Healing Environments: Design Thinking Research Book by Harsheen Kaur

HEALING ENVIRONMENTS

DESIGN THINKING RESEARCH BOOK FALL 2014 HARSHEEN KAUR

WAYFINDING RESEARCH

NATURE RESEARCH

BIOPHILIA RESEARCH

EMPATHY EXERCISE: EMILY COURIC CANCER CENTER

OPEN TABLE DISCUSSION: PATIENT EXPERIENCE

EMPATHY: ICU AND INFECTIOUS DISEASES

DESIGN THINKING RESEARCH

CASE STUDY ANALYSIS

PROTOTYPE

IDEATE

RESEARCH

IDEATE

RESEARCH + DEFINITIONS

EMPATHY + TESTING

IDEAS + PROTOTYPES

LOGIC MODELS CONCEPT MAPS RESEARCH FINDINGS RULES

EMPATHY + TESTING

IDEAS + DESIGN CONCEPTS PROTOTYPES

CASE STUD

DY ANALYSIS An exploration through models and drawings of the Maggie Center in Dundee, Scotland.

HOW PEOPLE MOVE INSIDE VS OUTSIDE

ARRIVING TO THE MAGGIE CENTER

HOW PEOPLE MOVE INSIDE VS OUTSIDE

â&#x20AC;&#x153;Perhaps the most important thing a window does is provide a portal- an escape from the frightening, painful reality of disease, or a way of accessing memories of a better time and placeâ&#x20AC;? -Healing Spaces, 9

â&#x20AC;&#x153;Maggie Centers are domestic in scale, centred around the kitchen, a place where you can make yourself a cup of tea and have an informal conversation.â&#x20AC;?

-Can Architecture Cure Cancer?

THE MAGGIE CENTER DECONSTRUCTED

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MODEL STUDIES

A series of models to understand the maggie center. understand how the shape of the spaces create movement, how peole move in the space and the views one has when in the central space where one can see everything.

VIEWS CONNECTING TO NATURE

Model attempting to understand the views of nature that the Maggie Center in Dundee offers. When one enters they have a view of all the spaces that the center provides and then those are connected to the views of nature that the center then provides.

LOGIC OF INSIDE VS LOGIC OF OUTSIDE

DESIGN THINK

KING RESEARCH Researching different design thinking methods to formulate my own process for the semester.

MY DESIGN THINKING PROCESS

The process began with researching case studies and learning how the Maggie Center was organized by vistas to the estuary. Then the process went through several stages of motivations that sparked ideas and then looped back because of meetings with key stakeholders and my own research and findings. The dots at the end indicate the process still isnâ&#x20AC;&#x2122;t complete...

EMPA

ATHY EXERCISES Open table discussions and initial observtions from visiting the ECCCCC

Some quick design ideas we had and were able to get immediate feedback on. We discussed sink design and using feet to adjust water pressure so one does not have to touch any handles.

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ICU + INFECTIOUS DISEASES DISCUSSION

We also discussed the nurses hub and talked about what if it was sinked into the ground and the patients doors were lass that could change transparencies. Visability was deemed incredeibly important for the ICU.

Parking takes up to 20-30 min at the ECCCC. Itâ&#x20AC;&#x2122;s a very mundane process where the cars keep circulating up until they find a spot. Finding where to go afterwards was not too difficult for us but it did take a long time to find a spot.

PARKING AT THE GARAGE

Maggie and I made patient profiles for an empathy exercise at the ECCCC. We tried our best to simulate feelings of stress and the unknown.

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EMPATHY: PATIENT PROFILES

Everyone was divided into groups of three in which one person was a patient, one a documenter, and one a family member/friend. Everyone had tasks they had to complete at random times

This is what one gets when they book an appointment at the ECCCC. No map is given, just a generic confusing text based paper, leaving the patient feeling stressed about the unknown.

PATIENT INSTRUCTIONS

Jacqui applying vaseline on her glasses to simulate blurry vision, we were trying to experience how the â&#x20AC;&#x153;extreme userâ&#x20AC;? would use the cancer center. She also had a very heavy backpack to simulate fatigue.

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VASELINE ON GLASSES: BLURRY VISION

A view from what vaseline covered glasses looks like. The challenge would be designing a wayfinding system that could work for someone with blurry vision.

For a patient with blurry vision, the signs were difficult to see.

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ackie was clautraphobic and could not take the elevator but he stiars were not located on the map.

