HI + D Health Impact + Design A Design Thinking Course SARC #### Spring 2014
Introduction Health Impact Design (HI+D) is a design and assessment course where, using the design thinking process, project teams work with community partners to propose design-based health interventions. Based on the proposed intervention, students then develop impact assessment tools that measures how that intervention impacts health.
empathy
definition
ideation
prototyping & testing
evaluation & logic
Stages of Design Thinking
empathy
definition
ideation
prototyping & testing
evaluation & logic
use observations and narratives to address issue
reframe point of view, ground it in user needs and insights
define solutions based on previous research and inspiration
test out ideas with prototypes to measure their success
assessment of research and adding other useful information
empathy
definition
ideation
prototyping & testing
evaluation & logic
Say Think Do Feel
empathy
definition
ideation
prototyping & testing
evaluation & logic
Say what are users of this space saying?
Think what do you imagine these users are thinking?
Do what do people do in this space?
Feel how does this space make people feel?
empathy
definition
ideation
prototyping & testing
evaluation & logic
Needs are human, physical, and emotional capture the goals and motivations of the person for whom you are designing are verbs, not nouns (opportunities, not solutions)
empathy
definition
ideation
prototyping & testing
evaluation & logic
Insights are unique and compelling discoveies - the “aha!� give you an actionable direction to go in lead to novel solutions
empathy
definition
ideation
prototyping & testing
evaluation & logic
empathize
deĂžne
ideate
test prototype This graphic demonstrates how designers should approach different stages of the design thinking process. For instance, it is important to stay focused when creating a project definition, so that observations made during the empathy phase are not misinterpreted.
empathy
definition
ideation
prototyping & testing
evaluation & logic
understand
observe
point of view
ideate
prototype
test
This diagram is an interpretation made by the d-school of the original design thinking process
Depicted is a design thinking workshop held at the beginning of the course. The class was put through a rapid application of the design thinking process by creating “the perfect gift” based on the students’ observations and conversations with their partners.
Groups present the “perfect gift� that they made for their partner, designs based off of empathy mapping and creating appropriate project definitions.
This group chose to partner with the hereford residential college at the University of Virginia because the project members had a personal connection with an audience of university students. In this project, the group aims to strengthen the community of its residents by implementing various programs and increasing the number of resources offered in the area.
Hereford Residential College
Site
The team used a remote controlled drone to observe the site from a different view, one that was more overarching and general. This new perspective informed the group about approach of the site as well as openness and vastness of areas of the college.
The team prepares the drone to fly over the Hereford College Residence.
The site in winter conditions. Note the lack of public spaces in the college once there is snow on the ground. How might we introduce a program here that could allow for community gathering even in the cold months?
How might we indicate a community program in an area by design of pedestrian pathways? Can different designs inform different program?
How might we use the existing style of the hereford residential college to create a space built for the community?
How might we design the college so that spontaneous and informal program, as seen in this photogrpah from 1992, are encouraged in addition to more formal gatherings?
Hereford needs to build a community. How might Wendy and HRC leadership build community, identity, and pride at Hereford and among its residents? Think about a topdown and administrative solution. How can HRC better attract and retain residents who will love to live there? Think about marketing and advertising. How might the spaces of the Hereford Residential College be altered to better support community and gathering? Think about programming and spatial design.
The Hereford Residential College uses dynamic lighting conditions and coverings to indicate gathering space. How might we mimic this aesthetic when creating our own designs for the College?
Bike Academic Areas Residential Areas Food spaces Commercial Area Train Atheltics
This series of maps reveals the experience of those visiting the Hereford Residential College via different routes. These are timed as well.
