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UVA/Inter-Architecture, Gerrit Rietveld Academie

Insight Series #8 Hacking Healthcare

Insight Series #8 Hacking Healthcare

Introduction

Insight Series #8 Hacking Healthcare Introduction by Renske Kroese, Tim van de Grift (UVA) and Henri Snel (InterArchitecture)

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This book is about our Hacking Healthcare experiment. Hacking Healthcare is an educational project designed to address some of the many challenges our healthcare system is currently facing. For example, how can a psychiatric ward become more human, while ensuring high quality and safe care? Or how could we design our care environments in such a way that demented elderly are simulated to move more? As today’s healthcare challenges become more complex and multifaceted, we cannot solely rely on our default way of attacking problems anymore. We need not only specialist knowledge of healthcare professionals, but also the ability to observe,


UVA/Inter-Architecture, Gerrit Rietveld Academie

Insight Series #8 Hacking Healthcare

Introduction

UVA/Inter-Architecture, Gerrit Rietveld Academie

emphasize, and create. Therefore, in Hacking Healthcare, future healthcare professionals from the University of Amsterdam and future artists and designers from the department of Inter-Architecture of the Gerrit Rietveld Academie were brought together to solve some of Amsterdam’s challenges in healthcare. In this book you will find their problem analyses, solutions, and reflection on the process they went through. We hope that, with their stories, we give you insight into what such a process could look like and maybe even inspire you to design something you find important. Renske Kroeze and Tim van de Grift (UVA)

Henri Snel

(Inter-Architecture, Gerrit Rietveld Academie)

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Introduction


UVA/Inter-Architecture, Gerrit Rietveld Academie

Contents

Insight Series #8 Hacking Healthcare

UVA/Inter-Architecture, Gerrit Rietveld Academie

Introduction

Insight Series #8 Hacking Healthcare

Contents

Which domains play a part in the conflict between

> Renske Kroese, Tim van de Grift (UVA) and Henri Snel (Inter-Architecture)...................... 1

> Sharon van den Bosch, Psychology........................ 64

Case #1: Cordaan

Providing cohesive care

The benefits from a healing garden

The ambiguity of visual identity

> Linde van Vlijmen, Psychology........................... 12

> Natascha Oduber, Inter-Architecture..................... 26

> Phebe Kraanen, Medicine................................. 80

Case #4: AMC, Cardiology department

> Dimitra Chysovergi, Inter-Architecture.................. 30

Case #2: GP Clinic Bureau Studentenartsen

> Paz Ma, Inter-Architecture ............................. 76

Renaissance of the environment

Humanizing long-term dementia

> KC Chaviano, Social Sciences ........................... 70

Tipping the scales

> Cherie Cheung, Inter-Architecture....................... 38

> Iris Christine Mikulic, Medicine........................ 90

> Daniel Schwartz, Inter-Architecture.................... 100

Inside out study

How could we satisfy

Case #3: GGZ inGeest

Case #5: St. Lucas Andreas Ziekenhuis and Onze Lieve Vrouwe

> Au Kwong Ming, Inter-Architecture....................... 46

Humanizing hospitalization

> Romy Yedidia, Inter-Architecture....................... 104

I’d rather wait here

> Frédérique Albert-Bordenave, Inter-Architecture......... 54

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> Isak Boardman, Inter-Architecture.....................

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UVA/Inter-Architecture, Gerrit Rietveld Academie

Insight Series #8 Hacking Healthcare

Contents

UVA/Inter-Architecture, Gerrit Rietveld Academie

> Salie van der Wal, Inter-Architecture.................. 122

> Yaniv Schwartz, Inter-Architecture..................... 128

The design process

Case #6: The Odensehuis

The benefits of art in healthcare

> Muriël Lindeijer, Psychology........................... 140

> Fernando Dias Conclaves, Medicine...................... 296

The creatively ill

> Iris Christine Mikulic, Medicine....................... 290

Art & Science

> Fernando Dias Concalves, Medicine...................... 134

Grieving & dementia

> KC Chaviano, Social Sciences........................... 278

The art of preventing obesity 1

The Prevention of Alzheimer’s disease

Contents

Image Section.................................... 228

Home of sick

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> Mai-Loan Gaudez, Inter-Architecture.................... 152

> Phebe Kraanen, Medicine................................ 304

Mindful not mindless

Design Thinking

Communication and diversity in group creativity

The importance of critical thinking

Togetherness

The perks of prototyping

The design Process

The art of preventing obesity 2

The treasure box

The circuit of experimentation

> Olivia B. Noe, Social Sciences......................... 162

> Muriël Lindeijer, Psychology........................... 178

> Mai-Loan Gaudez, Inter-Architecture.................... 192

> Sharon van den Bosch, Psychology....................... 206

> Paz Ma, Inter-Architecture............................. 220

> Leonie Poelstra, Psychology ........................... 316

> Linde van Vlijmen, Psychology.......................... 330

> Iris Christine Mikulic, Medicine....................... 344

> Natasha Oduber, Inter-Architecture..................... 350

Brief essay on empathy, Dimitra

> Dimitra Chrysovergi, Inter-Architecture................ 358

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UVA/Inter-Architecture, Gerrit Rietveld Academie

Insight Series #8 Hacking Healthcare

Contents

UVA/Inter-Architecture, Gerrit Rietveld Academie

Design

> Romy Yedidia, Inter-Architecture ...................... 384

of patients

With special thanks to.................... 496

> Yaniv Schwartz, Inter-Architecture..................... 408

Colophon........................................... 498

Publishing reader-friendly academic papers

> Cherie Cheung, Inter-Architecture...................... 414

The manual of reading connection

> Au Kwong Ming, Inter-Architecture...................... 426

Obesity and the future self experience

> FrĂŠdĂŠrique Albert Bordenave, Inter-Architecture........ 476

Impressions....................................... 490

> Salie van der Wal, Inter-Architecture.................. 392

Home of sick

> Olivia B. Noe, Social Sciences......................... 458

The design process hacking healthcare case study

What can curvelinear architectural forms tribute to the welfare

> Iris Christine Mikulic, Medicine ...................... 452

Alternative communication: project development for the chronically ill

> Isak Boardman, Inter-Architecture ..................... 372

The connection between exercise and overcoming obesity

Contents

The art of preventing obesity 3

The orthopedic waiting lounge

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> Daniel Schwartz, Inter-Architecture.................... 442

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Case #1: Cordaan Cordaan, one of Amsterdam’s largest healthcare providers, offers day care for Surinamese people suffering from dementia in the small nursing home Kraka Sewa. As people with dementia lose the ability to take initiative, these patients do not move much. The manager of the centre asked the students to design aspects of the shared living space to seduce these patients to move.

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The benefits from a healing garden for the Surinamese residents suffering from dementia of the Anton de Komplein

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Linde van Vlijmen

The Anton de Komplein is a smallscale nursing home housing thirty elderly Surinamese dementia patients. Most of the them suffer from vascular dementia (VD). This disease is characterised by white matter lesions and infarcts in the brain due to damage of the great veins (Handboek足 dementie, 2009). In VD cognitive processes such as semantic memory, attention, executive functioning and visuospatial and perceptual skills are impaired (Graham, Emery & Hodges, 2004). Changes in personality and mood arise from the cognitive impair. Patients with VD experience feelings of depression and anxiety, lose their sense for appropriate behaviour and become apathetic (Kalaria, 2002); they lose initiative and become indifferent. Also aggression and agitation are common symptoms. Other symptoms that are not typical for VD, but are results of strokes are paralysis and aphasia. Observations and interviews with staff members indicated high levels 12

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Linde van Vlijmen

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Linde van Vlijmen

independently. Momentarily, space and interior do not stimulate activity. For instance, due to the location of the residence on the third and fourth floor in a busy area, no circular routes or outside areas are present. Research has been done on the increase of both independence, activity and wellbeing in dementia patients due to garden therapy. A recent study by Lee and Kim (2008) showed that participants who engaged in indoor gardening activities for four weeks improved on sleep rhythm, agitation, orientation, memory, calculation, attention and semantic word fluency. Thelander, Whalin, Olofsson, Heikkil채 and Sonde (2008) also let their participants engage in gardening activities, but also in walks and social activities. They found that independence of dementia patients was present mostly in activities initiated by themselves. In this paper it is argued that a garden is beneficial for reducing inactivity of the dementia residents of the Anton de Komplein. Analysis of conducted inter-

of inactivity as a problem for the residents. Staying active is important. Activity is recommended for people with dementia since abilities and functions must be exercised in order to be retained. The activity theory states that older people who stay active and social become more satisfied and better adapted to later life than those who are inactive. This is true even for people with dementia (Thelander, Wahlin, Olofsson, Heikki채&Sonde, 2008). Physical and mental limitations make moving for dementia patients difficult or even impossible. As a result they have to be guided by others. However, it was repeatedly stated in interviews with the nurses that because of staff shortage, much time is needed for basic care and few time is left for spontaneous activities. The residents are therefore dependent on planned activities, family visits or volunteers for exercising. As a result, some parts of the day are spent without meaningful, enjoyable activities. Therefore, residents should be stimulated to move 14

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ed in a natural environment. Kaplan (1995; retrieved from Diaz-Moore, 2007) states that nature reduces stress because it elicits the use of a more unconscious effortless type of attention. Health effects of gardens may also be derived because of activities that can be performed within the garden. Gardening is both meaningful and enjoyable and therefore rewarding. It can offset a flow-experience. Here a harmonization between ability capacity and the challenge is felt, giving ways to feelings of well-being, total commitment, happiness and forgetfulness of time and self (Csikzentmihalyi, Harper & Row, 1990). However, no research has been done on the capacity of dementia patients to experience flow, Jarrot and Gigliotti (2010) suggest that gardening activities should be broken down into small steps in order to match personal competence with challenging tasks from the environment. According to Csikzentmihalyi, Harper and Row this should give way to a flow experience. Jarrot and Gigliotti found that using

views and observations leaded to a problem definition that states that the environment (space, time and people) does not provide sufficient stimuli to invite the residents to be active in a way that stimulates their well-being. In this paper arguments will be given for the fact that gardens could stimulate activity for all the residents of the Anton de Komplein. After, arguments will be given to show a garden reduces rather than increases the amount of nursing tasks. In addition, some advice about implementing a garden into a homecare together with a concept idea for an indoor garden in the building of the nursing home will be described. GARDENS STIMULATE ACTIVITY Gardens can be experienced either passively or actively. Stigsdotter and Grahn (2002) state that health effects from healing gardens can be derived from the garden as such. Being in a garden reduces stress because people’s innate reflexes are stimulat16

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horticultural therapy (health improving gardening activities) improved engagement levels of dementia patients. Besides physical activity, working in a garden also stimulates the senses of smell, touch, sight and hearing. The passive experience of a garden and horticultural therapy are two extremes along the same scale. A balance should be find which corresponds to the mental power of the user of the garden. Complementing the Anton de Komplein with a garden is suited for the residents since it meets the needs different kind of people have. Residents who are unable to perform gardening activities can still gain benefits from the garden such as stress reduction. Plants and animals stimulate the senses of hearing, smelling, touching and sound. The residents who have more physical and mental capabilities can enjoy gardening activities besides the sensational experience. Besides providing stimuli to encourage activity, gardens or garden activities may also reduce caregiver burden. This will be discussed in the next paragraph.

Studies: Psychology

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Linde van Vlijmen

GARDENS REDUCE TASK PRESSURE FROM CAREGIVERS As was described before, studies have shown that gardening activities increase the independence of dementia patients (Lee & Kim, 2008). This was true especially when initiative was taken by the participants themselves (Thelander, Wahlin, Olofsson, Heikkil채&Sonde, 2008). Another effect of having a garden at the nursing home is that it provides possible meaningful activities for family members to exercise with the dementia patient (Chapman, Hazen &Noell-Waggoner, 2007). A caregiver at the Anton de Komplein noted that family members, staff members and volunteers often have difficulty interacting with the dementia patients, because verbal communication channels are unavailable and cognition is impaired. Family member might not enjoy the visits to the nursing home as much as the residents do and are more reluctant to visit. Furthermore, nurses might be less 18

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of family visits will help to reduce the task pressure of care givers.

motivated to engage in spontaneous personal activities with the residents when they are not sure what to do and do not enjoy the activity themselves. When walking through a garden or gardening together private interaction is possible, while performing activities that are enjoyable for all parties. Flowers, the weather and sounds or smells can be used for conversation (Brawely, 2002). Qualitative research indicated that residents, family members and staff members all reported positive feeling and pleasure after the implementation of a garden in a nursing home (Heath, 2004; Hernandez, 2007). When family members visit more often, they take over some of the tasks from the caregivers. As a result, care givers have more spare time to spend on extra attention for other residents. In addition, some nurses and volunteers that work at the Anton de Komplein also have trouble interacting with the residents because of a lack of knowledge. Both the stimulation of the patients independence and increased frequency

IMPLEMENTATION CONSIDERATIONS AND SUGGESTIONS When implementing a garden in a nursing home it should be taken into consideration that the design meets the residents’ needs. This is the difference between a regular garden and a healing garden. The garden should be fit for the end-users, but some generalities exist. In research explaining why some parks are visited more often than others it was found that popular parks were composed of more different kinds of characters than unpopular parks (Stigsdotter&Grahn, 2002). For dementia clients the characters of serenity (peace and sounds of nature), a coherent holistic space, richness in species and culture are of importance. The benefits of a garden can only be gained when it is actually used. Grant and Wineman (2007) developed the garden-use theory in order to identify 20

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features that should be present in order for the garden to be used. These features regarding organizational policies, staff attitudes, visual and physical access to the garden and garden design should all be aligned with the needs of the end-users. For the residents of the Anton de Komplein, the garden should be visible in order for residents to use it and for staff members to feel like they can safely leave the patients alone. The garden should also be made in such a way that the residents who are in a wheelchair or have unsteady feet can still enter the garden and participate or observe gardening activities (Brawely, 2002). Chapman, Hazen and Noell-waggoner (2007) noted that maintenance of the garden should be taken care of as well as the fact that some resident might eat plants or soil and kill plants by pulling them out or overwatering them.

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Linde van Vlijmen

causing cognitive, behavioural and physical obstacles that keep them from taking initiative to move. In addition, the environment does not stimulate movement. However, staying active is important for well-being and retaining physical, cognitive and behavioural functioning. In this paper it was argued that a garden could benefit the health of the residents. A healing garden provides stimulito invite the residents to move in a passive and/or active way, making the garden not only suitable for mobile patients in earlier dementia stages, but for all patients who enjoy being outside. A healing garden stimulates independence and does not increase staff task burden. Both staff and family enjoy the garden room and activities within this room gives way for staff and family to interact, communicate and engage in meaningful activities with the residents. It should be noted that the studies discussed in this paper mainly used participants suffering from Alzheimer’s

CONCLUSION AND DISCUSSION Residents from the Anton de Komplein suffer from vascular dementia, 22

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American Journal of Alzheimer’s Disease and Other Dementias,

disease and might therefore not always be generalizable to the target group discussed in this paper. However, more often Alzheimer’s Disease and vascular dementia are seen as two extremes on the same dimension (Handboekdementie, 2009; Kalaria, 2002). Patients often suffer from symptoms related to both Alzheimer’s Disease and vascular dementia.

19, 239 - 242. Hernandez, R.O. (2007). Effects of therapeutic gardens in special care units for people with dementia. Journal of Housing for Elderly, 21, 117 - 152. Jarrott, S. E., Gigliotti, C.M. (2010). Comparing responses to horticultural-based and traditional activities in dementia care programs. American Journal of Alzheimer’s Disease & Other Dementias, 25, 657 - 665. Jonker, C., Sleats, J. P. J., &Verhey, F. R. J. (2009). Handboek dementie. Houten, BohnStafleu van Lochum. Kalaria, R. (2002). Similarities between Alzheimer’s disease and vascular dementia. Journal of the Neurological Sciences, 203 - 204, 29 - 34. Lee, Y., & Kim, S. (2008). Effects of indoor gardening on sleep,

Brawley, E. C. (2002). Therapeutic gardens for individuals

agitation, and cognition in dementia patients-a pilot study.

with Alzheimer’s disease. Alzheimer’s Care Quarterly, 3, 7 -11.

International journal of geriatric psychiatry, 23, 485 - 489.

Chapman, N.J., Hazen, T., &Noell-Waggoner, E. (2007).

Stigsdotter, U.A., &Grahn, P. What makes a Garden a Healing

Gardens for people with dementia. Journal of Housing for

Garden? American Horticultural Therapy Association, 60 - 69.

the Elderly, 21, 249 - 263.

Thelander, V.B., Wahlin, T.B.R., Olofsson, L., Heikkilä, K., &

Csikzentmihalyi, M., Harper, & Row. (1990). Flow: The psychology

Sonde, L. (2008). Gardening activities for nursing home

of optimal experience.

residents with dementia. Advances in Physiotherapie, 10, 53 - 56.

Diaz-Moore, K. (2007). Restorative dementia gardens. Journal

of housing for the elderly, 21, 73 - 88. Graham, N.L., Emery, T., & Hodges, J.R. (2004). Distinctive cognitive profiles in Alzheimer’s disease and subcortical vascular dementia. Journal of Neurology, Neurosurgery & Psychiatry, 75, 61 - 71 Grant, C. F., &Wineman, J.D. (2008). The garden-use model. Journal of Housing for the Elderly, 21, 89 - 115. Heath, Y. (2004). Evaluating the effect of therapeutic gardens.

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We know that because of their age of 70 and older they can have other health conditions in the mix that also gives the residents the difficulty to move or have initiative to do so. We have received from them documents of their “Moving plan” and “Moving Policy”, so both letting us know what activities are already being done with them and what they want out of them. THEY FOCUSED ON 1.

Daily movements – things normally done on your own like taking care of yourself (hygiene), cooking and other homes like chores folding cloths and go shopping.

2.

Moving activities a. Indoors –activity at the table like reminisce box or passing the ball, dance to music, drum group and walk group gym group. b. Outdoors –Visit the market, the park. 26

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Studies: Inter-Architecture

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Natascha Oduber

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VISITING THE SITE WE ENCOUNTERED SOME PROBLEMS THAT WE CAN WORK ON. • The corridors end in a dead end so there is no flow for walking and is not that stimulating. We could see forehead marks on windows or doors at these points. • Some unused spaces like balcony area, beautiful space that if worked on can have many uses in activities. The space can be also for sitting and enjoying the sum mer breeze and like many times reminisce. I have this close to me because that is what many people like my families do to pass the time search for a nice place like a garden or balcony sit and have a good time. • Some areas need a more stimulating envi- ronment, like the entrance and the corridors. They can have more of that home feeling and could use the tiles or a haptic wall, or a change when walking to and from a spot. • Lack of skilled staff and volunteers, due to financial restraints. The design can make it easier to work around this problem. By

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having things in the same room as an activity or having the design is portable, that it’s capable to have active residents even with small staff. • Physical and psychological limitations, there is 25 residents, 13 of them are in dependent when walking, 12 that’s need variety help when standing or walking and 3 residents that can’t stand. This also connects to the dead ends and loss of initiative.

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We came up with the problem definition of “The environment (time, skill, people, and space) does not provide sufficient stimuli to invite the residents to be active, in ways that would benefit their wellbeing.“ So we hope to the change or improve the environment that can help them with the problems of the time, lack of staff, and the space not being stimulating enough. Having an outcome that can have the residents be active and help slow down the dementia process and also give them happy life, enjoying with family and friends.    


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Dimitra Chrysovergi

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Humanizing long-term dementia

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Dimitra Chrysovergi

KRAKA E SEWA “Kraka e Sewa” = “Support and Care” Is a small center (part of a bigger organization “Cordaan”) that hosts 25 Surinamese patients in different stages of Vascular Dementia. They provide activities like crafts and physical exercise in a weekly base with lot of potentials to enrich. Residents have the opportunity to get out of the center only with 1 to 1 supervision of a volunteer , fact that is not often possible. The environment feels stark, evidences of institutionalization can be sensed and home-like attributes could be enhanced. EXAMPLES AND ALTERNATIVE PROPOSALS This are the common spaces between the living areas (lounges) and the private rooms. The home-like feel is absent. Some (eatable) plants could add a lot to the environment as well as furniture and 30

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wooden tables with many comfortable chairs and couches but still with lot of potential for incorporating music and activities. One of the most important issues is the lack of a coherent circuit. Every floor has two corridors reaching dead ends. At the same time balcony is abandoned and access is denied due to danger. As a result we see resident’s frustration as skin marks on windows. A “green wall” could turn the balcony to a functioning space offering clean air and activities. Creating a circuit. Patio heaters can assure usage the hole year. By adjusting eatable plants and by creating a big cage for birds we create activities and generating flexibility and therefore movement.

pictures. The glass next to the door can be enhanced with semi-transparent images of nature. The training elements (like balls and stretching objects) could be on display and free to use. The corridors are decorated with painting of the residents but I doubt if by the time they still have an impact on the residence, due to loss of memory. I would suggest images from Suriname where patients could relate to them more strongly. Moreover I observed the lack of supporting railings that would invite people to walk with a feeling of safety. Cultural elements should be in access and not staffed few centimeters of the ceiling. Strange objects may cause confusion and is better to avoid. Due to specific circumstances I don’t have an insight of the private rooms, as well as photographic documentation of the “lounges” where the people mostly spend their time. The environment there was more close to home due to more natural colors, orange floral curtain, long

PANIC DESIGN FOR A VIVID GREEN WALL. The lack of staff in addition to busy timetable of the existing staff results to the involvement of unqualified persons in the 32

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care of the patients. All that concludes to a general lack of empathy, vital ingredient for such a center to run. More empathy from the staff required (through training) as well as autonomous designs which will ease staff’s daily work. CONCLUSION There can be detected many impediments in the established Dementia center, but interventions designed to humanize care facilities will be suggested and test. Music, Art, Plants and Animal therapy seems to be the keys for a long term facilities to provide support, selfmanagement and control, to the residence. Smoothen the experience of the disease and delay its progress is the ultimate goal.

http://www.health.vic.gov.au/dementia http://www.who.int/en/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC181170/#!po=45.5556 http://www.altro.co.uk/Sector/Health-and-social-care/Dementia http://www.helpguide.org/articles/alzheimers-dementia/dementiaand-alzheimers-care.htm

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Case #2: GP Clinic Bureau Studentenartsen

The large GP Clinic Bureau Studentenartsen, located in the city of Amsterdam, stumbled upon the large number of students suffering from concentration problems. They asked this group to dig into the issue of concentration of students and design possible solutions for it.

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INTRODUCTION

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Cherie Cheung

very little to do with acquiring knowledge and receiving education, i.e. indulging in love and relationships, making money, having fun etc - students who question the ultimate purpose and effectiveness of the education system and therefore have a hard time making effort for anything related to school - students who have very low resistance to temptations that would hinder their study progress: internet, TV, nap time, food - students who cultivated an unhealthy lifestyle: fast food, little exercise, little sleep, alcohol, drugs

The case of our group is “How could we reach and help students with attention problems?”. In general, “attention problem” by definition is a decreased ability to focus ones thoughts on something. However, our group tried to reach a more specific definition of ‘attention problems’, since they can come in very abstract and diverse forms. We all agreed that students can lack focus ability due to various reasons and their attention problems can also be very personal and unique.

METHOD

SOME COMMON EXAMPLES OF REASONS FOR ATTENTION PROBLEMS WOULD BE:

After having done a series of discussion and research on the topic, we have come up with four factors that are fundamentally linked to concentration problems: Health, Environment, Technology and Motivation. Based on the four factors, our team has developed a questionnaire specially

- students who chose their studies according their parents’ / friends’ expectations would have low incentive to actively pursuit their studies - students whose sources of happiness has 38

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for university students. The purpose of the questionnaire is collect first-hand information for our group to look in depth into a students’ life. From that we hope to find out common (or different) problems / habits that they have during their studies and to reach a potential solution that can effectively help improve their situations. There were 23 students who participated in the questionnaire.

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stressed drags focus down even further. Researchers at the University of WisconsinMadison found that meditation can serve as a relaxation technique to increase ability to block out distractions. Regular exercise can keep one’s mind sharp and increase learning and memory capacity. Sweating from exercise can further help burn off the extra energy that causes to feel fidgety, and it can contribute to better sleep at night.

HEALTH To start with, missing out on sufficient sleeping hours will result in having difficulty managing daily tasks. Lack of sleep or low quality sleep can make students wake up unrefreshed, suffer from constant moodiness, fatigue, and eventually have attention issues. Stress can also drain a student’s concntration level. It competes with the cognitive centers - the areas in the brain that are responsible for quick, sharp thoughts. Therefore being anxious or

ENVIRONMENT A versatile study environment is very popular nowadays. Students do not desire for a static study space, but a mobile one. The accessibility to their own desks, as well as that to the community spaces and a wide range of facilities (concierge services, café, snack facilities, different furniture etc). A collaborative working environment with additional breakout spaces in the same environment is also an effec40

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more multitasking a person try to do, the harder it is for the person to stay focused on any single task.

tive study space. Studies have shown that changing working / studying environment from time to time will help boost energy and attention for completing tasks.On the other hand, when the brain is not functioning properly, it’s impossible to bounce from task to task without being easily distracted by thoughts or background activities.

MOTIVATION Things work out the best when students feel happy and productive about their studies. Sometimes it’s possible to be less motivated when dealing with monotonous tasks, and that’s completely normal. However when a student is consistently unable to focus on projects and tasks, there are usually underlying causes that are killing the motivation. Personal interest is a big factor when it comes to students’ motivation. There are some students who are hardly ever interested in what they study to begin with, hence the constant lack of concentration / commitment. There are also students who study what they had found interesting, but eventually find out things are out of their expectations, and start feeling

TECHNOLOGY In recent years a trend has formed where overload technology is making a profound impact on people. Especially the rise of smart phones / iPads and apps provides a lot of escape and entertainment that interrupt concentration. On top of that, the fact that those devices are made to be extremely light and increasingly easier to carry around suggests that temptations are following the students everywhere. It is not uncommon to see students tapping on their phones during their revision. However, research shows that the 42

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less motivated. Students who immensely love what they study can and will fight their way through all the hardships. http://www.healthgrades.com/symptoms/concentration-difficulty http://www.humanities.manchester.ac.uk/studyskills/organising/ psych_factors/concentration.html http://www.johnsoncontrols.com/content/dam/WWW/jci/be/global_ workplace_innovation/oxygenz/Netherlands_Oxygenz_Report.pdf http://www.scientificamerican.com/article/three-critical-elementssustain-motivation/ http://blog.pickcrew.com/the-science-behind-fonts-and-how-theymake-you-feel/

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Studies: Inter-Architecture

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Au Kwong Ming

Studies: Inter-Architecture

Inside out study environment

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Au Kwong Ming

Most Students understood that they have an attention problem, especially doing a book reading and doing uninteresting thing. Some students do not consider the problems, but, other students tried to do something to improve their concentration problem. Such as studying in study room, although it still cannot help them improve their problem because of the external factors (Social media and laptops are an obstacle for concentration). They would like to find different spaces of levels of sound. Such as home, study room, library and coffee shop. Depends students’ personality. One student said studies in a suitable environment rather than quite space. Furthermore, maintaining good relationship with people is very important, because their families or friendship sometimes cause the problem that affect their studying mood. Also, Students with a clear goal/motivation feel they can bring up better discipline because they know why they are studying and they are intrinsically motivated. 46

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Au Kwong Ming

Studies: Inter-Architecture

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Au Kwong Ming

FOR THE ABOVE ANALYSIS, I HAVE DEFINED TWO MAJOR ELEMENTS THAT MOST AFFECT STUDENTS. Soft element: (Relationship) Students are lacking in social circulation and have a very few or no friends to discuss their feelings and problems. As such, they are easily susceptible to stress related problems; such as, Examination Phobia or Test Anxiety due to Peer Pressure and high expectations of the parents. Hard element: (Environments) In our research, we understood that different levels of sound, lighting can attract and improve students’ concentration. Such as Study room, coffee shop, Green Park where mostly separate at different locations. Although we got only 17 answers, I think that a significant and important problems should easy to find in our life. Even we know most of the students who are attracted by modern technology, students with attention problems depend on the situ48

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Au Kwong Ming

Studies: Inter-Architecture

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Au Kwong Ming

http://www.ncld.org/types-learning-disabilities/adhd-related-

ation and the students’ condition. Therefore, I would like to focus on different studying spaces to coordinate with different kinds of students. As we know, our cities existed different kinds of public places for students studying, but we are lack of a study environment and atmosphere for study. Students do not know which space is suitable for them at that time. In my perspective, the design should be concerned about different kinds of atmospheres lighting, colour, sound, human density and a mobile phone signal of study spaces that already designed by other people. In order to provide various spaces to improve Students’ Attention Problem, we have to do more analyses for different kinds of spaces and basic on the spatial qualities to connect these spaces together.

issues/adhd/attention-learning-problems-when-you-see-one-lookfor-other http://repository.tudelft.nl/view/philips/uuid%3A720cf2c55de1-4b66-ae5b-d42f601ce65d/ http://well.blogs.nytimes.com/2012/04/16/attention-problems-maybe-sleep-related/?_php=true&_type=blogs&_r=0 http://www.readingrockets.org/article/15-strategies-managingattention-problems http://studentconcentration.com/ http://well.blogs.nytimes.com/2012/04/16/attention-problems-maybe-sleep-related/?_php=true&_type=blogs&_r=1 http://www.techtimes.com/articles/6481/20140506/whats-wrong-ivyleague-university-students-use-adhd-drug-to-succeed-in-exams.htm

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Case #3: GGZ inGeest An Amstelveen based laction of GGZ inGeest, the specialist mental healthcare institution, offers day care to psychiatric patiens. As the location faces a more severe patient population combined with limited resrouces, they asked the students to think about how the ward could be designed to promote more human patient-centered care.

