Patient Experience Lab: Trauma Bay Project Kicks Off

Week 1: Chair Irony

As a conference room at Hasbro Children's Hospital began to fill up with potential volunteers, the groan of the cheap plastic and metal chairs grew louder and louder. The chairs, ubiquitous in every office environment in America, are iconic of lowest-common denominator design. They're incredibly uncomfortable, small, and stiff. This is worth noting, at the outset, because sitting in these poorly designed chairs, at these poorly designed tables, were several brilliant young industrial designers and a director for an industrial design firm called Item. The irony was not lost on anyone: already, there was a clear need for better design in the hospital environment.

What's an RBoF?!

The people seated around me at that training were the core of a design team tasked with the mission of designing a “Resuscitation Bay of the Future.” The project is an innovative collaboration between the above-mentioned Item New Product Development, Lifespan Corporation (a consortium of RI hospitals including Rhode Island and The Miriam hospitals), University Emergency Medicine Foundation (the professional organization of Emergency Medicine physicians, associated with Brown University), and the Business Innovation Factory.

It’s so novel, in fact, that the Business Innovation Factory is documenting and sharing the innovation and collaboration process. That’s where I come in. I’m Brian McGuirk. It’s my job to be there for everything, observe, ask questions, and see how this experiment goes.

“Thank you for volunteering.”

Everything in a hospital is more complicated than it appears to be at first glance, and for good reason. Even something that is simple in every other venue can be a huge, exhausting process (like becoming a volunteer). This is a necessary side effect of two intrinsic facts about hospitals:

1) They are prisms of the human condition, and venues for every possible scenario of sickness, pain and suffering. Thus they are prepared for every scenario. To make sure everybody is on the same page, that things like transmission of illness and infection are curbed, that security is maintained at all times, etc. a lot of factors need to be addressed. It’s intrinsically a complicated space.
2) The currency of every hospital is life itself. Life is a very, very valuable currency, the most serious one on the planet. If protection of life means that a few steps need to be added to a training regimen, or something, it’s a no-brainer for all involved.

The first step on this necessarily complicated path toward being a volunteer is the orientation, which for us was on the Friday prior to the project kickoff. Over the course of an hour and half, all of us sat, constantly shifting position, through a reading and discussion of the "Rhode Island Hospital / Hasbro Children's Hospital Volunteer Orientation Handbook." None of us had any real plans to be volunteers, but, for the purposes of vetting and screening people who were to be in an active clinical environment, it had been decided that the closest thing to our actual status was a volunteer. The orientation dealt with the generalities of the volunteer responsibility, and the specifics of hygiene policy (regarding Purell dispensers: "Take a squirt, don't hurt."), emergency procedures and codes, fire procedure, and how to get discounted IMAX tickets.

This completed, the prospective "research volunteer" must take an extensive online course dealing with topics related to ethical research standards, patient privacy as required by HIPAA, the IRB process, and the specific policies of the Lifespan Corporation and Rhode Island Hospital, which we completed over the weekend. This modular course, with quizzes at the end of each section, takes a minimum of about 6 hours to complete.

Already, the prospective volunteer has had more than 7 hours training and indoctrination and has yet to see a patient or enter a hospital room. If you add in the amount of time spent filling out paperwork, faxing recommendation forms to former employers and colleagues, calling former pediatricians you haven’t talked to in 15 years to get them to verify that you had the chicken pox, waiting in line to get a Tetanus shot or a badge or a parking pass, you're looking at perhaps twice that.

If this sounds like a complaint, it's really not. These procedures may feel like jumping through hoops, but they undoubtedly save countless lives in the long run. In fact, from a design standpoint, the procedures that run the object of this whole project, the resuscitation bay, are equally as important as the equipment, supplies and their placement.
I hear taupe is very soothing.

The most important fact about this project is that it is a dynamic project, with dynamic partners. On Monday, we started meeting these partners, and getting the design team familiarized with the Resuscitation Bay (RB) itself.

The external/internal contrast of the Item offices is astonishing. From the outside, it’s... well, hideous. Like everything else in its Cranston Street area industrial park, the offices are a 60’s era, solid, square, building with faded light brick walls. But one walks through the door and enters decidedly into the 21st century. The whole design bespeaks sophisticated industrial precision and feels like a very suitable container for creative design personalities. Elegant, inviting devices stand on platforms around the lobby, while the walls are filled with posters of past accomplishments and (as one of Item’s founders pointedly noted to me) highly classified future products.

Kat Darula met the seven members of the design team and myself in the cafeteria/waiting area. Kat is the project manager for this effort. She is a young, very fit, very intense designer who just joined Item this year from her own firm. There are other people in the managerial orbit, but she is the focal point, the “foreman,” as I heard a few executives call her.

Kat showed us around, pointed out the eventual workspace that was still being prepared for the design team. We were led to a generic looking, large conference/brainstorming room filled with the detritus of previous projects. We sat in a circle on tables that were eerily reminiscent of those at the Volunteer Orientation session, and started the professional and personal introductions.

“Let’s call them collaborative partners...”

