient Navigator' role specifically for GI cancer patients. In the Inspiration Phase, we are researching the challenges faced by both patients and providers in coordinating care. In the Ideation Phase, we will analyze this information and develop workflows for the navigator role. Finally, in the Implementation Phase, we will test this new role in the UCSF Surgical Oncology GI Clinic and assess its impact on patient outcomes.

    • Research Publications:

      Inspiration Phase - forthcoming

      Ideation Phase - forthcoming

      Implementation Phase - forthcoming

    • Funding: UCSF Department of Surgical Oncology

    • Project Lead: Marianna Salvatori

    • Research and Community Partners: Ajay Maker, MD, UCSF Department of Surgical Oncology

    Injury Survivorship Clinic at ZSFGH

    • Description:

    • Research Publications:

      Inspiration Phase - forthcoming

      Ideation Phase - forthcoming

      Implementation Phase - forthcoming

    • Funding:

    Drop-in Clinic

    • Description:

    • Research Publications:

      Inspiration Phase - forthcoming

      Ideation Phase - forthcoming

      Implementation Phase - forthcoming

    • Funding:

    • Project Lead: Marissa Boeck, MD MPH

    • Research and Community Partners: SF Department of Public Health

  • American College of Surgeons Trauma-Informed Care Curriculum

    • Description:

      Trauma-informed care (TIC) focuses on training healthcare staff to better support patients with complex needs by understanding and responding to the impact of trauma. In 2021, the American College of Surgeons developed a 4-hour TIC training program, which was piloted in 21 trauma centers across the U.S., including Zuckerberg San Francisco General Hospital. After the 2023 pilot, The Better Lab used human-centered design to assess how the curriculum was implemented and its effectiveness. We are now in the Ideation phase, creating new curriculum content and recommendations for local and national rollout.

    • Research Publications:

      Abstracts Presented - The Implementation and Evaluation of a National Trauma Informed Care Curriculum Pilot: A Single-Center Experience, UCSF Department of Surgery Research Symposium, May 2024, UCSF

      Inspiration Phase - forthcoming

      Ideation Phase - forthcoming

      Implementation Phase - forthcoming

    • Funding: UCAAN

    • Project Lead: Adrienne Greer, MPH

    • Research and Community Partners: Triads, Trauma Transformed

    Trauma-Informed Perioperative Care

    • Description:

      Trauma-informed care (TIC) is crucial for helping physicians support patients with emotional and physical trauma, empowering them to take control of their care. However, adapting TIC in fast-paced acute care settings, like emergency and surgical environments, is not well understood. Using human-centered design, we conducted interviews with surgical providers at ZSFGH during the Inspiration phase to better understand the acute care environment and how care is adapted for trauma-affected patients. In the Ideation phase, we will analyze key themes, brainstorm ways to improve TIC, and prototype solutions at ZSFGH.

    • Research Publications:

      Abstracts Presented - Exploring Gaps in Trauma-Informed Care in the Perioperative Setting: A Qualitative Study at a Federally Qualified Health Center, United California Community Health Conference (UCCHC), April 2024, UC Davis School of Medicine

      Using Human Centered Design to Overcome Barriers for Trauma-Informed Care (TIC) in a Perioperative Setting, December 2023, UCSF Summer Explore Poster Session

      Inspiration Phase - forthcoming

      Ideation Phase - forthcoming

      Implementation Phase - forthcoming

    • Funding: Internal UCSF Funding

    • Project Lead: Angelica McDaniel

    • Research and Community Partners: Faithful Fools

    Trauma-Informed Care for Spanish-Speaking Patients

    • Description:

      Trauma-informed care (TIC) is a framework for improving care for patients who have experienced trauma. However, its implementation for patients with limited English proficiency, especially in trauma and acute care surgery, is not well understood. Using a human-centered design approach in the Inspiration phase, we identified key insights from both clinicians and patients. We are now entering the Ideation phase, aiming to redesign how TIC is delivered to Spanish-speaking patients in acute care surgery.