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Studies: Inter-Architecture

Insight Series #8 Hacking Healthcare

Fréderique Albert-Bordenave

Studies: Inter-Architecture

Humanizing hospitalization of people with severe psychiatric problems

Insight Series #8 Hacking Healthcare

Fréderique Albert-Bordenave

GGZ inGeest is an open ward located in Amstelveen, specialized in short term crisis intervention care. Anxiety disorder, depression, bipolar disorder and psychotic disorders are the type of mental illnesses the institution is treating. The desire to humanize the psychiatry ward is prominent and palpable. Built fifty years ago, the ward is no longer reflecting the way the patients are currently being treated. In that sense, it is noticed, “As they build, the people who design and run psychiatric facilities still put their ideas of how to care for patients into the very walls of their buildings. Over the last two decades, the design of new psychiatric hospitals and new psychiatric wings of general hospitals reflects the emphasis on recovery, shorter stays, and the patients’ role in their treatment.”1 The research process towards that humanized environment involved interviews in the ward with even patients, one former patient, the head of the ward, and multiple 54

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Fréderique Albert-Bordenave

Studies: Inter-Architecture

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Fréderique Albert-Bordenave

members of the staff (two interns, two nurses and a creative therapists), which led to different perspectives and opinions on the ward. The following open questions were asked to every person interviewed: 1.Where do you spend the most time in the ward? a. What do you of this space? b. When are you there during the day? c. What do you think of when you’re there? d. Who else is there? e. Could you tell me something more about that place?

3. What do you do during the day? Do you have any examples? To identify the problematic, the interviews highlighted the lack of in-group communication and the conflicting views and desires. However, the assessment of the space could spoke for itself through the discomfort, the chaotic setting, the difficulty of access and the ambiguity in purpose. The creations of a chart (Figure 1) depicting the common and recurring themes gathered in

2. Senses a. What do you see there? b. What do you hear there? c. What do you smell there? d. What do you feel there? e. What do you taste there?

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the interviews and in the observation of the ward, and of drawings of the wards helped get a clearer understanding of the situation and to conciliate the different needs. Inside the ward, you can’t help but notice the corridors. They are inevitable and omnipresent. The ward is comparable to a rectangular maze of corridors, enhancing the feeling ofconfinement. In fact, those corridors experience a large amount of traffic from patients, staff and visitors. However, after acknowledging comes understanding. More precisely, to understand the social and historical implications that corridors can carry and the effect on the way humans function in the healthcare environment. In this context, the corridors work as intermediate spaces, which serve as guidance, meeting and exchange points for everybody who happens to be in the ward. Narrow, long and convoluted, they induce feelings of oppressive confinement, as an isolated navigation device. 58

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Studies: Inter-Architecture

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Fréderique Albert-Bordenave

Studies: Inter-Architecture

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Fréderique Albert-Bordenave

Picture 1 Corridor in the ward Picture 2

The research process led to multiple Wednesday mornings spent at the GGZ inGeest. As an outsider to the ward, the regular visits allowed to catch glimpse of everyday situations and interactions. One specific moment particularly struck me. It was around 11 AM, a Wednesday. I was waiting in the corridor for two patients to get prepared for the interview, and in the living room, a patient was crying. Being in shared spaces including the living room, the corridors, the bathrooms and the television rooms, there is no other possibility than to retreat in a bedroom to avoid or escape such scenes. You couldn’t help but be a part of that scenery, because of the lack of private spaces. The patients are faced with two quite radical and opposite options: either the reclusion of their privacy or the unpredictable environment that the public life provides. In that sense, “providing day rooms and other shared spaces with movable seating, for example, gives patients the ability to control their personal

Shared space that serves as one of the two television rooms Picture 3 Private space that operates as a patient’s bedroom

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space and interactions with others.”2 Frank Pitts, architect of architecture+ makes an explanatory comparison of the private and public areas in psychiatry architecture: The “house,” in this case, is the patient’s room, a place of comfort and familiarity, Pitts told Psychiatric News. When ready, the patient can move from the bedroom to a seat just outside the door (the“ neighbourhood”), to places farther along the hall, and to more open shared spaces. The “downtown” may include the treatment areas, gift shop, or other common areas.” 3 Going back to the moment of the patient crying, I can’t help but wonder if the reason of my discomfort was the sight of someone being upset, or the nature of the environment where it was happening. George Hadjimichalis, the Greek artist who transformed the Greek Pavilion at the 2005 Venice Biennale in a hospital said: “The hospital is a paradoxical space; it is within society and plays a very important role in it, yet at the same time it is outside it. People

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Fréderique Albert-Bordenave

change identity once they are admitted as patients or when they enter it as relatives or friends. As space itself referential rather than related with the outside world, so it’s a closed circuit.” However, the ward should act as a springboard toward rehabilitation to independent life. Richard Lippincott, M.D., a professor of psychiatry at the University of Arkansas for Medical Sciences supports that statement: “A psychiatric hospital should recapitulate a real community in which patients will live after treatment. You make the inside represent the community outside.” 1,3 Aaron LEVIN. Psychiatric Hospital Design Reflects Treatment Trends. Psychiatry News, January 19, 2007. 2 Roger S. ULRICH. Designing for Calm. The New York Times, January 11, 2013 

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Sharon van den Bosch

Studies: Psychology

Which domains play a part in the conflict between views and desires from patients and staff?

Insight Series #8 Hacking Healthcare

Sharon van den Bosch

RESULTS FROM SCIENTIFIC BACKGROUND Different studies show which domains play a part in the conflict between views and desires from patients and staff. Different aspects of satisfaction and the cooperation seem to play a part in the conflict between views and desires from patients and staff. Research suggests that patients and staff have different perceptions of the psychiatric ward environment. In one study they examined the influence of patients’ and staff’s perceptions of the psychiatric ward ambience on the satisfaction of patients and staff. To examine this question, patients and staff had to fill in the WAS (Ward Atmosphere Scale) and the WES-10 (Working Environment Scale). The results shows that staff had a higher score on the WAS than patients. Satisfaction of patients was correlated with the WAS score of the patients, but not with the WES-10. This 64

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concludes that different aspects are important for the satisfaction of patients and staff. For the staff the working environment is strongly related to their satisfaction, but for the patients this seems to be unimportant (Rossberg&Friis, 2004). To optimize clinical wards there has to be a design that improves not only the satisfaction of patients, but also the satisfaction of the staff. Altimier (2004) suggests the introduce of healing environments. An healing environment is a care institution that is designed to improve the comfort of the patients and the staff. Natural lighting, soothing colors, views of nature and interaction with family seem to improve healing. Healing environments not only enhance healing of patients, but also enhance the satisfaction of the staff, retention and morale (Altimier, 2004). According to a systematic review not only natural lightning and views of nature, but also odour(taste) and seating arrangement affect the well-being of patients (Dijkstra, Pieterse&Pruyn, 2006).

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Sharon van den Bosch

In addition, bad team cooperation plays a part in the conflicting views and desires between staff members. According to Katzenbach and Smith (1993) an effective and coherent team is a small group of people with complementary skills who have a common goal, concrete performance goals and a approach in which they are jointly accountable. If staff members do not discuss, decide and work together, it’s not a team. In this case, staff members are more likely to have their own visions instead of a joint vision. This could result in conflicting views and desires of staff members (Katzenbach and Smith, 1993). CONCLUSION Our empirical research shows that three domains are playing a part in the conflicting views nd desires between patients and staff in the psychiatric ward in Amstelveen. Firstly, there are conflicting views and desires of the comfort in the 66

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Studies: Psychology

ward. Secondly, there are conflicting views and desires of the identity of patients and staff and the interaction between patients and staff. Thirdly, there are conflicting views and desires of the aesthetic and decoration of the ward. In addition, scientific background shows some other domains that play a part in the conflict between views and desires from patients and staff. However there are some critical points about these findings. One is that the empirical findings are from the psychiatric clinic GGZ inGeest in Amstelveen. This clinic could be different than other clinics. This means that those findings can’t be generalized to other psychiatric clinics. Another critical point is that more domains could play a part in the conflict between views and desires from patients and staff. For example, social aspects between patients and staff are not discussed in this essay. Social aspects could play a crucial part in this conflict. More scientific background is needed

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to find out if other domain also play a part in the conflict between views and desires from patients and staff. Altimier, L. B. (2004). Healing environments: for patients and providers. Newborn and Infant Nursing Reviews, 4(2), 89-92. Dijkstra, K., Pieterse, M., &Pruyn, A. (2006). Physical environmental stimuli that turn healthcare facilities into healing environments through psychologically mediated effects: systematic review. Journal of advanced nursing, 56(2), 166-181. Katzenbach, J. R., & Smith, D. K. (1993). The discipline of teams (pp. 111-120). Harvard Business Press Rossberg, J. I., &Friis, S. (2004). Patients’ and staff’s perceptions of the psychiatric ward environment. Psychiatric Services, 55(7), 798-803

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Studies: Social Sciences

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KC Chaviano

Studies: Social Sciences

Providing cohesive care: Humanizing the GGZ inGeest acute psychiatric ward

Insight Series #8 Hacking Healthcare

KC Chaviano

In the process of interviewing many people with various roles related to the ward, we gathered a diverse, and often conflicting, collection of perspectives. Our group was able to identify what we found to be three of the most significance issues for the ward related to our case problem of “humanization”: comfort, interactions among staff and clients, and aesthetics. COMFORT The issue of the comfort of the ward related to its utilitarian aspects was highly divisive in our interviews. More specifically, staff and clients had very different opinions related to elements of the ward related to the residents’ individual comfort, such as furniture, technology, and décor. Residents expressed a desire for more of a sense of coziness on the ward, closer in nature to a home setting. Staff, on the other hand, maintained that the ward should remain more of a clinical, hospital-like setting. 70

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KC Chaviano

Studies: Social Sciences

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KC Chaviano

Nearly every staff member expressed that the space should not feel too cozy, familiar, or comfortable in the interest of the clients’ wellbeing, lest they not feel motivated to get better and leave the ward.

to ensure client safety and reassurance, both the physical elements of the ward and behavior of staff did not foster this. As a result, the ward often has a chaotic, disorganized feel to it.

STAFF-RESIDENT INTERACTIONS

AESTHETICS

In our group’s experience of spending time on the ward and through interviews with patients, we came to recognize the problem of confusion related to staff and resident interactions. Patients consistently expressed to us that they could often not determine who was a staff member and who was a patient on the ward, a phenomenon that we as a group also experienced in our time at GGZ inGeest. Staff members do not have any sort of identifying clothing or uniform, and their nametags, while required, are not worn. While some staff expressed the importance of having physical and interpersonal closeness to patients in a professional capacity in order

While not necessarily emphasized as the most important element by all, the aesthetics of the ward came up in nearly every conversation we had with interviewees. The ward, with its all white interior, generic, office-like furniture, and haphazardly selected art pieces on the walls, was described as impersonal and sterile. There is no sense of a color scheme or aesthetic vision for the ward’s environment. Despite aversion to the element of comfort on the ward, staff often criticized the unappealing aesthetic qualities of the environment similarly to residents. Due to these findings, our group concluded that the overarching problem 72

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KC Chaviano

Studies: Social Sciences

faced by GGZ inGeest was an absence of consistent, methodical approaches to serving the needs of the ward’s residents as related to their engagements with the physical environment. This is to say, a consistent sense of purpose related to spaces on the ward was unclear, along with an impression of how patients should best engage with said spaces in order to best facilitate their healing process.

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KC Chaviano

to adapt and to self-manage” is extremely relevant to the care-related goals of a program like the one implemented by GGZ inGeest (Huber, et al., 2). In our consideration of a problem definition for this case, we aim to integrate this mentality into the ways the physical space can be improved for residents. This falls in line with an understanding that quality mental healthcare goes beyond merely providing appropriate medication, but also helps clients to develop “a strengthened capability to adapt and to manage…[to] improve subjective wellbeing and [allow for] positive interaction between mind and body” through developing coping and self-regulation skills (2).

DISCUSSION In their article How Should We Define Health?, Huber and colleagues discuss the need for healthcare providers to reconsider the definition of health, especially as providers increasingly must tailor their services to those with chronic or long-term illnesses. Additionally, Huber et al. describe health as multifaceted, focusing on social and mental conditions as well as one’s physical state. With this in my, this article’s focus on health as defined by “the ability

Huber, Machteld; et al.:How should we define health?, BMJ 2011;343:d4163

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Studies: Inter-Architecture

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Paz Ma

Studies: Inter-Architecture

The ambiguity of visual identity within GGZ inGeest

Insight Series #8 Hacking Healthcare

Paz Ma

The client GGZ inGeest is located at Amstelveen. It is an open ward and now offering seventeen beds to patients with severe psychiatric problems. With the help and guidance on every Wednesday by department manager Karin van der Kamp and a former patient the whole picture of the hospital is quite clear. At the first visitation, it was difficult to tell the difference between staffs and patients. The staffs used to wear name tag, but because of forgetfulness they are not doing it anymore. In the interviews with nurses, they admitted that in the beginning it is hard to start the conversation without knowing the name. and they do not feel comfortable about it. It takes a few weeks for the nurses to get accustomed to this situation. Besides, there are mysterious arrow signs in four distinct colors, blue, green, purple and to different directions without explanation. Only the pink one is with description saying ‘wachtkamer’ which means 76

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Studies: Inter-Architecture

waiting room in English. However there is no series of pink arrow to guide the visitors to the waiting space but just one posted in front of it. Even the tour guide, the ex-patient, does not know where the arrows are heading for. In my first experience at GGZ inGeest, the hospital was like a maze which consists of the same proportions. Without the guide, it was not hard to lost the orientation. Trying to get some help, but I could not recognize who were the staffs. Moreover, according to the observations and the interviews, I found that the visual identity in GGZ ingest is ambiguous and unclear not only for the visitors but also for patients and new staffs. Since the vision is the dominant of all senses, it is important to design an understandable sensory experience, especially the visual system. A clear visual between patients and hospital, yet a well-designed one will integrate the experience and the trustfulness of the space. 78

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Studies: Medicine

Insight Series #8 Hacking Healthcare

Phebe Kraanen

Studies: Medicine

Renaissance of the environment in the psychiatric ward in the 21st century

Insight Series #8 Hacking Healthcare

Phebe Kraanen

When listening to lectures about architecture and health (Hacking Healthcare), I kept on hearing that from about 20th century on the psychiatric hospitals were being moved towards the city and mostly lacked spatial design with a garden. Approximately in the past 10 years a new trend is rising in healthcare, we are reinventing the effect of the Healing Environment. (Raz Gross) In this essay I will describe the transformation in environment in mental healthcare that has led us to a renaissance. Noor Mens, a Dutch historical architect, describes in her book ‘architectuur van het psychiatrischziekenhuis’ (2003) how architecture in the psychiatric ward has developed itself from the 1750’s. During the end of the 18th century society started to realize that psychiatric patients could get health improved by the environment, locking up wasn’t the solution anymore. The wellbeing of the patient became a center point in mental healthcare, and so you could see in the design of the institutions. Different 80

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Phebe Kraanen

Studies: Medicine

visions established itself, ‘did the patient have to be in an institution out of town with nature, or in an urban context? Did the patient needed to be treated on a largescale or a small-scale?´. Patients were put into environments with a lot of nature during the 19th century, as nature seemed to improve mental health. The first sanatorium established in Germany in 1863, for TBC patients, shows the perception of nature and physical health. ( McCarthy ) In 1885 there was a mental Hospital built 22 miles outside rural London, designed for the middleclass. The idea for this prestigious project is well seen in this quote of Robert Mayo, an architecture researcher who participated in this project: ‘An asylum should be placed on elevated ground and should command cheerful prospects, should be surrounded with land sufficient to afford outdoor employment for males, and exercise for all patients, and to protect them from being overlooked or disturbed by strangers.’ ( Holloway ). They

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Phebe Kraanen

seemed to know what environment could do with mental health. Then the 20th century started. More patients were admitted then were being released, and it seemed patients didn’t improve fast enough. The problem of not enough space expanded. The answer to this problem was building new space, and tearing down the sometimes over a 100 years old majestic 19th century asylums, because of high maintenance. Due to specialization of drugs and therapy, the patients could be released sooner. The psychiatric ward became a drug focused place with no notion of the environmental knowledge. When visiting our case study of a psychiatric ward ‘GGZ InGeest’ in Amstelveen for the course ‘Hacking Healthcare’, we did our own empirical research by interviewing and observing for 4 weeks. Every time we visited we sensed a bit better how the place felt. To summarize the architectural part, it had an illogical furnishing and characterization of areas, no overview 82

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Studies: Medicine

on patients because of walls and no sense of comfort besides chairs and neglected plants. This building was built in 1996, right before a shift was made in the understanding of architecture and health. In the 21st century a shift started to take place. A new perception of environment, or should I say old one, slowly gained more attention. We became to realize how important we find the environment we work or live in, especially having to do with efficient improvement. We came up with the term Healing Environment. (Gaffry) So, what is a Healing Environment? In the article of ‘Healing environment of the psychiatric ward’, written in 1993, they argue architecture is a tool for the therapeutic process. As an example they take the Chaim Sheba medical center in Israel, designed by cooperation between psychiatrists and architects. The premises of this medical center allows ongoing interrelation and dialogue between the medical staff and that of the other wards. The patients are not

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Phebe Kraanen

overcrowded or over concentrated, they are not forced to interact with too many people. They are given the opportunity to retreat physically when they feel threatened, and to form beneficial relationships when they are able to. These beneficial relationships can form because of the variety of spaces that support social interaction, such as a big day room, a dining area that is well lit and ventilated, a spacious lobby and corridors. All this resembling a living room with residential furniture instead of commonly used clinically adapted pieces. In a study they found that a small number of patients spent their time near the open nurses station. Nurses often fear that patients will abuse their easier access if the nurses’ station is open. The data of this study (Whitehead) shows that openness of design may encourage staff to leave the station and spend more time in the day room, also doing maintenance in these areas. In the High & Intensive Care Criteria, put up in February 2014 by a small group of Dutch researchers, they focus 84

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Phebe Kraanen

Studies: Medicine

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Phebe Kraanen

Social structure and interaction processes on a psychiatric ward.

on a humanitarian treatment with safety and protection combined with respectful care in acute psychiatry. In mental institutions in Holland, like ours in Amstelveen, they are trying to slowly implement these criteria. One aspect of these criteria is the Healing Environment. The essentials of this healing environment are individual rooms with their own bathroom, a comfort room on the ward, a diversity in meeting spaces, an outside area, a family room, a time-out emergency bed for 24 hours, and an open station for the nurses. In the article ‘social structure and interaction processes on a psychiatric ward’ (1952), you read that the patient group researched sensed that they were cut off from playing roles in areas of life which furnished them with some measure of self-esteem, because of hospitalization. This finding is interesting for our Healing Environment in the psychiatric ward, should we maybe implement activities usable after discharge, in the design of the ward?

Caudill, William; Redlich, Frederick C.; Gilmore, Helen R.; Brody, Eugene R. American Journal of Orthopsychiatry, Vol 22(2), Apr 1952, 314-334. N. Mens, De architectuur van het psychiatrisch ziekenhuis, Wormer 2003 / Inmerc bv McCarthy OR (August 2001). “The key to the sanatoria”. J R Soc Med 94 Papers of George Martin-Holloway Royal Holloway, University of London Archives Healing Environment in Psychiatric Hospital Design, Raz Gross, M.D., Yehuda Sasson, M.D., Moshe Zarhy, Architect, and Joseph Zohar, M.D., 1992 http://healtharchitecture.wikifoundry.com/page/20th+Century+ Mental+Healthcare+Architecture McCaffrey R Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida 33431, USA. rmccaffr@fau.edu Journal of Psychosocial Nursing and Mental Health Services [2008, 46(10):39-44] Results of the Consensus Conference on Fostering More Humane Critical Care: Creating a Healing Environment. HARVEY, MAURENE A. RN, MPH, FCCM; NINOS, NICHOLAS P. MD, FCCM; ADLER, DIANE C. RN, MA, FCCM; GOODNOUGH-HANNEMAN, SANDRA K. RN, PHD; KAYE, WILLIAM E. MD, FCCM; NIKAS, DIANA L. RN, MN, FCCM, 1993, Copyright 1993 American Association of Critical-Care Nurses Whitehead CC, Polsky RH, Crookshank C, Fik E: Objective and subjective evaluation of psychiatric ward design. Am J Psychiatry 141:639–644, 1984 Werkboek HIC, High en intensive care in de psychiatrie Tom van Mierlo, Frits Bovenberg, Yolande Voskes, Niels Mulder druk 1 | paperback | juni 2013 Uitgeverij De Tijdstroom

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Case #4: AMC: Cardiology department

The cardiology department of the Academic Medical Center (AMC), one of the largest hospitals of The Netherlands, offers integrated patient care, and conducts fundamental and clinical scientific research. Among other things, mechanisms behind obesity are being studied. The AMC requested the students to think about how an artistic approach could contribute to preventing or treating obesity, for example by subsituting food by art.

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Iris Christine Mikulic

Studies: Medicine

Tipping the scales: Childhood obesity

Insight Series #8 Hacking Healthcare

Iris Christine Mikulic

THE PROBLEM Obesity is not only a problem in the U.S. as obesity has also become a problem in Europe and mainly in Eastern and Southern European countries. Nonetheless, obesity is also an issue in the Netherlands and the prevalence of obesity has particularly increased in those with a relatively low educational level. (Seidellet al, 1995) Not only does obesity have many health-related consequences such as increased risk of cardiovascular disease, diabetes and cancers but it also has physiological and social effects. These effects range from depression, anxiety, low quality of life, low self-esteem, body dissatisfaction but also less friends, lower education attachment and lower employment. This also holds for children who are obese. In fact, the amount of children with obesity is also increasing and according to Richard Strauss obesity affects children´s self-esteem immensely and especially females. He mentions in his 90

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Studies: Medicine

article Childhood Obesity and Self-esteem that ‘’obese children with low self-esteem demonstrate significantly higher rates of sadness, loneliness and nervousness and are more likely to engage in high-risk behaviours such as smoking or consuming alcohol’’. This is only one of the reasons why obesity and in particular childhood obesity are big problems in modern society and healthcare. Therefore, it is crucial these problems are analysed in order to come up with possible solutions to decrease the amount of people and children with overweight.

Insight Series #8 Hacking Healthcare

Iris Christine Mikulic

thing we discussed in our group. In order to understand why people get obese we brainstormed about the different causes and this resulted in the formation of a web (see figure 1). Some of the causes could be biological but we decided to exclude these cases from our research as we will primarily focus on obesity that is causes by psychological, social and cultural factors. Furthermore, what we discussed was the importance of environmental factors and the socio-economic status of the person. Socio-economic status proves to be an important factor and according to Sobal and Stunkard “a strong direct relationship exists between socioeconomic status and obesity among men, women, and children’’. We learned more about this in the interviews with the experts.

CAUSES OF OBESITY Some people are emotional eaters. Others might eat out of boredom. There are also a few who just do not know what healthy food is and therefore reside on fastfood as their food-intake. In short, there are many different reasons why people with obesity become obese. This was the first

RESULTS According to the articles of Marks (2004), is successful weight loss achieved by the combination of motivation, physi92

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Studies: Medicine

cal activity and caloric restriction. In order to maintain weight loss, lifetime awareness is crucial in balancing caloric intake and energy expenditure. Mr. Coronel in fact mentioned that the key to losing weight is reducing food intake and exercising more. There are truly no other natural methods to shed off pounds and he mentioned that this should remain the chief focus of our research. However, he told us that we should find a way to increase the motivation of people with obesity. We could find a way to create this motivation by using creativity and art. This could range from letting people with obesity paint, make music or dance. The way in which we would do it would not matter as long as we would be able to get to the root of the problem. The other expert, I talked to was Ms. Langkemper. She stressed the importance of tackling the problem by involving the whole family. She namely believes that it is important to involve the whole family in order for weight loss to be

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achieved by the child. This means sitting together and analysing the cause of the issue. She told me that it is usually parents/ caregivers that experience guilt, the lack of control and/or knowledge of healthy food that causes the children to become obese. Therefore, it is important to re-educate the whole family. Additionally, she mentioned that the process of losing weight takes around two or three years but this can of course vary between each case. It is a step by step process which results in the most success if the child is not gaining weight but its resting at a stable weight. Furthermore, ms.Langkemper stressed the importance of self- awareness in the process of weight loss. This means that in order for an older child to really start losing weight, he or she needs to understand him or herself the importance of eating healthy and exercising. So again motivation is crucial in initiating and sustaining weight loss. Furthermore, ms. Langkemper talked about the cultural background of many children. Namely, most 94

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of the children that come to her are from Turkish, Moroccan or Surinam origin. Their parents have sometimes different beliefs about weight for instance being overweight is actually healthy. Furthermore, they might be afraid to let the children play outside which could contribute to the weight-gain in the children. Therefore, we believe that it is important to use cultural factors in our approaches.

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INTERVIEW QUESTIONS EXPERTS Q: How do you approach a sensitive subject (obesity)? Q: How do you think the patients feel about their condition? Q: Why do obese people come to you? What are they seeking to accomplish and how? (this may seem like a simple question but sometimes the problem is more than simply losing weight) Q: What do you think the core of the problem is in obesity? Are there criteria/ variables that need to be fulfilled? And what do you think the solution is? What is your role in helping alleviate this disease?(e.g. Do you believe in fast solutions/gastric bypass, or is it more psychological/ingrained) Q: How does obesity start? Is there a vicious cycle? Q: Are there different kinds of obesity? Or differences in their personality? are

Graham-Pole, J. (2001) The Marriage of Art and Science in Health Care. The Journal of Biology and Medicine. Vol. 74, p.21-27 Marks, J. (2004) Obesity in America: It’s Getting Worse. Journal of Clinical Diabetes. Vol.22, no. 11-2 Must, A. and Strauss, R. (1999) Risks and Consequences of Childhood and Adolescent Obesity. International Journal of Obesity. Vol. 23, p. 2-11 Webster, S. (2005) Art and Science Collaborations in the United Kingdom: Perspective. Nature Reviews Immunology. Vol. 5, p. 965 Seidell, J.C., Verschuren, V.M. and Kromhout, D. (1995) Prevelance and Trends in Obesity in the Netherlands 1987-1991. International Journal of Obesity and Related Metabolic Disorders. Vol. 19, no. 12, p. 924-927 Sobal, J. and Stunkard, A. (1989) Socioeconomic Status and Obesity: A review of the Literature. Psychological Bulletin.Vol . 105 no. 2. p. 260-275 Strauss, R.S. (2000) Childhood Obesity and Self-esteem. Journal of paediatrics . Vol. 105, no.01

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there different subgroups of obese patients? Q: How do you think successful ex-obese people achieved their goal? (insist on psychological aspects and not gastric bypass patients) Q: What do you think causes relapse? Q: What do you think the role of friends/ family is? What do you think is the best thing for family to do is? (Bring association diagram and other potential ideas and ask for constructive criticism)   INTERVIEW QUESTIONS PATIENTS Q: Are you willing to share your story? Q: What kind of things have you tried to tackle obesity? Did it work? Why/why not? Q: Growing up, what did you learn about food (in specific, what is considered as healthy eating)

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Q: When did you decide to take action and why? Q: (for ex patients) what made you succeed? Q: How do the people around you (family, friends, society) affect your internal motivation? Q: What do you think about the people around you? Do you want them to act different? Are they supportive, if so how are they? Q: If you had any advice or had to explain obesity from your perspective to other people, what would you say? Q: How would you raise awareness on the key issues underrepresented in obesity? Q: What’s your passion in life? Does this affect your eating patterns? Q: (ask only when comfortable): What triggers you to eat? How do you feel after words? (do you feel guilty when you do?) 

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CONNECTING TO OUR FUTURE SELF

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us “on the spot” right before we are taking the next destructive step. Keeping in mind that the “damage” will come after, that we will be the ones who are going to experience it.

Every day we take decisions that contradict our natural way of behavior, we all have those moments when we do something which is completely distracted, irresponsible or even harmful. The question is why do we make decisions that we so often regret? It seems like we don’t have the ability to remember bad implications. For some reason we are not able to remember pain, we can’t recall how was it to be sick or how our last stomach pain felt like, I believe that this is one of the reasons we attend to make the same mistakes over and over again, we keep “harm” our selves by taking destructive decisions. Remembering and thinking of the past in relation to this problem is something we proved as not working. It might be time to rethink our decision making process. We always try to reconnect to our past memory, what if instead, we’ll create a new connection to our future self? A new bridge which will put

IS IT JUST A PERCEPTION OF TIME? We all live in a present reality. We live in the moment; this is the reality, as we know. Our perception of time based on what our senses able to recognize and our brain to process. We grow with the idea that we are never going to get old, or at least it’s impossible for us to put ourselves in this state of mind. When the moment arrives we are able to react, we can work with it and choose our path. Our basic instinct is to take the present for granted and the future as a recommendation – as an abstract idea which is hard to relate to. What if we could turn it around? What if we could create a system where the future is clear and vivid, when we almost can touch or feel it? 100

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Can we make it become part our instincts? Can we change completely the way we live by integrating the future in our present system?

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than immediate results, are among the most painful exertions of the human will.” Many times we are standing in a cross road, right before we are about to fulfill our desire something is stopping us, It might be our past experience or our future fear. The questions is what affect us the most, which one of them will determine our next step. 

OR ALSO OUR DEEP DESIRES? What is the role of desires in our daily life? Do we need them in order to keep being motivated or they just destructing us from our real goals? Often we experience a moment of temptation that we can’t resist. A moment, which makes us, goes against our instincts and do something, we usually regret. Our desires play a big role in our decision making process. We might understand the consequences of our actions but still go against it. More than that desires can keep us motivated in a very effective way, when we desire something out of an instinct most likely we’ll get it. As the 19th century English economist Nassau William Senior said, “To abstain from the enjoyment which is in our power, or to seek distant rather 102

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How could we satisfy appetite of people with obesity by subsitutes from food?

