HI + H E A LT H
IMPACT
HI + D Health Impact + Design
HEALTH IMPACT + DESIGN ARCH 5500 Spring semester, 2014 School of Architecture, Dept of Architecture; Dept. of Urban and Environmental Planning School of Medicine, Dept. of Public Health Sciences Instructor: Schaeffer Somers Lecturer, Departments of Architecture and Public Health Sciences Teaching Affiliates: Wendy Cohn, PhD, Associate Professor, Dept. of Public Health Sciences Reuben Rainey, Prof. Emeritus, Co-Director Center of Design & Health Matthew Trowbridge, MD, MPH, Dept. of Emergency Medicine Melissa Goldman, Fabrication Facilities Manager, ARCH 5500-08 The World is Flat Book Design: Margaret Nersten BS Arch 2015 + Global Sustainability
Introduction This course will provide a review and application of systematic approaches to assessment and design that focus on human health outcomes, Health Impact Assessment and Design Thinking. These combinations of procedures, methods, and tools originate outside the conventional domain of architecture, landscape architecture, and urban planning practice. The goal of the first phase of the course is to situate these two approaches in a larger context of analysis and design. In addition to these two approaches, students are encouraged to bring their own discipline’s knowledge and practice to inform and expand the discussion of design process. Once basic familiarity with the concepts is established, students will be introduced to the project opportunities and their respective stakeholders and constituents. Working in groups students will develop plans for a human-centered design approach for each project making use of the established methodologies, and possibly synthesizing an integrated approach. The remainder of the course schedule is allocated to implementing the plan through direct collaboration with the project stakeholders and constituents. Tools used in Health Impact Assessment will be introduced and applied to the testing and evaluation of project ideas. Students will be exposed to analytical methods including logic modeling and health pathway diagramming based on research of published evidence in health literature. On a project-by-project basis, teams will have the opportunity to explore more time and material intensive fabrication techniques in collaboration with the students and instructor of ARCH 5500-08, The World is Flat. A social network will be used to connect group work outside of class and document process in image and text-based pages online. The analysis, process, and outcomes of the human-center design projects will be presented at the end of class to the project participants and documented in print as a book using online publication service.
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Stages of Design Thinking 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
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Say Think Do Feel what are users of this space saying?
what do you imagine these users are thinking?
what do people do in this space?
how does this space make people feel?
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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)
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Insights are unique and compelling discoveies - the “aha!� give you an actionable direction to go in lead to novel solutions
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converge
empathize
deĂžne
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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.
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understand
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This diagram is a re-interpretation of the d-school of the original design thinking process.
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Photograph of a design thinking workshop held at the beginning of the course. The class was put through a rapid application of the design thinking process in a d.school exercise called “redesign the gift-giving experience for your partner�
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Each participant develops + tests iterations of designs to rethink the gift giving experience for their partner. Matthew Trowbrudge provides his design for Anne Chen, 2nd year undergraduate architect.
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Hereford Residential College One group chose to partner with the Hereford Residential College at the University of Virginia. In this project, the group aims to strengthen the community of its residents by implementing various programs and design ideas.
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Asa Eslocker, master of landscape architecture, used a remote controlled drone to observe the site from a new point of view, one that is becoming increasingly accessible through drone technology.
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Asa Eslocker prepares the drone to fly over the Hereford College Residence.
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Hereford Residential College in winter conditions.
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HOW MIGHT WE... How might we indicate a community program in an area by design of pedestrian pathways? Can different designs inform different program?
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HOW MIGHT WE... How might we use the existing style of the Hereford Residential College to create a space built for the community?
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HOW MIGHT WE... How might we design the college so that spontaneous and informal program, as seen in this photograph from 1992, are encouraged in addition to more formal gatherings?
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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 top-down 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.
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HOW MIGHT WE... The Hereford Residential College uses dynamic lighting conditions and coverings to indicate gathering space. How might we extend this aesthetic when creating our own designs for the College?
Bike
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Academic Areas
Residential Areas ideation Food spaces
prototyping &Commercial testing Area
Train evaluation & logic
Atheltics
This series of maps reveals the experience of those visiting the Hereford Residential College via different routes. These are timed.
Bus
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Pedestrian empathy definition
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How is the residential college using pedestrian walkways to indicate enjoyable space? is there a way to program pathways with a space?