WAYFINDING IN ECCCC

Wait are we in the right place? Are we allowed to be here? Are these where the stairs are? Can we use these stairs?

WAYFINDING IN ECCCC

We finally found the staircase and it had nice windows where one could sit but it is so isolated from the rest of the building.

he view after getting out of the staircase. Homogenous hallways and no signage.

WAYFINDING IN ECCCC

The need for different spaces for checkout and check-in are ineffecient from an operations perspective.

UNDERUTILIZED SPACES AT ECCCC

The meditation room seems so cold, the furniture is the same as the rest of the building.

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NOT LOSING YOU? Does the ECCCC address YOU? Does it give back o YOU? What about all the things the patient has LOST.

NOT LOSING “YOU”

Difficult things from an operationals standpoint: -Making sure that all the resources are available -Prioritize time, energy, and the team

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Notes from the open table discussion, issues about EAMWORK and PRIORITIZING came up.

STAFF AMENITIES + TEAMWORK

IDEATE

E + PROTOTYPE Ideating based on my initial observations from my visit, focusing on wayfinding.

HOW MIGHT WE?

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he KTPH Acute Care Hospital in Singapore was created with the idea of a “hospital in a garden”.

BIOPHILIA + HOSPITAL IN A GARDEN

The interior courtyard, covered with nature and a trail of pathways.

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People come and use the beautiful courtyard for other purposes. The hospital is no longer just a hospital.

KTPH: SINGAPORE HOSPITAL IN A GARDEN

There is a lucious green wall inside the lobby of the hospital, an excellent positive distraction.

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here is a fully functional urban farming on the rooftop of he hospital. The produce gets used in patient meals.

KTPH: SINGAPORE HOSPITAL IN A GARDEN

How might we connect nature with self? How might we find nature in the ECCCC?

well as physical measures including blood pressure, skin conductance, brain activity, heart rate and muscle tension. Among the qualitative methods are observations of behaviour as well as surveys, including selfreports (Table 2). Behavioural changes were mainly assessed through observations, self-reports, questionnaires, structured interviews or by parent ratings and direct observation in the case of children.

Groups of respondents The target individuals varied widely among the studies. Most studies addressed the general public (37%) or students (28%). In 13% of the studies ‘‘stressed individuals’’, were respondents exposed to a stressor before exposure to landscapes. In 9% of the studies the respondents were hospital patients, their families or hospital staff (Fig. 3).

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evidence. was identiﬁed between openness and clear relationship We use the word ‘‘landscape’’ as deﬁned by the health effects.

subcategories within the urban or natural landscape

NATURE + SELF = WELLBEING

European Landscape Convention: ‘‘an area, as perceived by people, whose character is the result of the action and interaction of natural and/or human factors’’ (Council of HEALTH EFFECTS Europe, 2000, p. 3). + Range of greenery 29% (9)

Results The ﬁndings from the literature review are summarised in Table 1. URBAN

NATURAL

Landscape categories assessed in nature and health research -

LANDSCAPE

Through the literature review, we have identiﬁed the CATEGORIES landscape categories assessed in studies of health effects of viewing landscapes; 48% assessed two contrasting Fig. 4. Schematic diagram showing health effects of viewing of landscapes, natural versus urbaneffect or landlandscapes;categories natural scenes generally gave a more positive scape versus no view (e.g., white wall); 29% of the compared to urban scenes.

Table 2.

Subcategories of nature and/or urban 23% (7)

Nature vs Urban 35% (11)

Landscape vs No View 13% (4)

Fig. 1. Landscape categories used in the studies (in brackets: number of studies).

Types of measures applied in the studies

Type of measurea

Authors

Frequency of sick-call visits Number of days in hospital after surgery Crime rates reported to the police Doses of pain-killers during recovery Attention-tests

Moore (1981) Ulrich (1984)

Blood pressure Heart rate Brain activity (Electroencephalogram) Skin conductance Muscle tension Tests of motor function Emotion-tests Behavioural observation Neighbourhood social ties-test Self-reports of emotional state

Nature Sacred is a program of the TKF Foundation whose mission is to provide the op a deeper human experience by inspiring and supporting the creation of public greensp offer temporary sanctuary, encourage reflection, provide solace and engender peace a