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PERSONAL THOUGHTS At first, when I realized that I am a part of the group that is studying Obesity, my approach to the matter was to reach obese people in a way that is more profound. In my opinion, obesity may occur due to genes, and of course choice of nutrition and lack of physical activity; but further than that, I think that the starting point of that vicious cycle is because of a certain mental state. I believe that if a person eats so much and so often, he keeps thinking about food constantly and obsessively. If a person is so preoccupied with food and eating, it is a sign of a void in his life. In my opinion, if the obese person was more motivated in life and dealt with a profession or a hobby that he is passionate about, he would be less obsessed with food. In the article A review of psychosocial pretreatment predictors of weight control it says: “A lack of motivation leading to poor adherence has been presented as a rationale for including MI in weight control programs and 105


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‘internal motivation to lose weight’ and ‘self-motivation’ have been identified as predictors of successful weight control.”2 INTERVIEWS After concluding my personal ideas about obesity, I attended interviews with specialists that shed a new light about the topic. In an interview with Kees van Wijk (Physician Assistant internal medicine at Slotervaartziekenhuis) he agreed that a lack of motivation and passion in life are an important factor in solving obesity, but according to him, a healthy nutrition in reasonable amounts and exercise are the key towards healing obesity. He suggested designing a healing space for obese people where the actions and functions that occur there will be separated. He explained that obese people are chaotic by nature, and mix activities in life. For instance, going to the bedroom in order to sleep, while in reality keep dealing with the cell phone or watching televi-

Figure above: Maquette Side View Figure below: Maquette Top View

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sion. The outcome will be lack of sleeping, which causes tiredness, which cause over eating in order to give the body and mind energy. He says that people confuse their needs because they don’t address them separately and deal with each need with its own solution. Another example is “Mindless Eating”. According to Kees, people keep eating while dealing with other things, and not focusing on the action, thus not giving their mind the chance to realize that they are satisfied.

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second floor, and in order to reach it the person will have to climb up the stairs. In order to reach the stairs, the person will have to walk in a twisted corridor that is built on a ramp. In the wall that separates the corridor from the living room, there are openings that will remind the person the long path he has to walk in order to reach the kitchen. Further ideas, were to place every room in the house in different heights, and ramps to go from one space to another. As a result, the person who lives there will be much more active than in a plain house which has no difference in levels. This design does not answer the aspect of functionality in general, but is functional to an obese person.

PANIC DESIGN While creating and thinking in the “Panic Design” session, I felt very motivated and clear towards the prototype idea. After discussing with Kees about a space that has total separation in functions, we had an idea to create a maquette that will represent that idea, but with further aspects. The idea was to create a house for an obese person, while the kitchen will be in the

1 - Prof.dr.ir. J.S.C. Wiskerke, Lector Foodscapes Amsterdam Academy of Architecture 2 - Lohman TG, Sardinha LB, Teixeira PJ A review of psychosocial pre-treatment predictors of weight control 

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Case #5: St. Lucas Andreas Ziekenhuis and Onze Lieve Vrouwe Gasthuis

The two Amsterdam-based hospitals ST. Lucas Andreas Ziekenhuis and Onze Lieve Vrouwe Gasthuis (OLVG) are in the process of merging. The heads of the orthopaedic departments would like to use this merger as an opportunity to redesign the experience of patients undergoing orthopaedic surgery. The students are asked to represent the “patient voice� in designing the operation room (or) lounge.

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I’d rather wait here – The orthopedic waiting room

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Waiting rooms are generally very much the same. You sit, and you wait, and if you’re lucky there might be an ok magazine to lay or hands on. The point is, a typical waiting room symbolizes passive waiting - and even if yes, you’ll have to wait, maybe the atmosphere and function could be focused on something else. In St Lucas the situation is like this, but there are now possibilities of changing it, of making a waiting room into something that symbolizes start, or change, something other than just passive waiting. It is important though to look at how a hospital is different from other spaces, like for instance the home. Especially for elderly people, it seems like aspects, that for someone like me can be quite annoying, for them are comforting. For example, I personally find a sterile hospital environment quite depressing, symbolizing institutional forces, a huge machinery in which you have nothing to say. We can’t prove it statistically yet, but the impression 113


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is that many people seem comforted by the feeling of this larger machinery just going on and on, because it signals routine and efficiency. Even I of course, am somewhat reassured by a building that does not look like a restaurant with doctors, but a place that signals that doctors know what they’re doing, that due to efficient routines, they know how to handle any situation (even if they perhaps don’t). I had a surgery for a broken collar bone some years ago, and my main concerns where of course not about the space, but getting the most professional help I could and being assured that everything worked. The typical boring, sterile atmosphere, I will conclude, in some ways are in a connotation of spaces. Many hospitals have similar attributes: the linoleum floor, long corridors, a regular lighting, white walls. These factors can be very important in recognizing it as a place where the job is to get patients better. Though, this doesn’t mean that a hospital

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has to be an unaesthetic function-box. I think all people are affected by aesthetics, even if they choose to not call it that. A breathing, harmonious space strongly affects your emotions and even your thinking a lot. A high roof for high thoughts, a bright room for brightmoods. A good hospital (design-wise), does not have to be only this efficient machine with straight and fast corridors, clinically white walls and furniture from the seventies, it could have many other references in it’s architecture, if some important attributes of the hospital is kept clear and understandable. I have an example of a more unorthodox hospital which is located in Järna, a few miles outside of Stockholm (picture 1, Vidarkliniken). Here the architecture bears some references to Gaudi and other creators of organic space. The patients are said to be quite happy staying here. It’s though important to mention that they often stay longer and have, sometimes, 114

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severe conditions. It makes the hospital function as both a medical center, but also a residence. Personally I feel that this atmosphere is too connected to the Rudolf Steiner society, which is profound in Järna, to really feel like it is a serious hospital. Still, if it was a bit more balanced, I think it could be a good example of architecture that focuses on the spatial and aesthetical aspect of well-being. A hospital that maybe better keeps the balance in it’s appearance, of functionality and aesthetics, is the Malmö University Hospital (picture 2). My associations with cheerfulness and optimism do not get circus-like exaggerated, but stays within an interpretation of serious work going on inside. To get back to the planned-to-be waiting lounge we’re to design, my personal belief is that this space is very suitable for a “larger-than-hospital” experience, however still related to the procedure that the patients undertake, and not disturbing

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them in their trust for the system, and so forth. The patients themselves, according to our interviews, say that the now existing waiting room is where they can go for a more non-hospital atmosphere, a more home-resembling experience. Though, that will not say that the existing space is really warm and harmonic, it’s just a bit different from the rest of the hospital. My personal view on the project, which we also at large share in the group, is on the possibilities we have of creating a waiting area with a different function than waiting, and to differentiate it from the rest of the hospital space. Thus it can in a higher degree be associated with positivism and activeness, rather than passive boredom. It can also, through a different appearance than the rest of the hospital, function as a “center” in a sense, which makes the orientation in the whole building easier. One idea that I had, which we discussed in the group, was to make the waiting room into some sort of library 116

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1.

(though unclear if it would function exactly as one, but one could maybe have a filial of a medical library) where the patients can find books, films and other information on their medical condition and the treatment of it. An issue that came up in the group to focus on, was to give an invitation to the patients to participate more in the procedure they undertake, to know how things work and what they could do to improve their situation. The library idea was a response to that. We also discussed that patients also could write in books themselves, on tips and tricks, what to know etc, that other patients could read later and benefit from. Importantly, this should not be seen as demands on the patient, but options for those who want and are able. Some for instance, might be on too strong medication or too nervous to participate in this way. This is a strong factor to take in to the design, that comfortable and a psychologically supportive environment is the frame for the concepts that come up.

MalmÜ city library 2. Vidarkliniken, Järna

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4 & 5. Renderings of lamp-concept Concept/mood sketch on library/home atmosphere as differentiation to the rest of the hospital, including the idea of giving patients options to

Another approach to concepts that I took, was the idea of maybe playing with lighting, collecting old lamps and reassembling them in different ways, to make the space more cheerful and signal possibility, and also connect it to the ease of the home (picture 4 & 5). A conclusion we’ve all come to, is that the project has good possibilities of bringing in new concepts which are up to us to consider reasonable.

inform them3. Malmö University hospital

selves about the process they’re undertaking. (below)

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Salie van der Wal

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Salie van der Wal

I see, for example, a long pathway with a handrail which leads to a waiting room. Also a wall which results in uncertainty of what the space behind is composed of. It remains unpredictable and mysterious (figure 1).

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Salie van der Wal

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Salie van der Wal

In the space itself I see a colorful wall which the patient may use to hide himself from being noticed by passers. The mysterious curvy shape stimulates and invites you to look at it from all sides (figure 2,3). I see a space in which out of a sudden objects can grow from the walls. I see, instead of screens on the walls, a screen on the ground with clouds. From a computer patients may write their own stories for these screens (figure 4). 124

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A large gate, which I draw after having read a book about triumph arcs, is colored blue. The orange square planes, which are already present at the floor of the Sint Lucas Andreas Hospital are connected to the waiting room. I slowly reduce them as a shape of perspective, a route towards an open space (figure 5).

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Yaniv Schwartz

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Home of sick

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A rough translation forms the Hebrew word- Hospital. Point up a need to rethink the way we precise hospitals and the concept of a patient. For centuries the idea of a patient remained the same, a person who need to be treated in order to “fix” a physical failure. A passive approach from the penitent side and an active one form the health care provider. A quick overview on the process chain of health care revel a disturbing scenario. a dictatorship like approach. The patient located in the bottom of the pyramid, waiting to be directed by the health care providers. The patient doesn’t understand the process or the possibilities, his knowledge is limited and therefore he is not in a position to question it. In other words “who will guard the guardians?”, we should ask ourselves- what can be done in order to make the patient less dependent? How can we give the patient more options to choose? And take the right choice? How the patient can learn about preventive medicine? What is the rule of the environment in 128

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the healing process? In my work I would like to introduce a new way of thinking about Health care and the connection to space. In 2011 Machteld Huber et al. introduced a new concept of health with a cover publication in the BMJ: “Health as the ability to adapt and to self-manage, in the face of mental, social and physical challenges”. This new concept describes health not as a stable endpoint, as in the traditional WHO definition, but highlights function, resilience and self-direction. I believe that space have a major role in “liberating” the patient from his absolute dependency. And by doing that achieving an effective and positive healing process. Space- can be a platform for any process to flourish. By providing various functions and atmospheres, it is possible to support the healing process from the practical and psychological aspects. In my work I would like to point up the direct connections between recovery process and space design, while focusing on the psychological aspect. 130

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Case #6: The Odensehuis The Odensehuis, located in Amsterdam-Zud, is an open house for people suffering from dementia and their relatives, offering daily activities and a place to connect with others. Many of the people visiting the Odensehuis are confronted with losses, which may be death, or the fact that one is not visitng the home anymore because of deterioration of the illness. Odensehuis asked the students to look for ways to cope and give meaning to these losses.

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The Prevention of Alzheimer’s disease

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Fernando Dias Concalves

In the Netherlands, there are at least 20.000 new cases of dementia each year. That is reported by the Dutch guidelines for general practitioners (NHG-standaard). The Alzheimer patients form the biggest part of that number. Alzheimer’s disease is chronic. The cause of Alzheimer’s is not really known yet. The disease is progressive. A summary written by Henri A. Snel (2014) explains the disease is a process three stages. In each stage the patient loses more cognitive functions and memory. THE ODENSENHUIS The case I am working on together with my group is about the Odensehuis. The Odensehuis is a voluntary organisation for early stage dementia patients. This is the stage when they don’t get professional help yet. The Odensehuis helps them coping with their disease by giving them information, giving them contact with other people with dementia and helping them still

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being part of the society. People can walk in any time in the Odensehuis and there are lot of daily activities they can participate. The Odensehuis is a great way of secondary prevention of Alzheimer. To understand more about the kind of institute of the Odensehuis, I am going to focus on the following question in this essay: How can prevention for Alzheimer’s disease be done and how can Alzheimer’s patients stay as healthiest as possible?

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contains eight elements: starting early, freedom, optimism, acceptance, motivation, rhythm, nature and physical exercise. A few of the elements in Leo’s method where impressing and have been inspiriting to me. One of the elements that have impressed me a lot was acceptance. Leo van Dijk explains in his method that accepting your faith and your disease can relief you from a large pain. Leo told during the interview that accepting his disease was the most important step took after his diagnosis.

LEO VAN DIJK

STARTING EARLY

To get a better view on the patient’s perspective we interviewed Leo van Dijk. Leo van Dijk was born in 1933 and diagnosed with Alzheimer’s in 2007. After seven years of living with Alzheimer’s disease, Leo van Dijk claims to have a great quality of life. He has developed a method based on his own experiences for early stage Alzheimer patients to slow the process of the disease down. His method

The most important element of Leo’s method is starting early. Leo says that people shouldn’t wait too long to do something after they notice that their cognitive functions are decreasing and they are starting to forget. A cross-sectional study of YonasGeda (2012) shows that activities like computer activities, craft activities such as knitting and quilting, 136

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playing games and reading books were associated with decreased odds of having mild cognitive impairment. This means that if people start early with training their memory by doing these kind of activities, they can reduce harm.

that there is an effect of physical exercise, but that effect is very small.

PHYSICAL ACTIVITY

which interventions work and how large are their effects?

Henri Snel (2014) Alzheimer’s disease summary NHG-standaardDementie Grondslagen der epidemiologie chapter 5. J.P. Vanderbroucke (1999) Huber et al. (2011) How should we define health? M. Pinquart (2006) Helping caregivers of persons with dementia: http://alzheimervoorbeginners.nl/ YonasGeda (2012) Engaging in Cognitive Activities, Aging and Mild

Not only mental exercise, but also starting early physical exercise may help. J. Eric Ahlskog et al. (2011) noted that many researches pointed out that physical exercise might attenuate cognitive impairment and reduce dementia risk. The Cochrane review M. Angevarenet al. (2008) showed that there is evidence that aerobic physical activities which improve cardiorespiratory fitness are beneficial for cognitive function in healthy older adults, with effects observed for motor function, cognitive speed, delayed memory functions and auditory and visual attention. However, the majority of comparisons yielded no significant results. This means

Cognitive Impairment: A Population-Based Study J. Eric Ahlskog et al. (2011) Physical Exercise as a Preventive or Disease-Modifying Treatment of Dementia and Brain Aging M. Angevaren et al. (2008) Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. Christan Y. (2000) Oxidative stress and Alzheimer’s disease M.C. Morris et al. (2004) Dietary fat intake and 6-year cognitive change in an older biracial community population O.I. Okerekeat al. (2012)Dietary fat types and 4-year cognitive change in community-dwelling older women M.J. Engelhart et al. (2002) Diet and risk of dementia. Does fat matter?

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Grieving & dementia

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Muriël Lindeijer

THE ‘NORMAL’ GRIEF PROCESS Early theories of grief where usually based on Freud’s theory of ‘Grief Work’ (1917, cited by Lister et al., 2008). Grief Work is described as ‘a cognitive process of confronting the reality of loss, of going over events that occurred before and at the time of death, and of focusing on memories and working toward detachment from the deceased.’ (Stroebe & Stroebe, 1991). This theory states that grief is a stage-like process and that Grief Work and thus confronting the loss is necessary for an adaptive bereavement outcome. According to this view, avoiding grief would lead to unresolved or pathological grief. However, later studies suggest that confronting loss (a requirement in Grief Work) isn’t essential for adjustment to bereavement. For instance, Stroebe and Stroebe (1991) found that widows avoiding their loss did not differ from widows confronting their loss. Also, some researchers, 140

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such as Bonanno et al. (2005), even suggest that extensive Grief Work is a form of rumination, which may result in extended grief or even depression. On the other hand, they also see suppression of grief (thus deliberate grief avoidance) as a maladaptive coping strategy. In their study with U.S. participants, they found poor long-term adjustment as well in people who performed extensive Grief Work, as well as in people who deliberately avoided their grief. Besides that, a lot of bereavement researchers question the validity of a stage-like model such as Freud proposed. Although the five-stage theory of KĂźbler-Ross (1969, cited in Bregman, 1989) became very popular during the years after Freud, it has been criticized as well (Bregman, 1989), just like the models that have derived from it (read Maciejewski et al., 2007 and Weiner, 2007). Not everyone seems to deal with loss in the same, fixed way following certain stages (Lister et al., 2008). A more recent model that approaches grief in a non-stage manner, is

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the Dual Process Model (DPM) (Stroebe & Schut, 1999). This model describes two types of stressors: a loss-oriented and a restoration-oriented stressor. Loss-orientation means concentrating on and dealing with the loss itself. Restoration-orientation means dealing with the secondary consequences of loss: adjusting to substantial changes in your life. Both the loss itself, and being forced to make adjustments in your life, are sources of stress. Stroebe and Schut also propose a dynamic, regulatory coping process, that oscillates between this two stressors. By doing this, the bereaved person switches between loss-orientation and restoration-orientation. The oscillation process allows the person to sometimes confront, and sometimes avoid the grief. The Grief Work hypothesis has also been criticized because it states that the bereaved person has to work toward full detachment from the deceased (Lister et al., 2008). Therefore, Boerner and Heckhausen (2003) proposed the Mental Representation 142

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Theory (MRT), in which the bond with the deceased person is both continued and relinquished. This is possible through mentally-constructed representations of that person, that are stored in the explicit memory. The lost relationship will be substituted with recalled or newly constructed mental representations of the person who passed away. These can be for instance imagining what the deceased would say or actually remembering what that person said. A third theory that has been used for explaining the individual differences in dealing with grief is the Attachment Theory of Bowlby (1969, cited in Stroebe et al., 2010). This theory states that the way people form and maintain relationships, arises from the interactions and relationship with a person’s primary caregivers when they are young. As a result, people can become securely attached or insecurely attached. Ainsworth (1978, cited in Stroebe et al., 2010) defined different attachment styles: Secure Attachment is characterized by a positive view of

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the self and the other, what translates into ease in being close to others. People with a Preoccupied Attachment style have a negative view of themselves and a positive view of other and they have a great need for closeness. Dismissing Attachment is characterized by a positive view of themselves and a negative view of the other. People with this attachment style find it difficult to trust others and to depend on them. People with a Disorganized Attachment style have a negative view of both themselves and the other. They find it difficult to trust others, but would also like to have closer relationships. Research also suggests that one’s attachment style can influence the reaction to bereavement (Wayment & Vierthaler, 2002). Recently, Stroebe et al. (2010) proposed to combine this compatible models, as an alternative for the Grief Work hypothesis. By putting these models together, they suggest that bereaved people deal with their grief by sometimes avoiding and sometimes confronting their loss (according to the DPM), 144

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while forming mentally-constructed representations of that person to both continue and relinquishing the bond (according to the MRT). They also suggest that the attachment style of the bereaved person influences the outcome of the grieving process, because people with an insecure attachment style will probably hold on to the bond with the deceased in a maladaptive way. Stroebe et al. (2010) reasoned that Securely Attached people will follow the grief process as described by the DPM. Preoccupied Attachment can result in too much of a Loss-orientation, which can become chronic grief. Dismissive Attachment can result in too much focus on Restoration-orientation, which can become absent, inhibited grief. Disorganized Attachment could result in a disturbed oscillation process.

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ple need at least a number of psychological abilities in order to cope with loss. Purely focusing on the cognitive functions that are required in this process, I will discuss some localizations of these functions. Because describing the complex structures of the brain goes beyond the scope of this essay, this localizations may be simplified. First of all, people must be able to switch between confronting the loss and avoiding the loss. This requires shifting the attention to one of the two, and then maintaining it. The Prefrontal Lobe plays a crucial role in these functions (Kessels et al., 2012, page 216). Secondly, people need to be able to construct mental representations of the deceased person. This requires recalling some form of memory and probably forming new memories. This relies on a lot of different brain regions. (Kessels et al., 2012, page 217). The memory that has to be recalled, can be a visual memory of what the person looked like, or a auditory memory of

The significance of the lost abilities NEEDED ABILITIES When we assume that grieve happens according to the above theories, peo146

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the person’s voice or something he or she said (Boerner & Heckhausen, 2003). Depending on the specific sensory content of the memory, different brain structures are activated. (Kessels et al., 2012, page 217). This depends on the kind of memory that is referred to as Episodic Memory, where people store their explicit personal events. The Hippocampus is a brain structure that is active during recalling memories and forming new ones.

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ineffective consolidation of new information. In a later phase of Alzheimer’s, people develop retrograde amnesia. This means that memories of events or semantic knowledge acquired before the beginning of the illness, are impaired. Attention problems also arise in various phases of the illness. People with Alzheimer’s usually find it difficult to divide their attention and to shift their attention from one thing to another. Also, because their cognitive flexibility and planning ability decreases, they tend to rely more and more on daily routines and a fixed structure. The most common and notable MRI-findings in people with Alzheimer’s, are a decline in the medial temporal lobe and the Hippocampus, that is mentioned before. In a later phase, there will also be a overall decline in brain volume (Kessels et al., 2012, page 439). The abilities required for grieving are the same abilities that are impaired in people with Alzheimer’s. Because of this,

LOST ABILITIES When looking at the functions that are usually impaired in people with Alzheimer’s, we see much overlap between the functions needed for dealing with grief and the functions that are lost. Kessel et al. (2012, p. 435) describe the course of Alzheimer’s as follows: In the beginning phase, anterograde episodic memory impairments predominate. This means that since the beginning of the disease, the memories of events are impaired due to 148

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Bregman, L. (1989). Dying: A universal human experience?. Journal

we can conclude that dementia does effect the grief process of people with Alzheimer. Dealing with grief may be even harder for people with Alzheimer’s, than for people without Alzheimer’s*: they lose their abilities that would otherwise help them to cope with the grief.

of religion and health, 28(1), 58-69. Lister, S., Pushkar, D., & Connolly, K. (2008). Current bereavement theory: Implications for art therapy practice. The Arts in Psychotherapy, 35(4), 245-250. Maciejewski, P. K., Zhang, B., Block, S. D., &Prigerson, H. G. (2007). An empirical examination of the stage theory of grief. Jama, 297(7), 716-723. Odensehuis. (n.d.). Retrieved from http://odensehuis.nl Stroebe, M., &Schut, H. (1999). The dual process model of coping with bereavement: rationale and description. Death studies. Stroebe, M., Schut, H., &Boerner, K. (2010). Continuing bonds in adaptation to bereavement: Toward theoretical integration. Clini-

* It should be noted that this cannot be generalized to other

cal psychology review, 30(2), 259-268.

forms of dementia, since the impaired functions can vary strongly

Stroebe, M., &Stroebe, W. (1991). Does” grief work” work?. Jour-

between different types of dementia.

nal of consulting and clinical psychology, 59(3), 479. Wayment, H. A., &Vierthaler, J. (2002). Attachment style and bereavement reactions. Journal of Loss &Trauma, 7(2), 129-149.

Alzheimer Nederland. (2014). Retrieved from http://.alzheimer-

Weiner, J. S. (2007). The stage theory of grief. JAMA, 297(24),

nederland.nl

2692-2696.

American Psychiatric Association. (2014). Diagnostic and statis-

Wind, A. W., Gussekloo, J., Vernooij-Dassen, M. J. F. J.,

tical manual of mental disorders (5th ed.). Amsterdam: Boom.

Bouma, M., Boomsma, L. J., &

Boerner, K., &Heckhausen, J. (2003). To have and have not: Adap-

Boukes, F. S. (2009). NHG-standaard dementie. In NHG-Standaarden

tive bereavement by transforming mental ties to the deceased.

voor de huisarts 2009 (pp. 497-520). BohnStafleu van Loghum.

Death Studies, 27(3), 199-226.

Zwaanswijk, M., Van Beek, A. P. A., Peeters, J., Meerveld, J.,

Kessels, R., Eling, P., Ponds, R., Spikman, J., & Van Zandvoort,

& Francke, A. L. (2010).

M. (2012). Klinische Neuropsychologie (2nd ed.). Amsterdam: Boom.

Problemen en wensen van mantelzorgers van mensen met dementie:

Bonanno, G. A., Papa, A., Lalande, K., Zhang, N., &Noll, J. G.

een vergelijking tussen de beginfase en latere fasen in het

(2005). Grief processing and deliberate grief avoidance: a pro-

ziekteproces. Tijdschrift voor gerontologie en geriatrie, 41(4),

spective comparison of bereaved spouses and parents in the United

162-171.

States and the People’s Republic of China. Journal of consulting and clinical psychology, 73(1), 86.

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Mai-Loan Gaudez

Remembrance: the social and the spiritual, the Ancestors and the Inheritors. The issue of dementia and the project at the Odensehuis we have to deal with are here a pretext to introspection. What is remembering for me? When you no longer know where you’re going, just remember where you came from. My father used to tell me that a lot, and as a bothered child, I would not grasp the meaning of these words, wallowing idly in ordinary parent denial, as my own parents did before me. At home we have an altar. It is resting on a very nineties shelf from Ikea, just above the collections of old CDs, vinyl and tape records. There is one at my grandmother’s, one at my aunt’s, and one at my other aunt’s. There is one in our new house in Vietnam, as there was one in our former house in Vietnam. On this altar, there is a 152

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Buddha and there are photographs of all the people in my family who died. We call them the Ancestors. My family is definitely not religious, but I should remember it used to be. My parents being anarchists, they define themselves as profoundly atheists. Yet freedom through education and self-determination being their life motto, they raised me with both their religious and spiritual backgrounds. I ended having the tales of the Bible for bedtime stories as well as Vietnamese tales full of spirits and geniuses. My dad comes from a French old school catholic family. He once told me my grandfather was a “traditionalist” and my grandmother a “papist”, and this distinction was the subject of numerous dinner arguments at home, especially after the Second Vatican Council. He indeed was a child in the 1960s. My dad told me many stories about him messing around at church as a kid, about his family’s celebrations, weddings, communions, funerals… and his

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recurrent jokes and misfits. He rejected his entire family heritage. He did not marry my mom, and is still very much against the idea. He refused that my sister and me got baptized as babies. And I can tell this made my grandmother suffer a lot. But still, rejecting did not mean not passing down. I was encouraged going to mass with my gran, and it is still something I enjoy, even if I feel more like an observer when I go. When I turned twelve, my father asked me if I wanted to be baptized. It had to be my decision, brewed and matured through knowledge and education. My mom comes from a quite unique background that we could call Vietnamese aristocratic-communist leninist-buddhist-confucianist. That is indeed a funny mix but not so incompatible as it could seem. I would say it influenced me in the idea that there is no such thing as a self. To simplify, in communism, we exist within a collectivity, in Confucianism we exist within a family, in Buddhism we are media of the 154

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flow of thoughts, in the process of awareness and knowing. This background fed my position as an individual constantly feeling “in the middle”. And there I realize where my parents’ ideas of being connect. They told me: “You are an Inheritor.” To be understood in Bourdieu’s meaning. I am the product of my social class, of the history of my family. I am a child of my age, a child of decolonization, of globalization. I have choices but they exist and happen within the frame of the context that bore me. There lies my inner struggle inherited from my parents: between self and social determination. When this idea hit me, I fully understood the ritual of the altar. We use it twice a year: for the Vietnamese New Year and for my great grandmother death anniversary. We have to take care of it constantly though: there should always be light on it, a lamp or some candles, there should always be flowers and when possible food. So whenever my 156

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mother goes shopping, she would tell me to take the nicest fruits and to put them nicely on a nice plate, to put them on the altar and to light up one stick of incense or two. I like it best when it is Christmas and she puts the Christmas chocolates on the altar. Then I feel I really am the result of a funny mixture. For the celebrations, as I said New Year and death anniversaries, my mother would cook a huge meal and arrange samples of each dishes in front of the altar. Everyone would take a couple of incense sticks and light them up. One by one, we would pay our respects to the Ancestors. My mother would go first then my father, then me, then my younger sister. It is always from the eldest to the youngest, but as well from the closest related to the farthest, this is why my father would go after my mother. As a child I did not know how to deal with this ritual, I would go in front of the altar with the incense sticks burning in my hands, close my eyes for a couple of minutes, plant the sticks in the bowl of rice serving this

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purpose and wait. It would then become even more mysterious: we would wait until the food is cold. Well that was my view on things as a food lover kid. My mother would say that we wait until the incense sticks are burnt down, because it would mean that the Ancestors finished to eat the meal spiritually. So the food would then be ready for the living ones. As I grew older, the ritual took a lot more sense. One of the reasons being that I would relate now to the photographs on the altar: as I grew older, people died, as I grew older, the Ancestors were not anymore people I had heard of but people I had known myself. I realized my mother did not believe at all in spirits and geniuses as I thought she did. I realized it was a ritual of remembrance, a ritual my dad was relating to as well. Because it is not here matter of religion, it is not matter of beliefs and worshipping, it is matter a remembering where you come from. It became clear to me that what my mum was doing when 158

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I though she was “praying” – whatever it meant to me by that time – was thanking, for what she was, for what she had and for what she was able to give back to my sister and me. I relate to Buddhism this way: I don’t know about reincarnations and other myths, but life is indeed a cycle. You get given things and you give them back.This way we are all media of a flow. My parents do not think of their selves, they think of themselves between past and future generations. This way the altar becomes a shrine, a spiritual space of transition, a space in-between where generations meet and where temporality is vibrant.

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Mindful, not mindless: A spiritual insight into Alzheimer’s disease

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Olivia B. Noe

INTRODUCTION Death is pervasive. Every person, throughout the course of their life, will experience the loss of friends and family until they also eventually pass on. With the astounding 150,000 people that die each day, roughly 75-90% of the deaths are age related (De Grey; 2007). Yet despite the seemingly large mortality rate, it is projected that 1 in 10 people will be over the age of 75 by 2020 (Walker & Maltby; 1997). A rapidly aging population has its consequences. The American Alzheimer’s Association outlines that as the “baby boom generation” ages, the prevalence of dementia rapidly increases. Coincidentally, as the number of people with progressive neurological disorders increases, so will the need for professional healthcare systems to treat the patients. Especially since physical brain changes may occur 20 years before Alzheimer’s symptoms become prominent, early engagement is critical (Reiman et al; 2012). 162

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Alzheimer’s disease has an interesting, and possibly overlooked, psychological dimension. After a diagnosis, the patient may still feel functional and independent although they are now aware of their unspecified, impending death. While assisted living centers typically treat those who are in later stages of the disease, facilities such as the Odensehuis (located in Amsterdam-Zuid) allow for an understanding community to lessen the psychological burden of a diagnosis and to ease the process of departing from one’s self and from loved ones. Yet, effective strategies for coping and acceptance in this specific program are not yet fully equipped to combat the suffering of an Alzheimer’s patient. As Alzheimer’s patient and advocate Leo van Dijk has voiced to the team, “when acceptance has occurred, there is no more pain.” He promotes a method that utilizes optimism and rhythm in combination with mindfulness to eventually reach the phase of acceptance.