Ed O’Rourke, Item’s Director for Research and Strategy, Kat and eventually Steve Lane, Item’s Founder and Chief Executive, gave us the broad outline of the genesis and trajectory of the project, roughly summarized as follows:

In 1993 faculty and students at RISD started what became the “Universal Kitchen” project. It was a holistic reconceptualization and redesign of what a modern kitchen should be. The RISD website describes its innovations: “The team began by literally deconstructing the existing elements of the kitchen, debunking the myth of the kitchen triangle as they blew apart stoves, refrigerators and dishwashers... A series of studios generated thousands of innovative blue-sky ideas: a utility mouse, continuous wet surfaces, pop-up dishwashers, grey water irrigation systems, countertop waste channels, toe-kick suction, electronic consumption tracking, built-in retractable appliance cords, misting bays, steaming bays, retractable burners and more. In the end, the team conceived of its Universal Kitchen as a “kit of parts,” with interchangeable modular components for refrigeration, cooking, water delivery and storage. Each component is meant to be custom selected and arranged, so that heights and depths can be manually or automatically adjusted to that highly personal, but absolutely crucial “comfort zone.”” The project was a critical success and was featured in the 2004 PBS series “Freedom Machines.”

Steve Lane, being a RISD alum and industrial designer himself, was keenly interested in this project and in applying its methodology to other areas. Steve also had two connections that would set this project in motion: Dr. Nathan Siegel, of the University Emergency Medicine Foundation, and an emergency medicine physician with Lifespan hospitals, and Saul Kaplan, the Chief Catalyst of the Business Innovation Factory (and also the executive director of the Rhode Island Economic Development Corporation). Dr. Siegel was interested in doing academic research on ways to improve RB design and configuration, Saul Kaplan was interested in promoting novel, perhaps ground-breaking, collaborations between different elements of Rhode Island's diverse business, academic and non-profit communities. This project is the result of that fusion of communities.

This almost post-modern process of deconstructing the elements and operation of a mythified space is what the RB Redesign project is all about. Most importantly, from Steve Lane’s point of view, is that Item keep “pounding the drumbeat of reality. This is not a hypothetical. We’re gonna make this.” The whole thing is aimed at today’s industry, at implementing a total solution that would work for today’s Emergency Departments (EDs). The RISD Universal Kitchen, after all, was sold to Maytag.

Dr. Siegel and UEMF are keenly interested in the research data that comes out on the other side of this project for purposes of advancing the academic sophistication of RB design and operation.

The question then became how the team was going to go about understanding an RB enough to confidently design things for it. First and foremost: actual observational research. (Thus the volunteer certification.) The team is going to, if not live in, then become a fixture in the 12 RBs of Rhode Island Hospital. Parallel with that will be background academic and business plan research to get a larger-scale understanding of the RB and the system in which it resides. Lastly, the team was to conduct a series of focus groups consisting of doctors, nurses and technicians with ED, specifically RB, experience.

Here we confront a central, problematic dynamic of the overall project: how to maintain depth of research while protecting patient privacy to a degree acceptable not only in accordance with the law, but with RIH’s Institutional Review Board. There is an elaborate and arcane system of research documentation whose central goal is to make it physically impossible to link any observations of what happens to or around a patient with that patient’s name. There will never be any digital video observation of what happens, or any digital photos taken of the RB during treatment. What observations are made will be made with text notes and non-patient-related sketches.

"Everyone has a superpower.”

After the overall project introductions, we made our personal introductions. The Item Industrial Design Interns (collectively referred to, with Kat, as the Design Team) are an impressive group of college students and recent graduates of RISD and Massachusetts Institute of Art (MassArt). Over the course of the project, we’re going to meet these team members in detail, but here is a quick overview of them:
• Nicole Latorre - RISD BFA Program in Industrial Design - Nicole’s has worked with Lifespan before. Last year she was part of a studio team that designed rehab toys for child patients at Hasbro Children’s Hospital.
• Matt Suplee - LSU BA in Architecture - RISD MID in Industrial Design - Matt worked with BIF last summer on its first healthcare project, looking at how to improve the overall primary-care environment.
• Alex Blue - RISD BFA Program in Industrial Design - Alex is intimately familiar with various aspects of emergency medicine because his RISD thesis project was a total redesign of the sleds that Ski Patrol EMS staff tow behind them in emergency situations.
• Sochenda Uch - MassArt Industrial Design Program - “Soch,” as he goes by, was on Dunkin’ Donuts Product Development Lab team last year when they looked at how to design stores and vendor applications for the college environment.
• Brian Bond - Mass Art BFA Industrial Design Program - Brian designed the “MOBILO Bag,” an innovative organizational solution for modern on-the-go professionals.
• Kate Dudgeon - Mass Art BFA Industrial Design Program - Kate is about to be the most famous designer in this group, as her project last year was a conceptual redesign of the modern beer keg that made it more resilient and easier to transport and use.
• Katie Montgomery - Brown University Entrepreneurship & Biotechnology Management - Katie is not an industrial designer, but is a compliment to them. Katie’s focus is the business end of innovation, and is an expert on business-plan research and writing. She worked for And1 in Chile, doing community-based market research. While at Brown, she developed a “choose your own adventure” book for guiding biotech startup management decisions.

Just as the institutional partners of this project are dynamic and complimentary, on a smaller scale so is the actual design team. They come from very different personal, academic and professional backgrounds and it’s tempting to think that that’s why they were chosen in the first place.

Posted July 15, 2007 10:36 PM by Allan Tear | Permalink