Bus Academic Areas Residential Areas Food spaces Commercial Area Train Atheltics
Pedestrian Academic Areas Residential Areas Food spaces Commercial Area Train Atheltics
How is the residential college using pedestrian walkways to indicate enjoyable space? is there a way to program pathways with a space?
other caption to explain this map, or quotes by students who travel here/how they feel about travel and timing, etc
empathy
empathy
Needs To understand the personalities of Hereford residents Better and more enthusiastic residence leadership Programs and spaces to allow formal and informal gatherings
There are other housing choices that compete against Hereford population A lot of the rooms in Hereford are single dorm rooms Hereford residents do not know how many students are at the ressidential college, RAs do not bring them all together
Ideas include: Create a community garden Shared study spaces or good academic program Communal kitchen space Games and spectacles to bring the community together
definition
Hereford Residential College will create a stronger community by using extroverted leadership to bring residents together as a group in newly defined communal spaces. These spaces will be defined by one’s approach to them, which means that paths will have markers or allusions to the type of space to which they lead. The College will also feel as convenient as other housing options with the introduction of better resources for the students.
Ideation
HEREFORD NITY...WHAT DO?? NOT HEREFORDTODOES DOES NOT HAVE HAVE A A STRONG STRONG STUDENT STUDENT COMM COMM
S O
ISSUE how can this ISSUE be framed?
how can this problem be framed?
Students who might love HRC are out there but do not CONDITION know about what it what existing CONDITION condition this has todoes offer what existing
The current model for HRC is not Hereford is working, is not Hereford is perceived as what it achieving perceived as far away from needs to as student far from mainaway campus housing
framing respond to? condition does this framing respond to?
main campus
Students feel like the are “stuck” at HRC
EFFECT what are the EFFECT problematic effects
students are
VA do as a ption
farther friends,from friends, classes and classes and activities activities
t the types of students who live at Hereford
or success measures at RESPONSE university level what kinds of RESPONSE responses are
what kinds of suggested responses by arethis ommitments tobypathway? live view of the suggested this at HRC retention bottom line view ofare the pathway?
EACH AND RECRUITING TRATEGIES +
ITY ATTITUDE TOWARDS HRC ESS IMPLEMENTATION MEASURES
IMPLEMENTATION
how might we implement these responses? how might we implement these responses?
ION OF THRIVING AT HRC AND UVA)
Hereford has a Hereford communityhas butaof community but of quieter students, quieter students, international international students and students transfer and students Herefordtransfer does not students have adequate amenities or facilities to attract enough/”the desired” students
HRC enrollment and what are the stemming from this are problematic effects farther from retention isstudents low condition? stemming from this condition?
HEREFORD IS HEREFORD REACHING IS ST REACHING WHO WOULDST L WHO L LIVEWOULD AT HRC LIVE AT HRC
HEREFORD DOES HEREFORD NOT NEEDS HEREFORD DOES MORE/DIFFERENT NOT FEEL CONNECTED TO FEEL CONNECTED TO REDEFINITION OF ITS THE MAJORITY OF IDENTITY AWAY FROM THE MAJORITY STUDENT LIFE OF STUDENT LIFE WHAT EXISTS THERE NOW
problem
Hereford is too anti-social and is not fulfilling its goal as a residential college
Students at Students Hereford at do Hereford not want do to be not want to be at Hereford at Hereford
focus amenities and options at Hereford in order to bring more student enrollment Give Hereford a new identity (different from existing groups) that will attract student leaders desired groupsto get from decrease amount of or time it takes
decrease of time it takes to get from Hereford amount to popular destinations with Hereford popular with existing to methods of destinations travel existing methods of travel make the travel experience from Hereford to make the travel experience destinations more pleasant from Hereford to destinations more pleasant
assess existing links between HRC and other assess existing links HRCaccess and other destinations; add new between routes and destinations; add new routes and access points points NEW/INCREASED RESOURCES AND AMENITIES AT HRC bring activities and student population from bring and student population from other activities locations to Hereford other locations to Hereford +