Kuo and Sullivan (2001a) and Kuo and Sullivan (2001b) Ulrich (1984) Tennessen and Cimprich (1995), Grahn et al. (1997), Kuo (2001), Taylor et al. (2002), Hartig et al. (2003), Laumann et al. (2003), Van den Berg et al. (2003), and Ottosson and Grahn (2005) Ulrich (1981), Ulrich et al. (1991), Hartig et al. (2003), Ottosson and Grahn (2005), and Lohr and Pearson-Mims (2006) Ulrich (1981), Heerwagen (1990), Ulrich et al. (1991), Laumann et al. (2003), and Ottosson and Grahn (2005) Ulrich (1981) and Nakamura and Fujii (1992)

Ulrich et al. (1991) and Lohr and Pearson-Mims (2006) Ulrich et al. (1991) Grahn et al. (1997) Hartig et al. (2003) and Van den Berg et al. (2003 Grahn et al. (1997), Wells (2000), and Taylor et al. (2002) Kuo et al. (1998) Ulrich (1979), Kaplan et al. (1988 reported in Kaplan, 1993), Heerwagen (1990), Kaplan (1993), Staats et al. (1997), and Leather et al. (1998) Interviews/questionnaires Ulrich (1981), Herzog and Chernick (2000), Kuo (2001), Laumann et al. (2001),Staats et al. (2003), and Stigsdotter (2004) Self-rating of perceived health Maas et al. (2006) and Diette et al. (2003) a

Note that some of the studies have combined different measures.

Research evidence of the benefits of nature and wellbeing. If there is such evidence out there then why not incorporate nature in the ECCCC?

2D VISUAL

OUTSIDE IMMERSION

TYPES OF NATURE IN ECCCC

Is this an effective use of natural elements in the ECCCC?

How might we make the ECCCC in a garden?

How might we bring nature and self together at the ECCCC?

How might we find nature?

How might this help wayfinding?

NATURAL LIGHT

HOW WAYFINDING WORKS

The existing flows of people throughout the hospital areas. The dark red indicates that there is a built pathway conecting the buildings.

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FLOWS IN HOSPITAL AREA

he hospital streets are organized in an hierarchical system, much like a tree branch. The photographs depict the major cognitive gatewways one encounters while driving through the hospital area.

The city of Charlottesville is also organized in a hierarchical system where the branches do not connect in an effective way.

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FLOWS IN CITY + ECCCC

hese are the flows of the third floor of the ECCCC. There is â&#x20AC;&#x153;front of the house, back of the houseâ&#x20AC;? ystem, seperating the front and back of the building. The pictures show the homogenous hallways and paces found on the third floor.

Adding depth to the buildings makeâ&#x20AC;&#x2122;s the map more readable and understandable. I wonder if that would help make the map more intuitive to understand?

WAYFINDING PRECEDENTS

Makeing the wayfinding experience an actual space might make it more calming. The bench allows one to sit and actually read the map without stressing.

WAYFINDING PRECEDENTS

Iteration of a new map following the figure ground reversal and highlighting key spaces.

RETHINKING WAYFINDING

Could floor maps on the floors be applied at the ECCCC? Does that work with the existing conidtions? Is it inntuitive? Is it clear?

IDEOGRAMS OF FLOOR MAPS

Does adding depth make the map more clear? Is there too much information being shown? What can we keep and not include in this map to make it clear/intuitive?