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Some needs of the Residential College include understanding the personalities of Hereford residents, having better and more enthusiastic residence leadership, and creating programs and spacesthat allow formal and informal gatherings.
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Insights to consider with the Residential College are that there are other housing choices that compete against Hereford population, a lot of the rooms in Hereford are single dorm rooms, and that Hereford residents do not know how many students are at the residential college because their RAs do not bring them all together.
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Ideas include: Create a community garden Shared study spaces or good academic program Communal kitchen space Games and spectacles to bring the community together
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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.
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Ideation
empathy empathy NITY...WHAT TO HEREFORD DO?? DOES NOT HAVE A STRONG ST definition
HEREFORD NEEDS HEREFORD DOES NOT MORE/DIFFERENT FEEL CONNECTED TO REDEFINITION OF ITS IDENTITY AWAY THEFROM MAJORITY OF WHAT EXISTSSTUDENT THERE NOWLIFE
ISSUE
S O
how can this problem be framed?
ideation
prototyping & testing prototyping Students who might love HRC are out there but do not evaluation know about &what evaluation logicit has to offer
The current model for HRC is not working, is not Hereford is CONDITION achieving what it perceived as needs to as student what existing far away from condition does this housing framing respond to?
main campus
Students feel like the are “stuck” at HRC
Hereford does not have adequate amenities or facilities to attract enough/”the desired” students
EFFECT
HRC enrollmentwhat andare the problematic effects retention is low
students are farther from friends, Hereford is too anti-social andand is classes not fulfilling its activities
stemming from this condition?
VA do as a ption
goal as a residential college
Students at Hereford do not want to be at Hereford
t the types of students who live at Hereford
focus amenities and options at Hereford in order to bring more student enrollment
or success measures at university level
Give Hereford a new identity (different from existing groups) that will attract student leaders or desired groups
ommitments to live at HRC retention are bottom line
Hereford has a community but quieter studen international students and transfer stude
RESPONSE
decrease amount of time it takes to get from Hereford to popular destinations with existing methods of travel
what kinds of responses are suggested by this view of the pathway?
make the travel experience from Hereford to destinations more pleasant
EACH AND RECRUITING TRATEGIES
assess existing links between HRC and other destinations; add new routes and access NEW/INCREASEDpoints RESOURCES AND AMENITIES AT
HRC
bring activities and student population from other locations to Hereford +
+
ITY ATTITUDE TOWARDS HRC ESS MEASURES
ION OF THRIVING AT HRC AND UVA)
RECRUITMENT OF DIFFERENT STUDENTS THAN CURRENTLY LIVE THERE
IMPLEMENTATION
how might we implement these responses?
SPATIAL DESIGN INTERVENTION
(ATTRACT A DIFFERENT HRC COMMUNITY WITH NEW AMENITIES)
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HAVE A STRONG STUDENT COMMUNITY...WHAT TUDENT COMMUNITY...WHAT TO DO?? TO DO??
T O
Hereford has a community but of quieter students, international students and transfer students
a
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HEREFORD
HEREFORD IS NOT REACHING STUDENTS WHO WOULD LOVE TO LIVE AT HRC
HEREFORD IS NOT REACHING STUDENTS WHO WOULD LOVE TO LIVE AT HRC
HEREFORD NEEDS MORE/DIF MORE/DIFFERENT REDEFINI IDENTITY REDEFINITION OF ITS IDENTITY AWAY FROMWHAT EXI WHAT EXISTS THERE NOW
Students who might love HRC are out there but do not The current model know about what it for HRC is not has to offer
Students who might love HRC are out there but do not know about what it has to offer
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students do not attend group activities, respond to efforts of HRC Students feel like leaders to increase the are “stuck” at social life
reford do t want to be Hereford
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HRC
HRC enrollment and retention is low
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embrace and recruit the types of students who do tend to want to live at Hereford redefine thriving or success measures at college level and university level
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nks between do HRC tend and other to want to live at Hereford lengthen student commitments to live at HRC new routes and access if attendance and retention are bottom line
lengthen student commitments to live at HRC if attendance and retention are bottom line
+
TO ACTIVATE SPACE
Heref have ameni facil attra Hereford is desir
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Hereford is too anti-social and is not fulfilling its goal as a residential college
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focus amenities and options order to bring more student
Give Hereford a new identity existing groups) that will a leaders or desired groups
redefine from thriving or success measures at nd student population college level and university level Hereford
IGN INTERVENTION
The current model for HRC is not working, is not achieving what it needs to as stude housing
NEW HRC OUTREACH AND RECRUITING STRATEGIES
NEW/INCREAS
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RECRUITMEN SHIFT IN UNIVERSITY ATTITUDE TOWARDS HRC C , CONNECTIVITY AND SUCCESS MEASURES HERING) NEW/INCREASED RESOURCES NEW HRC OUTREACH AND RECRUITING (ATTRACT A (CHANGE DEFINITION OF THRIVING AT HRC STRATEGIES HRC AND UVA)
HEREFORD WANTS TO BUILD A STRONGER STUDENT COM empathy empathy
ISSUE
how can this problem be framed?