RECRUITMENT OF DIFFERENT STUDENTS THAN CURRENTLY LIVE THERE
SPATIAL DESIGN INTERVENTION SPATIAL DESIGN INTERVENTION
(ATTRACT A DIFFERENT HRC COMMUNITY WITH + NEW AMENITIES)
+
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HAVE A STRONG STUDENT COMMUNITY...WHAT TO DO?? MUNITY...WHAT TO DO?? HEREFORD IS NOT REACHING STUDENTS WHO WOULD LOVE TO LIVE AT HRC
T
SO NOT TUDENTS LOVE TO C
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IGN INTERVENTION +
TO ACTIVATE SPACE
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STRATEGIES
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the are “stuck” at HRC
HRC
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HEREFORD MORE/DIF REDEFINI IDENTITY WHAT EXI
HEREFORD NEEDS MORE/DIFFERENT REDEFINITION OF ITS IDENTITY AWAY FROM WHAT EXISTS THERE NOW
Hereford does not have adequate HRC enrollment and amenities or retention is facilities low to attract enough/”the desired” students Hereford is
not see the college as a successful housing option
Hereford is too anti-social and is not fulfilling its goal as a residential college
anti-social not fulfill goal as a residential
embrace and recruit the types of students who do tend to want to live at Hereford
focus amenit order to bri
redefine thriving or success measures at college level and university level
Give Herefor existing gro leaders or d
focus amenities and options at Hereford in
order to more lengthen student commitments to bring live at HRC student enrollment if attendance and retention are bottom line
Give Hereford a new identity (different from existing groups) that will attract student leaders or desired groups
NEW HRC OUTREACH AND RECRUITING STRATEGIES
NEW/INCREAS
+ SHIFT IN UNIVERSITY ATTITUDE TOWARDS HRC SUCCESS MEASURES
RECRUITMEN C
NEW/INCREASED RESOURCES AND AMENITIES AT
(CHANGE DEFINITION OF THRIVING AT HRC HRC AND UVA)
(ATTRACT A
D WANTS TO BUILD A STRONGER STUDENT COMMUNITY...WHAT
hese
HEREFORD COULD BE MORE CONNECTED TO THE MAJORITY OF STUDENT LIFE
Student housing and social life are concentrated in the Corner and Rugby areas
Hereford is located on Observatory Hill, south west of campus
HEREFORD COULD FIND NEW OR DIFFERE WAYS TO REACH OUT TO POTENTIAL RES
Hereford has a community but of quieter students, international students and transfer students
Students love HRC there but know abou has to of
Students feel like the are “stuck” at HRC
students do not attend group activities, respond to efforts of HRC leaders to increase social life
students feel farther from friends, classes and activities
Hereford is a less popular choice for student housing
HRC enroll retention
HRC leadership and UVA do not see the college as a successful housing option
decrease amount of time it takes to get from Hereford to popular destinations with existing methods of travel
embrace and recruit the types of students who do tend to want to live at Hereford
make the travel experience from Hereford to destinations more pleasant
redefine thriving or success measures at college level and university level
assess existing links between HRC and other destinations; add new routes and access points
lengthen student commitments to live at HRC if attendance and retention are bottom line
bring activities and student population from other locations to Hereford
SPATIAL DESIGN INTERVENTION + PROGRAMMING TO ACTIVATE SPACE
(CREATE SPACES, CONNECTIVITY AND GATHERING)
NEW HRC OUTREACH AND RECRUITING STRATEGIES +
SHIFT IN UNIVERSITY ATTITUDE TOWARDS H SUCCESS MEASURES
(CHANGE DEFINITION OF THRIVING AT HRC AND UVA)
prototyping & testing
PROTOTYPING
what will we implement and how?
identify path improvements that can better connect hereford to nearby dormitories (ie its really not that far away)
develop design concepts for these spaces
develop a plan for thier construction/installation that involve HRC students
The rendering shown depicts a pedestrian path that is both functional as a community garden as well as an indicator that there has been a program implemented at the end of the path.
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kes HRC great, location etc
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NEW AMENITIES)
long-term: supplemental program ideas, pathway mapping for continued development
A class called “The World Is Flat,� led by professor Melissa Goldman, explored prototypes for path markers in partnership with the Hereford Residence College project.
