Localizing a service strategy for cataract patients through a combination of ethnographic research and co-creation workshops

  • Project Type: Design Research
  • Team: Jason Lam, Zhen Xie, Francisco Porras, and Gump Huang
  • Contribution: Research Plan, Ethnographic Observation, Data Analysis, Ideation, and Co-creation Workshop
  • Deliverable: Report


At present, there are 35 million people diagnosed with cataracts in China. It is regarded as one of the top “messengers of darkness”, accounting for half of the 5.8 million blindness cases. Despite being an easily curable eye disease, many Chinese cataract patients are left out from treatment due to three barriers:

  • Capacity To Provide Treatment - only 450,000 people are being treated per year and there are only 4,000–5,000 qualified eye doctors to perform cataract surgeries.
  • Geography - 70% of patients are living in rural areas while 80% of the doctors are living in cities. This creates a supply-demand mismatch between physicians and patients.
  • Awareness of The Disease and Treatments - Finally, most cataract patients are undereducated and have low-income. Many don’t have knowledge about the disease itself, and don’t know how it can be treated or where they can get treatment.

Witnessing this healthcare blind spot, a non-profit organization named Vision in Practice (ViP) introduced a new business model to serve cataract patients at an affordable price. The concept originated from India and was created to help small, private, rural hospitals gain the capacity to treat cataract patients. Their vision is to provide safe and secure cataract surgery to the patients who are living in the countryside, regardless of their ability to pay. To test the business model, the hospital had established a cataract outreach team to approach residents in remote villages. Unfortunately, they were not gaining much support in villages and the team wasn't sure why.


As we conversed with ViP, it became clear that social and cultural differences between Indian and Chinese societies impacted the business model and localizing their efforts would require an analysis of the services that were being offered. Together with ViP’s team, we defined three objectives that needed to be done to improve the surgery conversion rate:

  • Understand the factors that cause cataract patients to choose not to return for surgery;
  • Identify weaknesses in the existing service journey; and
  • Create a new service strategy to help the program to fit better in China.


As the results required an intimate understanding of the culture of the local villages, we decided to use a 4 step process that borrowed from community based research methods and involved the key stakeholders of the medical outreach program –- local villagers, hospital staffs and ViP’s team members.


We interviewed ViP’s key team members to learn about their experience and challenges of the program. These helped our team and ViP to reach alignment on the project’s objectives and research approach.


We immersed ourselves into the rural town of Tancheng in Shandong province for 10 days and engaged in the activities among patients, nurses and doctors. Using techniques such as participatory observation, in-depth interviews, and shadowing, we captured facts and perspectives about the lives of doctors, nurses and villagers, day-to-day healthcare service operations, and interactions between patients and healthcare staffs. In the process, we built empathy to the key stakeholders of the cataract treatment service.


After our field research, we analyzed and visualized research data using techniques such as Affinity Diagram and Journey Mapping. These activities helped build a clear view on the existing service journey and the pain points at each stage of the process.We also organized and facilitated an information synthesis workshop, which our team collaborated with ViP’s key team members to identify insights and opportunities, such as “what are the key barriers that keep patients from returning for treatment”, “how hospital staffs should engage with the local stakeholders”, and “what are the areas that can be enhanced to improve efficiency”.


Our work went beyond presentation of key research findings –- we set up a co-creation workshop and invited hospital staff members to generate new ideas for addressing the shortcomings in their treatment process. This process helped the hospital team reach alignment on how to better serve their patients. It also allowed the ViP team to better understand how to adjust their core business model to better fit into the Chinese culture.


We created a pain point map to summarize the key pain points that led to understanding the refusal for surgery in a simple and visual way. The patterns of the pain points also led us to conclude that activities prior to surgical treatment, such as promotion, screening and patient transportation, could directly impact the surgery conversion rate. For instance, one of the key insights was that even after going through the screening process, many patients still didn’t truly understand the causes of cataracts and the benefits of surgical treatment. This insight highlighted the importance of patient education, since many of the elderly in the area are illiterate.

A thorough review of the medical outreach journey helped our team to identify opportunity areas for service enhancement. Combining ideas generated from the co-creation workshop, we proposed new service concepts and strategies to enhance the treatment process. For instance, learning that locals are very busy during a farming session and that different crops have different growing cycles, we recommended that the hospital staff take into consideration the farming period before scheduling their outreach operations


Prior to this research engagement, Xin Yi Min hospital had not developed a systematic approach to plan as well as monitor their operations. While they were highly adaptive in handling difficult situations or emergencies, their inputs had not been converted into results in an effective way. Our work helped Xin Yi Min hospital to build a service strategy framework and allocate resources to better answer the key concerns of the local patients. The hospital team has also become more strategic, doing advanced planning before their outreach operations. Within six months of adopting our recommendations, Xin Yi Min hospital reported that its cataract surgery rate had increased from 35% to 63%. An increase in patient volume helps the hospital’s ophthalmologists to accumulate experience and skill sets in treating cataract patients. Xin Yi Min hospital is impressed by our design research toolkits, which helped the hospital to effectively and thoroughly understand their patients and operation procedures. Soon afterward, with our training and support, the hospital quickly incorporated our methodology into their operation evaluation process. Our research toolkits helped the hospital to build empathy with their patients and evaluate their operation procedures. Our work had helped ViP to identify the key barriers that prevented successful adoption of the cataract medical care program. With modifications to the principal operation model, ViP can now better engage local communities in various parts of China.