HEREFORD COULD BE MORE CONNECTED TO THE MAJORITY OF STUDENT LIFE
HEREFORD COU WAYS TO REAC
definition
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existing prototypingwhat prototyping & testing
Student housing and social life are concentrated in the Corner and Rugby areas
Hereford is located on Observatory Hill, south west of campus
condition does this framing respond to?
Hereford has a community but of quieter students, international students and transfer students
evaluation & logic evaluation
EFFECT
what are the problematic effects stemming from this condition?
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
RESPONSE
what kinds of responses are suggested by this view of the pathway?
HRC leadership and not see the colleg successful housing
decrease amount of time it takes to get from Hereford to popular destinations with existing methods of travel
embrace and recr do tend to want
make the travel experience from Hereford to destinations more pleasant
redefine thrivin college level an
assess existing links between HRC and other destinations; add new routes and access points
lengthen student if attendance an
bring activities and student population from other locations to Hereford
IMPLEMENTATION
how might we implement these responses?
SPATIAL DESIGN INTERVENTION
NEW HRC OU
+ PROGRAMMING TO ACTIVATE SPACE
(CREATE SPACES, CONNECTIVITY AND GATHERING)
SHIFT IN UNIVE SU
(CHANGE DEFIN
HEREFORD DOES NOT HAVE A STRONG STUDENT COMM empathy ISSUE
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how can this problem be framed?
PROTOTYPING
ideation and how? what will we implement
HEREFORD DOES NOT FEEL CONNECTED TO THE MAJORITY OF STUDENT LIFE identify path improvements that can better connect hereford to nearby dormitories (ie its really not that far away)
HEREFORD IS REACHING ST WHO WOULD L LIVE AT HRC connects to other s spaces themselves, space
prototyping & testing
CONDITION
what evaluation existing & logic condition does this framing respond to?
respond to what mak develop design concepts for these spaces Hereford has a Hereford is community but of perceived as quieter students, far away from international make the process of main campus develop a plan for thier students and communtiy building construction/installation that involve HRC transfer students students
students do not attend group activities, respond to efforts of HRC leaders to increase social life
EFFECT
what are the problematic effects stemming from this condition?
students are farther from friends, classes and activities
Students at Hereford do not want to be at Hereford
RESPONSE
what kinds of responses are suggested by this view of the pathway?
HRC leadership not see the col successful hous
decrease amount of time it takes to get from Hereford to popular destinations with existing methods of travel
embrace and r do tend to wa
make the travel experience from Hereford to destinations more pleasant
redefine thri college level
assess existing links between HRC and other destinations; add new routes and access points
lengthen stud if attendance
bring activities and student population from other locations to Hereford 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.
IMPLEMENTATION
how might we implement these responses?
SPATIAL DESIGN INTERVENTION +
NEW HRC
social options, are socail provide outdoor activity
kes HRC great, location etc
f building these places activiteis themselves
long-term: supplemental program ideas, pathway mapping for continued development
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Identifying recreation in the landscape between residences.
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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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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.
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Greenwall Concept Rendering: Identity and billboard of HRC as a sustainable residential college.
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Gameday lighting from Hereford Residential College.
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University affiliated public outdoor program and events.
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.
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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 does not really fit in with the room.
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In the waiting room, people waiting are fairly spread out, distancing themselves from one another because they value their privacy.