prototyping & testing
prototyping & testing
emily couric cancer center Using the design thinking process, five students from the Health Impact Design Course in spring 2014 designed a wayfinding system for the Emily Couric Clinical Cancer Center (ECCC). The system demonstrated the value of patient care and resulted in an electronic app, kiosk, and map system. Throughout the course, the students interviewed administration, staff, and patients in order to identify meaningful needs through storytelling. The stories at ECCC reflected a general theme of “the unknown� which was resulting in patient confusion and vulnerability. The process was published into a book and displayed via a poster at a Biomedical Engineering Conference. Emily Couric Cancer Center provides comprehensive care for gynecologic oncology, infusion, neuro-oncology, and radiation oncology. Because patients commute from all regions of Virginia and bordering states they can drive up to eight hours just to get to an appointment. In addition to the long commute, it is common for patients to spend a full day going to stacked appointments without eating. As patients are going through a time of stress, it is important that the cancer center provides a space that is comfortable and compassionate through their long visit. Currently the space is aesthetically pleasing and newly built, but the structure inhibits the care that the staff and patients need due to inconvenient long hallways with an elevator on only one end, awkward large and small spaces, and a confusing layout.
empathy
Effort is needed to find the meditation room, and it is easily mistaken from the outside as a meeting room. The furniture appears to be the same as the rest of the hospital, and doesn’t really fit in with the room.
In the waiting room, people waiting are fairly spread out, distancing themselves from one another because they value their privacy.
The challenge of the students was find unexpected solutions to “the unknown” that would lead to embracing the current structure at ECCC. The design thinking process was used to find unexpected solutions through meaningful conversations with staff and patients. The project team first met with key stakeholders at UVA who explained the history of the space, their own stories of why they work there, and their daily relationships with patients. They were also asked to share positive aspects of the ECCC that could be magnified and leveraged into a project. During the next phase, the project team toured the building and interviewed staff. Four staff were interviewed...Part of the group accompanied a patient during her appointment to see from the patient perspective all steps of the cancer treatment experience. The conversations and observations were captured using the Design Thinking “Story-Share-Capture” method, using post-it notes and a white board.
empathy
Depicted was our partner Amy’s nurse showing her various features on the chair she uses as a patient. She is pretty amazed at how many features there are. She also enjoys interacting with this particular nurse. Amy has probably had her treatments in much less comfortable situations. She might also be trying to ease her nerves about the upcoming shot, which can be pretty painful.
The reception area used for registration is left empty. There is no one there to give you instructions, except for the sign. This is actually a replacement for the old system. The ECCC simply does not have the staff to man the desk, and this is considered the best way to see patients in an orderly fashion.
This is the long corridor between the radiation and treatment rooms. Amy experiences a number of emotions coming back down to radiation, and tells us her stories. Radiation treatment leaves patients extremely vulnerable, and Amy is certainly remembering that feeling. But, it gave her the opportunity to see some of her favorite caregivers that helped her through her treatment.
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empathy
Needs
Insights After identifying needs and insights from the stories, the group moved into the “ideate” phase,where they were prolific with ideas that shared a general theme of “the unknown”. The ideas were narrowed by receiving feedback from experts and by prototyping. The final proposed wayfinding products are outlined below and are meant to be used by patients before and during appointments. This interactive and integrated system would be displayed at critical points like the elevator, mid-hall, and on personal smart devices. • App • Check-in • Kiosks • Signage The significance of these products cannot be undervalued. Hospitals are now utilizing their spaces as a further mechanism for achieving their missions. Like a physician who encounters complex issues with communication and empathy when seeing a patient – hospital design too needs to address these important issues when designing for patient care. This patient care includes reducing environmental stressors that lead to being lost and feeling alone. Improving signage is one way to alleviate the issue. Further issues that need to be addressed include patients wondering how long they will walk for, where their family members should go to get lunch, and whether they will need a wheelchair. These questions can be addressed through apps and kiosks.
fa trav way t app nee
“I always try to think from the patient’s perspective.”
ch e
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“The front desk is often empty and it is easy to pass by the numbering system.”
ng i
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“When patients enter, they intuitively want to turn to go up the elevator, but they have to go around the corner to registration and people get confused.”
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“The space needs to meet the needs of our patients.”
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“Signs would be helpful on the walls to break up long hallways.”
Definition: Use wayfinding designs to minimize confusion for the patient and make spaces more interactive.
ideation Aside from improving the patient experiences, these solutions also address overall hospital effectiveness. For example, patients that are disoriented are more likely to have raised blood pressure, headaches, and increased physical exertion (Carpman and Grant, 2001). Additionally, patients who are lost are more likely to be late to appointments and use more staff time asking for assistance due to wayfinding issues, costing up to $222,000 a year according to one study (Zimring, 1990). Improving the patient satisfaction is also an important goal for the hospital system, leading directly to more funding.