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Elderly patients with such neurological illnesses face not only the burden of illness, but also of the natural aging process. The following reviews attempt to provide insight into the coping process for elderly patients, with Leo van Dijk’s input serving as the foundational inspiration, by first developing a more in-depth understanding of old age and then finding implications for Alzheimer’s and dementia patients. The incorporation of “gerotranscendence,” rituals, and religion are of personal interest to the present case study. UNDERSTANDING OLD AGE METHODS & THEORIES: ERIKSON’S NINTH STAGE Erikson’s psychosocial developmental theory (1963) tells the story of eight psychological crises that one may face throughout the duration of his or her life. Upon completion of each stage, acquisi164

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tion of a new virtue occurs so that one may eventually move to acquiring wisdom after facing the final issue of “ego integrity versus despair.” At this point the individual accepts their past as satisfying and their death as inevitable. In the reverse, if the individual finds their life to be a failure, they become filled with despair when realizing that their remaining time is short. Yet, Erikson found personality development to be a lifelong process. Perhaps, he thought as he grew older, another form of development existed past his eighth stage. Following his death, he wife Joan excited the idea that her and her husband never truly “confronted their aging selves” until extreme old age (80s and 90s), thus setting the stage for a ninth phase (1998). Brown and Lowis (2003) surveyed 70 females to confirm the hypothesis that a ninth stage exists. Factors that differentiated the ninth stage from others include references to “acceptance of change, an increased understanding of the meaning of life, and a

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closeness to those who have gone before” which confirm “a replacement of preoccupation with self with something together more transpersonal.” Proving the theory of a ninth stage could open a whole field of understanding for geriatric medicine. Regardless of certain physical decline, individuals can still grasp the capacity for “potential psychological and spiritual growth.” Apart from providing personal comfort, this confirmation can add insight into how caregivers can better understand behaviors and thought processes of their elderly population. METHODS & THEORIES: GEROTRANSCENDENCE Swedish researcher Lars Tornstam (1997) develops an optimistic theory for aging that promotes change and development. He describes his idea of gerotranscendence as “a shift in meta-perspective, from a materialistic and pragmatic view of the world 166

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to a more cosmic and transcendent one, normally accompanied by an increase in life satisfaction.” Psychologist Carl Jung (1923), too, recognized a theory of individuation, where the natural progression of life steers one toward a final acquisition of wisdom. At an older age, individuals respond to interviews as though they better understand concepts of time, egocentrism, and personal relationships. Participants in Tornstam’s interviews specifically noted how early years have “come alive” as they age, how realization of past selfish motives have come to light, and how few close friends now seem more important than meaningless social agendas. The theory of gerotranscendence opposes the hotly debated disengagement theory (Cumming, Newell; 1960). This idea recognizes that aging individuals will gradually withdraw from their social environment in a normal, acceptable manner. Gerotranscendence theory, however, studies a positive approach that focuses less on

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withdrawal and more on final fulfilment of self-accepting experiences that are mediated by a social environment. From his interviews, Tornstam hones in on the idea that elderly individuals yearn for “the need…and the pleasure of contemplative positive solitude.” This approach to understanding old age transcends an inward sense of self. Instead, dimensions of time and space may alter to promote an environment that is less self-centered and more reflective. Like the proposition for a ninth stage, the gerotranscendence theory evokes a greater sense of empathy and understanding for the elderly. Instead of approaching a situation with annoyance about an elderly individuals inability to habituate to their environment, a new prevailing view is that this population is in the midst of undergoing drastic, dynamic change.

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A SPIRITUAL DIMENSION

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same solution towards the issue of death: faith and trust allow for an external locus of control where a loving God (or another higher being) has ultimate power over one’s circumstances (Koenig; 2002). Life satisfaction and coping abilities are largely dependent on the subjective experience of spirituality: if one relates to an environment where humanity is innately moral and altruistic, one will experience a religion that “engenders a feeling of control over health matters and helps elderly inpatients to cope” (Lowis et al; 2005)

METHODS & THEORIES: TRANSITIONS The transitions that come with ging are often confounded with the adjustments of moving from an independent lifestyle to a more dependent one. Whether voluntary or involuntary, these situations can understandably be followed by periods of high stress for both the elderly individual and the family. One study in particular found that when moving to assisted living centers, those who had a strong religious affiliation were still able to restore self-confidence because they believed that their life had purpose and meaning (Towers; 2003). Despite the chaotic nature of losing a sense of self-efficacy, religion provides consistency and order. Lowis et al (2005) cite the sense of homeostasis that individuals feel, as a balance is restored “between their internal selves and their external environment.” Every religion has the

METHODS & THEORIES: RELIGION MEETS ALZHEIMER’S Religious officials and counsellors are especially familiar with providing comfort for those who mourn losses. This comfort given in the context of a spiritual dimension allows for a more unified method to coping, as individuals feel connected to not 170

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there, even when everything else seems to be gone.” A study by Wright, Pratt, and Schmall (1985) found that spiritually oriented caregivers of Alzheimer’s patients were more likely to positively reframe their negative situations than those who were not spiritually affiliated. Major life events, both of sorrow and joy, are often centered on religious events. Religion, which serves as a contribution and a product of the coping process, allows for a mystical outlet. Congregational support reaffirms the selfless aspect of humanity, and in the face of hardship, religious ties can intensify (Pargament et al; 1990). Especially since death and the afterlife are often regarded as mysterious processes, spirituality can give form to a more concrete tactic for facing the misunderstood.

only their pastor but also their community. As one of the medical directors of geriatric psychiatry, Dr. Vonda Gravely states that the most deeply rooted, emotional memories of Alzheimer’s patients are still intact, such as those relating to music and religion. Ensconcing these memories is painful since this means hiding the remaining parts of one’s self. She suggests the therapeutic element behind encouraging elderly patients to embrace spirituality. Gravely goes on to explain the implications that the fatal disease can have for caregivers. More than 50% of the friends and family that look after their loved ones suffer from psychological ailments, such as depression and anxiety, as well as physical exhaustion. Battling Alzheimer’s now begins to move past the scope of self. The affected patients can experience guilt from the suffering that their caregivers also face. Rev. Paul Harmon from South Carolina sums up Gravely’s finding best as he emphasizes the “need to realize that the faith is still 172

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ANTICIPATED RESULTS AND BRIEF

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that enables others to have a quiet space to communicate their own grief and to reminisce about their friends. Such a project acts as a reminder of what patients have lost, but also of what they still have to gain. Deeply rooted, and mostly left intact, a sense of spirituality can positively shape the remaining years of one’s life. Instead of being trapped in a world of disconnected neurons and conflicting signals, a patient learns the warm and uplifting nature of letting go. Instead of being trapped inside their mind, an Alzheimer’s patient can feel mindful and free.

DISCUSSION The amalgamation of illness and spirituality can enrich our comprehension of Alzheimer’s patients’ suffering tremendously. One personal hypothesis is that those who knowingly face impending death transition into the phase of gerotranscendence more deliberately and more quickly. Alzheimer’s can strike people as young as forty. However, the ability to accept mortality, especially when years are cut short, is an art that can perhaps never be perfected. Yet, coping mechanisms involving spirituality are proven to help alleviate mental anguish. For the purposes of the Odensehuis, I propose a solution that involves an accessible dimension of spirituality. Since the project also focuses on dealing with the death of others who have passed away from the Odensehuis, a plausible idea could incorporate some form of a shrine or ritual 174

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Brown, C., &Lowis, M. J. (2003). Psychosocial development in the

Pargament, K. I., Ensing, D. S., Falgout, K., Olsen, H., Reilly,

elderly: An investigation into Erikson’s ninth stage. Journal of

B., Van Haitsma, K., & Warren,R. (1990). God help me:(I): Reli-

Aging Studies, 17(4), 415-426.

gious coping efforts as predictors of the outcomes to significant

Cumming, E., Dean, L. R., Newell, D. S., & McCaffrey, I. (1960).

negative life events. American Journal of Community Psychology,

Disengagement-a tentative theory of aging. Sociometry, 23-35.

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De Grey, A. D. (2007). Life span extension research and public

Pratt, C. C., Schmall, V. L., Wright, S., & Cleland, M. (1985).

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tients. Family Relations, 27-33.

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Puchalski, C. (2004). Spirituality in health: The role of spiri-

Religa, D., &Eriksdotter, M. (2014). Differences in routine

tuality in critical care. Critical Care Clinics, 20(3), 487-504.

clinical practice between early and late onset alzheimer’s

Reiman, E. M., Quiroz, Y. T., Fleisher, A. S., Chen, K., Velez-

disease: Data from the swedish dementia registry (SveDem). Jour-

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nal of Alzheimer’s Disease,

Arbelaez, A. (2012). Brain imaging and fluid biomarker analysis in

Jung, C. G. (1923). Psychological types: Or the psychology of

young adults at genetic risk for autosomal dominant alzheimer’s

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disease in the presenilin 1 E280A kindred: A case-control study.

Koenig, H. G. (2002). A commentary the role of religion and

The Lancet Neurology, 11(12), 1048-1056.

spirituality at the end of life. The Gerontologist, 42(suppl 3),

Schneider, E. L., &Guralnik, J. M. (1990). The aging of america:

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Impact on health care costs.

Koenig, H. G., Larson, D. B., & Larson, S. S. (2001). Religion

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Lavretsky, H. (2011). Meditation improves depressive symptoms,

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coping, cognition, and inflammation in family dementia caregivers in a randomized 8-week pilot study. Alzheimer’s & Dementia, 7(4), S436. Lowis, M. J., Edwards, A. C., Roe, C. A., Jewell, A. J., Jackson, M. I., &Tidmarsh, W. M.(2005). The role of religion in mediating the transition to residential care. Journal of Aging Studies, 19(3), 349-362. McCullough, M. E., Hoyt, W. T., Larson, D. B., Koenig, H. G., &Thoresen, C. (2000). Religious involvement and mortality: A meta-analytic review. Health Psychology, 19(3), 211.

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Communication and diversity in group creativity

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MuriĂŤl Lindeijer

The last four months we have been working together in multidisciplinary teams, trying to find new and creative solutions for certain problems in the healthcare system. Our team was involved in finding a way to relieve the departing process of people with Dementia in the Odensehuis. We all were quite diverse in background and in the amount of experience with creative processes and/or the healthcare system. I was curious about how our communication together and this diversity of team members has contributed to our creativity. In thisessay I will try to discover the how communication and diversity contribute to creativity in groups. In order to come closer to an answer to this broad, complex question, I will try to discover the relationship between the following variables: - communication and group creativity - group diversity and group creativity 178

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I will conclude this essay by comparing the outcome of the research with my own experiences with group creativity after four months of work.

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quency has a negative relationship with team creativity, measured with self-reports of the team and team manager data. The authors mention that very frequent communication may cause mutual production blocking and free-riding, and can limit the cognitive capacity. This implies that too much communication can bring down the creativity of the team. A second factor of communication that received attention in literature is de centralization of communication. Gaggioli et al. (2013) define group centralization as to what degree the team depends on it’s most important figures. If a team is strongly centralized, this means that there are people in the team that dominate the problem-solving process. Authors of Kratzer et al. (2004) reasoned that it is possible that a strong centralization in the group has a negative influence on the creative process of the team. This would be because not everyone receives the sufficient amount of information, since

RELATIONSHIP BETWEEN COMMUNICATION AND GROUP CREATIVITY When investigating communication, one can focus on a number of aspects of the communication process. One factor is the frequency of communication. No team can function without any communication, so a minimal frequency is needed. Communication frequency on team level is determined by the density of the communication network, which means the overall level of interaction reported by the team (Kratzer et al., 2004). Leenders et al. (2004) examined the minimal frequency of communication needed in a innovative team. They state that this minimum lies around one to three times every week. On the other hand, Kratzer et al. (2004) found that communication fre180

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most of the information is managed by a single member of the team. They further reason that creative performance of a team depends on everyone getting a wide range of information, so they expected that centralization would be positive related to team creativity. Interestingly, they did not find such a relationship. However, outcome of the research performed by Gaggioli et al. (2013) confirmed that indicators for decentralization are highly informative measures for team creativity. A third aspect of communication that might be important for team creativity, is internal communication and external communication. Internal communication refers to the communication with people inside the team, external communication refers to communication with people outside the team (Reiter-Palmon et al., 2012). According to the meta-analysis of Hülsheger et al. (2009), both internal- and external communication are positive related to innovation and team creativity. Internal communication enables the

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team-members to share their knowledge and experience and to discuss ideas. However, Reiter-Palmon et al. (2012) state that the relationship between internal communication and creativity is a complex one. This is for example because of the negative relationship between communication frequency and team creativity mentioned above. Apparently too much of internal communication reduces the team creativity. According to Lovelace et al. (2001), collaborative communication is related to higher creativity and innovation than contentious communication. So, the nature of the internal communication may play a role in the team creativity. External communication is also positively related to creativity, but stronger than internal communication (Hülsheger et al., 2009). According to Reiter-Palmon et al. (2012) is this form of communication beneficial for creativity, because the social ties with people from outside the team are often weaker. This gives breadth to connections 182

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and accesses new and also non-redundant information, which may help to form new creative ideas. These results suggest that frequency of communication, internal- and external communication all play an important role in creative team processes. The role of the centralization of communication in team creativity still remains unclear.

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Hülsheger et al. (2009) expected a positive relationship between job-relevant diversity and team creativity in their meta-analysis. They suggested that by putting together a team with diverse members, one combines much expertise, skill and knowledge, which can help solving a complex task. These different perspectives and approaches may in turn stimulate creativity-related cognitive processes. Their study indeed found a positive relationship between these two constructs. This might be partly explained by Keller (2001) who also linked job-relevant diversity to external communication, which promotes team creativity. On the other hand, Hülsheger et al. (2009) expected a negative relationship between background diversity and group creativity, because this may lead to difficulty reaching consensus and resolving opposing ideas. But unexpectedly, the authors found a negative, but non-significant relationship.

RELATIONSHIP BETWEEN GROUP DIVERSITY AND GROUP CREATIVITY Another process that plays a role in group creativity, is group diversity. Milliken & Martins (1996) already stated that diversity in an organisation may increase the creativity as well as the dissatisfaction of the members, so that they don’t identify with the group. Researchers of creativity usually differentiate between job-relevant diversity and background diversity (Hülsheger et al. 2009). Job-relevant diversity refers to job- or task related heterogeneity and background diversity refers to non-task related diversity. 184

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COMMUNICATION AND DIVERSITY IN MY OWN TEAM

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diversity should have no relationship with the group creativity. This matches with my own experience. While working on our case, it became very clear that each field of study looks at the case from different angles. Also, everyone focuses on different things in the process. For example I noticed the quality of the Arts students in isolating one aspect of our subject and looking at it from a totally different angle. In my opinion this really helped us further in the brainstorming phase. Especially at the beginning of the project I noticed how the knowledge of our team-member of Medicine School helped us to form an image of our target group (people with dementia). Apart from the advantages of our job-relevant diversity, I sometimes experienced some difficulties with the language difference. Fortunately everyone spoke English very well, but for example I found it difficult to participate in a brainstorming phase while speaking in another language.

Reflecting on the literature mentioned above, I will now discuss my experience with our team process conducted the last 4 months on people with dementia in the Odensehuis. DIVERSITY Our team consisted of five students, who were both diverse in terms of job-relevant diversity as in terms of background diversity. We are all have different nationalities: French, Swedish, American, Brazilian and Dutch. Besides that, we also follow different types of study: Medicine, Arts (Inter-Architecture) and Psychology. Onthe other hand, we all were from around the same age. According to the results of the above literature, our job-relevant diversity could facilitate the creativity process and our background 186

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members of the team could not be present at the weekly sessions, which caused a unintended centralization of communication, because then the team had to rely on the people who were present. I think that this kind of centralization sometimes undermined our group creativity, for example because we came up with less diverse ideas when there were two team members present, then when we were with all five of us. As mentioned above, the internal communication was helpful for finding a solution for our case. However, what to my opinion helped us even more in the process, were the meetings and discussions with different experts on the content of our case. They really gave us fresh insights, which really increased our creative thinking.

COMMUNICATION Our team usually met 2 times a week at the planned sessions. Sometimes we would also go to the Odensehuis (the minimal amount communication frequency). Most of the time, we would work quite productively, but sometimes we would get distracted and get lost in non-redundant communication. Still, I feel that when we had to make decisions, we all would work very collaborative. The communication was in my opinion variably centralized. For example, during the creation-phase I felt that the team relied more on the Rietveld-members, because they had more experience with this. I was the one who had most contact with the case owners, so in that regard the team relied more on me. In my opinion this kind of communication centralization has contributed to our project, because we let everyone use their talent and experience. Sometimes, though, it happened that

CONCLUSION This essay addresses some very broad and complex subjects and of course 188

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Gaggioli, A., Mazzoni, E., Milani, L., & Riva, G. (2013). The

it is very difficult to identify aspects of the process that have contributed to our final result. However, it turns out that the result of the literature studied above, corresponds quite well with my own experience in a interdisciplinary team.

creative link: Investigating the relationship between social network indices, creative performance and flow in blended teams. Computers in Human Behavior. Keller, R. T. (2001). Cross-functional project groups in research and new product development: Diversity, communications, job stress, and outcomes. Academy of management journal, 44(3), 547-555. Kratzer, J., Leenders, O. T. A., & Van Engelen, J. M. (2004). Stimulating the potential: Creative performance and communication in innovation teams. Creativity and Innovation Management, 13(1), 63-71. Leenders, R. T. A., Kratzer, J., Hollander, J., & van Engelen, J. M. (2004). Managing product development teams effectively. The PDMA ToolBook 1 for New Product Development, 141. Lovelace, K., Shapiro, D. L., & Weingart, L. R. (2001). Maximizing cross-functional new product teams’ innovativeness and constraint adherence: A conflict communications perspective. Academy of management journal, 44(4), 779-793. Milliken, F. J., & Martins, L. L. (1996). Searching for common threads: Understanding the multiple effects of diversity in organizational groups. Academy of management review, 21(2), 402-433. Reiter-Palmon, R., Wigert, B., & De Vreede, T. (2012). Team creativity and innovation: the effect of group composition, social processes and cognition. Doi: 10.1016/B978-0-12-374714-3.00013-6

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Togetherness

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Mai-Loan Gaudez

Team work, group discussion, sharing, exchanging‌ All words we have been hearing a lot in the past weeks. I would like here to discuss the expression of being together. I would like to confront the working in a team process to the actual purpose of our work: bringing people together. I will first explain the questions that were brought to our group. Then I will express my critical point of view on expression, communication and dialogue. To finish I will introduce the problematic that, in my point of view, our project bears: the gift. My group focuses on the Odensehuis, an organisation setting up activities for people suffering from dementia on an early stage. The difficulty this organisation is facing is that they need to find a way to help people with dementia to confront their disease. Organising activities can easily fall into a simple distraction. Painting together, singing together, going out together‌ are all different ways of running 192

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away from the loneliness brought by the loss of mental abilities. However running away does not mean you can avoid indefinitely to face it. Moreover, the very fact of bringing people together on the basis that they share the same disease lead to more confrontation: people of the Odensehuis are constantly facing their fellows’ own loss of abilities and to a certain extent, their fellows’ death. The problem was define in these terms: how to find a tool for people of the Odensehuis to cope with the loss of their self and with the loss of others. Starting with the project, our group agreed on two main points: first, not to bring some more «distracting» activity, second, to find a common shared interest, so both parties (the people of the Odensehuis and our group) gain from this experience. In that sense we are not here working toward a solution, but toward an interaction. The lines below are a quote from our statement of the very first presentation.

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From their own perspective, and not from our external point of view, we wish to find a common interest so that both parts are engaged. The strength of our group is its multidisciplinarity. We are from different backgrounds: art, design, psychology, medicine. These disciplines gather together in the sense that they are human focused. However this strength is also a weakness: our different backgrounds mean that we all start from different knowledge, different methodologies, different perspectives concerning our impact as professionals on the society. In other words, we don’t speak the same language. What I mean here is that my co-workers have a certain vision of what art is, that is different than mine, the same way I have a certain vision of what is medicine or psychology, that they probably don’t share with me.

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The very difficulty we have to face in workinThe very difficulty we have to face in working as a team is to find a common language that is not going to fall into simplicity because we cannot take the time to dive into each other disciplines, but a common language that will grow into being critical toward all those disciplines and that will finally go beyond each of these disciplines.ÂŹ As an illustration, it would be somehow similar to try not to fall into simple English, because it is none of us native language, but to go beyond the simple expression into creating new words that definition we would all share. During the first semester, I led an introspective research on myself interacting with others. The two main key ideas of this research were remembrance and reflexivity. On the one hand I came to the conclusion that I, as an individual, am a product of set (past) circumstances: a culture, a history, a family. This set of circumstances is giving me the knowledge and the material I have to

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grow as a person, as a subject. On the other hand, the only element enabling me not to be a passive individual is the encounter of others. Others enable me to reflect onmy own subjectivity. They enable me to go forward. In his essay What is an apparatus? Giorgio Agamben tries to define the concept of apparatus as used by Michel Foucault in his writings. What is said there is that, between the dichotomy of the being and the acting there is a structure, a system that organises power relationships and strategic mechanisms. In the context of my own work, I understand it this way: the being is what I am, as a product (what I am out of the legacy of my culture, my history), it is my substance as a being, it is the knowledge I was given, the tools and material I inherited. The acting is what I encounter: what happens in the facts, the events that are happening to me. At the crossroad of my being and my acting, my subject is being born. In other words, I become a subject, 196

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an individual capable of subjectivity at the intersection of what I have with what I meet. Only from my inheritance and my encounter, my point of view is being born. You might wonder where I want to go with this. It is very simple. Our strength as a group is the multiplicity of are beings – from different cultures, Dutch, American, Brazilian, Swedish, French, Vietnamese – from different disciplines – and our strength is also the fact that we encounter each others. This encounter is already an action, it is already a making. We are growing from it at the moment we meet. Agamben is also stating that the apparatuses rule the meeting of our being and our praxis, and this way are determining us. There is not so much decision towards what we want to do as the apparatus is the filter that will define our action. He takes the cell phone as an example for an apparatus: it is a technological device that is ruling our point of view on communication. What he says is: there is not a good use or a bad use

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for a cell phone, there is only the use you can have of it, that is intrinsic to the device as an apparatus. In other words, if our subjectivity is being born from the meeting of our being and our acting, through the apparatus, this subjectivity is only able to be conscious of itself being born form the encounter. So we do not have so much of a choice apart from the awareness of our subjectivity. The only thing we can have is the awareness of our subjectivity being ruled, being the result of the use of the device. In the development of my research on reflexivity and the other, I had a similar thought : that there is no such things as a conversation, but only versation. Meaning, when talking to somebody it can happened that you are so focussed in your own process of thoughts, and so is your interlocutor, that you just talk at the other person, without actually sharing ideas. You only use the interlocutor as a surface to project your inner perspectives. It absolutely does not mean that you or your interlocutor 198

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are not going to grow from the conversation, but rather that there is no actual exchange of ideas. What you gain is the result of your being and your encounter, but it is not in any case a gain out of what your interlocutor may have transmitted you. It actually happened during our group discussions about the project that I was talking about something and the others about something else and it felt the whole discussion was pointless – feeling enhanced by the fact that it took place late in the evening. In a way each of us was ruled by their own inner apparatuses, inner mechanisms that direct our way to look at the world. What I am trying to express here is a fundamental doubt about the being together, exchanging and sharing. However after moments of doubts there is a time for reconciliation. What I found out out of this project, and in parallel out of my personal introspection, is that I would rather talk about being for each other than about being together. I think that the only thing we can

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achieve for other is to be next to them, to be available, as the tool of the encounter, as the surface were their subjectivity shapes. The project we developed focuses now on a workshop where people from the Odensehuis are going to paint on plates. We will ask them to recall a memory linked with food and to translate it on a plate. You will say, «isn’t it another distraction activity, just what you were trying to avoid ?» Well, no. Why ? Because we gave it meaning. This meaning is born out of our shared experiences. Because the workshop is aiming for a ritual, the ritual of eating together. Because eating calls for memory, for dishes recipes, knowledge, culture, history, family. Because eating calls for senses, for taste, and smell, and sounds, and colors, and textures. Because eating is warmth, it is belonging, it is at the origin of humanity. Painting a plate is not about customising your things. It is putting down some of your self, some of your being, some of your substance. 200

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with dementia could be compared to what Michel Foucault describes in Madness and Civilisation, the exclusion of mad people as they are of no use for the rest of the society. So if the only things we can really exchange are objects and if one of the essential qualities that define our humanity is that we are able to give, then it is somehow a « solution » for people with dementia to go back to this essential aspect of humanity that is giving some of yourself, through the plate as a place, a frame, a surface that is as well a useful and symbolic object. We were not looking in this project for solution, for improvement, but for a meaning to an use. And as we saw, giving, well, it is like cooking, it is at the origin of humanity. Funnily enough, talking about cooking, Claude Lévi Strauss in The Raw, the cooked, remarks that to reach the reality, you have to make abstraction of what you lived (experience, background, personal history). In other words only

By putting some of your being down into an object, you virtually extract it out of yourself, you materialise it and give this fragment a life of its own. The materialisation of some of your substance (thought, memory) is, to me, answering the critique I expressed about the conversation. Probably, the only way you can really exchange and share some of your self is through objects. This is the only way you can give it, as a thing. Marcel Mauss, in his book The Gift, states that the exchange of objects between groups builds relationships between humans. I believe dementia is a difficult disease because it partially and gradually de-humanise people. If you cannot recall memories, if you cannot be present for the other (because you cannot even be present for yourself in the first place), if you cannot give, you somehow lose your status as a part of humanity, as a part of a society. You are put on the side, you cannot be next to others. What happens to people 202

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new experiences enable developing new paradigms. The thesis of this book is that in cultures that do not cook food, well, there is no word for cooked. With this, I go back to the first part of this essay: how to be critical / go beyond our respective inner languages to create the novelty. As conclusion to draw, what I gain from this project, from this experience, this encounter is that the one things that matters is to give meaning to what you do, to give meaning for yourself. You cannot give meaning to others. Most probably my co-workers have a complete different vision of this project, most probably they would find quite strange what I am here writing. But is it the point that we agree? The point is I was there for this project, for and next to them, as they were there for and next to me. Not in term of exchange but in term of availability. In a way you can only bring from what you have – and are busy with – and from what you encounter: I took Agamben

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as an example not because he is particularly relevant for this project, but because I am currently busy reading him. Because I am busy with his writing and because I have to produce my own essay, the essay becomes a result of the encounter of Agamben’s theory with the Hacking Healthcare project. I created meaning out of this. Maybe I am not even reading Agamben properly, maybe I can only understand his writings through my own mind being busy with the Odensehuis project. But I guess that is how ideas are being born.

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Sharon van den Bosch

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The design process: The effect of values on the cooperation of a team

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Sharon van den Bosch

INTRODUCTION In this essay I am focusing on the effect of these values on the cooperation of a team. We are working in an interdisciplinary team. In an interdisciplinary team people from different disciplines cooperate. Each discipline has his own tasks, but they also have common tasks with the other disciplines (Van Leeuwen, Maas & Miles, 2004). Interdisciplinary cooperation often occurs in healthcare. Private tasks in healthcare require competency and expertise and can only be done by powers, for example specific medicines for depression by a psychiatrist. Because each discipline has his own expertise, each discipline can contribute in his own way (Beernem et al. 1997). An important common task in interdisciplinary teams in healthcare is communication and the creation of a good care and living climate to improve the development of patients. Communication is a complex behaviour, which combines physical 206

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and mental events, to exchange messages between two or more persons (Schindler, Ruoppolo & Barillari, 2010). In other words, through communication one person gives information to other person(s). This mainly occurs through verbal communication. Verbal communication is communication through language. But there is also a lot of non verbal communication such as body posture (Hinde, 1972). We, as an interdisciplinary and multicultural team, agree that communication in our team is very important. Communication is one of the values of our team. In the beginning of this course we also discussed about other important values for us. After consideration we came up with six values which we think that are important for the cooperation of our team. Our values are 1) communication 2) openness/vulnerability 3) responsibility 4) flexibility 5) efficiency 6) sensibility/sensitivity. In this essay I will discuss the effect of our values on the cooperation of a team. Hereby I will focus on

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two values of our team, namely openness and responsibility. Firstly, I will describe the methods I used. Secondly, I will discuss the effect of openness on the cooperation of a team. Thirdly, I will discuss the effect of responsibility on the cooperation of a team. Lastly I will give the conclusion and discussion of the research question. METHODS When answering these part questions I’ll involve scientific background, empirical findings in our team and my own experience. Empirical findings in our team come from experience out of lectures, observations, interviews and feedback. THE EFFECT OF OPENNESS ON THE COOPERATION OF A TEAM Here I will discuss the effect of openness on the cooperation of a team. 208

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In our vision openness indicates the transparency of your own knowledge or opinion, but it also indicates acknowledgement for someone else’s knowledge or opinion. Openness plays an important role in the group processes of a team. Lauring and Selmer (2012) studied the relationship between openness to diversity and group processes in multicultural organizations. They involved openness of diversity of linguistic and visible information and openness of personal and common values. They found that openness to values and openness about information has a positive effect on group trust and a negative effect on group conflict in multicultural organizations. The findings suggest that openness should be a priority in in multicultural organizations (Lauring & Selmer, 2012). Openness is mainly possible through working meetings. Working meetings improve the collaboration and group cohesion of a team and are significant for

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communication. Working meetings play a role in sharing information and knowledge, problem solving, decision-making, coordination, creation, trust and the strengthening of group relationships. Trust and the strengthening of group relationships create more openness and liberty at the group level and individual level, and play a role in sharing and creating knowledge. Unfortunately, working meetings can also be very unproductive. Therefore, good working meetings require planning of the meeting, preparation, assessment, realization and continuation (Lopez-Fresno & Savolainen, 2014). We, as an interdisciplinary and multicultural team with students from the Netherlands, the United States, Canada and Taiwan, agree that openness in our team is very important. We think this is an important value and it’s a good thing to be open and vulnerable and not afraid to say what you think. Through our working meetings and openness during this meetings we shared a lot of information which contributed to 210

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ward. They also agreed that the nurse station has to be more open, so there would be more interaction between staff and patients. Because of our open attitude and asking for feedback we were sure that the staff agreed and that they didn’t have much critique. If we weren’t open about our problem analysis and our ideas, we might forgot something which was very important for the staff.

creation and problem solving. For example, at one session we decided to think a few minutes about how to make the nurse station more open. After thinking about it we all called our ideas. Because we all had different ideas we discussed about these and we combined the ideas as one whole. One team member called a speaking point for the patients to talk to the staff. Another team member had drawn a nurse station with an open atmosphere but still enough privacy for the staff. After discussion we decided to ad the speaking point to the nurse station that was drawn. Through openness of all team members this creation was possible. Besides we not only have been open to members of our team, but also to the staff and patients of the ward, to our classmates and to our teachers. For example, we have presented the problem analysis and global ideas to the staff of the ward and asked for feedback. The staff totally agreed with our opinion of the problem, namely that there is no coherence in the

THE EFFECT OF RESPONSIBILITY ON THE COOPERATION OF A TEAM In this section I will discuss the effect of responsibility on the cooperation of a team. Responsibility is the duty to satisfactorily perform a task that must fulfil. This task can be assigned by someone else, or created by circumstances or promises of yourself. Social responsibility is the obligation of an individual or a group to act for the benefit of the group (Mc Williams & Siegel, 2001). A study reveals that groups with social responsibilities improve the group 212

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responsibilities, I contributed to the process. In our team, everyone fulfilled their responsibilities. Therefore, everyone contributed to the group process, which improves the cooperation of our team. An aspect of responsibilities in our team is that everyone has different responsibilities. We divided these responsibilities. For example in the beginning phase, Phebe was responsible for contacting the head of the ward and making appointments, KC and I did a lot of scientific research and PAZ and Frederique did research to innovation. Another example is that I couldn’t be present during a few lectures. To make sure that the cooperation in our team is still evenly distributed, I will contribute more to the final presentation of this case. The division of responsibilities improves our group process, because every team member can focus on her own task and is not distracted by the other tasks.

cooperation because they want to maximize their own and group outcomes. A group with social responsibilities feels responsible to promote the group’s interest and are also more likely to help each other than groups with no social responsibilities (De Cremer & Van Lange, 2001). Responsibility is also an important value in our team. Each team member has his responsibilities for the team. So each team member has social responsibilities. Our group cooperation and group process improves, when members of our team fulfil their responsibilities. For example, we make different appointments with the ward. Each time a few team members are present. If I have an appointment with the ward I make sure that I am on time and that I am prepared. When we interviewed a few patients I brought my laptop with the question mark and recorded the interview. Afterwards I summarized the interview and uploaded it on Google drive, so every team member was able to read it. Because I fulfilled my 214

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CONCLUSION AND DISCUSSION

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sibility also improves the cooperation and group process of our team. Because everyone in our team fulfilled their responsibilities, everyone contributed to the group process, which improves the cooperation of our team. In addition, the division of responsibilities improves our group process, because every team member can focus on her own task and is not distracted by the other tasks. However, there are a few critical points to make. Firstly, I’ve not discussed the effect of the other values of our team. Communication, flexibility, efficiency and sensibility/sensitivity could also improve the cooperation of a team. But because there are no scientific articles, empirical findings or experiences of these values in this essay, I can not conclude that these values also improve the cooperation of a team. For example, it could be that flexibility leads to more individual work and less team work. In this case flexibility would decrease the cooperation of a team. Therefore, more scientific and empirical research is needed.

