Patient Experience Lab: Getting the Best Ideas for the Trauma Bay

Week 6: Survival of the Fittest

"You must always be mindful that you are taking into account real need, not perceptions of real need," says Aidan Petrie. Aidan is a tall man in pretty good shape with very broad shoulders. In another life, one imagines he would have been terrifying on a rugby field. He has an undeniable, high British accent, but once in a while I detect a vaguely Scottish tinge to it, like when he slides, slightly, over the "t" in "not."

Aidan is Item's co-founder and now "Chief Innovation Officer," a title he says he despises. This is the first time he has spoken in this internal Item design review, and it won't be the last. He is responding to the presentation of the team's research thus far by Katie Montgomery. In particular, the diagram the team made of "Doctor's Unmet Needs," and "Nurses Unmet Needs." At the top of the nurses' list is the statement "More nurses."

“The desire for more nurses, more people generally, is a symptom of bad design,” Aidan says.

The presentation goes on quickly through a summary of the rest of the research and on into the three major design themes: “Patient-Centric,” says Nicole Latorre, “which includes patient privacy, comfort and–”
“That’s a pretty big shift in just a few weeks. A while ago, patient comfort was something you were thinking about, but now you say it’s a major design theme,” says Aidan.
“Yea, I mean why these themes, particularly?” says Ed O’Rourke.
“These things have never been considered holistically in ED design and we’re trying to sort of shine light in new places,” Nicole replies.
“Patient privacy, comfort, support, etc. is a low priority,” says Aidan. “I don’t think it should be a ‘major theme’ of this project.”
“Well, to you, maybe, but you’re not lying on a gurney for 6 hours,” says Justin Sirotin, Item Director of Operations, who has just walked into the presentation.
“‘Patient as hub’ is a far bigger idea than patient privacy, comfort and support,” Aidan says.
“‘Patient as hub’ is a major theme of one of our central design ideas thus far, so we’re definitely still looking at that and incorporating it into our designs,” says Nicole.
Ed turns back to the group presenting and says, “How do you connect the dots between your observations and these themes?”
Alex Blue: “I consider them lenses for looking at design opportunities.”
“I like that.”

With that, Nicole launches back into the actual design presentation. The sketches and designs are laid out on large vertical pin-boards, and Nicole’s board is first. She presents each idea up there that the team voted was a “Yes” idea. She does so quickly, as apparently the Item cultural ground rules for presentations of this kind limit explanations of ideas to 30 seconds a piece. After each sketch on the board has been preliminarily explained by one of the designers, the voting process takes place.

Having been around the designers for weeks now, watching them research and develop their ideas into proper sketches, I find this whole process a bit cruel, in a Darwinian speed-dating sense. One sketch that I know Soch really took his time with, that he really liked, is voted down by unanimous consent in maybe five seconds. And on it goes. Aidan, Justin, and Ed, along with a sprinkling of other designers who come in for a few minutes to check things out and then leave, are blunt about what they think works and what they think is terrible. There are many disagreements among these parties (Justin on a carousel-storage design: “Wow, that’s a really cool idea.” Aidan: “Are you kidding? That’s pointless.”), and on certain sketches the designers try to defend their work from being voted down, but the process is quick, efficient and, above all, honest.

From the presentation of ideas and the subsequent voting discussions, gradually some themes emerge, most notably that a lot of the problems observed in the ED and thus a lot of the proposed solutions have to with architecture and space management. Another theme, observed by Ed O’Rourke and discussed throughout, is that there a lot of opportunities for standardization in this space. In some hospitals the arrangement and configuration of devices and supplies in trauma bays varies, not just between it and other hospitals, but between individual rooms in one ED: “A doc should be able to walk into any RB in the country and immediately have his bearings.” Thus, from here on, in addition to research results and design ideas, the team will keep track of “best practices,” and “intelligent ED design concepts.”

Kid Gloves, sort of.

This is it, really. I consider this stakeholder presentation to be a little bit like aiming a bottle rocket before it takes off: small changes in orientation right now could end up in a very different flight path.

Ed O’Rourke starts things off: “The goal today is to connect the dots and critique our future design direction. This is really important, because from Week 7 until the end of the project, we’re going to be finishing our designs and building prototypes. We really want your input as to what we should be thinking about going forward.” Kat makes a comment about how the team is attempting to make the designs globally applicable and that everyone should keep that in mind going forward as well.

Dr. Leo Kobayashi, of UEMF, has just joined Dr. Siegel on the project. Dr. Kobayashi has a reserved air about him and is extremely soft-spoken, but the points he makes are well worth making an effort to hear. Immediately, upon hearing about how these designs should be globally applicable, he makes a very good point about hospital design: the institutions the team has been looking at are academically affiliated. They have residency programs, are constantly teaching, and their organization, no doubt, reflects this to some degree. He strongly suspects that non-academic hospitals that handle trauma may perceive the world and their role in it much differently. Kate Dudgeon grabs a pen and starts writing this down.

Matt Supplee starts off this presentation. He has shifted his role, a bit, from pure designer to something like “information overseer.” He is starting to formalize all the research, design concepts, etc. into usable, polished forms. As such, things like presenting a summary of the research and conceptual thinking about the project, are now his responsibility.

In the course of doing this, he notes the oft-mentioned “F1 pit crew” analogy. In a pit crew, each team member knows exactly what they’re doing, they practice their movements and orientation for critical pit runs, and all of their tools are designed to make their jobs as easy, fast and efficient as possible. This sparks an interesting discussion:

Allan Tear wonders, aloud, how far the analogy goes. F1 teams, for example, have real-time telemetry on their car, and know exactly what the problems are with it well before it arrives in the pit lane. No medical system in the world has that kind of advance knowledge.

Kat responds that “We’re trying to express the ideas of time-sensitive tasks, and the maximization of utility in the critical real estate around the patient.”

“There’s a surprising amount of predictability to what the doctors and nurses do each time there’s an intervention,” says Matt.
“Whether it’s a Ferrari or a Peugeot, you go through the same engine check, as far as we’re concerned,” says Nate, effectively settling that point.

These conversations are emblematic of this entire collaborative review process. People with very different day-to-day lives and very different worldviews come together and look at problems from very different angles. As the presentation goes on, and the freshly-culled design ideas are presented, it becomes even more apparent how powerful an experience this is. The reviewers are led through a preliminary mockup of some design ideas, and you can see them starting to visualize what it would be like.

At one point, Dr. Kobayashi, who again I must note seems quite reserved, is standing over a very rough mock-up of some future “super-gurney” concepts that Alex Blue is explaining to him. His eyes trace along the sides of the gurney, his mind’s eye placing useful devices and removing impediments. He puts his hand to his chin and kind of leans on it, then he smiles as he turns to Alex and says, “Yea, that would be great.” It’s not a gushing of praise, but it’s a clear positive endorsement.

Getting Physical

The next step, the one the designers are practically salivating over, is the physical realm. For the rest of the project they’re going to be building real physical mockups of their concepts. The future is almost palpable.

But first, we’re going to take a look at the status quo: the critical care areas of Rhode Island Hospital.

Posted August 12, 2007 11:21 PM by Allan Tear | Permalink