The following demonstrates how the ideate phase introduces designers to a plethora of design solutions
prototyping & testing Next steps include improving product effectiveness through designing and prototyping variationsof the concepts. The following are the objectives of the next course: • Observe patient flow and points of confusion. • Test different designs of the maps, signs, and apps. • Test variations on placement for seeing – signs perpendicular to walls, and at eye level. • Design in ways that the maps, signs, and app data can be easily manipulated and moved. • Design for extreme users – those in wheelchairs, with visual impairment, and for those without smart phones. • Review literature of best-practices and physiological needs. • Design for the first time visitor. • Utilize a variety of navigation approaches – such as touch, smell, sight, and sound. • Identify and enhance needed landmarks and other clues to identify a reference point. • Identify effective universal symbols for different population groups. Mobile wayfinding systems in hospitals have been tested for effectiveness. In Boston Children’s Hospital, during the first 6-months the app was downloaded by more than 4,500 patients. Sixty-five percent of the patients who used the app reported that it improved their experience at the hospital (Meridian). The project can be evaluated by studying the effect of the wayfinding system on missed appointments,
prototyping & testing
Interactive wayfinders to be placed in underutilized hallways
Interactive maps on display at info desks
These maps will also be available as a mobile app.
Map systems will be color coded by program for ease of navigation.
These are the various options on the app interface.
prototyping & testing
prototyping & testing
prototyping & testing
This course, The World Is Flat, joined with the design thinking course to imagine innovative designs that could speak to the projects that were being researched. Here, a group demonstrates sculptural elements that could work as wayfinding devices.
evaluation & logic
human-centered emergency department design The following project explores conditions that take place in the highstress area of the emergency department and seeks to find a design that improves waiting conditions for patients, makes patients feel more comfortable and safe, and utilizes the tight space of the area.
empathy
The group visits the hospital’s ER for observations, but cannot take photos for privacy issues. Their empathy maps are documented instead by sketches, and for more personal observations of what patients may be experiencing while waiting in the ER, the group referred to a documentary for information.
Empathy Phase: Stories from Dear IRB, Subjects (n= about a dozen) patients – both children and adults (possibly adults who don’t speak English), and include patients coming in by ambulance, in addition to those coming through the waiting room. staff – a doctor, nurse, EMT, unit coordinator, social worker. Recruitment We will not advertise, but plan to simply approach individuals and ask if they are interested in helping with the project. Privacy We won’t necessarily need to take patient names, but we’d like to have photographs and age (to tell their story). We like the idea of using photo journals– supplying identified subjects with cameras– and providing prompts to inspire photo taking, as well as a place to record (write) a feeling about the photo/experience. If photographing is going to be problematic, we can try to use storyboards instead – where identified subjects draw, instead of photograph. For either method, we would like to be able to follow-up with participants (thereby having participants take part in a completely anonymous way is less ideal). Filming – Would be ideal. Photographs – Whether we can take them or have subjects (staff and patients) take them, or both, we would like to know if this is an option. We would also like to try to simulate an experience (especially if we are limited as to how we can engage the patients) – that is we would like to act through the patient experience. Data usage Data will be used in our end of class book; we can de-identify the data as much as possible; we wouldn’t want to destroy photographs that were a part of the patient stories; we wouldn’t need to include age, address, date of birth, etc. Time frame We will need to complete the subject “enrollment” and data collection process in the next few weeks (by a month from now). It may be feasible to spend 24 hours in the ED to capture/collect our data; with potential followup workshops/sessions…..
We wrote to permission p pa?ent stori
Sketches of current conditions in Emergency Room corridors.
How might we use written narratives be a vehicle for change in design, one that is centered around the patient’s experience? Does the practice of writing imply a healing process in itself?