Concluded, our values have a positive effect on the cooperation of a team. Firstly, the value openness has a positive effect on the cooperation of a team. Openness to values and openness about information has a positive effect on group trust and a negative effect on group conflict in multicultural organizations. Therefore, openness plays an important role in the group processes of a team. Openness is mainly possible through working meetings. We experiences that openness during our working meetings contributed to creation and problem solving. Secondly, the value responsibility has a positive effect on the cooperation of a team. Teams with social responsibilities want to maximize their own and group outcomes. They are also more likely to help each other in comparison with groups with no social responsibilities. Therefore, social responsibility improves the cooperation of a team. Respon216

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Beernem, P.C. (1997). Interdisciplinair samenwerken in een team

Secondly, our team might miss some important values, which would also improve the cooperation of our team. For example curiosity. If we considered curiosity as an important value, we might have found better ideas, because we would look for more new information. To find out which other values would improve the cooperation of a team, we could ask other teams from our class to tell about the effect of their values or search for scientific articles.

van zorgverstrekkers. Ethisch advies GGZ – interdisciplinair samenwerken De Cremer, D., & Van Lange, P. A. (2001). Why prosocials exhibit greater cooperation than proselfs: The roles of social responsibility and reciprocity.European Journal of Personality, 15(S1), S5-S18. Hinde, R. A. (1972). Non-verbal communication. Lauring, J., & Selmer, J. (2012). Openness to diversity, trust and conflict in multicultural organizations. Journal of Management & Organization, 18(6), 795-806. Lopez-Fresno, P., & Savolainen, T. (2014). Working Meetings-a Tool for Building or Destroying Trust in knowledge Creation and Sharing. Electronic Journal of Knowledge Management, 12(2), 130-136. McWilliams, A., & Siegel, D. (2001). Corporate social responsibility: A theory of the firm perspective. Academy of management review, 26(1), 117-127. Schindler, A., Ruoppolo, G., & Barillari, U. (2010). Communication and its disorders: Definition and taxonomy from a phoniatric perspective. Audiological Medicine, 8(4), 163-170. Van Leeuwen, M. H., Maas, I., & Miles, A. (2004). Creating a Historical International Standard Classification of Occupations An Exercise in Multinational Interdisciplinary Cooperation. Historical Methods: A Journal of Quantitative and Interdisciplinary History, 37(4), 186-197 Vyt, A. (2012). Interprofessioneel en interdisciplinair samenwerken in gezondheid en welzijn. Maklu.

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The teasure box of group

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Paz Ma

In the hacking healthcare course, we are five students from four classes, such as architecture, medicine, psychology and social sciences. We work together as a team and our task is to analyze the circumstances of GGZ inGeest in Amstelveen and later to offer a design/conclusion according to our analysis which is based on our own backgrounds. In the first three months we went there in every Wednesday morning to make observations of the environment and do interviews with the department manager, nurses( including interns ), social worker, therapist and ‘clients’. We documented everything with photos, records as well as diary, then uploaded them to google drive in case that one of us cannot join the visiting. Owing to different time schedules, it is not easy to find common timing for everyone to have a discussion; however, by doing the diary, we shared all the information. In addition, each of us can edit or add her point of view into the diary which also 220

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The diary of the group

helped the inner communication. Besides, the team members also shared articles which are related to our topic. For example, the psychology student posted an article about color and lighting in hospital design from her own study and a text of patients’ and staff’s perceptions of the psychiatric ward environment from a social sciences student. In contrast with them, the design background students tended to give their opinions by showing sketches or making models.

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It is such a good experience to work with people from many fields; nevertheless, it also means that there are many difference within the group. For instance, the social sciences students were lacking of the sense of spatial dimensions and the ways to visualize their ideas. They might lose their points in the prototyping process, they have to wait for other’s visual proposition instead of presenting their very own concepts. For the design members, they are capable of expressing their thoughts by sketches or images. It is always more effortless and efficient to communicate with clients with the visualization. In addition, they have extra notion of space, they pay more attention to the details, such as the usage of floor plan and the movement within the hospital. Still, they are short of theories to support their ideas and this made their design not very thoughtful. To sum up, the way of sharing information by google drive and diary are helpful and useful. It is like a common 224

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treasure box, everyone put a piece of jewelry inside day by day and at a later time we will be very rich because of the immense database. And in order to get consensus for the design, the design students should apply or help others with sketches, pictures, models and even samples of materials. Meanwhile, the social sciences students can collect associated essays and put the highlight in.

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Case #1

Cordaan


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AMC, Cardiology department


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The Odensehuis


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Design Thinking


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Studies: Social Sciences

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KC Chaviano

Studies: Social Sciences

The design process

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KC Chaviano

I have learned a lot about the practical applications of interdisciplinary work from following our Hacking Healthcare course. I find studying interdisciplinary theoretical frameworks both challenging and immensely important, and I have strong convictions that the use of this perspective should lie at the root of all academic pursuits. The primary benefit of including various personal and theoretical perspectives, in my opinion, is that it allows for problemsolving that is progressive at its core, that strives to continually improve whatever solutions we’ve come up with in a radical manner. However, it is my opinion that the most difficult part of interdisciplinary work is actually applying it in practice, in our actions with others, as well as in the relationships, objects, and spaces we create. This is a challenge that can be both inevitable and valuable, which I think many groups came upon during the course of the Hacking Healthcare projects. 278

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For our group specifically, I think the practical application of interdisciplinary work was very difficult. When working with a small group with rather varied backgrounds, I think it’s essential for everyone to participate actively throughout in order to maximize the use of each group member’s skills. I think our group had some issues with consistency in this regard, and there were parts of our project that I believe, at times, suffered as a result. For example, our group had a very difficult time transitioning from the problem definition and design solution phases into the prototyping phase and, in a lot of ways, I think our project lost some momentum at that point in the semester. I think this is unfortunate as we had some very critical conversations and productive research, but perhaps the design process needed to be somewhat more structured than the general brainstorming it ended up being. Perhaps if we had been assigned a few drawings to present by a certain deadline and then come up with a model at a

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later date, we would have come up with a clearer view of our design solution sooner. I felt really at a loss during this part of the project, though, because it marked a shift in our group interactions, in which I didn’t feel like it was appropriate for non-design students to lead the research and prototyping. Maybe making this more explicit would have helped us. In part, I think leadership styles change based on whatever skills each person can “lead” with, which meant that in many ways, even though we had basically the same group through the entire semester, it was as if we were starting completely over with new roles. Unfortunately, we never really discussed this as a team. However, overall, I felt that the interdisciplinary lens impacted our group positively. On the most simplistic level, I think each member of the group could not have accomplished individually as much as we did as a collaborative group, which certainly was a primary point of our art and science interdisciplinary cross-over experi280

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ment. Additionally, having different group members from a range of nationalities, including the Netherlands, Canada, the US, and Taiwan, allowed us to come up with design solutions from a variety of cultural contexts. For example, we tried coming up with different structures that could bring people together on the ward, putting them in greater conversation with one another. I thought of different scenarios in which people interacted from my life and came up with coffee bars and diagonal seating at dinner tables from my experiences in US cities, while Paz thought of the frequent rainstorms in the tropical climate of Taiwan in which people gather under shared umbrellas. I think this kind of idea generation was much more fruitful because it allowed our differences to fuel new ideas that a more homogenous group might not have come up with. For the fields I work within, psychology and social sciences, I find interdisciplinary study and practice as essential.

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KC Chaviano

Using an interdisciplinary scope understands that one-dimensional answers do not exist for complicated, multi-faceted issues that we face in the realms of mental health, interpersonal & community issues, and social injustice. I think most often, however, these fields use “adjacent� fields to inform their interdisciplinary scope, so I find it interesting to push the boundaries of what is possible within these fields using somewhat unexpected disciplines such as technology, art, and design. The field of social sciences was one of the first to benefit from the perspectives of various disciplines. It draws its theoretical and quantitative basis from the areas that engage with the social world, from urban studies to sociology to gender and feminist studies and more. Indeed, there would be no study of social life and social issues without a various perspectives and disciplines. In as many ways as it is possible for us to interact with various disciplines, we are able to also incorporate that into the dis282

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cipline of the social sciences, which vastly looks at and measures how humans interact with various aspects of society and culture. Relative to my own studies, I use the disciplines of gender, sexuality, and feminist studies, sociology, and critical race studies to inform my work within the social sciences. Even each of those independent disciplines also features the frameworks and understandings of other fields, further complicating, in a positive way, the way we theorize and address the social world. By virtue of people and communities being inherently complicated, an academic perspective of social issues lacking an interdisciplinary perspective is not only insufficient and limiting, but also dangerous. In order for a field to be progressive in the way that it embodies enacting social change through research and study, it must involve innovative ways of being radical, that is, of getting to the root or the core of the issue. As for psychology, I believe the field is necessarily beginning to expand its

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scope in somewhat more of an interdisciplinary manner. I think the dominant view of clinical, therapeutic psychology today is that it is a strictly professional and scientific field that addresses those with mental health issues. However, psychology, at least in the therapeutic realm, is increasingly incorporating an applied understanding of family dynamics, close relationships, and issues of marginalized groups as central to providing competent care. Because the field is still so new in its ethical practice, I think these practices that incorporate broader perspectives will begin to expand more and more in the coming years as more is published and researched. Most prominently, an interdisciplinary approach to psychiatric inpatient wards is really valuable in providing a holistic heath care environment for clients. Seeing a care environment as not simply dependent on proper medication but the entire set of skills, experiences, and relationships a client can develop is far superior, 284

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the working and living environment of the GGZ inGeest psychiatric ward in this way made me realize how little collaboration usually occurs when constructing healthcare facilities, and I think many parties lose out when this happens. It was also interesting to be able to compare therapeutic environments in an international context, which I believe can aid in the production of innovative, healthy spaces. A major personal take away in all of this, in short, boils down to providing holistic care to clients with psychiatric healthcare needs, rather than short cutting using only medication and generic care. Understanding that someone’s routines, behavior, and relationships with others, in addition to being attentive to their physical wellbeing, is closely tied with their ability to recover is something that I know I am going to incorporate into my practices going forward. We also learned so much from talking to all the various people involved with the ward, from clients to staff to therapists, and

in my opinion. A skillful and competent psychologist needs to embody a multi­ faceted approach, which can be attained in understanding core concepts from related fields such as sociology, disability studies, and gender studies. Additionally, I think there is a lot of value in experimenting in this area, as long as it remains ethical. I think there are a great many possibilities and breakthroughs we could discover with a more playful or “out of the box” approach to psychology, and I think using seemingly incongruous fields like art and technology can be key in that regard. My experiences of spending time on the ward throughout the course of this semester as well as working closely with a group of peers were probably the most significant in regard to what I feel I can relate to my studies and professional life. Specifically, understanding how clients relate to the space of a ward within the healing environments design perspective was really interesting. Being incorporated into 286

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I think from that I see the benefits of taking an approach that is not strictly theoretical or scientific. Learning to incorporate the perspectives of those my work impacts can be challenging, but is an important endeavor to the “humanization” that groups like GGZ inGeest wish to accomplish. The connecting factor to all of these experiences with interdisciplinary study and practical applications is the value of academic experimentation. By this, I mean using scientific process and preexisting disciplines and bodies of knowledge to develop new solutions that can come out of unconventional approaches. Sometimes this kind of experimentation leads to failure, but that is so much of the scientific process as well. I think embracing the potential of failure, embracing the risk taking in idea generation that so often comes with prototyping, embracing the uncharted territory of disciplines we might be un­ familiar with – this is where interesting work develops. I think our Hacking Heathcare

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course was a very successful experiment overall, complete with all of the hiccups and messiness that comes with incorporating so many different kinds of students and educators in several large projects.

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PERSONAL OPINION ON THE INTERDISCIPLINARY APPROACH The course Hacking Healthcare enabled and encouraged art students to mingle with students doing medicine, neuroscience and psychology. In fact, Stanford Social Innovation encourages this as “to achieve divergent thinking, it is important to have a diverse group of people involved in the process”. The diversity of the whole Hacking Healthcare group led to very interesting discussions and brainstorm sessions which stimulated the formation of new thoughts, ideas and opinions on healthcare issues and possible solutions. I agree with Stephan Webster when he said that “… by working with artists, scientists will find themselves reframing their enquiries. For some scientists, it is this possibility that will continue to entice them into these most interesting of collaborations.” Personally, I feel that the art-science collaboration happening nowadays is leading to the development of 291


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go out into the world and observe the actual experiences..”. I believe this new approach really helped us better understand the significance of the concept inner motivation and future-self in relation to obesity. Furthermore, I agree with Sutton when he said that: ”our mission is to explore new possibilities and our goal is to build a culture that supports constant mindfulness and experimentation”. Personally, I also think there is no better way to solve complex-issues then through an interdisciplinary approach.

innovate ideas and projects which will prevent rise in additional health-care costs. Because of the diversity of our group we were able to expand our ideas and come up with the model we have now. There is no doubt, that the installation including the interviews will leave a mark on the participant as “happenings become experiences when they are digested, when they are reflected on, and related to general patterns and synthesised”. (Bate & Robert, 2006) Furthermore, I liked that design thinking was used in this course as it is different than scientific analytic thinking, which thoroughly defines all the parameters of the problem in order to come up with a solution. In fact, I think design thinking is a great approach in solving complex issues (such as the issues in healthcare) as it forces the designers to think more outside of the box. Similarly, I liked that we tried to solve the problem through talking with many people. Brown and Wyatt also say that “a better starting point for designers is to 292

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Fernando Dias Goncalves

Studies: Medicine

The benefits of art in healthcare

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Fernando Dias Goncalves

I worked in an interdisciplinary group on a project for the Odensehuis. Our group consisted of five people: three science students, including me, and two art students. Each one of us contributed his part on the design from his point of view. I felt that the interdisciplinary way of work had a very positive effect on the outcome. This development I went trough made me formulate the following question: how can an artistic way of thinking have a positive effect on healthcare? During the process of design I noticed that the two art students had a very different way of thinking than I had. I was very used to think in a very systematic way and they were more liberal in their way of working. Working together with them was hard in the beginning, but later it turned out positive for me because I learned looking to things from a different perspective. It brought me to new ideas that were very useful. Thinking in a more artistic way can be very useful in the scientific research 296

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art, music and dance therapy. In an article by Pratt (2004) it is shown that these kind of therapies are broadly used in western medicine and highly effective. But art that is applied in the space where the patient is in can also have a positive effect on the patient’s health. In a research by Dijkstra, Pieterse & Pruyn (2006) it is shown that physical healthcare environment can make a difference in how quickly patients recover or adapt to specific acute and chronic conditions. The authors concluded that environmental factors that can be easily manipulated, that are relatively simple, and that are low-cost interventions might have a considerable impact on health-related outcomes. There are more studies done about the impact of art and design on healthcare. In a systematic review by Daykin et al. (2013) 600 papers published between 1985 and 2005 on the impact of arts, design and environments in mental healthcare were reviewed. The largest number of those studies suggests that art; design and environment

process. This is shown in a paper written by Webster (2005). The researcher interviewed scientists and concluded that scientists can benefit a lot from art-science collaboration. Art can improve the skills of a doctor. In a study by Elbert & ten Cate (2013) the writers concluded that observing art might have a positive effect on the observing skills of medical students. The reported beneficial effects of observation were art advances in a general or detailed observation, in the recognition of patterns, and in recognizing emotions. However, there is a lack of evidence to tell with certainty that it’s true. In a article written by Antelo (2012) the author states that art (in his article the art of Frida Kahlo) can serve as a resource for physicians who want to better comprehend the consequences of pain. His statement is based on his observation and experience. Applying art into the healthcare systems can be also directly beneficial for the patient and his treatment. A well-known example of art in the healthcare system is 298

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can affect health, including physiological, psychological, clinical and behavioral effects. The paper shows that exposure to stressful visual and aural environments may reduce levels of stress and enhance recovery. It was also found that architectural design consideration is important in mental health settings, especially for patients with conditions such as dementia that can make way finding difficult. Besides, exposure to art in healthcare environments has been found to reduce anxiety and depression. Environment features have also been found to affect staff, and improvements in visual and acoustic conditions may reduce risks of errors in some care settings. However, there is further research needed. The system of healthcare can also benefit from a design approach. In a paper by Searl, Borgi & Chemali (2010) the vulnerabilities within our current healthcare system were examined. The authors purposed borrowing tools from the fields of engineering and design like user-centered design.

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The author concludes that an understanding of human thought processes, emotions, and behaviors needs to guide the design of healthcare delivery systems. A good design for the healthcare system can also safe a lot of money. A good example of a creative design of healthcare is the Triple Aim design by Jan van Es Instituut (2014). This design is based on the simultaneous achievement of three goals: improve the experienced quality of the healthcare; improve the health of the defined population; lower the cost per capita of the population. In the current system these three goals are pursued separately. This can lead to inefficiency and loss of quality. The Triple Aim system could improve the healthcare system. In conclusion, there are many ways in which the collaboration of art into science can have a very positive effect. Having a creative way of thinking gives many benefits in the scientific research process. Besides that, observing art can improve someone’s observation and empathic skills as a doctor 300

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Antelo, F. (2012). Pain and the paintbrush: the life and art of

and as a scientist. Furthermore art can be directly beneficial for the patient when applied in the healthcare system. An example of this is art, music and dace therapy. A good design of the space and the environment of the patient’s residence can also improve the patient’s health. However, there is more research needed for these methods. Design thinking should also be applied in the system of healthcare. Hereby more quality can be reached for a lower price. My opinion is that there should be more attention for the introduction of multidisciplinary teams in healthcare. Seeing things from a new perspective can have a positive effect on many different fields.

Frida Kahlo. The virtual mentor: VM, 15(5), 460 - 465. Daykin, N. et al. (2013). Review: The impact of art, design and environment in mental healthcare: a systematic review of the literature. Perspectives in public health. Dijkstra, K., Pieterse, M., & Pruyn, A. (2006). Understanding healing environments: effects of physical environmental stimuli on patients’ health and well-being Duncan, A. K., & Breslin, M. A. (2009). Innovating health care delivery: the design of health services. Journal of Business Strategy, 30(2/3), 13-20. Elbert, N.J. & ten Cate, Th, J. (2013). Kunstobservatie in het medisch curriculum. Nederlands Tijdschrift voor Geneeskunde. 157(A6015), 1-7 Jan van Es Instituut (2014). De 7 stappen opweg naar Triple Aim Pratt, R. R. (2004). Art, dance, and music therapy. Physical medicine and rehabilitation clinics of North America, 15 (4), 827-°©‐841. Searl, M. M., Borgi, L., &Chemali, Z. (2010). It is time to talk about people: a human-centered healthcare system. Health Res Policy Syst, 8, 35. Webster, S. (2005). Art and science collaborations in the United Kingdom. Nature Reviews Immunology, 5(12), 965-969.

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Phebe Kraanen

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The creatively ill: A literature search

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Phebe Kraanen

INTRODUCTION In the psychiatric world there is a lot of mysteriousness around the mental illnesses. Although there are descriptions of the diseases and treatments that go along, the not understanding of a patient’s craziness stays. By craziness I mean what is seen as abnormal behavior in the social construct we are in. This could be unreal thoughts, hallucinations or inappropriate behavior, traced back to a psychiatric diagnosis. What I would like to research in my essay, is how this ‘craziness’ finds a way of communication through art. Why is it that we are often amazed by the artwork a mentally ill person can produce? How come there is this plausible connection between the mentally ill and creativity. And what are examples of production of artwork done by psychiatric patients.

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RESULTS If we take a quick look back into the Middle ages, insanity was seen as caused by demons.1 Those who were ‘different’ were sometimes turned out of their homes and villages, they wandered the roads of early modern Europe. Many of those ‘village idiots’ were those who had suffered mental retardation or schizophrenia from birth trauma.8 There is this painting by Antoine Wiertz, made in the 19th century, called ‘Wahnsinn’. You see a hysteric woman, a little babyleg in the kettle and blood spilled on her dress. This is an example of how the mentally ill could be interpreted through a painting at that time. So, what is psychiatry and what is art, and why do they connect? Psychiatry is the medical specialty devoted to the treatment of mental disorders. Art is, according to Wikipedia, a diverse range of human activities and the products of those activities. These could visually include sculptures,

paintings, printmaking and other visual media. Art can be an expression of the artist, or a piece of work communicating on it’s own. In the essay “Creativity and mental illness: is there a link?” the author argues there is no significant link between mental illnesses and creativity. There is not enough evidence to proof that people with a manic depression or psychosis are more creative.6 Although the authors are critical on the link between mentally ill and creativity, they 306

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wouldn’t want to harm the decreasing stigmatization of people with a mental illness. Making art as a mentally ill shows a talent, a way of communicating in society. What does this creating do with the mind of a patient? In the ‘Art, psychotherapy and Psychosis’ two experienced art-therapists argue that through actions and symbolic forms, such as art and language, that a sense of self, and of agency, develops. They say that a psychotic patient suffers because he/she does not experience him/herself as a member of a community. Belonging to a group involves shared rituals and a common language, it is through these that membership of community is confirmed.4 In a research about art and recovery they observe the drawings made by patients. The researchers let acute schizophrenic patients on an NIH Clinical Center participate in individual art sessions during drug-free periods at admission, at discharge, and at 1-year follow up. In each session the patient drew a picture of his

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choice, a self-portrait and a picture of his psychiatric illness. What they have seen is that by admission the richness of the experience was clearly shown in the picture drawn by the patient. By follow-up, one year later, the disease was put in a box or very minimally drawn. In therapy extreme efforts are made to block unconscious flow into awareness, this resulted in a constricted artistic flow as seen in the pictures made by follow-up.5 In the research of Linda Chapman et. al,7 they compared art therapy to standard therapy with pediatric patients with PTSD. There was no significant overall difference in patients’ PTSD scores between those who received a certain art therapy and those who received standard hospital treatment. Although with examination of individual symptoms it showed that intervention of the regular treatment with the art therapy, made the PTSD symptoms decrease. This could imply that the art therapy effectively reduces stress symptoms, and 308

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may allow children to discuss and process their traumatic experiences more effectively when compared to the standard treatment group. The researchers also state that the drawings may contain valuable developmental information about how children perceive traumatic events, medical care and rehabilitation. So for producing art as a patient there is scientific evidence this improves mental health. Now we can look at what there is actually made, and why is it attractive to look at. In the paper of MacGregor about ‘The discovery of the art of the insane’2 he discusses the change in the opinion about art by the mentally ill, for example Adolf Wölfli was acknowledged for his extraordinary power of visual statements. Typical in the work op Adolf Wölfli is his fear of emptyness, horror vacui in latin. The psychiatrist of Adolf Wölfli wrote a book about him as an artist in 1921, Ein Geisteskranker als Künstler.3 This was the first book that

treated a patient with schizophrenia as a serious artist. In 1922 the german psychiatrist Hans Prinzhorn published a book with artworks collected since 1912 of mentally ill people. This inspired a lot of artists. Jean Dubuffet came up with the term ‘art brut’, because it is raw, untamed and dazzling. The artists aren’t making the works for others, or in response to other artists, but are making it because they have to. For example Adolf Wolfli was drawing every day, at the end of the week his pencils were all used. The artwork by mentally ill is mostly very individualistic, not influenced by new tendencies. CONCLUSION There is no significant evidence on the relation between mentally ill and artwork. What we do know is that patients with mental disorders greatly benefit from the making of art, at art-therapy. There are also 310

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1. Trapp, C., and Trapp, M. about Psychiatry in Art, pages 511-517. 1936. 2. The discovery of the art of the insane. MacGregor, John M. Princeton, NJ, US: Princeton University Press. (1989). xix 390 pp. 3. Book, Walter Morgenthaler: Ein Geisteskranker als Künstler, Bern 1921/reprint Wien 1985 4. Art, Psychotherapy and Psychosis, edited by Katherine Killick, Joy Schaverien, 1995 5. Art and recovery style from psychosis by Thomas H. McGlashan, M.D., Harriet S. Wadeson, A.T.R., William T. Carpenter, Jr., M.D., and Steven T. Levy, M.D. Published in the journal of nervous and mental disease, 1977 6. Waddell, Charlotte. “Creativity and mental illness: is there a link?.” Canadian Journal of Psychiatry 43.2 (1998): 166-172. 7. Chapman, Linda, et al. “The effectiveness of art therapy interventions in reducing post traumatic stress disorder (PTSD) symptoms in pediatric trauma patients.” Art Therapy 18.2 (2001):

some mentally ill artists highly appreciated for their artwork, as described and shown in books and galleries. We find these artists quite interesting because it is mostly very individualistic and extraordinary, quite unusual in comparison to other artists. I see the work of art of the mentally ill as a grasp of their reality, a possible representation of what they are experiencing. Because it helps in their process, I see the making of art as a necessity in their therapy.

100-104. 8. Shorter, Edward. “A History of Psychiatry.” Cahan, Douglas Hospital (1998): 248-55. 9. Boisen, Anton T. “Religion and psychosis.” Pastoral Psychology 4.9 (1953): 55-56. 10. Pierre, Joseph M. “Faith or delusion? At the crossroads of religion and psychosis.” Journal of Psychiatric Practice® 7.3 (2001): 163-172. 11. De Witte, Marieke. “De perceptie van het kunstenaarschap van psychiatrische patiënten door Prinzhorn en Dubuffet.”