RENDER: 1ST FLOOR

Roof Garden

Floor 4

East Clinic Reception

West Clinic Reception

Floor 3

Womenâ&#x20AC;&#x2122;s Clinic

You Are Here

Pharmacy

Infusion Reception

Floor 2

EXISTING MAPS OF ECCCC

You Are Here

Floor 2

Meditation Registration Entrance

Positive Image

Radiology, Medical Imaging & Lab

Financial Counseling

Floor 1

Radiation Oncology Waiting

Ground F LEGEND Information

Elevators

Restrooms

Food

Roof Garden

Floor 4

East Clinic Reception

West Clinic Reception

7 8

Floor 3

Womenâ&#x20AC;&#x2122;s Clinic

Infusion Reception

Pharmacy

Floor 2

Meditation

MY ROUTE THROUGHOUT THE CANCER CENTER

Floor 2

Meditation Registration Entrance

15 14

Positive Image

Financial Counseling

Radiology, Medical Imaging & Lab

Floor 1

Radiation Oncology Waiting

Ground Floor LEGEND Information

Elevators

Restrooms

Food

Roof Garden

Floor 4

East Clinic Reception

West Clinic West Clinic Reception Reception

Floor 3

Womenâ&#x20AC;&#x2122;s Clinic

Pharmacy

Infusion Reception

Floor 2

PATIENT MOVEMENT ON EXISTING

Floor 2

Meditation Registration Entrance

Positive Image

Radiology, Medical Imaging & Lab

Financial Counseling

Floor 1

Radiation Oncology Waiting

Ground Floor LEGEND Information

Elevators

Restrooms

Food

East Clinic

West Clinic

Floor 3

Womenâ&#x20AC;&#x2122;s Clinic

Infusion

Pharmacy

Floor 2

Financial Counseling

Radiology

Entrance Offices

Registration

Meditation

Floor 1

RETHINKING THE MAPS OF THE ECCCC

East Clinic

West Clinic

Floor 3

Womenâ&#x20AC;&#x2122;s Clinic

Infusion

Pharmacy

Floor 2

Financial Counseling

Radiology

Entrance Offices

Registration

Meditation

Floor 1

IDEAGRAM OF MAP ON THE FLOOR

WHAT IF THE MAP WAS LIKE THE SUBWAY MAP?

Financial Counseling

TAC Radiology

West/East Clinic Womenâ&#x20AC;&#x2122;s Clinic Infusion Registration Financial Counseling Radiology

Registration

Womenâ&#x20AC;&#x2122;s Clinic

Infusion

East Clinic

West Clinic

IDEAGRAM OF SUBWAY MAP ON FLOOR

The coloring of the elevators makes them really stand out more. Each floor has itâ&#x20AC;&#x2122;s own color/ Dotted lines leading the to aapplication seat. Sittingofallows onelines to take in information onwayfinding their own pace. theme. Furthermore guiding on the ground helps as well.

WAYFINDING PRECEDENTS

IDEAGRAM OF DOTS LEADING TO BE

WHAT IF YOU FOLLOWED DOTS TO YOUR APPT?

The colored elevators act as a landmark, so one willnot be confused on what floor they are and how to get to another one. This could be applied to the doorway of stairs as well.

WAYFINDING PRECEDENT

DIALING UP THE THEMES TO CREATE LANDMA

PIEDMO

LED DEER THAT MOVES ALONGS THE WALLS

IDEAGRAM OF DIGITAL WALLS IN THE ECCCCC

WAYFINDIN

NG WITH VISTAS

Following an animal to your appointment, patient mobilization through choosing your own environment.

Bringing nature stimuli to the ECCCC

PROTOYPE

Choosing your own environment

PROTOYPE

The scale immerses you, you cannot ignore it

PROTOYPE

What if you could walk through the fore while at the ECCCC?

est

PROTOYPE

Or through the ocean?

PROTOYPE

Or through an apple orchard?

PROTOYPE

What if it also guided you where to go?

PROTOYPE

What if getting lost wasnâ&#x20AC;&#x2122;t so bad anymore?

PROTOYPE

AGENT MODELING ON 3RD FLOOR

VISUAL GRAPH ANALYSIS ON 3RD FLOOR

Using depthmap topographical analysis to understand fields of views from given points.

ISOVITS MAPPING

ISOVIT MAPPING

2 9

West Wing East Wing Waiting Room Check in

WAYFINDING WITH VISTAS

Creating a system that allows nature stimilui to guide a patient to their appointment and leave the cancer center. Always being able to see the next panel from where you are and following your own animal to your appointment.

West Wing East Wing Waiting Room Check in

Pa yo

WAYFINDING WITH VISTAS

West Wing East Wing Waiting Room

in in the back hallways because there is nothing there to guide Patients are oftenCheck found lost ou. How might we change that?

WAYFINDING WITH VISTAS

2 9

8 3

2 9

WAYFINDING WITH VISTAS

Follow a deer to your appointment

WAYFINDING WITH VISTAS

Do you want to take a walk with me?

PATIENT MOBILIZATION

FULLSCALE PROTOTYPE OF ELECTRONIC PANELS

APPENDICES

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To h

MAGGIE CENTER BIBLIOGRAPHY

Brown, T. (2008). Design Thinking. Harvard Business Review, 86(6), 84–92.

Dominiczak, M. H. (2013). Illness and Culture: Maggie’s Centres. Clinical Chemistry, 59(1), 333–334. doi:10.1373/clinchem.2012.188318

Jencjs, C., & Heathcote, E. (n.d.). Architecture of Hope.

