Patient Experience Lab: Deep Observation in the Trauma Bay

Weeks 2 and 3: Now, the work begins.

After the whirlwind nature of the first week of this project, the second week was decidedly more sedate. (Research is like that, a lot of the time.) The team commenced work in three major research areas: scholarly and business-derived research online, actual in-hospital observations, and focus groups. While this activity may have been more sedate, less kinetic and on-the-go than the first week, there was still an intense feeling of a group of people diving into the intricacies of an alien environment.

This is the sound of 8 people Googling.

Early in the second week, the collective design experience of Item showed through. The straight-up, online research tasks were divided up into several areas (overall research, research on specific equipment devices, etc.) and the design team plowed away. By the end of the first day, the stark, bare walls of the project space had huge, blown-up photos of the vacant RB that we’d toured, the product whitesheets of every conceivable kind of medical device, including all those whose model names were written down by the designers during our tour, and the floor plan of the Emergency Department (ED).

I was fascinated by the way that the design team went about researching these broad themes, of course, but I was more fascinated by the emphasis on public display, of crafting a work-space that intimately connects and elucidates the themes currently at hand. Perhaps there’s something innate in the psyche of industrial designers that engenders this kind of intellectual nesting instinct.

Focus, now.

Due to scheduling conflicts, only two focus groups happened during week II, and they were both with nurses and technicians. While doctors and executives may ultimately be responsible for the outcomes of emergency room procedures, the nurses and the technicians run the place. They are the lynchpin, the firewall and the backbone of the whole hospital. The nurses and technicians that work in the ED are particularly inspired, technically sophisticated professionals. They know their jobs well, they work hard, and they are perhaps the most keenly aware of the opportunities better design could present.

At the focus group sessions, they let it all out.

At a broad, more philosophical level, there was a consensus that there was tons of room for improvement. There was a keen desire for a more holistic solution that was arrived at through intense research and consultation with them, the people who would end up using it.

As the questions bore down to more specifics, asking what key problems were, the attendees opened up even more, and were quite excited by the possibility of even minimal improvements. The focus of the focus groups seemed to end up in the direction of two plaguing problems: communication and layout.

The nurses, in particular, went to great lengths to describe the practical problems involved in trying to maintain communications around the ED and around the hospital within the current wall-based system, which wasn’t designed for this kind of use, though “it’s a lot better than nothing.”

There’s one particular layout problem in the RB that is emblematic of the rest: to turn on the exam light, one needs to either roll a shelving unit full of supplies out of the way, or try and snake a hand around the shelving unit to get to the light switch. It obviously wasn’t originally intended to be this way, the shelves were supposed to be in another part of the RB entirely, but that particular spot got in the way of nearly everything else. So they moved it. In front of the light switch. “It’s better than the way it was.” There are other layout problems, both in a horizontal and vertical sense. There’s lots of stooping to get common supplies, there’s a boom-mount with electricity for a bunch of sensors and devices that routinely results in bruises for staff.

There’s room, literally and figuratively, for improvement.

Observation

The last segment of research was easily the most intense: actual, in-hospital observation rounds. For eight hours, 3-11pm, members of the design team would stand in the RB and watch actual procedures happen, sketchbooks and notebooks in hand. As I noted in the last report, hospitals are venues of every conceivable human misery, and the team was exposed to a large cross-section of it. A few gunshot wounds, which one team member described as “not as bad as I’d thought it would be,” a terrible motorcycle accident that another called “just horrifying.”

These observation rounds were powerful experiences, and not just for their shock value. Every day after these rounds, team members would come in and post the sketches they’d made on the fly the previous evening. These sketches, obsessively anonymized for patient privacy, detail almost every procedure done that evening, with others taken off the usage and stocking of supplies during non-critical times.

There was a sense from the design team, though no one ever said so outright, that this was clearly the most valuable research venue. The other forms were necessary to give the larger scale context, but the observation rounds brought all the other research home and elucidated myriad ways the whole process and environment could be improved.

Wash, Rinse, Repeat

The design process seems to go a lot like this: think, generate, overflow, regroup, refocus, think, generate, overflow, regroup, refocus... continually closer to the final product. That Friday, everyone sat down and tried to coalesce all the information and observations. It was mostly just a “download” of everything they’d learned, and initial observations of areas of opportunity. They eventually agreed to a set of elements to be considered in every design, areas of design focus, and concept areas to be covered under those design foci.

Pouring Out

The following Monday, the start of Week III, there was a distinct change in tone to the whole design team operation. The previous week had been spent gathering information, acquiring fluency in the lingua franca of the ED and the RB. Now, taking all that information and experience, the team let the floodgates open. The space at Item quickly filled with sketches of all different aspects of the RB, both as it is now and how it could be in the future.

This whole process was really just a clearing of the buffer, a release of stored up ideas and energy after the first wave of information and the nascence of understanding. All of the sketches are impressive-looking to a non-artist like myself, some are impressively clever, to boot. Some are outlandish, some are unrealistic, even for a project like this that has an inherent dalliance with futurism. The instructions from Kat, the project lead, were to come up with sketches that were “small,” “medium,” and “large.” The designers took a while to interpret what exactly that would mean (though they doubted that she meant physical size). They reinterpreted this instruction to actually have a temporal dimension: small meaning near-term, medium meaning a few years out, and large meaning perhaps a decade or more away.

The work was constant, and the volume of sketches sizable. The sketches were all intentionally quite conceptual: no one was working out how these inventions could be produced or manufactured. They were exploring an ideation space that got at some of the problems they had come across in research.

Around Thursday morning, the design team started to ask these questions again. They met to look at their sketches, see what other people had come up with. One designer noted to me that, “As much as this whole process can be a good collaboration, sometimes it’s best to just go away on your own and dream something up.” In this case, a number of very strong ideas had emerged, but there was a great deal of overlap as well. “We’re all focusing on a lot of the same things, which doesn’t seem very productive,” one designer noted.

Meta-analysis time

The team decided to divide the work into concept areas (see sidebar). One person would have “surfaces” and “accessibility,” another would have “storage” and “technology,” and so on. There would still be some conceptual overlap, of course, and many, if not most, of the designs would fall into a few of the large-scale “buckets” of design focus. This leads to the obvious point that at this point the previously-agreed upon design foci were beginning to feel a little like straightjackets. They were good things to keep in mind, but their intertwined nature made it so that almost everything touched everything else. The conclusion was clear: they would have to craft a new framework for approaching the work.

On Friday, the team met with Dr. Nate Siegel for a relatively quick Q&A session. In the course of the research process, a few knowledge holes came up. They were from most aspects of the operation of the RB: protocols, roles of individuals, equipment and why it was chosen, how often certain stocked items get used, etc. Dr. Siegel, as he always does, fielded the questions with very intelligent, clear, nuanced answers. Just from background and reputation, we’ve always had every reason to believe Dr. Siegel was an expert in his field. His facility and clarity in answering these questions in a way that non-medical people can quickly grasp is the more day-to-day evidence of his expert status. It’s an impressive thing to watch. I also find it particularly heartening to know that someone this great is working at the hospital where I'd be taken if something were to be befall me.

Train Your Sights

I think it’s fair to say that there was a good deal of excitement at the end of these first three weeks, as well as the inkling of a bit of trepidation: the first big design review was next Friday. All the collaborative partners (BIF/RIEDC, UEMF, and both of the Item founders) would be there, offering their opinions. Next week would see designs honed, expanded upon, organized into a more intelligent framework, and worked into a proper presentation.

Posted July 25, 2007 10:43 PM by Allan Tear | Permalink