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Leonie Poelstra

Studies: Psychology

The importance of critical thinking in design thinking

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Leonie Poelstra

In commission of the course Hacking Healthcare given by the University of Amsterdam and the Gerrit Rietveld Akademie and our case holder the Onze Lieve Vrouw Gasthuis/ Sint Lucas Andreas Ziekenhuis (OLVG/SLAZ), my project group has been asked to design an orthopedic surgery waiting room. Although the management of the OLVG/SLAZ had some practical ideas about the new design of the waiting lounge, they were still thinking of a conventional waiting room like in any other hospital. However, the name of our course was “Hacking Healthcare�, and if people already know what the problem is and how to solve it healthcare innovation cannot occur. Innovation does occur when people are not sure what the problem is but they want to change the current situation. With this idea in mind our case suddenly shifted from designing an orthopedic surgery waiting room into designing a better healthcare service. At this point the challenge was how where we, one psychology student from the 316

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Leonie Poelstra

Studies: Psychology

University of Amsterdam and three architecture/design students from the Gerrit Rietveld Akademie, were going to hack healthcare? I, as a psychology student, was not sure of what my contribution in designing an innovative healthcare environment would be. But surprisingly my background field of study proved to play a significant role in the design thinking process, and with this essay I would like to explain why this is so. Contemporary organizations have increasing interest in design thinking (Brown, 2010). Because of the urgent need to broaden their current repertoire of strategies for addressing complex and open- ended challenges, business and management communities are more and more looking for design thinking- based approaches (Dorst, 2010). Design thinking can be described as a methodology that imbues the full spectrum of innovation activities with a human- centered design. This way innovation is powered by thorough understanding, through direct observation, of what people

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want and need in their lives and what they like or dislike about the product, service or system (Brown, 2008). And since psychology is the science of behavior and the mind of humans (and animals), it is obvious that this field of study could contribute to a humancentered design (Gray, 2007). The process of design thinking can be divided in five stages, in succession; empathize, define, ideate, prototype and test. The strength of design thinking lies within its procedure. Designers are forced to constantly test, improve and retest their ideas, which in turn increases the chances of creating a good design. Particularly in the empathize-, define-, and test stage there is a clear role for psychologists, which I will demonstrate below. I would like to start with the first stage of the design thinking process: empathize. Empathy is the ability to understand and share the feelings of another (Oxford Dictionary). In the context of designing; to learn about the audience for whom you are designing, by observation and interview. 318

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Leonie Poelstra

Studies: Psychology

As a psychologist you are trained to go beyond your own experience, and to enter someone else’s personality and consequently imaginatively experiencing the other’s situation, feelings and motives (lecture by Phillips). These skills should make it easier for psychologists to design for someone else’s needs instead of their own (lecture by van de Grift & Phillips). Although it sounds needless to say, letting go of your own frame of reference is not as easy as it sounds. When we were designing the orthopedic surgery waiting room, my group had the strong tendency to imagine for themselves what they would want to do or have in the waiting room. But, since we were no orthopedic surgery patients, our beliefs and views turned out to be rather inadequate. After interviewing the patients we found out that they were already quite satisfied with the waiting room. This insight was against all expectations, as we were convinced that the space was dull and unimaginative. For us this was an important

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realization, apparently we were looking with a frame of reference as a designer, and the patients with a patient frame of reference. Therefore, they had totally different demands and expectations from the waiting room than our project group. Secondly, during the empathizestage, the key to thorough understanding of what people want and need is by doing field observation (Brown, 2008). The traditional ways of doing psychological research such as questionnaires and surveys rarely yield important insights. These techniques simply ask people what they want, but most of the time these methods do not lead to gamechanging innovative ideas (Brown & Wyatt, 2011). One classical fallacy in observing human behavior is the observer bias. The observer bias is occurring when preconceptions of the observer influence the way of how the observer sees the behavior or event (Mook, 2011). The implications are that the observer sees the situation in a biased manner, and another observer could observe 320

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the behavior or situation completely differently. This idea is based on the theory of naïve realism: people tend to believe that one perceives objects and events as they are, rather than as they appear in light of one’s particular vantage point, prior beliefs and expectations (Sternberg, 2007). As a psychologist, one of the first things you learn is to be aware of these bias problems and how to cope with them. For example when my group visited the OLVG/SLAZ we were taking a look around in the orthopedic surgery waiting room and the rooms of the patients. Instead of interpreting the elements of the waiting room, I described the elements in the room. So instead of writing down: “This space is boring and looks dull”, I would write down: “The space has a rectangular shape and white walls.” You can ask a dozen people what they think of an object, person or space, and get twelve different answers. But if you ask them to describe what they see, you probably get a lot more matching and consistent information.

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On the contrary, it could be possible that psychologists are biased in observing human behavior because their background field of study frames them. It is very plausible that in design thinking ignorance bliss could lead to new ways of looking at behavior and insights. On the other hand, the awareness of bias is the most important tool in preventing it. And as a psychologist you are thought to be an expert in recognizing your own susceptibility to bias and to seek it out in yourself and others (Sternberg, 2007). Furthermore in the second stage of design thinking- define you are asked to come up with a problem analysis based on the information you have gathered in the empathize- stage. Just as in the empirical cycle of scientific research, you extract your problem analysis from the information observed in the real world by induction. A psychologist has to be as specific as possible in formulating a theory or hypothesis, since they have to be falsifiable and 322

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replicable by other researchers (Sternberg, 2007). Otherwise it is impossible for other researchers to disprove a certain hypothesis or theory. So, when evaluating a theory, a psychologist pays close attention to how well the constructs in the theory and the relationships between them are defined (Sternberg, 2007). Exactly the same is needed in the define- stage of design thinking. In his research on creativity in designs Christiaans (cited by Dorst & Cross, 2001) found that ‘the more time a subject spent in defining and understanding the problem, and consequently using their own frame of reference in forming conceptual structures, the better he or she able was to achieve a creative result.’ Additionally, Dorst and Cross (2001) found that a creative event occurs as the moment of insight at which a problem- solution pair is framed. And that a designers ‘framing ability’ is crucial to high-level performance in creative design. This ‘framing ability’ is about demarcating your definition, so in which circumstances

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does your problem analysis tallies and in which circumstances it does not. These are very important critical skills because it provides you from a clear problem analysis, which in the end will lead to a better problem- solution fit. For example for us we needed to know for whom we were designing. Eventually we chose a patient- centered perspective, which led to one design idea of reducing anxiety with patients by making the space transparent. But if we would have chosen for a management cost- efficient perspective, we might have designed a space where it would be possible to run as many orthopedic surgeries in one day as possible. Although critical thinking is helpful in the empathize-, define- and test stage (the test- stage will be described in the next paragraph), it is not very welcome in the ideate- stage. This stage has to be free of critics, and generating ideas is key to find the best design solution here. As Linus Pauling, scientist and two- time Nobel Prize winner 324

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audience to collect background information. During the test- stage the prototypes will be adjusted and tested again, until the best prototype has been found (Brown, 2010). Between testing and adjusting their prototype designers interview their audience and ask them for feedback. However, the interviewer has to be careful with his or her formulation and sequence of questions. Several studies have shown that the way questions are framed and asked have enormous impact on how they are answered (Sternberg, 2007). Before interviewing the patients and nurses we wrote down all of our questions and thought of how people could interpret and respond to them. After rephrasing them there was no doubt that we had a well-structured list of interview questions. This probably has led us to answers and feedback that were far more useful and meaningful than would have been without these adjustments. Otherwise we probably had gotten answers that were ambiguous, vague or useless in the way

puts it, “To have a good idea you must first have lots of ideas” (cited by Brown, 2010). And one of the most important rules during the brainstorming process is to defer judgment (Brown, 2010). During the ideatestage it was hard not to judge each other’s ideas, also because as a group you try to structure the wide tangle of ideas to have some sort of oversight during the process. But as Tom Kelley explains in his book, The Ten Faces of Innovation, “The best ideas naturally rise to the top, whereas the bad ones drop off early on” (cited by Brown, 2010). In the end when we got into the prototype- stage, we still had a handful ideas left which beheld complete different aspects of the problem. This way we could start testing our ideas and still have the opportunity to drop one of the ideas or to integrate them with each other. Both in the final and empathizestage the psychologist shows great value as an interview expert. In the empathizestage the designers will interview their 326

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that they were not the answer to our question but another. With this essay I hope to have convinced my readers of the importance of the part of someone with a background in the field of psychology in every design thinking process. First of all psychologists are needed in the empathize- stage. Because of their empathic skills they are well suited for understanding the needs, thoughts and emotions of their audience. Secondly they are aware of bias problems in observing behavior and know how to cope with these problems, which is very useful during the field observation phase. Furthermore in the define- stage they are experts in the process of empirical induction and defining a well- framed problem analysis. And finally they are the best in interviewing people, which will lead to a thorough understanding of their audience and needs. Together these skills are essential to lead towards true understanding of the “problem”. And innovative designs come from

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the perfect match between problem and solution. Thus, half of the design thinking process is already covered by these critical thinkers. Brown, T. (2008). Design thinking. Harvard Business Review, June, pp. 1-9. Brown, T. & Wyatt, J. (2010). Design thinking for social innovation. Stanford Social Innovation Review, winter, pp. 31-35. Cross, N. & Dorst, K. (2001). Creativity in the design process: co- evolution of problemsolution. Design studies, 22(5), pp. 425437. Dorst, K. (2011) The core of ‘design thinking’ and its application. Elsevier Ltd. Design Studies, vol. 36 no. 6, pp. 521- 532. Gray, P. (2007). Psychology, the 5th edition. New York, NY: Worth Publishers. Halpern, D.F., Roediger III, H.L. & Sternberg, R.J. (2007). Critical thinking in psychology. New York, NY: Cambridge University Press. Mook, D.G. (2001). Psychological research: The ideas behind the methods. New York, NY: Norton & Company, Inc. Philips, S. (2014). Lecture on September 15th. Philips, S. & van de Grift, T. (2014). Lecture on October 7th. http://www.oxforddictionaries.com/definition/english/empathy

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The perks of prototyping in art-science collaborations: How it influences the end product

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BENEFITS OF PROTOTYPING IN ARTSCIENCE COLLABORATION ON THE END PRODUCT Although Leonardo Da Vinci was both artist and inventor, art and science are usually seen as two distinct and unrelated pursuits. However, over the last decade these two poles seem to have found each other more often. Art emerges at science museums and science turns up in art galleries. For instance, Marc Quinn made a portrait of genetic scientist Sir John Sulston. Instead of portraying Sulston in a traditional way Quinn choose to depict the genetic scientists DNA by creating a quadrat of agar covered in Sulston’s sperm cells (Webster, 2005). Another artist who uses science as inspiration is Anna Dumitriu. She works together with microbiologists to create art using bacteria as her tools. These examples suggest that artists are the ones to benefit from the collaboration between art and science. However, scientist can be helped by artists as well. For instance, filmmakers 331


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Studies: Psychology

and biologists work together to investigate behaviour of animals (Midge Bait) or to find new ways to map the migration of cells (Magic Forest, Webster, 2005). Another interdisciplinary cooperation beneficial for scientists is the manufacturing of glass implants uniquely matched to patients. Because of these refined implants, surgery time is reduced. More evidence that art is profitable for scientists comes from a study done by Elbert and Ten Cate (2013). They argue that the occupation of a medical doctors is characterized by recognising, describing and interpreting patterns in order to correctly diagnose a patient. These are the same skills used to studying art. Therefore, the authors tested whether a training in artistic observation skills might improve the clinical observation skills of medical students. They found exactly that. The six investigated studies indicated that students from the intervention group were better able to empathise, recognise patterns, describe observations more

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Linde van Vlijmen

detailed and extensive. In addition, an art observation training added to the clinical observation skills and the students feeling of personal competence as a doctor. Overall, the collaboration between art and science can be both beneficial for scientists and artists. Cooperation between artists and scientist is not naturally successful. It is important that designs match the needs of the end-user. That a design solves a problem nobody knew they had. A humancentered approach that pursues this goal is design thinking. In short, this is a designing method in which the designer’s sensibility is used to match customer’s needs and the infrastructure to enable the product (Brown & Wyatt, 2010). In this definition a product could also be a strategy, business, innovation or vision. Brown (2008) explains that design thinking consists of three spaces: Inspiration, ideation and implementation (Brown & Wyatt, 2010). Designers do not necessarily 332

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go through these spaces sequentially and different spaces can be visited more than once and simultaneously. Nevertheless, one usually starts at the inspiration space. This space comprises the problem, change or opportunity that motivates the search for a solution. These circumstances are viewed in depth to find out what people want, what drives them and especially what they need. Integrating people from different disciplines from the beginning will help to gain a broader understanding of a problem, combining scientific and more intuitive-oriented research methods. In the ideation space insights from the inspiration space are used to brainstorm for possible solutions. For this empathy for people and disciplines beyond one’s own is vital. Again, creating an interdisciplinary projectgroup will accommodate this goal and will stimulate divergent thinking. Third, the implementation space is about producing prototypes of the best ideas and testing these prototypes. Feedback from tests

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might lead designers back to the ideation space or even to the inspiration space. Prototyping is not constraint to the implementation space. By means of visualisation rapid prototyping is a useful way to communicate ideas. Consequently prototyping, to my opinion, is highly important if not vital for successful artscience collaborations. Prototyping allows team members to create a shared vision, but also to uncover unforeseen implementation problems and unintended consequences (Brown & Wyatt, 2010). In the coming paragraphs arguments will be given to support the statement that prototyping is beneficial for interdisciplinary project-group and therefore influences the end-product positively. The presented arguments will be supported with literature as well as with examples of personal experience. These experiences were gained during a project in which psychology students worked together with architecture student to come up with a design to help stimulate Surinamese 334

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dementia patients to intrinsically motivate them to move more.

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in the brainstorming phase becomes more difficult. Here prototyping becomes helpful. By quickly drawing or crafting an idea someone physically visualises his or her idea. As a result, the whole group holds the same image of that idea and it simultaneously brings the different frame of references closer to each other. In other words, prototyping facilitates a shared vision between the group members both on the problem and the visualisation of possible designs. Alavi (1984) supported this view with field and laboratory studies. She found that by using a prototyping approach communication channels improved. Communication was relatively conflict free and easy. Prototyping helped creating a common language and a common frame of reference.

PROTOTYPING CREATES A SHARED VISION Prototyping ideas in an early stage of the design thinking process helps team members communicate by physically representing their ideas. During the empathising phase of the inspiration space hundreds of possible ideas for designs come to mind already. The empathising phase mostly consisted of observing the dementia patients while doing their daily activities. Consequently different observers empathise differently with the end-users. In other words, team members’ frame of references differ from each other. As a result opinions about what the endusers needs are differ between the team members. On one hand this diversity in observations is beneficial since it broadens the understanding of the problem. On the other hand, communicating ideas 336

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fixation occurs. Herbert Simon (1986, retrieved from Youmans, 2011) stated that a design process is the mental manipulation of representations in the memory system to explore complex relationships between design features. Hence, many cognitive abilities are necessary in creating new and innovative ideas. To lighten these cognitive burdens prototyping comes in handy. By creating a prototype one can physically store an idea, thereby getting it out of your head. Consequently, more cognitive capacity is free to critically evaluate the idea. Youman (2011) supported this theory. In his study it was found that physical prototyping expanded communication and critical thinking and reduced cognitive workload. These effects help detect and eliminate design fixation which in turn is beneficial for generating innovative and creative designs. A practical example to illustrate these results comes from the Surinamese dementia project. At one type a prototype

PROTOTYPING STIMULATES PROGRESSION So prototyping facilitates communication between interdisciplinary group members. Once the communication is set and the brainstorming has provided the group with some promising ideas, another advantage of prototyping becomes apparent. Prototyping possible designs helps progressing the design process. A common phenomenon seen when trying to find innovative problem-solutions is design fixation. Designers are fixated on features of existing designs. As a result they new designs that are similar to pre-existing ones are generated. Design fixations keeps designers from creating truly innovative and new designs (Youmans, 2011). However, due to the associative way our memory works, the first ideas that occur are usually based on some conceptual representation that was recently activated in the brain. Roughly, this is how design 338

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An early idea to create a machine that stimulates all senses and adapts to its user. A prototype was made and brought to the care facility. Soon it was found that both caregivers and patients did not seem to respond positively to the prototype simply because it was too difficult and abstract. Nobody knew what to do with it. Testing the prototype gained insight on whether to continue developing an idea or to, in case of the Magic Apparatus, to take on a whole new direction. This illustration shows that a designer can be very fond of his or her own idea, but in the end the designer should keep the needs of the end-user in mind. Testing prototypes helps staying focused on solving the problem. Altogether, prototyping facilitates progression of the designing process because it helps designing groups to critically evaluate their ideas both by reducing cognitive workload and testing. In addition prototyping helps in making sure progression is directed towards solving the problem.

was made that depicted the idea to create different small tables that can be put together to one big table or could be taken apart to form smaller groups. Each table would have a different activity to stimulate movement. After playing around with the prototype it became clear that the core of the idea (smaller subunits which hold different activities) was good, but the design in the current shape would not work. Moving around the table takes too much effort and the table would lose its main function; a dining table. From that point the decision was made to keep the original shape of the table, but to incorporate the function of modifying the shape of the table. The prototype allowed for looking at the idea from a distance and critically evaluate the whole design; both function and aesthetics. Besides eliminating design fixation, prototyping also allows designers to test the prototypes and see if the design matches the end-user’s needs. Another practical example is that of the Magic Apparatus. 340

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CONCLUSION AND DISCUSSION

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implementation challenges and unintended consequences in order to have more reliable long-term success.” (Brown & Wyatt, 2010). In this contemplation it was argued that prototyping is an import aspect of successfully completing a designing process in an interdisciplinary team. However it should be noted that all stages of the design process are important. In the Surinamese dementia patients case, empathizing with the clients was just as important. Without empathizing with the end-user coming up with a solution that fits their needs would be impossible.

Collaborations between art and science can benefit from prototyping because it provides the interdisciplinary team members with a shared vision and because it stimulates progression. A shared vision facilitates communication between team members allowing to work more closely together. As a result a shared problem definition and a shared visualisation of ideas is created. This benefit of prototyping is used mostly in the beginning of the designing process, when team members have to get used to each other and brainstorming ideas is important. However, when good ideas have been selected prototyping stays important in guiding the designing process. By reducing cognitive workload and enabling testing, prototypes helps designers to stay on track to fulfil the needs of the end-user. “Through prototyping, the design thinking process seeks to uncover unforeseen

Alavi, M. (1984). An assessment of the prototyping approach to information system development. Communications of the ACM, 27 (6), 556 – 563. Brown, T. (2008). Design thinking. Harvard Business Review, 1 - 9. Brown, T., & Wyatt, J. (2010). Design thinking for social innovation. Stanford Social Innovation Review, 29 - 35. Elbert, N. J. & Ten Cate, Th. J. O. (2013). Kunstobservatie in het medisch curriculum. Nederlands Tijdschrift voor Geneeskunde, Amsterdam, 157, 1 - 6. Youmans, R. J. (2011). The effect of physical prototyping and group work on the reduction of design fixation. Design Studies, 32 (2), 115 – 138. Wester, S. (2005). Art and science collaborations in the United

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Kingdom. Nature Publishing Group, 5, 965 - 969.


Studies: Medicine

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Iris Christine Mikulic

Studies: Medicine

The art of preventing obesity 2: An interdisciplinary analysis

Iris Christine Mikulic

DESIGN THINKING & ART-SCIENCE COLLABORATION Design thinking is an approach that tries to solve problems by solution-focused thinking, namely starting with a goal and not with problem solving. Hereby, it is important to use and combine for instance empathy, creativity and rationality. This new method of approach and design is a fundamental aspect of the course hacking healthcare. In fact, the whole course was set up around this model and we were continuously encouraged to use it. During the course we followed a stepped approach (figure 2) that started with defining the problem, doing research on it and coming up with different creative solutions. Afterwards, we made a prototype and picked a final product which was in our case, the future-self enlightenment project. The next step for us, is to make a real-size model and to test it in different settings. The final step is seeing whether ad-

Figure 2: Design Thinking: SteppedApproach Figure 3: SCAMPER model (Litemind)

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only done “through doing, and experimentation”. (Brown and Wyatt, 2010) Another lecture during the course, which I found interesting and helpful was the use of new brainstorming techniques named SCAMPER (see figure 3). SCAMPER is a new way of brainstorming used for problem-solving and is based on the notion that “everything new is a modification of something that already exists”. (Litemand) Firstly, the problem is defined and then afterwards the SCAMPER model is used to come up with new and useful questions about the topic and project. In our specific case, we used this model and we came up with many new insights, which came from existing thoughts such as our first idea to start a specially designed cooking workshop. This was enormously helpful during our project as by using this model we were able to come up with the idea of the futureself in combination with the prevention of obesity. Figure 3: SCAMPER model (Litemind)

justments need to be made in order to reach the best results. Figure 2: Design Thinking: Stepped-Approach One class of Hacking Healthcare based on the principle of design thinking, which I in my opinion found extremely helpful, was the lecture on empathy. During this class we were taught to learn how to empathise more with the target group we were researching. Through a few games, including a role-play, we got to learn the importance of this quality, in order to reach the core of the problem we are investigating. We used the things we learned from this class also to create the design of the enlightenment room including the set-up and questions of the interview. We filmed ourselves and also fellow-students while answering questions and afterwards looked at the suitability of the questions through trying to empathize as much with them. This was extremely helpful for the design thinking process because empathy for people and for disciplines beyond one’s own is crucial and it is 346

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Another aspect of the course, which I personally found very effective were the many guest lectures and speakers who visited us during the first few months. Many of these speakers were experts in their field (eg. Anna Dumitriu; an artist that combined her love of microbiology with art) who gave very inspirational talks and lectures. Personally, I also liked that some of these experts talked to each group separately . All their advice and opinions on our project, helped us tremendously through our design process. For instance, for our future-self project we were very focused on making the participant feel very overwhelmed by wanting to use dark colours, and bright lights as we believed this would add to the shock factor of the installation. Nonetheless, after having talked to a few experts about this, we realised we should not make it a “traumatic� experience, instead we should focus more on making the participant feel at ease throughout the whole interview which would instead leave a more positive and motivational message. 348

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Studies: Inter-Architecture

Insight Series #8 Hacking Healthcare

Natasha Oduber

Studies: Inter-Architecture

The circuit of experimentation

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Natasha Oduber

Design process is very much like a racing circuit the process has to go round and round until it reaches the goal. Racing in this circuit you will have to come to the pit stops and have your car ready for another go. There are many ways to approach the design process. I found this one a great way to analyses the process our group went through: - The five phases of design process (Stillman, 2012) 1. Examine – dig into the problem look at the history, the context, the objects, and (most importantly) the people involved. 2. Understand – go deeper and find patterns. Establish open questions to build on. 3. Ideate – have lots of ideas, good and bad; do not stop at the obvious or the impossible. 4. Experiment – try some things out. Make some things. Fail, cheap and fast. 5. Distill – Strip your solution down to the essentials and tell the story to others.

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Studies: Inter-Architecture

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Natasha Oduber

effective. At the same time however AD patients are oversensitive to noise pollution, which causes anxiety and agitation. We can use nature sounds, music of the time they lived in - 50’s and 60’s, use of cultural music and children songs. We can also use communication via walky-talky to other patients on the different floors and staff or family via other means like Skype with video this can also belong to sight. Taste and Smell is noticeably reduced early on in the disease. We can have nonpoisonous plants, herbs or flowers in proximity or have objects that emit certain smells, potpourri in pouches. Touch is one of the senses least impaired and is an important source of communication in advanced stages of the disease. We can have sensory stimulating surfaces or objects like ropes with many surfaces.

The experimentation phase is what I would like dive into. It is also called the testing phase in which with the following texts we see the importance it has in the design process, by finding problems and changing these problems, by testing it again, and then finding the problems and so on, until you find what you need for your end design. EXPERIMENTATION PHASE Our aim is the patients; we chose to use the senses of the body to trigger them to be active. Senses referring to dementia patients (Snel, 2014): The sense of sight is relatively long intact, although miss-interpretations of the environment are easily to occur. We can use videos or pictures of old days of Suriname. We can also use colourful puzzles and materials. The sense of hearing by communicating through music and sound is very 352

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Studies: Inter-Architecture

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Natasha Oduber

MAGIC APPARATUS

TACTILE STIMULATION + TABLE

First prototype: “Magic Apparatus� A box with many sense stimulating objects together. Made of a cardboard and many objects set together implying objects like touchpad that can be used to hear music look through photos among others. Games movable puzzle, pushpin, theatre box with lights, instruments that can be played and touch box with soft interior with bumps. When we tested it is too compact too much stuff going on it was confusing and the patients did not know what to do. That is why we tried separating some parts and it was a bit more successful, although when testing these parts the patients where a bit uneasy because we were like there waiting for something expecting something from them, it felt a bit forced. Reflecting on this I think with this prototype we chose to throw all our ideas in one, thanks to the testing process we saw that it is too much information to handle.

In the second prototype we chose to center on lose objects and focused a bit more on one sense as well the sense of touch. With such things as pushpin box, ropes tied in knots, a ball made out of many surfaces and 3D puzzles. How will this prototype reach the patients? Brainstormed further we came up with a table we went into many directions. Searching from references in the Suriname culture to having sketches of bio morphed shapes. We came up with circular forms that connect to each other and each table has its own function, this with the help of three girls visiting from University of Dundee. Talking it over we chose to choose to hack the tables the center already has, we have to take measurements and make the prototype of the table to test it. For the tactile objects we made that will be incorporated to the table, we visited the center and left some objects tied to the tables, chairs and handle bars and other lose 354

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around the rooms to test them out. This time we were not with them but observed them a bit from far. Some touched them slightly and other repeatedly, some of them took them to their rooms, and others did not react to them. In our observation we saw that some of our objects worked differently from what we thought. To give them more time, we left the objects in the center to pick them up later and have feedback from staff. Reflecting on it I see that we have to still work on some objects make them smaller or bigger and adjust them to the table. But like the design process states this will go round and round. Every step in the designing process is important; hopefully we do not get stuck in some steps. The testing is very important part of the Design process it gives you a clear view on what works with your target audience, what you have to discard and what to take in consideration. Sometimes you are surprised from what can come out you did not think it would happen

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Natasha Oduber

that way, this is just answers for us to work on our designs further. It is the pit stops of the circuit make everything work right until we can reach the finish line. Stillman, D (2012) - Design Process Kills Creativity / Design Process Creates Creativity Snel, H (2014) - Alzheimer’s disease summary

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Dimitra Chrysovergi

Studies: Inter-Architecture

Brief essay on empathy

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Dimitra Chrysovergi

Empathy is the experience of understanding another person’s condition from their perspective. You place yourself in their shoes and feel what they are feeling. Empathy is a key ingredient of successful relationships because it helps us understand the perspectives, needs, and intentions of others. Design is also about perspectives, needs and intentions of people so inevitably a strong bond between empathy and design is created. The late decades a new term has introduced to design, and that’s the empathic design that refers to a usercentered design approach, which pays attention to the user’s feeling and thoughts for an object-product. By established strategies empathic design is a relatively low-cost, low-risk way to identify potentially critical customer needs. It’s an important source of new product ideas, and inspiring tool for innovation. In our times, we live in such a plethora of products that it feels like the next step of evaluation among them. We need products and services to be effective, 358

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own environment, in the course of normal, everyday routines. In such a context, researchers can gain access to a host of information that is not accessible through other observation-oriented research methods. The goal is to identify latent customer needs in order to create products that the customers don’t even know they desire or, in some cases, solutions that customers have difficulty envisioning due to lack of familiarity with the possibilities offered by new technologies. Unarticulated needs abound in daily routines, even when a technological solution exists. For example, Nissan Design’s president, Jerry Hirshberg, was driving along a freeway one day when he saw a couple at the side of the road wrestling the back seat of a competitor’s minivan out of the way so they could pick up a new couch. “We bought this so we would have room,” they told him, “but we can’t use it for what we want without taking out the seats.” They would never have thought of asking for any solution to their

they need to satisfy both functional and emotional needs of individuals as they were made “just for them”. In this brief essay I will refer to empathic strategies on design process, apposing my personal experience. Many researches have been done according to empathic design. Leonard Dorothy (Professor of Business Administration) and Jeffrey F. Rayport (consultant and strategy advisor) identify the five key steps in empathic design as: 1. Observation 2. Capturing Data 3. Reflection and Analysis 4. Brainstorming for solutions 5. Developing prototypes of possible solutions 1. At its foundation is observation —watching consumers use products or services. But unlike in focus groups, usability laboratories, and other contexts of traditional market research, such observation is conducted in the customer’s 360

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to be here or there and it is not. Such cues come and go within the span of mere seconds and are hard to capture in notes.

problem, but one immediately occurred to Hirshberg—six-foot runners that would enable van owners to fold up the backseats and slide them out of the way, thus easily creating cargo room.

3. After the gathering of data it come the reflection upon them. Is the phase that the researchers try to identify all of its customers’ possible problems and needs.

2. Because empathic-design techniques stress observation over inquiry, relatively few data are gathered through responses to questions. Most data are to gathered from visual, auditory, and sensory cues. Video can capture subtle, fleeting body language that may convey large amounts of information and store it for future review and analysis. For more than a decade, researchers at Xerox PARC, the Xerox Palo Alto Research Center, have videotaped users when they were confronted with a product such as a new copier machine. The researchers can see puzzled looks on the subjects’ faces, they watch as people search for controls, and they can observe the kinds of automatic responses that happen when someone expects a control

4. Brainstorming is a valuable part of any innovation process; within the empathic design process, it is used specifically to transform the observations into graphic, visual representations of possible solutions. Although brainstorming is generally associated with a creative process, it is not undisciplined. Managers at IDEO, one of the leading practitioners of empathic design, tell their employees to heed five rules: defer judgment, build on the ideas of others, hold one conversation at a time, stay focused on the topic, and encourage wild ideas.

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5. Prototypes are a critical part of the empathic-design process. They clarify the concept and the function of the product. They can stimulate reaction and foster discussion with potential customers of the innovation because of their concreteness. THE EMPATHIC MODELING This technique has mainly developed for use with disabled users. In empathic modeling the designer/developer tries to put themselves in the position of a disabled user. This is done by simulating the disability by various techniques. Like a designer who designs for blind individuals covers his eyes and living in the dark for meeting blinds’ needs.