    • Research Publications:

      Abstracts Presented - Using Human-Centered Design to Improve Trauma-Informed Care for Spanish-Speaking Patients Receiving Acute Care Surgery, UCSF Department of Surgery Resident Research Symposium, May 2024, UCSF

      Inspiration Phase - forthcoming

      Ideation Phase - forthcoming

      Implementation Phase - forthcoming

    • Funding: UCSF School of Medicine Inquiry Funding

    • Project Lead: Manami Diaz Tsuzuki

    • Research and Community Partners: The Wraparound Project

Past Work

  • Improving Perinatal Healthcare Delivery

    • Description:

      Extreme disparities in access, experience, and outcomes highlight the need to transform how pregnancy care is designed and delivered in the United States, especially for low-income individuals and people of color. We used human-centered design to understand the challenges facing Medicaid-insured pregnant people and design interventions to address these challenges. We engaged a total of 171 stakeholders across the Inspiration and Ideation phases of the HCD methodology.

    Solid Start

    • Description: This project was inspired by the Solid Start Initiative’s interest in better understanding transitions within the perinatal s ystem of care at ZSFG in order to improve care coordination and overall experience. The Inspiration phase revealed that patient information is often lost across transitions of care, and that providers rely on patients to report valuable and sensitive information. While this information is important to providers and community organizations for the delivery of appropriate services, the process inappropriately places this responsibility on the patient. The Ideation phase identified four main workstreams

      to address the themes, insights and design opportunities revealed from the Inspiration phase: Honor the Patient Story, Builda Robust Relationship, Interpersonal Violence Education and Support and the Transition from Labor and Delivery. Solution ideas for each workstream were generated with stakeholders through a series of brainstorming sessions. Outputs from this phase include 12 prototype concepts. The Implementation phase iteratively tested and refined 5 prototype concepts with patients and providers over a series of 23 in-person, in-context testing sessions. Due to constraints with the project timeline, only 3 prototypes were implemented in patient care environments including 5M and 6M clinics, and with the Homeless Prenatal Program.

    • Research Publications:

      Facilitating Integrated Perinatal Care for Families Affected by Substance Use

    • Funding: Solid Start

    • Project Lead: Benjamin Alpers, MS, Devika Patel, MS

    • Research and Community Partners: Solid Start, Homeless Prenatal Program, Team Lilly, OB Psychiatry Clinic, Plan of Safe Care Collaborative Perinatal Health

  • 99DOTS Digital Adherence Technology in Uganda

    • Description: Tuberculosis (TB) is the leading cause of infectious disease death worldwide. However, globally, treatment adherence is much lower than the WHO-recommended level of 90%. In Uganda, treatment adherence ranges from 60-75%. We utilized human-centered design to redesign a current digital adherence technology called 99DOTS to better suit the needs and priorities of Ugandan TB patients.

    3HP: Tuberculosis Preventative Treatment Adherence in Uganda

    • Description: Recently, the World Health Organization recommended a 3-month (12-dose) regimen of weekly isoniazid and rifapentine (3HP) for the prevention of tuberculosis (TB) among people living with HIV (PLHIV) on common antiretroviral therapy regimens. However, the optimal method for delivering 3HP to PLHIV remains uncertain. To address this, a 3-armed randomized trial was conducted, where participants were assigned to either the Directly Observed Therapy (DOT) arm, the Self-Administered Therapy (SAT) arm, or a choice arm, allowing patients to select DOT or SAT using a shared decision-making tool. DOT involves a weekly visit to a healthcare provider for dosing and monitoring of side effects, while SAT requires a weekly phone call to confirm adherence, with in-person visits only for refills. We collaborated with Dr. Adithya Cattamanchi's team to develop a shared decision-making aid to help patients choose their preferred treatment delivery method: DOT or SAT. Additionally, we designed the experience for patients assigned or opting for SAT by creating a carrying case for their medication and planning the call-in process. Tuberculosis (TB) remains the leading cause of infectious disease death globally, but adherence to treatment is often below the WHO's recommended level of 90%, with Uganda's adherence rates ranging from 60-75%. There is an urgent need for improved ways to track adherence and provide effective care. Digital adherence technologies, which help monitor patient compliance, are one potential solution. We are partnering with Global Health Labs to design, prototype, and test an innovative TB medication adherence technology to assist patients and providers in monitoring adherence. Drawing from prior research phases, including the redesign of 99DOTS and work on TB preventive treatment for PLHIV, our efforts have already led to a 10% increase in TB medication adherence in Uganda.

