Healthcare
EMERGENCY DEPARTMENT
research - strategy - illustration
WHAT
Partnered with the Emergency Department at Michigan Medicine to conduct design research and propose interventions with the objective of improving the experience of patients being treated in hallway beds.
WHEN
September - December 2017
ROLE
I was part of the master of design students team (5 students in total). We did observations on-site and contextual inquiry. At the ideation stage, I worked on the "Privacy" part of the project.
METHODS
Observations, heat map, affinity mapping, journey map, pain point analysis, survey, ideation matrix, screen analysis
Hallway bed
RESEARCH
IMPROVING THE HALLWAY BED EXPERIENCE
This project — investigating the current practice of treating patients in ED hallway beds — is the result of a partnership between the Michigan Medicine Emergency Department (ED) and the University of Michigan Stamps School of Art & Design, Masters of Design (MDes) in Integrative Design program.
90%
Nationally, over
of emergency departments experience overcrowding.
In an effort to meet demand, EDs have resorted to providing treatment to patients in beds placed in hallways. Despite recognition that this temporary solution can lead to suboptimal care, use of hallway beds remains standard practice.
Over the course of four months, the team of 5 MDes students engaged in design research to formulate key insights and propose solutions to improve hallway bed care.
120h
of observations within the Emergency Department
We took notes about hallway bed care at different locations, times of the day and week, as well as interactions between care providers, patients and others.
Heat map: Considering the observations on the ED, we mapped how overwhelming the experience felt in each area. The green areas were the calmest, while the red areas were the busiest and had the worst patient experience.
The black and red squares represent the hallway beds.
Through this process, we have come to appreciate the
interconnection of the patient and staff experiences and
believe that creating positive outcomes for both is a mutually
reinforcing cycle that ultimately leads to optimal care.
SYNTHESIS
Affinity Mapping: We synthesized our observations, creating
categories to understand relationships and major concerns. We identified three primary areas of opportunities:
Communication: Barriers arise when staff are reluctant or unsure how to discuss the hallway bed process. This leaves patients uninformed and confused which creates anxiety and frustration.
Environment: Patients and staff can encounter pain points due to the physical space and the sensory experience (light, noise and sound) in the hallways. This environment differs in each of the specific hallway bed locations.
Privacy: Multiple times during the ED process, the lack of privacy (either physical or personal information privacy) is painful for both patient and staff.
Patient-Staff Journey Map: Working from our observation notes, we mapped patient and staff “pain points” over time to deepen our understanding of the process of care and barriers that arise for both a patient and staff during the hallway bed experience.
Patient-Staff Pain Point Analysis: This chart considers the pain points according to the ED process we outlined in the Patient-Staff Journey Map (horizontal) and the three primary categories that arose in our Affinity Mapping (vertical). We found that most pain-points occur within the “communication about process” row and the “waiting” column.
Patients do not know what to expect within the hallway bed process and staff are uncertain how to communicate to patients.
This analysis helped us determine the opportunity areas in
which we believe interventions would have the most impact.
RESEARCH (part 2 )
Staff Survey: Using our initial research insights, we formulated an 8-question survey to gather staff feedback regarding our three main areas of concern. 158 staff responded. The goal was to gain insight into the staff perception of the hallway bed process and validate our pain-point analysis.
What do you say when assigning, transporting, or caring for patients about the hallway bed context and process?
Results show that the communication was not consistent for patients.
IDEATION
"How might we..." statements represent our understanding of the problem space and help us begin to focus ideation.
How might we help patients feel confident they are being well cared for through the whole experience?
How might we help staff provide optimal care to hallway bed patients?
How might we help patients feel the hallway bed “belongs” and is an appropriate site for care?
Ideation Matrix: We brainstormed potential solutions and then considered their ease of implementation and potential impact.
The most promising (highlighted) ideas were chosen for further development.
INSIGHTS & OPPORTUNITIES
We chose to work on 3 opportunity areas:
Communication, Environment, and Privacy.
I worked on the Privacy part of the project.
PRIVACY
Insight
Lack of privacy — both visual and auditory — leaves patients feeling exposed and keeps staff from being able to do their jobs properly.
For both staff and patients the lack of privacy in the hallway bed care setting creates difficulty and discomfort.
Opportunity
More functional screen coverage can improve care and make patients more comfortable.
How it can be used
Our privacy recommendations fall into two categories: for the short-term, we suggest existing screen products;
for longer-term consideration, we propose developing more customized solutions.
Most relevants aspects to consider:
To deepen our understanding of the pain-points experienced by staff, we analyzed the current screen and identified the four aspects most relevant to ED hallway bed challenges:
Analysis of current ED screen:
The current screen has three panels and two hinges and can be used in either a straight line or “Z” configuration, as shown. Although it is mobile and easy to store, its poor stability and Z form does not provide consistent or adequate coverage.
Alternative screens available in the market:
Analysis of alternative screens:
We chose four of the most appropriate available screens and ranked their coverage, mobility, storage and stability.
Existing screen recommendation:
Our short-term privacy solution recommendation would be to buy two models of screens — a single and double panel — that could be used separately or in combination. Both screens offer good mobility, stability and ease of storage.
The panel width is similar to that of the hallway bed.
The single panel could be used easily by patients and the use of two in combination provides a good balance of coverage and accessibility for staff to perform exams.
Developing a custom privacy solution:
Our long-term privacy solution recommendation
would be to develop a new screen specific to the needs of a hallway bed.
From observing and talking to patients, as well as understanding staff needs, these are the important features that all the screens should have:
-
Non combustible materials
-
Material that reduces noise
-
Blocks light
-
Easy access for staff to perform exams
-
Ease of use for patient to control level of privacy
-
Ease of storage
Free standing enclosure
Type
3 panels, 2 hinges that close as an “U”
Features
Patient can control amount of visual privacy
Ok for fire code (same size as current screens)
Suspended enclosure
Type
Lower curtains that do not block exit signs
Features
Patient can control amount of visual privacy
Easier access for staff to perform exams
Easy storage
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Fold down enclosure
Type
Curtain that folds down from wall
Features
Patient can control amount of visual privacy
Easier access for staff to perform exams
Easy storage
Patient canopy
Type
Canopy that attaches to bed
Features
Patient can control level of privacy
around the upper body
Blocks light
Can be attached to any bed/area in ED
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Bed attachment enclosure
Type
Screen that attaches to bed and rolls out + canopy
Features
Patient can control level of visual privacy
Blocks light
Can be attached to any bed/area in ED
Easier access for staff to perform exams
Easy storage
We recognize that the challenges for both patients and staff
in the hallway bed context are many, but hope that some
of the ideas we have proposed can contribute to improving
the care experience. We are grateful for the opportunity to work
and learn in the ED.
MDes in Integrative Design, cohort 3, 2017