Human Centered Design Approach to Pa?ent Centered Care: A Case Study of the Alberta Children’s Hospital NICU e Raber, Emily Carr University of Art and Design, Canada
study Blue CoMage Consul?ng shares their uman centered design Alberta Children’s Hospital NICU useshphoto journals and storyboarding activities to gain a deeper r the development of a func?onal program and ounderpera?onal vision standing of the needs and desires of patients, their e Neonatal Intensive are Unit NICU) at activities Alberta Children’s families, C and front line (staff. These introduce ideas forethe design of future space. is approach included ngaging families and front line staff in photo storyboarding ac?vi?es in order to gain a deeper understanding ds and desires for the future space.
This book uses literature in order to improve patient conditions.
The Waiting Room is a documentary the group used for observations concerning how the Emergency Department feels to patients, since they were not allowed to personally interview any at UVA’s ER.
How Might We...
How might we improve patient access to the services they need? •Access to specialty services •Access to primary care provider; a provider to manage chronic illness •Access to support
Rethinking the Design?
can we rethink the way waiting spaces are designed so that patients can be calmer and more comfortable? Case Studies
“... the aspects of care most important to patients included access; safety; excellent technical care; respect for their values and preferences; care that is coordinated� -from Inspired to Change, An Open Invitation to Partner
what does hope mean to you?
we were able to identify three distinct activities (each generating their own protocol; or exemption) that would be feasible in our limited time frame: (1) observational research in the ER- watching and noting activities (photos of space) (2) creation of an opportunity (or tool) for patients and staff to submit a story (or complete a survey) anonymously (3) interview patients and staff face-to-face perhaps using a similarly compelling, single question, such as the “What does hope mean to you?� questions used in the Palliative Care study
What
A patient is waiting in “flex beds” in the hallway for care, patient has his things with him, changed into a hospital gown
Another patient is being pushed past in the hallway, he is still in his street clothes
Another man is observing the situation
How
The patient who is alone is just sitting there waiting, he has his belongings with him but isn’t doing anything, possibly bored, he doesn’t look very pleased to be there alone without any attention
Why
The ER is overcrowded and there isn’t enough room for treatment
The first man (who is alone) is probably confused about why he is sitting there waiting and not getting any care or attention
Likely that he is nervous, afraid, confused, frustrated, anxious
Patient being pushed likely feels the same way, not sure why the other man is just in the hallway, are they going to put me there too?
Observations in the Emergency Department at UVA Medical Center
Needs •Access to health insurance •Access to a primary care provider •Positive thinking •Opportunity to connect with others; supportive environment •Family support •A place for prayer •Communication from ER about status; i.e. why is the wait so long •Privacy •Interpretive services •A place to rest •Food and water •Access to a social worker
Insights •ER staff treat a large variety of health problems (medical and social; urgent and non-urgent) •Patients wait a long time for feedback from healthcare providers •Medical history and physical reports are not conducted in private spaces •There are language and cultural barriers •The patients are afraid •The patients don’t understand the triage system •The staff showing empathy goes a long way •The waiting room resembles the DMV •Some patients were treating the ED like “going to the doctor;” someone tried to make an appointment; one woman in the waiting room said into the phone “I’m at the doctor;” others showed up to get surgery (expecting same day treatment/surgery); another called in for a prescription refill •The “safety net for society” - get the impression patients just don’t have anywhere else to go •People (patients and their support persons) are connecting whiel they wait •Evident that many patients are coming to the ED on a regular basis for routine medicale advice/care; follow-up visits •Lots of waiting •ER waiting room seemed to be mostly lower income persons w/o insurance •It seemed as if there was a lot of bureaucratic red tape in admitting patients and making sure that they got the attention that they deserved
definition The UVA Emergency Department is undergoing an expansion project. This creates an opportunity to use a human-centered design approach to inform the project. When a human-centered design approach is implemented, the end result can be a space, process, or program that better meets the needs of its users. Our project aims to gain patient and staff perspective in orer to define the human- centered design problems at play in the Emergency Department at UVA. The data we collect will thus be used to generate ideas for process, space, and /or program improvements. (Utilize a human-centered design framework to better characterize patient and staff needs and experiences within the UVA emergency department to inform and improve near-term and long-range process and environmental design decisions.)