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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.
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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 occupy the desk, and this is considered the best way to see patients in an orderly fashion.
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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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Needs
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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. 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
Student Poster Presentation.
“I always try to think from the patient’s perspective.”
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“The front desk is often empty and it is easy to pass by the numbering system.”
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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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Use wayfinding designs to minimize confusion for the patient and make spaces more interactive.
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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. 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. Improving the patient satisfaction is also an important goal for the hospital system, leading directly to more funding.
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The following demonstrates how the ideate phase introduces designers to multiple design solutions.
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Next steps include improving product effectiveness through designing and prototyping variations of the concepts. There are several objects of the next course, such as observing patient flow and points of confusion, and testing different designs of the maps, signs, and apps. The team will test variations on the placement of these signs, and design in ways that make the maps, signs, and app data easily manipulated and moved. The team has to consider designing for extreme users, such as those confined to wheelchairs, those with visual impairments, and those without smart phones. Then, literature will be reviewed to gain knowledge on best practices and physiological needs. The design should be for the first time visitor, and it should utilize a variety of navigation approaches which appeal to all senses. Landmarks will be identifiable to be used as reference points, and universal symbols will be determined 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.
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Precedents and inspiration.
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Kiosks combining interior GPS wayfindingwith attractive signage fabrications.
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Interactive map on display at information desk.
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These maps will also be available as a mobile app.
Map systems will be color coded by program for ease of navigation.
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Wire framing the app interface on a tablet computer.
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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.
Students Ximena Robero Gutierrez and Enrique Cavalier show off their projects from the class.
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ECCC Assessment Diagram
Human-Centered Emergency Department Design The following project explores conditions that take place in the high-stress 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.
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A scene from the documentary, The Waiting Room.
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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…..
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Sketches of current conditions in Emergency Room corridors.
empathy empathy
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Alberta Children’s Hospital NICU uses photo journals and storyboarding activities to gain a deeper understanding of the needs and desires of patients, their families, and front line staff. These activities introduce ideas for the design of future space.
empathy empathy
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How might we... 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?
empathy empathy
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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.
empathy empathy
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How Might We... How might we improve patient access to the services they need? This includes access to specialty services, access to a primary care provider or a provider to manage chronic illness, and access to support.
empathy empathy
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Rethinking the Design? Can we Srethink the way waiting spaces are designed so that patients can be calmer and more comfortable? Case tudies
Precedent research.
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empathy empathy
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“... 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?
The team was able to identify three distinct activities (each generating their own protocol; or exemption) that would be feasible in their limited time frame. The first was observational research in the ERwatching and noting activities (photos of space). The next was the creation of an opportunity (or tool) for patients and staff to submit a story (or complete a survey) anonymously. The third was to interview patients and staff face-to-face 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
empathy empathy
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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
empathy empathy
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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 do not 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” The “safety net for society” gives the impression patients just do not have anywhere else to go People (patients and their support persons) are connecting while they wait Many patients come to the ED regularly for routine medical advice/care; follow-up visits Lots of waiting ER waiting room seemed to be mostly lower income persons without insurance There was a lot of bureaucratic red tape in admitting patients and making sure that they got attention
empathy empathy
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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.)
Project team at work.
empathy empathy
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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
empathy empathy
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Ideation
empathy empathy
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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?
empathy empathy
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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-emergencydepartment?page=2&spMailingID=45231992&spUserID=NTA3NzEwNDcxODAS1&spJo bID=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/8-trends-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-waitingroom-no-wait-a-new-ed-model-at-washingtons-swedish-medical-center.html]
empathy empathy
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Live time updates of most recent calls to the ED.
empathy empathy
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empathy empathy
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Make available in waiting rooms.
empathy empathy
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Wall display in waiting room to show approximate wait time.
ER patient storyboard prototypes Individual
Large-Scale
evaluation & logic empathy
Logic Map of Core Changes for the Emergency Department
evaluation & logic empathy
Logic Map of Core Volunteer Changes for the Emergency Department
Work Session: ECCC
Work Session: HRC
Poster Session
Poster Session
Rachel (Last Name), MLAR Professor Anselmo Canfora, Director of Architectural Design Thinking Asa Eslocker, MLAR
ECCC Stakeholders Meeting
+D DESIGN