MY APPROACH Presently in my practice as a design student I cooperate in a team, with students of the design and psychology field, that deals with a Dementia Center aiming to stimulate patients to be active, physically or even mentally. From the beginning we realized we had to empathize patients in order to be able to help them. It was a challenging process to cope with a declined mind and es364

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pecially when patients are in different stages of the disease. (So we approached that part mainly through literature.) At first place and through observations in their environment the most striking element we encountered was, forehead skin marks on every window, revealing the desperation of residents. Some people were walking randomly around the space all day long facing locked doors to the outside. The issue seemed to be the lack of coherent circuit. Even the balcony that could have contribute creating a circuit was out of use for safety reasons. Having that data we realized that the balcony was a very crucial and promising element in the space. Therefore we decided to turn it into a safe area by creating a “green wall”-bird cage. In this way we were offering to the patients an outside -in the fresh air- activity (planting-feeding birds) in addition to the circuit development. But soon we came across to an aspect that we haven’t consider till then. Empathizing also the staff. It seems that in the center there is a big problem by lack of staff, and the existing

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staff is in extremely tight schedule. Therefore we couldn’t proceed with the balcony idea since it would have require staffs’ involvement ( get dress the patients for outside, taking care the plants, clean the birdcage). In order to an effective design we should have the embracement of all parts involved (patients-staff) otherwise the design could be neglected. So we start observations again but having two axes that require empathy. The Patients and the staff. By new observations and data collection we realized that the majority of the patients were passive all day, sitting in front of empty big tables. On that account after brainstorming we attempt to hack the tables in order to provide stimuli and activities to the patients by not taking them out of their norm. First we thought of smaller tables with activities that could assembly in different ways, in order to bring patients closer to each other to enhance communication. But again we had to adjust the idea to the minimum staffs’ involvement. So what if we implement drawers with activities in the 366

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already existing tables of the center? In this way we bring people closer in smaller units, we offer easy accessible activities-elements to keep them busy and trigger their minds. And moreover we achieve to have no staff involvement as far the drawers can instantly close and you get back to the regular table ready to serve dinner. Presently we are in the phase of empathizing once more the patients in order to find activities and stimuli to introduce in the drawers. Games from their childhood, images, textures and household chores are all into consideration and testing. In our first experience with empathic design, me and my team, we faced many times the need of empathizing. Empathy was an ongoing element throughout the design process. We had to think broader. Our end user is not only the patients but there is an impact on the staff as well. In every step that we were taking we had to define our empathize target. Empathic research strategies are not solution- seek-

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ing, but problem-finding. We tried to identify problems and work in potential solutions. Long observations and being into their environment was the key ingredient to develop knowledge and understanding in order to generate appropriate solutions for real needs. In the case of healthcare, using empathic strategies is a way of encouraging the development of more effective products and services. This approach can also serve to further develop and deepen the humanistic-centered approach in the education of healthcare practitioners. Leonard, D. and Rayport, J.F., “Spark Innovation Through Empathic Design”, Harvard Business Review Landwher, P., “Empathic Design vs. Empathetic Design: A History of Confusion”, Nov 2007, hVp://privacy.cs.cmu.edu/dataprivacy/ projects/dialec+cs/designmethods/plandweh.pdf LoYhouse, V., Bhamra, T., and Burrow, T., “A new way of understanding the customer, for fibre manufacturers” Sara Gales, Empathy Deficits: Rehabilitation Considerations and Implications, University of Pittsburgh. March 17, 2010 http://www.core77.com/blog/essay/expecta+ons_and_empathy_the_ future_of_product_design_27927.asp nov.2014 Joyce Thomas and Deana McDonagh Empathic design: Research strategies. 2013

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The orthopedic waiting lounge

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WHO IS THE CLIENT? ”For who are we designing?” we the architects and designers (or soon to be), ask ourselves. ”For the clients of course”, anyone would argue. But who are theclients, and what are they? In our case with the Orthopedic surgery waiting room, the clients on a superficial level are patients and doctors that will share the same space and carry out needs and activities associated with the hospital. So the client is let’s say, someone with a broken arm. But this is not really what inspires me when I think of whom I’m making for (though of course the patients needs has to be satisfied, no arguing against that). A more interesting question to me is, what it means to have a broken arm, and to be someone with thoughts, dreams and feelings.

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we think and see it all as we do. What is our role? Are we the superstars of the universe, or just a negliable character in the Quantum Tale? Even if not everybody think of these things daily, I think that this is what lingers in the background when people escape into fiction, as a sort of self-reflection. And even though these questions maybe cannot ever be answered, they put the light on what defines us as humans. 4.4 million years ago, Ardipithecus evolved in Africa and eventually resulted in Homo Erectus and then us: Homo Sapiens Sapiens, the thinking thinking human. The bigger forebrain is what biologically most clearly distinguishes us from our earlier ancestors, making place for conscious and reflective thought. How this happened is closely connected to the human will of making - creating something new from the existing surroundings. The early humans who were best at making tools had a greater chance of passing on their genes to the next generation, which to some extent

HOMO SAPIENS AND HOMO LUDENS In the Podcast series ”Människan och maskinen” (man and machine) Eric Schuldt and Per Johansson argue that people are more than ever before involved in their imagination, as a sort of new escapism has evolved with new technology. One is now constantly connected to fiction and stories through smart phones and other devices. Further, they claim that the fascination people have with stories of all kinds, stems from a deeper human need of putting reality into a meaning.* They are therefore in fact not escaping from reality, but are trying to find it. “What is reality?” is a question probably as old as language itself and it has made humans worship religion, make art, poetry, put daring philosophical questions to life and make scientific progress over thousands of years. Even today, it is maybe the most crucial question of all. We want to know what our place in the Universe is, why 374

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explains why evolution became culture.** This making is in part rational – humans do what is logical in order to adapt and survive. But there is also a part of this making which is just an outspring of curiosity and playfulness. Homo Ludens , The Playful Human, is an ephitie of this characteristic feature. It is also the title of a book by the culture historian Johan Huizinga , first published in 1938. In it, he investigates the play element in human culture. He claims that what distinguishes us as a species is not only that we think consciously but also that we play, just as animals play - however conscious of our own doing so. We are therefore not the nature solely of logic, but as much of irrationality. As he puts it himself: ” We play and know that we play, so we must be more than merely rational beings, for play is irrational.” Already Aristotle argued for the playfulness in human culture as defining ourselves apart from animals, not that they don’t play, but that we laugh. That we are

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what he called Animal Ridens, the laughing animal.**** In architecture, the Homo Ludens approach towards culture by Huizinga has been fundamental in the visions of the creation of spaces by the artist Constant Nuiwenhuis. In his most famous work New Babylon, he spent years on creating models and drawings on spaces that would acknowledge humans as Homo Ludens. In his, though imaginatory, space - people could move from experience to experience, and the space itself inspired to creating and changing it. It would never be fixed. It was designed for new meetings, and encouraged play and exploration.***** CONCLUSION However utopian and unrealistic, or even unsuitable, Nuiwenhuis spatial visions were, I find his approach to architecture very attractive. Thinking of us humans not only in rational ways and to look at the importance 376

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Taking that particular context in which the patients are in, and making it into a big existential question, could, of course, easily result in pretentious utopian fantasies. That, might not be so great after all. What people seem to actually thrive in, spatially, is very far from great complexes that are supposed to reflect great ideas. Rather, people thrive in intimate spaces with variation that appeals to curiosity, yet feel safe. Even if the crucial requirements in the waiting room of St Lucas hospital is efficiency for the procedures that goes on, patient safety, hygiene etc. Even so, it doesn’t mean that there aren’t a lot more that is also crucial for the wellbeing of a patient, who is a thinking, reflecting individual. To connect to Homo Ludens and our need of escapism. What is really depressing in the existing waiting room, is the practical character of it. Even the decorative elements radiate practical narrow-minded solutions. ”Let’s put up a

of play is, I think, a very contemporary issue. I would say that our fascination with fiction and stories in general, argues for this too. I myself believe in art, film and other cultural ways of expression, perhaps just as strong as any religious believer do in their religion. For me, it is religion. It is what I believe in, in the sense that in art, what it means to live and think and feel, can be expressed in ways where science fall short. Art doesn’t prove anything and need not too, but however ambiguously, it gives reason for that which we cannot prove. Or feel but cannot know. It acknowledges our irrational side, which is I think, just as human as our rational side. It is the symbiosis of the two and the contradiction it makes, that makes us who we are. We are nature, and we are not. Now, when we talk about patients in a hospital that need comfortable surroundings in their process of undertaking surgery, it is maybe in practice far away from any philosophical question about who we really are and what we really want. 378

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view of Amsterdam like you’re outside in Amsterdam in the spring,” on the wall! It could’ve worked as an experience if not everything else suggest you are in a space where nobody cares about the space, or the furniture. The only function and experience is that you sit while you wait for the operation. As we have claimed before, the space signals nothing else than sitting and waiting. This, naturally, has the potential of making anyone nervous, as they’re only focusing on the waiting itself and what comes after. At best, if it doesn’t make you anxious, it makes you so bored you won’t even care what happens in the operation room. It really doesn’t have to be this way. One could easily combine both the rational side of undertaking operation, with that of being someone described as a Homo Ludens, an individual, a thinking, feeling person; one that has curiosity in their DNA - however one likes to define a person. Because we are not just rational pieces of meat, that are broken, and need to be fixed to function again. We are maybe also not

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really these Homo Ludens that only want to joke around in the hospital all day (so to say). But we are both. That is why I think that while the patients wait, there should be possibilities of exploring the space, to give in to curiosity, if they can and will. And that they can use the space in a more meaningful way than just sitting and waiting (again, not arguing against the need for that too). With the library idea, we hope to encourage curiosity and acknowledge the individual as an individual. Instead of useless magazines, a centered circular shelf provides literature and media about recreation, and gives insight in the processes that the patient is going to be part of. Among the books are also literature that in other ways that inspire to self-reflection. Hopefully, this will make the patient feel she or he is seen more as a thinking person, and less as piece of the large machinery. These feelings of being seen and to take over part of the control, is very important in the overall recreation process. 380

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transparent, as the doctors can be seen more as ”one of them” by the patients, and less as a hierarchical, unreachable figures. The space is made out of circular walls that all originates from one center in the ”library area”. This has a symbolic meaning and is closely linked to the concept itself, but the circles also function as calming elements. They are also a great way to indicate continuum, to encourage movement in the space and encourage interaction between patients. With this solution, I hope that we have come a bit further in understanding which tools we can use to set conditions for people to be themselves and be recognized as complex individuals, yet feel that they are belonging in a greater context.

In this idea, we have also incorporated more transparency. The whole space is quite public, yet intimated in sections where relaxation is needed. Where ever you are, you are not closed off from what is happening, around you, yet not disturbed by it. The transparency is also present literary, as we have placed the surgery room in the same area as the waiting lounge. At the entrance, an information wall with exhibitions about what is happening in the process of surgery, is leading towards the surgery room, which is though not accessible from that side. However, a semitransparent glass allows you to notice the activity taking place, but will not disturb you with graphic details. The idea is that, what happens in the surgery room hopefully will seem less scary and mysterious, and more natural and even trivial, as it is a natural and integrated part of the space. The doctors will also have a section of the library for new reports in their field etc. This will further make the space more

*pt 3, Människan och maskinen, E. Schüldt &

P. Johansson

** p. 9 A History of World Societies, McKay *** p. 1 Homo Ludens, J. Huizinga **** p.4 Homo Ludens, J. Huizinga ***** http://en.wikipedia.org/wiki/Constant_Nieuwenhuys

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The connection between exercise and overcoming obesity

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INTRODUCTION Depression is the most common mental illness—nevertheless, a body of research suggests that its cure is cheap (or even free) and available for every person. In 1999, a randomized controlled trial showed that depressed adults who took part in cardio exercise improved as much as those treated with Zoloft (antidepressant medication). A 2011 study took this conclusion to the next step: It looked at 127 depressed people who hadn’t experienced relief from SSRIs, a common type of antidepressant, and found that exercise led 30 present of them into remission—a result that was as good as, or better than, drugs alone. The basic explanation to these findings is physiological: When you exercise, your body releases chemicals called endorphins. “These endorphins interact with the receptors in your brain that reduce your perception of pain. Endorphins also trigger a positive feeling in the body, similar to that

1. Inspiration, Rem Koolhaas model

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of morphine. For example, the feeling that follows a run or workout is often described as ‘euphoric’. That feeling, known as a ‘runner’s high’, can be accompanied by a positive and energizing outlook on life.”1 OVERCOMING OBESITY

2 Connection between exercise and depression.

After realizing that obesity and depression are often connected, my primary thought was to approach this indirectly To improve a person’s motivation, by dealing with his depression: I thought that a way to help solve a person’s obesity is by exercise. The exercise will release endorphins to the person’s brain that will raise his level of happiness and motivation. Most importantly, that will affect positively on the person’s eating patterns - the frequency of emotional eating will lower itself down naturally. As discussed in the following article “Many overweight and obese individuals use eating as a means to relieve stress, reduce boredom and improve mood. However,

emotional eating often leads to over- eating. Another finding is that women are especially prone to emotional eating — and then feel guiltier and less healthy than men do after snacking “forbidden” foods.”3 DESIGN APPROACH While exploring a way to develop a concept I came across a picture of a model by Rem Koolhaas for a library in Paris, France (see figure 1). This model inspired me to think of a house for an obese person which is all built out of ramps. The house is not functional in an objective way; nevertheless, for an obese person it does come very handy, due to the fact that it forces him

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3 Functions diagram, Top view. 4 Functions diagram, Side view. 5 Movement diagram. 6 Project Identity

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James A. Blumenthal, Alisha L. Brosse, Heather S. Lett,

to move a lot around the house, because every function is placed in an entire different place. Moreover, functions that normally placed near each other (for instance, shower and bedroom) are positioned far from one another in this case.

Erin S. Sheets Exercise And The Treatment Of Clinical Depression In Adults Rosa M. Crum, William W. Eaton, Hochang B. Lee, Constantine G. Lyketos, Chiadi U. Onyike Is Obesity Associated With Major Depression? Rick Nauert Reduce Emotional Eating

PROJECT IDENTITY When I interviewed Kees van Wijk (Physician Assistant internal medicine at “Slotervaartziekenhuis”), he enlightened me about a one of the core problems of obese people. He said: “Obese people are chaotic by nature. For instance, they let into their bedroom the dining table, the living room, etc. That causes them trouble in sleeping, which has a crucial effect on their on-going appetite the day after.” Following that interview I thought about a house that has an entire separation between all of its functions. Every function will be in a “capsule” of its own, to ease the chaos and implement order in their lives. 390

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What can curvelinear architectural forms in hospital waiting rooms tribute to the welfare of patients

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INTRODUCTION In prehistoric times most human shelters were not as rectilinear as the squares we live in today. Early humans are often thought of as dwelling in caves, because that is where we find traces of them. For example the flints they used, the bones they gnawed, and most important their own bones. Caves are considered to be a winter shelter. In the summer there was need for a temporary shelter. This means the beginning of something approaching architecture. Humans developed tents in a V- shape. Dutch-German Philosopher Peter Sloterdijk calls the first residental housings, “initially stops” and “waiting rooms”(Sloterdijk, 2014, p. 352.) Peter Sloterdijk mentions houses as stops for ceased life. Housing means: “cant leave” (354). Here you can find the origin of thinking in terms of sowing and reaping. The old High German word “bur” means not only 393


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the house, the room or the cell, but also the cage where poultry is kept. In Swedish it means judgment. Who is willing to wait for the plant to grow, has to install himself in a cage in which inertia rules. The first house is a machine for the containment of a long time (355). Once human beings settle down to the business of agriculture, instead of hunting and gathering, permanent settlements become a factor of life. Mesopotamian structures, known to be first buildings similar to the concept of a village, were following the curvilinear form. A lot of the architectural forms in the prehistoric times had roots in mystical beliefs and rituals, curved and circular forms were a big part of that. Jericho is usually quoted as the earliest town we know. It was a small settlement in about 8000 BC, the builders of Jericho used a new technology- curved bricks, shaped from mud and baked hard in the sun. The round tent-like house reaches a more complete form in Khirokitia,

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a settlement of about 6500 BC in Cyprus. Most of the rooms here have a dome-like roof in corbelled stone or brick.1 Nowadays it is extremely hard to find a curved form in designs. It seems straight lines and rectangles have proved to be of more practical use. There is always concern over functionality, construction method and eventually costs. Maybe property dimensions, city zoning restrictions, pipelines and infrastructure, force the designer to be rectilinear. Maybe it has to do with the Greek invention of post and lintel or the Roman gridline (Nedjad K, 2007). Clear is that the construction materials are designed for the rectilinear system. In theory it makes sense to use curvilinear forms in buildings but in reality the construction remains challenging. In this essay I want to investigate the dynamic curved line and form. Research by Vartanian and others indicate that curvilinear forms in interior residential architectural settings are perceived as less 394

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behavioral outcomes (Vartanian e.a, 2013). The research team copied 200 images of interior architecture. Some of the rooms had a round, others had a rectilinear style. Vartanian and colleagues slid people into a brain imaging machine, showing them these pictures and asked them to label each room as “beautiful” or “not beautiful”. They reported that test participants were far more likely to consider a room beautiful when it was flush with curves rather than full of straight lines. It seems that oblong couches, oval rugs, looping floor patterns got our aesthetic engines going. This isn’t a ‘men love curves thing’, twice as many women as men took part in the study. Roundness seems to be an universal human pleasure.2 Oshin Vartanian and his research team took a second step in their study. They also captured the brain activity that occurred when the study participants in the imaging machine considered the pictures. People looking at curved design had significantly more activity in a brain

stressful (Vartanian, e.a, 2013). I want to study these and other effects curvilinear shape has on human beings. How do we perceive rectangular shape and curvilinear shape. What is the difference between the two. Is there a preference? My research will be interdisciplinary, combining research in neuroscience, environmental behavior and design, psychology and theories in (organic) architecture. THEORETIC FRAMEWORK Neuroscience A research team of designers, psychologists and neuroscientsts, led by psychologist Oshin Vartanian, of the University of Toronto at Scarborough argue that neuroscientific data have an important role to play in bridging the conceptual gap between architecture and psychology by elucidating some of the underlying mechanism that explain how systematic variations in architectural features lead to 396

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psychophysics, computational neuroscience, psychiatry and human brain imaging to explore issues concerning human vision, context and predictions. Together wit Matial Neta, who received her PhD in Cognitive Neuroscience at Darthmouth College they worked together to prove that humans like curves. In their article The proactive brain: Using rudimentary information to make predictive judgments, they argue that our preferences for objects has been shown to be influenced by many factors, including symmetry, familiarity, contrast, complexity, and perceptual fluency. Preferences are significantly influenced by the nature of an objects contour, whether its edges are sharp angled or curved. Moshe Bar and Maital Neta tested their hypothesis using stimuli that included pairs of emotionally neutral, real objects with either primarily pointed features and sharp angles or the similar objects with curved features. Their outcomes show that we are aware of the perceptual features

erea called the anterior cingulate cortex, compared to people who were looking at linear decorations. The Anterior cortex has many functions, one is noteworthy in the context of Vartanian’s study: its involvement in emotion. Curvature appears to affect our feelings, which in turn could drive our preference. Vartanian and his researchers claim that their results suggest that “judgment of beauty for curvilinear spaces is underpinned by emotion and reward, consistent with the role that emotion is known to play in aesthetic experience” (Vartanian e,a, 2013). Environmental behavior and design Moshe Bar, neuroscientist, director of the Gona Multidisciplinary Brain Research Centre at Barllan University, associate professor in psychiatry and radiology at Harvard Medical School, and associate professor in psychiatry and neuroscience at Massaschusetts General Hospital used methods of cognitive psychology, 398

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K 2007, p 217). Theoretically Nejad refers among others, to Hopkins who discovered in 1976 that subjects have special attention recruiting levels for curvature. Hopkins created four categories of line segments for judging the amount of curvature. The results showed minimum attraction for the straight line. On the other hand an increase of the intersection of curve contours will make the person experiencing them feel confused and anxious (Hopkins 1976, Roelfsema et al, 1999). In the psychology of art, experiments indicate that people associate adjectives such as “serene”, “graceful”, and “tender-sentimental” to drawings that contain curved lines. The same drawings with squares and angles have a tendency to suggest sadness and dignity (Hevner, 1935). Similarly Kuller (1980) found that pleasure is more often elicited by rounded-off architectural forms than by square edged. Curvilinear line segments are perceived to be more complex than straight lines (Berlyne, 1960, 1974, 1971, Barrow and

of an object but not necessarily aware of their influence on our preferences. Many types of first impressions are determined unconsciously. People associate sharp contours with a dangerous object, such as a knife, even if the object is an everyday object with a neutral emotional meaning. Moshe Bar and Matial Neta suggest that people might learn to prefer objects that promote safety and fear objects that impede it. People learn to associate sharpness with potential danger, learn to stay away from objects that might hurt. Psychology Architect Kayvan Mandani Nejad researched in his thesis the emotional effect of curvilinear forms in interior design, by the use of card sorting data and theory. His card sorting survey results show positive values significantly increase as curvature increases in interior architectural settings. Curvilinear forms tend to make observers feel safer and perceive the space as more private (Nejad, 400

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therefore a form which has both one-ness and two-ness in it. It makes a good shape for a hierarchical room with democratic pretensions (86). Architect Philip Steadman raised the question why most buildings are rectangular. We can find buildings or parts of buildings which are not rectangular such as igloos, mongolian yurts, tepees, dogon and tallensi huts, temples, chapels and other small places of worship. These are often single spaces. A second type of situation in which curvilinear or other non orthogonal elements are often found in the plans of buildings that may consists of many rooms- is around the building edges. Steadman mentions that many of the otherwise rectangular churches have semi circular apsis. In classically planned buildings with many rectangular rooms, such as villas or country houses, there can be circular space deep in the interior, for example a central hall, but just to fill out the corners. The rectangularity in buildings has

Tenenbaum 1981). Scott (1993), found that people prefer higher levels of environmental variety and richness (Nejad,K, 2007). Organic Architecture In the philosophy of organic architecture it is believed that flowing curved forms are more reconcilable with the human body and mindset (Pearson, 2001). Architect and sculptor Christopher Day argues in Places of the Soul Architecture and Environmental Design as a Healing Art that things that are alive never fit exactly in any hard-edges category (59). He makes the following distinction between straight and curved lines. Straight lines represent firmness, orientation and organization and curved lines life and fluidity. We need to give life to the firm geometric and firmness to the non straight, in a way that the elements speak to each other. Day makes in his book the remark that shape effects relationships. An Ellips for example is formed with a fixed length of string, but it has two foci. It is 402

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to do with the packing together of rooms in plan, says Steadman. “When many rooms of similar or varying sizes are fitted together so as to pack without interstices, it is there, that rectangularity is found. Non rectangular shapes occur on the edges of plans, or in single room buildings, since in both cases the exigencies of close packing do not apply�. Rectangular rooms can readily be formed out of rectangular components of construction and circularity in plan is often a characteristic of freestanding, widely spaces. Contemporary architects do escape the rectangular by gravitating towards buildings with single room structures, such as theaters and art museums (Steadman, P, 2006).

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Salie van der Wal

consisted out of a singular room and were round shaped. Nowadays it is hard to find curved designs, construction materials are designed for rectilinear. Neuroscientific research teaches us a lot about the effect of using curvilinear shapes in architecture. A room with curves is perceived as more beautiful then a room full of straight lines. The ACC gets activated and deals with emotion, curvature effect our feelings and drive our preference. Environmental behavior and design studies show us that preferences are derived by the nature of an objects contour, whether it edges are sharp angled or curved. People associate sharp edges with a dangerous object, even if the object is an every day object with a neutral meaning. People learned to prefer objects that promote safety, therefore prefer curved objects over rectangular objects. Psychological research prove that positive values increases as curvature increases in interior architectural settings. Curvilinear tends to make observers feel safe and

CONCLUSION Early humans lived in caves, but in the summer they needed temporary shelters. First tents, but when they started to settle down to the business of agriculture and needed permanent settlement village forming started. These first housings 404

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perceive the spaces as more private. Curvilinear segments are perceived as more complex and people prefer higher levels of environmental variety and richness. Architect Philip Steadman provides us with an explanation why there are so many rectangular housings. It has to deal with packing together rooms in a plan. The philosophy of organic architecture teaches us that straight lines present firmness, orientation and organization and curved lines life and fluidity. The art is to give life to the firm geometric and firmness to the non straight.

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Studies: Inter-Architecture

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Yaniv Schwartz

Studies: Inter-Architecture

Home of sick

Insight Series #8 Hacking Healthcare

Yaniv Schwartz

A rough translation forms the Hebrew word- Hospital. 
Point up a need to rethink the way we previse hospitals and the concept of a patient. For centuries the idea of a patient remained the same, a person who need to be treated in order to “fix” a physical failure.
A passive approach from the penitent side and an active one form the health care provider. A quick overview on the process chain of health care revel a disturbing scenario, a dictatorship like approach. The patient located in the bottom of the pyramid, waiting to be directed by the health care providers. The patient doesn’t understand the process or the possibilities, his knowledge is limited and therefore he is not in a position to question it. In other words “who will guard the guardians?”, we should ask ourselves- what can be done in order to make the patient less dependent? How can we give the patient more options to choose? And take the right choice? How the patient can learn about preventive medi408

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Yaniv Schwartz

cal and psychological aspects.
In my work I would like to point up the direct connections between recovery process and space design, while focusing on the psychological aspect.

cine? What is the rule of the environment in the healing process? In my work I would like to introduce a new way of thinking about Health care and the connection to space. In 2011 Machteld Huber et al. introduced a new concept of health with a cover publication in the BMJ: “Health as the ability to adapt and to self manage, in the face of mental, social and physical challenges”. This new concept describes health not as a stable end- point, as in the traditional WHO definition, but highlights function, resilience and self-direction. I believe that space have a major role in “liberating” the patient from his absolute dependency. And by doing that achieving an effective and positive healing process.

TIME = HEALTH Waiting room can hold within key elements which can support the healing and recovery process. The space can provide various options to spend time in a positive and productive way and promote the patient to engage in leisure activities. the benefits of leisure activities has been studied in various aspects of life. One of the most prevalent aspects of life studied with importance of leisure satisfaction. Whether a person experiences stressors at work, before medical operation, through depression or brain injuries. Leisure satisfaction may ease the stress regardless of the type. Stress is becoming a common issue, many people face

SPACE HEALS Space- can be a platform for any process to flourish. By providing various functions and atmospheres, it is possible to support the healing process from the practi410

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in these times, however, leisure activities may help lower a person’s stress levels and increase their satisfaction. When someone engages in enjoyable leisure activities, such as; Reading favorite books, enriching our Knowledge and understanding better our medical condition and healing process Their moods tend to increase, which in turn, allows them to better accept everyday stressors and deal better with their physical condition.

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Studies: Inter-Architecture

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Cherie Cheung

Studies: Inter-Architecture

The official guide for publishing reader-friendly academic papers

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Cherie Cheung

INTRODUCTION In the previous stages of the project, our group found out that attention problems between Dutch university students is an alarming issue. We were aware that attention problems come in too many forms and caused by too many different reasons. Within the questionnaire we developed to learn about students’ attention problem, a number of participants expressed that they often have difficulty to focus when reading academic papers. This is due various reasons, some of the more important ones being the poorly designed style of the text, a lack of illustrations to visualize text, too many words in one line / page etc. In the light of their shared opinions about reading papers, our group decided to focus on the typographic arrangement of academic papers, as a means to improve students’ ability to focus. We were going to search for a set of most favorable (as in, legibility and readability) texts for reading experience, to 414

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Created by the Microsoft ePeriodicals team for the study:

serve as a guideline for publishers in producing academic papers. Typography is the technique of arranging type to make written language most appealing to learning and recognition. The arrangement of type involves selecting typefaces, point size, line length, linespacing (leading), letter-spacing (tracking), and adjusting the space within letters pairs (kerning). Those elements that make up typography, are crucial in creating an effective reading experience.

1. Text with good typography 2. Text with bad typography

DEVELOPMENT Upon starting to develop on a prototype, we tried to look at the proof of an existing relationship between typography and one’s ability to focus. In a study performed by from Microsoft and Massachusetts Institute of Technology, twenty participants were invited, ten of which were randomly assigned 416

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Preference questionnaire designed for the twenty study participants, rating their reading experience.

Cherie Cheung

we confirm if the typography is a good or bad typography one in the first place? The above study came up with two typographies with a fixed typographic arrangement for the “good” and “bad” pieces. In reality, there are ought to be even better or worse typographies, with difference changes in the arrangements. This is to ensure that certain styles, instead of just one, would be the most favorable among students (i.e. the targeted readers). Therefore, our group decided to develop a test of our own, to learn about students preferences on typography more extensively. Our test was created with different pieces of texts based on four arrangements - text colours, spacing, line length and font rasterization. 20 students were invited to take part of the test. The red ticks indicate the most chosen piece of texts.

to reading a piece of good typography, and the other ten to reading poor typography. The results have shown that good quality typography is responsible for greater engagement during the reading task, that would be the ability to focus on the text. Furthermore, the result also discovered that participants who were reading the good typography finished the test with a good mood. And we all know that having a good mood in the first place has a lot to do with whether someone can still focus. The test results gave our group very valuable clues on how a good typography can affect reading experience. However, since our group is to find out good typographies for students to read - how do 418

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Text colour

Letter-spacing

Color is what the eye notices first, and it can influence people psychologically. It’s also very common to see that a published item choose dark grey text over absolute black text. In our text color test, we provided pieces of text presented in different shades of colors. The shades started from being absolute black (top left) to gradually lighter.

Letter-spacing means the general spacing of a word or block of text, which would make an affect to the overall density and texture of the text. The degree of letterspacing can result in different ways the text might be perceived. For instance, tight letter-spacing tend to reduce the legibility of a piece of text. On the other hand, an appropriate letter-spacing increases legibility.

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Font rasterization Font rasterization is the process of converting text from a vector to bitmap. This often involves anti-aliasing on screen text, making it smoother and easier to read.

The overall result shows that a dark charcoal grey colour for text is indeed more desirable than an absolute black one. While the letter-spacing shouldn’t be too tight, too much space would also cause more energy for students to read. Although students expressed that they were not able to see clear differences between the four pieces of text samples on the font rasterization column, the majority of them tended to pick the text with the ‘strong’ effect. The

Line length Line length is known as the length of a paragraph. Ideally, the line length is not to be too long. It is because the longer the line length, the more the human eyes have to go from the very left to the very right, back and forth, to read between the lines. As this process begin, it will easily cause a drop in attention. 422

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students also mentioned that they “really dislike” the texts with shorts and the longest line lengths. They found the one in between most comfortable for reading.