unpacking empathy: the group compiles their previous research and observations from staff and patients’ views and begins to recognize a set of opportunities for storyboarding and interview
March 3, 2014
Review ER data (statistics about usage) Complete CITI IRB training for human subject research Refine observational study Draft proposal for anonymous story collection Begin protocol for face-to-face interview study
March 10, 2014
Schedule observational field work Continue to work on protocol for interviews; and user story submission
March 17, 2014
Begin observational study Submit anonymous user story collection method to IRB for approval Continue to work on the interview protocol
March 24, 2014
Debrief from observational work Finalize the protocol for interviews and submit to IRB
March 31, 2014
Collect anonymous user stories Begin interviews if possible Discuss any emerging trend from data collected thus far; themes; identify problem statements of interest; identify opportunities
April 7, 2014
Begin (or continue) interview protocol
April 14, 2014
Begin (or continue) interview protocol
April 21, 2014
Use data collected to brainstorm solutions; begin prototyping
April 28, 2014
Translate data, solutions, and prototypes to print
Project Schedule
ideation
Unpacking empathy: phase one Opportunities •The core is functional with desk arrangement, should the hallway be wider? Can medical staff use all four desks? •How can patients have some more information while waiting and while in ED? •How can the experience be better for companions/visitors? •Are there any more roles for volunteers to fulfill? •What are the best ways to collect stories from patients and staff?
In terms of rethinking design altogether: Rapid Assessment Units (RAUs) → determine whether patients remain vertical or horizontal → vertical patients who require only minor care are allowed to remain in a chair or recliner (instead of unnecessarily being put on a stretcher) and are treated and wait in the “internal disposition area” (IDA) → because there are not stretchers taking up unnecessary space, the IDA can accommodate more patients and moves them through the system/ED more expediently and efficiently [see for more info: http://www.healthcaredesignmagazine.com/article/rethinking-emerg encydepartment?page=2&spMailingID=45231992&spUserID=NTA3NzEwNDcxODAS1&spJob ID=383761020&spReportId=MzgzNzYxMDIwS0] **Advocate for the “New Proposed ED Model”: consists of triage, rapid diagnostics intake, admissions unit, discharge lounge, and reducing the time patients spend in an ED Treatment room through alternatives for patient flow From Perkins + Will Slides: -advocate for increased flexibility of rooms [“ED will be planned for maximum flexibility in staffing and patient rooming with an ability to section off distinct areas for fast track.”] and bedside registration when possible with traditional desk registration as a back-up -Key Issues: visibility, privacy, noise, work space, travel distances, computerization, standardization, storage, bathrooms, admitted patients, security, behavioral health → looks at current trends in ER design – UVA currently incorporates several: linear in some areas, pods in others, express care is very crowded by more of a pod design (needs improvement) From 8 Trends in Emergency Department Design:
Waiting areas. An emerging trend in ED design is creating areas where non-emergent patients who have been treated but not discharged can wait. For example, patients frequently need to wait for medication or test results. To free up beds for patients with more serious conditions, these patients can wait in a separate area. Similarly, some EDs are creating open lounges where patients with non-urgent needs can sit under the supervision of a nurse. “Not all patients need a bed, so that’s going to help move patients through the ED,” Ms. Gamlen says. [see for more information http://www.beckershospitalreview.com/capacity-management/8trends-in-emergency-department-design.html] From: No Waiting Room, No Wait? -prototype an ED with no waiting room at all -Swedish Medical Center’s Issaquah campus example -unique process in which each team member plays a role – idea to have patient spend as little time in the ED as possible without sacrificing care leading to increased patient satisfaction -challenges and accomplishments: achieved 95% patient satisfaction and safety ratings; challenge of ensuring proper staffing ratios, nurses being comfortable asking for help, all staff adjusting to the new culture of the ED (collaborative, patient-centered culture has taken hard work to build but has also been one of the greatest factors contributing to the success of the firm [see for more info http://www.beckershospitalreview.com/hospital-management-administration/ no-waiting-room-no-wait-a-new-ed-model-at-washingtons-swedish-medical-center.html]
ideation
live time updates of most recent calls to the ED
prototyping & testing
make available in waiting rooms
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wall display in waiting room to show approximate wait time
ER patient storyboard prototypes
poster & presentations
poster & presentations
poster & presentations
poster & presentations