Maggie’s Cancer Caring Centre in Dundee. (n.d.). Retrieved August 31, 2014, from http://phaidonatlas.com/building/maggies-cancer-caring-centre-dundee/3102

Maggie’s Centre Ninewells NHS Hospital - Gehry Partners, LLP. (n.d.). Retrieved August 31, 2014, from http://www.arcspace.com/features/gehry-partners-llp/maggiescentre-ninewells-nhs-hospital/

maggie’s :: dundee | confessions of a design geek. (n.d.). Retrieved August 31, 2014, from http://confessionsofadesigngeek.com/maggies-dundee/

Powell, Kenneth. (n.d.). Find @ U.Va. - Discover online articles and journals - University of Virginia Library. Retrieved August 31, 2014, from http://re5qy4sb7x.search. serialssolutions.com/?genre=article&issn=00038466&title=Architects%27%20 ournal&volume=218&issue=11&date=20030925&atitle=Comfort%20zone%20 %5BMaggie%27s%20Centre%2C%20Dundee%5D&spage=32&sid=EBSCO:bvh&p d=

Rose, S. (2010, May 6). Maggie’s Centres: can architecture cure cancer? The Guardian. Retrieved from http://www.theguardian.com/artanddesign/2010/may/06/ maggies-centres-cancer-architecture

To be Frank | Magazine Features | Building. (n.d.). Retrieved August 31, 2014, from http://www.building.co.uk/to-be-frank/1023708.article

Allison, D. (2007). Hospital as city: employing urban design strategies for effective wayfinding. Health Facilities Management, 20(6), 61–65.

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Cervinka, R., Roederer, K., & Haemmerle, I. (2014). Evaluation of Hospital Gardens and Implications for Design: Benefits from Environmental Psychology for Architecture and Landscape Planning. Journal of Architectural and Planning Research, 31(1), 43–56.

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Eagle, A. (2009). Sprucing up wayfinding. From traditional signs to electronic kiosks, designers are making it easier to get patients to their destinations. Health Facilities Management, 22(9), 32–35. Fisher, T. (2014). Butaro Cancer Center. Architect, 103(3), 94–101. Flesher, M., Woo, P., Chiu, A., Charlebois, A., Warburton, D. E. R., & Leslie, B. (2011). Self-management and biomedical outcomes of a cooking, and exercise program for patients with chronic kidney disease. Journal of Renal Nutrition: The Official Journal of the Council on Renal Nutrition of the National Kidney Foundation, 21(2), 188–195. doi:10.1053/j.jrn.2010.03.009 Hill, K. H., O’Brien, K. A., & Yurt, R. W. (2007). Therapeutic efficacy of a therapeutic cooking group from the patients’ perspective. Journal of Burn Care & Research: Official Publication of the American Burn Association, 28(2), 324–327. doi:10.1097/BCR.0B013E318031A24C Hoelscher, C., Tenbrink, T., & Wiener, J. M. (2011). Would you follow your own route description? Cognitive strategies in urban route planning. Cognition, 121(2), 228–247. doi:10.1016/j.cognition.2011.06.005

WAYFINDING BIBLIOGRAPHY

Landmarks in nature to support wayfinding: the effects of seasons and experimental methods - Springer. (n.d.). doi:10.1007/s10339-013-0538-4

Vilar, E., Teixeira, L., Rebelo, F., Noriega, P., & Teles, J. (2012). Using environmental affordances to direct people natural movement indoors. Work (Reading, Mass.), 41 Suppl 1, 1149â&#x20AC;&#x201C;1156. doi:10.3233/WOR-2012-0295-1149

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DESIGN THINKING BIBLIOGRAPHY

Design Thinking | Thoughts by Tim Brown. (n.d.). Retrieved September 21, 2014, rom http://designthinking.ideo.com/

Lamster, M. (2010). Business philosophy? On the virtues - and perils - of design hinking. Architect (Washington, D.C.), 99(7), 36–37.

Nixon, N. W. (2013). Viewing Ascension Health from a Design Thinking Perspecive. Journal of Organization Design, 2(3), 23–28. doi:10.7146/jod.2.3.15575

Patel, M. I., Moore, D., Blayney, D. W., & Milstein, A. (2014). Transforming Cancer Care: Are Transdisciplinary Approaches Using Design-Thinking, Engineering, and Business Methodologies Needed to Improve Value in Cancer Care Delivery? Journal of Oncology Practice, 10(2), e51–e54. doi:10.1200/JOP.2013.000928

Thomas, J., & McDonagh, D. (2013). Empathic design: Research strategies. Ausralasian Medical Journal, 6(1), 1–6. doi:10.4066/AMJ.2013.1575