    Developing Novel Digital Adherence Technologies to Improve Tuberculosis Medication Adherence in Uganda

    • Description: Tuberculosis (TB) remains the leading cause of death from infectious diseases worldwide, yet treatment adherence globally falls short of the WHO's recommended 90%, with rates in Uganda ranging from 60-75%. This highlights the urgent need for improved methods to track patient adherence and provide enhanced care. Digital adherence technologies, which utilize technological tools to monitor patient adherence, offer a promising solution. Our collaboration with Global Health Labs focuses on designing, prototyping, and testing an innovative TB medication adherence technology to support patients and providers in monitoring treatment adherence. We build on insights gained from previous research phases, including the redesign of 99DOTS and work on TB preventive treatment for people living with HIV. Our efforts have already led to a 10% increase in TB medication adherence in Uganda.

    • Research Publications:

      Inspiration Phase - forthcoming

      Ideation Phase - forthcoming

      Implementation Phase - forthcoming

    • Funding: Global Health Labs

    • Project Lead: Devika Patel, MS

    • Research and Community Partners: Dr. Adithya Cattamanchi, Dr. Christopher Berger, Uganda Tuberculosis Implementation

  • Medical Student Wellbeing

    • Description:

      Medical student wellbeing is a critically important but understudied topic. We recently completed the largest survey of medical student wellbeing ever conducted. In addition to the survey, we conducted more than 20 in-depth interviews with medical students. Analysis of this data revealed that more than 50% of medical students meet criteria for severe distress, and 20% of all students surveyed have taken or considered taking a leave of absence for personal wellbeing. We also found that distress among medical students is exacerbated by multiple factors, including gender identity and debt burden. We are continuing to examine these associations to further understand the landscape of medical wellbeing. Through this work, we hope to identify coping mechanism, habits, and characteristics of medical students which promote resilience and reduce distress. Our aim is to use this data to develop interventions which promote medical student wellbeing and reduce burnout.

    • Research Publications:

      Inspiration Phase - Medical students in distress: The impact of gender, race, debt, and disability

      Risk factors associated with student distress in medical school: Associations with faculty support and availability of wellbeing resources

      Ideation Phase -

      Implementation Phase -

    • Funding:

    • Project Lead: Nikhil Rajapuram, MD

    • Community and Research Partners: Megan Marshall

  • Virtual Reality Training Program to Improve Trauma Care

    • Description:

      Historically, medical trainees were educated in the hospital on real patients. Over the last decade, there has been a shift to practicing skills through simulations with mannequins or patient actors. Virtual Reality (VR), and in particular, the use of 360-degree video and audio (cineVR), is the next-generation advance in medical simulation that has novel applications to augment clinical skill practice, empathy-building and team training. For this project, we focused on high-level trauma care at ZSFG. where out of approximately 255 trauma cases admitted each month, 90 are high-level “900 activations” that require speed and intense coordination across multiple departments. We developed a training experience using cineVR and eye-tracking technology to help trainees in surgery, anesthesia and emergency medicine to experience a real and simulated 900 trauma activations from different perspectives, such as the charting nurse, the attending, and their fellow providers.

    • Research Publications:

      Technical Methods Paper: Developing Virtual Reality Trauma Training Experiences Using 360-Degree Video: Tutorial

      Book Chapter: The Power of Virtual Reality Cinema for Healthcare Training: A Collaborative Guide for Medical Experts and Media Professionals

    • Funding: SF General Hospital Foundation

    • Project Lead: Devika Patel, MS

    • Research and Community Partners: Ohio University GRID Lab

    Trauma Rounding

    PPE Redesign

    • Description: Personal protective equipment (PPE) compliance amongst healthcare workers is low nationally. Trauma care providers are at significant risk of body fluid exposure. We identified poor PPE compliance rates of 29% among trauma care providers at our institution. From HCD research, with trauma care providers and staff, we identified two design opportunities to improve PPE compliance: improving the donning process and improving convenient access to PPE storage. Brainstorming yielded 216 ideas which were organized into 12 discrete categories. The 3 ideas selected to be further developed included 1) PPE Fanny Pack: PPE stored in a fanny pack or backpack that each provider wears; 2) Role Specific PPE packs: PPE packaged and placed in relevant locations in the trauma bay that contain role-appropriate PPE and 3) All-In-One PPE kit: A gown with gloves, mask, and hair cover attached to the gown. User feedback indicated the All-In-One PPE kit was the most desirable. This idea was refined to be a PPE Bundle: a gown with necessary PPE components adhered to the gown at ergonomic positions. A rack with a quick release mechanism was developed to hang the PPE bundle from current PPE storage systems. Next steps include refining the physical design of the prototype and user testing in clinical settings to understand compliance, effectiveness, and acceptability.

    • Research Publications:

      AAST 2020 conference abstract: From Opportunities to Prototypes: Redesigning Personal Protective Equipment in Trauma Care

    • Funding: Patient Care funds at UCSF/ZSFG

    • Project Lead: Patrick Martin-Tuite, MD, MS, Devika Patel, MS

    • Research and Community Partners: ZSFG Emergency Department

  • Improving Access, Efficiency, and Experience at ZSFGH Surgical Clinic

    • Description:

      This project aims to improve access, efficiency and experience for patients, providers and staff at a general surgery outpatient clinic at ZSFG. ​Access: In our pre-COVID research, we used HCD interviews and predictive analytics to develop insights and opportunities for understanding the 30% no-show rate in clinic, and prototyped various transportation-related solutions to help patients overcome barriers to attendance. We are currently identifying insights and opportunities for designing a system of remote surgical care that can improve both access and efficiency of clinic visits, without compromising outcomes. Efficiency: In our pre-COVID research, we found that patients often spend over 2 hours in clinic for a short outpatient visit. We used a combination of HCD and time-tracking observations to identify bottlenecks and pain points. Read more about our research here. Experience: In our pre-COVID research, we used HCD interviews and architectural mapping techniques to develop insights and opportunities for understanding the patient experience in the waiting room. Read about our insights here.

    • Research Publications:

      Inspiration Phase - Using a human-centered, mixed methods approach to understand the patient waiting experience and its impact on medically underserved populations

      Using Architectural Mapping to Understand Behavior and Space Utilization in a Surgical Waiting Room of a Safety Net Hospital

      Ideation Phase -

      Implementation Phase -

    • Funding:

    • Project Lead: Lara Chehab, MPH

    • Research and Community Partners: Department of Surgery, ZSFG Surgical Clinic

  • Covid-19 Experiences

    • Description:

      At the time of writing, over 78 million cases of COVID-19 have been documented worldwide. Of those, approximately 76 million people have recovered from the disease. In North America, nearly 19 million people have tested positive for the virus; yet, 18.5 million of those have recovered or are actively recovering from the disease. This project is a multi-centered design study that aims to understand the recovery experience of people who have been diagnosed with COVID-19 in North America. The goal of this study is to compare recovery experiences of hospitalized and non-hospitalized across San Francisco, Los Angeles, Michigan, Chicago and Toronto in order to inform recovery programs that can provide necessary and continued support to people during their recovery.

    • Research Publications:

      Inspiration Phase - Scale, Scope, Speed: Reflections on a Multi-site Covid-19 Study

      Ideation Phase -

      Implementation Phase -

    • Funding:

    • Project Lead: Lara Chehab, MPH

    • Community and Research Partners: Kim Erwin, Emergency Design Collective