Insight Series #8 Hacking Healthcare

Cherie Cheung

in form of a guide book, with the target group primarily being the publishers, and possibly the students themselves. (So that they have a better understanding of what they like, and why they like certain typographic styles)

CONCLUSION As we can imagine that there shouldn’t be just one “perfect” typographic arrangement for academic papers. Looking at the results for the tests our group developed, although there was always a piece of text that was selected by the most number of student, the truth is, there were a number of other students preferred another text pieces as well. We further confirmed our stance on the central idea of the project, and that is to search for (or create) a series of “good” typographies for academic papers, with first-hand research and analysis. At the same time, “bad” typographies can also be included, to emphasize mistakes and shortcomings of certain styles. Such series of “good” and “bad” typographies can come

Bringhurst, Robert. The Elements of Typographic Style Kevin Larson (Microsoft) & Rosalind Picard (MIT), The Aesthetics of Reading (http://affect.media.mit.edu/pdfs/05. larson-picard.pdf) Sue Walker, Typography & Language in Everyday Life: Prescriptions and Practices The Two Functions Of Type: Readability And Legibility, http://www.vanseodesign.com/web-design/display-text-type/ How Little Do User Read? http://www.nngroup.com/articles/ how-little-do-users-read/ Guidelines for papers and theses: House Style, https://www.jyu.fi/hum/laitokset/kielet/oppiaineet_kls/englanti/ studies/thesis-and-academic-writing/ohjeet/house%20style%20pdf

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The manual of reading connection

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Au Kwong Ming

CONTEXT OF IDEA In fact, we understood that the root of attention problems are developed from the students’ their own behaviors, motivations and environments. The problems are too complicated and too wide, a lot of directions we can focus to study. Therefore, we made a decision that our solution is based on students’ answers of interviews. We think that books and academic papers are important factors of connection between studying and concentration. Therefore, we decided to focus on indirect method to enhance their invisible relationship to improve student’s attention problems. UNDERSTANDING As I know, most of the writers focused on providing information only, they do not concern about typography and text style and which format are suitable for readers and easier to understand. Moreover, most of

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the people suggest reading real academic papers rather than read electric academic papers, because people would like to take notes and highlight on academic papers. Some posters are highlighted the key words of content to enhance the meaning and attraction. People can easily understand and get the point in a short time. But, these are not what I need, because if I applied this method to academic papers, it will enhance writers’ workloads to highlight the keyword in the essays and writers may highlight a whole page on academic papers. For this reason, I want to use an indirect method to improve the reading of relationship between readers and writers and cause the writers attention in the future.

Insight Series #8 Hacking Healthcare

Au Kwong Ming

But we did find some general elements of typography that indirectly connect to readers such as: reading distance, font size, font type and colour. I tried to analyze this connection and defined two major factors:

THE RELATIONSHIP OF READER AND ACADEMIC PAPERS The study was focused on real academic papers. We did not find a standard of typography design from academic papers. 428

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(HARDWARE) (VISIBLE RELATIONSHIP)
 FONT SIZE AND NEUE HELVETICA
 It is related our reading distance. But, It already has a non-official standard that around 10 to 13 size is defined. But it should have to re confirm base on reading distance and font styles. FONTS THAT WORK IN BOOKS The typefaces we use for books are a real contradiction. They can be so quiet you just don’t notice them. But if you enlarge the letters, you can see right away that they are full of idiosyncrasies and flourishes. FONTS SIZE Too-small fonts are hard to read, especially for older people or people who don’t read much. Too- large fonts look like a children’s book. Your eyes have to move more, and you have to turn more pages. This gets tiring.
Compact-width fonts, e.g., 430

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Studies: Inter-Architecture

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Times Roman, look best in 11 or 12 points. Wider fonts, e.g., Palatino, look best in a smaller font size, usually 10 or 11 points. “Large print” books are at least 14 points. Subhead (font size14) large text, typically about 14–18 point Regular (font size10)
usually left unnamed, typically about 10–13 point usually left unnamed, typically about 10–13 point Small Text (font size 8) typically about 8–10 point Caption ( font size 6 )
very small, typically about 6–8 point (SOFTWARE) (INVISIBLE RELATIONSHIP) The content of academic papers and production progress can be controlled by writers. But some writers would give it to printing house control. So that, the controller (writer, graphic designer and printing house) of academic papers are most important elements. We through that if we want to improve the relationship between students and academic papers and books, we have 432

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Studies: Inter-Architecture

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Au Kwong Ming

to make an attention in Academic papers design. We think that the hardware improvement will improve the relationship between readers and academic papers. And this relationship is most important things of improvement attention problems. THE BEGINNING OF DEVELOPMENT We designed a reading test and giving students to select which type of font setting that is suitable and comfortable for them. The test was considered different text format and applied to the academic papers of most number of students are studying in the world at this generation.
We selected financial academic papers, because this study subject is difficult to apply pictures, diagram and chart to explain its content, compare with other subject.

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Studies: Inter-Architecture

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Au Kwong Ming

FIRST TEST In order to understand which font style and layout are most comfortable for reading, we base on different levels of text colour, the spacing of text and anti–aliasing made a test. The first test was answered by round 20 students. GOLDEN RATIO TYPOGRAPHY After the first test, we still did not know how to control the whole page layout of academic papers. At the same time, we found the Golden Ratio Typography Calculator on internet. It help us control the picture
For any font size, as the CPL increases, the line width also increases. Base on pervious test, we also tried to apply Golden Ratio Typography to our design of prototype. In conclusion, our project was focused to analyze modern academic papers’ typeface, paragraph and layouts, in order to find a standard of academic paper for writers and authors references. 436

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We based on the interview and the reading test results to make a definition of good layout, create a manual that recorded all our research and study for writer, is for reader authors. I hope that the final product not only improve spatial or temporary solution. I want to make a design manual of academic papers that record our analysis of typeface, layout, space text to affect future paper setting, through that improve students’ concentration problem on reading. Furthermore, if students who have not studied front design understand basic logic of text and layout setting, it may help them design the presentation panel, book, letter and proposal.

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National Center for Learning Disabilities Inc.: http://www.ncld. org/types-learning-disabilities/adhd-related-issues/adhd/attention-learning- problems-when-you-see-one-look-for-other Lighting affects student’s performance positively: Findings from three Dutch studies: http://repository.tudelft.nl/view/philips/ uuid%3A720cf2c5-5de1-4b66-ae5b-d42f601ce65d/ 15 Strategies for Managing Attention Problems: http://www.readingrockets.org/article/15-strategies-managing-attention-problems Student Concentration: http://studentconcentration.com/ What’s wrong? Ivy League university students use ADHD drug to succeed in exams http://www.techtimes.com/articles/6481/20140506/ whats-wrong-ivy-league-university-students- use-adhd-drug-tosucceed-in-exams.htm How to Tune Typography Based on Characters Per Line: http://www. pearsonified.com/2012/01/characters-per-line.php Colour Theory p3 http://s-walker1215-dc.blogspot.nl/2013/01/colour.html 3 Great Typeface Combinations You Can Use in Your Book http://www.thebookdesigner.com/2010/02/3-great-typeface-combinations-you-can-use-in-your- book/ Golden Ratio Typography Calculator: http://type-scale.com/ http://www.pearsonified.com/typography/

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Studies: Inter-Architecture

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Daniel Schwartz

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Obesity and the future self experience

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Daniel Schwartz

THE FUTURE SELF Obesity does not happen overnight, rather it arises from an accumulation of unhealthy decisions which manifest itself in the long term. In this way, obesity can be seen as a disease of insufficient control over the decisions we make. But why are people so resilient to make a healthy change? Obese people are often more conscious of their health status than those who are not obese, furthermore the motivation of obese patients to change is usually pretty high. So what is stopping these individuals from making decisions? We believe that the key to making a change is by being more attuned to our future self. How much are we really connected to our future self? Try to take a moment to imagine yourself in the future. Imagine yourself within 10 or 30 years from now, where would you live, how would you look like, what kind of job would you have足 or more abstract; will you be happy? 443


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According to research at the Northwestern University, people don’t make a separation between the way they perceive their future self: the same region in the brain lights up when they think of ‘stranger’ or their ‘future self’. It becomes clear that when we have to make decisions, we often lack the ability to think about ourselves on the long term.4 A study in 2008, by Princeton psychologist Emily Pronin, showed that people often avoid doing something helpful in the now when they experience it as ‘unpleasant’. While on the other hand­when they were told that their help would be needed only in a year for now­they were more likely to sign up. This almost suggest that someone else will do the job for them. Most of us treat our future self as if he were a stranger. The gap between our present self and our future self is believed to be one of the reasons to the irresponsible decisions we make. What if we could develop more awareness and care for our future self?3

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Daniel Schwartz

Ersner Hershfield from NY university concluded that envisioning our future selves and by creating a feeling of connection to who we will become. This then guides our behavior in the here and now in ways that create longer-term rewards in economic and other realms of our life. With this in mind, how could we use the conclusions of this research to develop long-term decision-making skill, which has a positive effect on our health, or in other words, prevents us from obesity? 5 We all have the cognitive ability to travel with our mind for days, weeks or even years into the future, but for some reason not everybody seems be able to do this when it comes to their food intake. If we could focus part of our mind and consciousness on the future, we might take less impulsive decisions. We might choose differently what we eat and the way we treat our body and eventually develop the ability to perceive the real value of delaying rewards. 6 444

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Studies: Inter-Architecture

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Based on past research and experiments that have been done on this topic we will form a method and technique which is re­adjusted to our interest.

THE FUTURE SELF EXPERIENCE

Concept and design Target group: General public Design description:

Get connected to you future­self

‘Get connected to you future­self’

RE-­CONNECTING In the first stage the person will enter a room, which enable him to start talking about his desires and wished as if he would be himself 10 years from now.
The talking will be made in front of a video camera , recording the person face while he is answering on specific questions. By answering those questions he will start gain awareness about himself and slowly open up to the next transformative state.

Research question Will connecting and envisioning our future self will help us to prevent obesity? Approach In our design we would like to make a connection between obesity and the future self, we are aiming to design an experience which will cause or start transformative process in people minds. Making them start being aware of their future self and develop a relationship based on care and empathy, which will hopefully help to prevent obesity. 446

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elements in the room will be design to bring up the level of awareness by pressing on the awaking buttons of the unconscious. The person will be confronted with his own future self, in this moment of enlightenment we aim to create a new and strong connection that will be made between the person and his future self.

ENLIGHTENMENT Starting with a quote of Juhani Pallasmaa which represent our way of designing the room of enlightenment: “An architectural work is not experienced as a series of isolated retinal pictures, but
in its fully integrated material, embodied and spiritual essence. It offers 
pleasurable shapes and surfaces molded for the touch of the eye and
other senses, but it also incorporates and integrates physical and mental
structures, giving our existential experience a strengthened coherence and significance, A significant architecture makes us experience ourselves”10 The room of enlightenment will be an haptic experience deign by the philosophy of Juhani Pallasmaa, working with video projecting, bright light , noise, smell and textures we aim to open up the senses and create a special atmosphere, enable the person to experience a strong and meaningful moment. Each of the

THE AFTER EXPERIENCE The person will go out of the room, he will be welcomed back by one of our team members, he will be asked about the experience and will have the option to write about it at our guest book. Right after that he will have the choice to leave his e­mail address and decide when in the future he would like to receive his future self video massage ­a period of time which will starts at one day and end up in a year. In that e­mail he will be asked to rate the strength of the experience and the new connection he have with his future self. 448

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Daniel Schwartz

Stage number 3: The future self stage, when the participator meets his future self, the stage of trans­ formation ­re-connected to your future self Stage number 4: when the participator ends the experience, the after experience. the 2 “personas” ­The present and Future are reconnected.

By choosing the period of time we will be able to conclude and evaluate how strong his new connection to the future self is and how large the chance is to become obese. The installation will be open to the public, inviting people to participate in an experiment.
The whole process will be documented by video and our guest book, the e­mails and answers will be printed and be part of our final project case.

(1)
 http://news.sciencemag.org/2013/01/your­elusive­future­ self
(2)
http://www.theatlantic.com/health/archive/2014/11/live­ on­ purpose/382252/
(3)
http://www.scientificamerican.com/article/ when­im­64/
 (4)
 http://www.cbsnews.com/news/time­travel­the­key­to­

VISIONARY DESIGN SKETCH

financial­ security/
(5)
http://www.scientificamerican.com/.../how­ to­ plan­for­your­f.../
 (6) http://www.psychologicalscience.org/index. php/news/were­only­human/for­obesity­the­future­i s­now.html
 (7)
 http://

The participator will have the future self experience in 4 stages.
 Stage number 1: He will be explained about the experience and what he is required to do. Stage number 2: The present stage, when the participator will share his massage while he is been filmed and recorded

www.cdc.gov/obesity/adult/defining.html
(8)
http:// www.hsph.harvard.edu/obesity­prevention­source/obesity­ consequences/
(9)
http://www.who.int/mediacentre/factsheets/ fs311/en/
(10)
“The eyes of the skin” by Juhani Pallasmaa April 11, 1996

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Studies: Medicine

The art of preventing obesity 3: An interdisciplinary analysis

Iris Christine Mikulic

INTRODUCTION The past few month our group has been working on designing a few concepts on how to help solve this worldwide epidemic of obesity. We have attended classes, visited sites, had interviews and discussed many topics together continuously. Firstly, it was important for us to gain a better insight of the problem in order to understand the issue from a variety of different perspectives. What we found out the past months through interviews and research is that obesity and inner motivation are extremely linked to each other. Successful weight loss is achieved by the combination of motivation, physical activity and caloric restriction. Physical activity and caloric restriction are the key to losing weight, however individual motivation is crucial in initiating and sustaining these measures. Hence, helping obese people find this motivation, is a crucial step in the process of weight loss and therefore could be a detrimental part of our research.

Design of future-self project: 1 explanation 2 reconnection 3 enlightenment 4 after experience

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Iris Christine Mikulic

Studies: Medicine

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Iris Christine Mikulic

FUTURE-SELF CONCEPT & ENLIGHTENMENT So what can be done to help people with obesity find this inner motivation? Our group has thought about this aspect profoundly and one thing we came across what caught our attention was the concept of the future-self. So what does the futureself mean? The future self is collection of beliefs about oneself in the future that includes elements of psychological, social and physical well-being. All these elements are connected to each other, so it is important to take them equally into consideration. Another step in our design process, was to see how this concept of the future-self could help with increasing inner motivation. After much discussion and experimentation, we came up with the concept of the futureself enlightenment. We came up with this design which would have the goal to try to make participants aware of the future and hence increase inner motivation.

The design would consist out of two different rooms (see figure 1). The first room would be used to record an interview with a participant. This interview would consist out of several questions whereby the person being interviewed would have to think about how he/she would see himself/herself in the future (e.g. in the upcoming 10 years). The questions would be displayed on a screen and the participant would have to speak into a camera that would record the whole interview. The second room would be op454

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Studies: Medicine

Insight Series #8 Hacking Healthcare

Iris Christine Mikulic

Studies: Medicine

Insight Series #8 Hacking Healthcare

Iris Christine Mikulic

Bate, P., & Robert, G. (2006). Experience-based design: from

tional, whereby we were thinking to display the video to the participant instantly in a specific manner that would add to the effect of enlightenment. However, there would also be a possibility of the video being sent to you in a few years. Hereby, the participant would receive a video where he would see him- or herself talk and talk about his or her thoughts on the future-self. If the participant gets to see his or her video a few years later, he or she will hear himself talki about these ideas he or she had about the future during that time. Then the participant sees whether those ideas match with the present and if not, whether it is good or bad they deviate. This realization will hopefully make the participants more conscious about the future-self and how it is important to take good care of yourself specifically in relation to physical health. According to the article “The Elusive Future-Self”, which was based on a future-self research ; “people predicted less change in the future than they had experienced in the past”.

redesigning the system around the patient to codesigning services with the patient. Quality and Safety in Health Care, 15(5), 307-310 Brown, T., & Wyatt, J. (2010). Design thinking for social innovation. Herzlinger, R. E. (2006). Why innovation in health care is so hard. Harvard business review, 84(5), 58. Litemind Link: https://litemind.com/scamper/ Web access: 30/1/2015 Miller, G. (2013) Your Elusive Future Self Link: http://news.sciencemag.org/2013/01/your-elusive-future-self Web access: 2/2/2015 Sutton, R. I. (2001). The weird rules of creativity. Harvard business review,79(8), 94-103. Webster, S. (2005) Art and Science Collaborations in the United Kingdom: Perspective. Nature Reviews Immunology. Vol. 5, p. 965.

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Studies: Social Science

Insight Series #8 Hacking Healthcare

Olivia B.Noe

Studies: Social Science

Alternative communication: project development for the chronically ill

Insight Series #8 Hacking Healthcare

Olivia B.Noe

INTRODUCTION
 Five students coming from the Rietveld Academie, the VU, and the UvA were all assigned a case in the Hacking Healthcare course titled “Coping with Loss in Times of Oblivion” in early September. Over the course of four months, these students would come to collaborate with the Odensehuis facility, exchange numerous ideas, communicate with the elderly population and their caregivers, and bridge a part of the gap between the arts and sciences. Through various deliberate decisions despite several instances of uncertainty, the team has progressed several steps further in creating a solid plan to help combat the isolation and despair of this progressive, neurodegenerative disease that currently has no cure. As cited by the University of California San Francisco, developing coping mechanisms can often alleviate the challenges of Alzheimer’s. Yet, the process for 458

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Insight Series #8 Hacking Healthcare

Olivia B.Noe

Studies: Social Science

doing so is often riddled by the desire for individuality, the anxiety for change, and the disconnect of external and internal states. Behavior becomes overtly agitated as perceptions of stimuli become discombobulated and the world seems progressively more intense. Many patients can even exhibit a learned helplessness. UCSF promotes coping strategies that “set realistic and attainable goals, anticipate misinterpretation, remember that all behavior has a purpose, enjoy the good times, reminisce about the past” and “[are] flexible.” Important to note is that the changing environment is compounded with the changing white matter brain structure consistent with Alzheimer’s and even depression (O’Brien, Desmond, Ames, Schweitzer, Harrigan, Tress; 1996). Now that the estimates for the comorbidity of depression and Alzheimer’s have skyrocketed to an upwards of 40 percent, it is time to further investigate ways to ease the process (Alzheimer’s Association; 2014).

Insight Series #8 Hacking Healthcare

Olivia B.Noe

Catering to the needs of the Odensehuis and the Hacking Healthcare course, we students have encompassed our experiences, our difficulties, and our understanding into a singular problem definition for our case study. The definition, while concise, gives breadth to the aims in our project without undermining the difficulty of losing oneself while also losing cherished friends who also suffer from the disease. The definition is as follows: “There are a lack of effective tools in the Odensehuis to help the people accept and cope with the personal loss of self and others.” An appropriate “solution” to their problem should hone in on several facets, including the need for individualism but also the need for solidarity. This solution should embody a humaneness that allows for participants to feel unweighted by their illness. However, it is vital that participants fully realize the gravity of their situation. From personal experience, we worried that simple 460

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Insight Series #8 Hacking Healthcare

Olivia B.Noe

Studies: Social Science

activities continuously distracted the afflicted from facing their reality. Now, the hope is that regular activities can be translated to a more meaningful process.
My previous paper cited that the inclusion of spirituality could enhance the positive emotions of a person and could greatly help progress the process in a more optimistic direction. In the section titled “Breaking of Bread” we explore the concept of unity with religious undertones. Standing at the foreground of uncertain fates but impending death, Alzheimer’s patients feel at a loss. While we are unable to solve all of the problems that torment each patient, we hope that stringed together our experiences can shed some light on further ways to cope with the burden of disease.

Insight Series #8 Hacking Healthcare

Olivia B.Noe

influence and through psychological processes via sensory stimuli (Dijkstra, Pieterse, Pruyn; 2006). Perhaps an overlooked influence in patient well-being is the indirect effects of the sensory stimuli in the environment, such as color and textures, that mediate psychological experiences.
 A meta-analysis study, while somewhat limited in its scope, recognized slightly greater socializing behavior and positive emotions in redecorated, brighter areas (Dijkstra, Pieterse, Pruyn; 2006). Yet, healthcare outcomes are not solely based on external factors. The motivation of a patient is activated by his or her own involvement in the treatment plan (Gloor et al; 2011). Greater involvement of patients and increased communication between the patient and their caregiver team can greatly enhance the overall satisfaction level and can even allow for a more stable recovery process. First and foremost, treatment should be human-centered, realizing both

(I) METHODS: PATIENT EXPERIENCE
 A patient can be affected by their healthcare treatment by direct physiological 462

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Studies: Social Science

the accessibility of mistakes and the likelihood of error (Searl, Borgi, Chemall; 2010). In situations of stress and chaos, it is understandable that humans may act less logical than they would normally act. Aside from the doctor and the staff, the patient holds much liability for their daily treatment. People may often fall into the habit of assuming an external locus of control for decreasing health rather than taking the initiative to change personal behaviors. More progressive methods have drawn in the idea of utilizing artificial intelligence methods to capture data on health communication (Kreps, Neuhauser; 2013). Yet with a population that is advancing in age, we have chosen to elaborate on methods that are more common and less technologically savvy. Especially with Alzheimer’s patients, who may struggle with treatment adherence due to a declining cognitive condition, it is vital to realize that daily life is unpredictable. Therefore, we propose a

Insight Series #8 Hacking Healthcare

Olivia B.Noe

structure for our project that is widely utilized and is routine. This particular routine should involve the active engagement of the patients to increase self-efficacy. (II) METHODS: A STANDARD APPROACH
 The coping process requires a special type of self-communication, one that acknowledges personal needs and accepts pain while dealing with daily life. Especially critical in our project is the prospect of understanding one’s internal atmosphere. No one is fully able to recognize the depth of suffering for patients more than the patients themselves. Projects that enable fluid communication between care teams and patients are extraordinary additions to the healthcare system. However, on a large scale, the individual coping process must be recognized on a personal level. Finding certain creative outlets can help mollify the anguish of disease to promote a more collaborative healing environment. 464

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Insight Series #8 Hacking Healthcare

Olivia B.Noe

Studies: Social Science

For Alzheimer’s patients, forms of personal therapy have included, but are not limited to, dance, music, and art therapies (Pratt; 2004). Throughout the last century, these cultural forms of therapy have culminated in more formal healing environments present in most hospitals. For example, Cincinnati Children’s Hospital has entire wings devoted to craft rooms for outpatient children and their families. Such cathartic activities allow patients to release inhibitions and insecurities about themselves via less destructive methods. Aiming to further “the emotional, cognitive, social, and physical integration of the individual,” therapy associations (in this case the American Dance Therapy Association is described) become an alternative way for patients to speak, as communication is certainly not limited to formal speech. Communities such as the Odensehuis recognize the necessity for alternative therapy. Upon entry, one can immediately notice the walls adorned with self-portraits,

Insight Series #8 Hacking Healthcare

Olivia B.Noe

paper collages, and abstract paintings. Later in the day, the strum of the guitar can be heard throughout the center. As the Odensehuis seems to already have an engaging community, we are now presented with the task of creating something that they do not yet have. (III) A SHIFT IN PERSPECTIVE
 While the team is amazed by the unique decorations of the Odensehuis and the wonderfully organized activities, we cannot help but wonder if such activities can help but also hinder the healing process. For example, art and musical activities could possibly serve as distractions that prevent the confrontational part of suffering. Activities that offer immediate solace may only be temporary and may not offer an effective method to coping. Rather than exploring more conventional forms of creative therapies, the consulting team chose to explore other 466

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Insight Series #8 Hacking Healthcare

Olivia B.Noe

Studies: Social Science

ways in which individuals “communicate” and interact on a daily basis. Our hope is that what we prototype will be sustainable and easily accessible. In meeting an Alzheimer’s patient and advocate, Leo van Dijk, we learned of the healing nature of regular meditation, both individually and in groups. We listened to him speak of the pain at first receiving his diagnosis, but then the lack of pain at realizing that a large portion of his health was out of his control. Instead of opting to blame others for his largely untreatable illness, he chose to accept the natural ebbs and flows of life.

Insight Series #8 Hacking Healthcare

Olivia B.Noe

First, especially memorable was when we talked and ate pumpkin soup with the community, an unscripted act. People appeared rather cheerful, desired to be together, and spoke of their past. A vital aspect of our project was sharing parts of oneself. An activity called the “Gedachtekamer” (which we were not permitted access to) already achieved this goal, but in a more private orientation that does not involve the entire community. Important to note is that the project also has the ability to serve loved ones who are physically unaffected by the illness. Due to one of our group members having an Asian background and the impending Christmas holiday, the idea of some sort of tree flooded our minds. Components of the Asian “wishing tree,” which is decorated by offerings, became compelling (Kak; 2001). Even Leo van Dijk cited the idea of adding natural elements to the project, as going on walks outside became so peaceful to him and rather healing.

(IV) A PERSONAL ANECDOTE
 The team took lots of time to reflect on the interactions had and the acquaintances made at the Odensehuis. Certainly, some meetings were far more productive than others; however, a few instances were powerful enough to stick out in our minds. 468

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Insight Series #8 Hacking Healthcare

Olivia B.Noe

Studies: Social Science

(V) PROTOTYPING


Insight Series #8 Hacking Healthcare

Olivia B.Noe

a bit of pre-made dough. They then were told to construct an object of importance to them. In the process of doing so, people could stimulate their tactile sense, the sense left most intact during Alzheimer’s disease (Behrman, Chouliaras, Ebmeier; 2014). The results were far more astounding than we could have imagined. Previous interactions had been a bit painstaking, where affected members would drift off, unaware of the turn in conversation. This time, however, we felt that we were making a breakthrough. Again, rather than speaking with words, the Odensehuis members spoke with actions. One man shaped his dough into the first letter of his deceased wife’s name. Another woman crafted a duck, her favorite animals as a child. At this stage, patients are cognitive of thefact that they must slowly become more dependent than they are used to, and slowly the perception of their caregivers begin to shift (Slaughter, Hopper, Ickert, Erin; 2014). Cooking can help resurface thoughts of

The phase of prototyping was far more strenuous than we had anticipated. Using the SCAMPER method, we were able to tease a few of our ideas into more coherent wholes (Eberle; 1997). After some deliberation, it became clear that revolving our thought processes around mealtime would make the project less static and more sustainable. For example, our idea to incorporate meal time broke down into creating a memory cookbook, designed plates, and, in a more abstract sense, a set of drawers that contain “recipes” of each individual (i.e. trinkets, photos, notes). (VI) VISION AND DECISION
 To get a greater sense for how the community could engage in mealtime, we chose to develop a workshop where members of the Odensehuis could bake bread together. In the activity everyone was given 470

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Insight Series #8 Hacking Healthcare

Olivia B.Noe

Studies: Social Science

past family dinners and religious holidays, and can reawaken a sense of independence (CBS Denver; 2012). It was wonderful to see the Odensehuis members “lead” the activity from their own string of memories, revitalizing the spirit of the center.

Insight Series #8 Hacking Healthcare

Olivia B.Noe

people can have an immediate memory of the person who created them. My younger sister Isabella created such a plate when she was four. Although she is now 16, whenever I use the plate I laugh when I’m reminded of a small child splashing around in paints. Participants can stimulate their tactile senses during the creation process, molding their grief but also happy memories into a ceramic art form. But, unlike static art works that hang on the wall, participants can continuously use their art while activating a memory; therefore, they are actively able to deal with their grief. While the project is still in the works, we have finally developed a method. Such a method reaches less at the logical part of the mind, but more at the creative tendency of humans. Finally, we have developed a method to reach, or communicate with, our target population.

(VII) CONCLUSION
 Like the Alzheimer’s community, I too had to learn to alternatively communicate. I speak no Dutch, and only snippets of French, Spanish, and German. Several of the elderly participants have forgotten much of their second language, and we therefore had to rely on other methods to have positive interactions. Cooking proved to be one solution. Moving forward, we would greatly enjoy the prospect of creating plates with the Odensehuis members, and then decorating the plates in remembrance of the self or other individuals who have passed on. That way, each time the plates are used, 472

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Olivia B.Noe

Studies: Social Science

Alzheimer’s patients don’t have to quit cooking. (2012, ). CBS Denver
Behrman, S., Chouliaras, L., & Ebmeier, K. P. (2014). Considering the senses in the diagnosis and management of dementia. Maturitas, 77(4), 305-310.
Coping strategies for Alzheimer’s disease caregivers. (2014). Memory and Aging Center, University of California San Francisco,
Depression and Alzheimer’s. (2014). Alzheimer’s Association,
Eberle, B. (1997). Scamper: Creative games and activities for imagination development. Prufrock Press, Gloor, P. A., Grippa, F., Borgert, A., Colletti, R. B., Dellal, G., Margolis, P., & Seid, M. (2011). Towards growing a coin in a medical research community. Procedia-Social and Behavioral Sciences, 26, 3-16. Kak, S. (2001). The wishing tree. Munshiram Manoharlal, New Delhi,
Kreps, G. L., & Neuhauser, L. (2013). Artificial intelligence and immediacy: Designing health communication to personally engage consumers and providers. Patient Education and Counseling, 92(2), 205-210.
O’Brien, J., Desmond, P., Ames, D., Schweitzer, I., Harrigan, S., & Tress, B. (1996). A magnetic resonance imaging study of white matter lesions in depression and Alzheimer’s disease. The British Journal of Psychiatry: The Journal of Mental Science, 168(4), 477-485.
Pratt, R. R. (2004). Art, dance, and music therapy. Physical Medicine and Rehabilitation Clinics of North America, 15(4), 827-841. Rousseaux, M., Sève, A., Vallet, M., Pasquier, F., & MackowiakCordoliani, M. A. (2010). An analysis of communication in conversation in patients with dementia. Neuropsychologia, 48(13), 3884-3890. Searl, M. M., Borgi, L., & Chemali, Z. (2010). It is time to talk about people: A human-centered healthcare system. Health Res Policy Syst, 8, 35. Slaughter, S. E., Hopper, T., Ickert, C., & Erin, D. F. (2014). Identification of hearing loss among residents with dementia: Perceptions of health care aides. Geriatric Nursing,

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Studies: Inter-Architecture

Insight Series #8 Hacking Healthcare

Frédérique Albert Bordenave

Studies: Inter-Architecture

The design process hacking healthcare case study

Insight Series #8 Hacking Healthcare

Frédérique Albert Bordenave

Coherence, congruence and consistency stand as the aims and intentions of the design process and results of the healthcare case. Those objectives were fixed after the observation – through research, discussions, interviews and visits – of the lack of primary purpose to the ward, reflecting on the actual operating system and the state of the ward. Nevertheless, the weight of bringing something coherent to the table started to become more present and less inevitable. The next step was clear, but the way to get to it wasn’t. How to translate a scientific approach to a creative result? How to move from the brain to the hands? Defining and making felt like a contrasting pair more than ever. Somehow, they seemed to be fighting and limiting each other, but mostly myself. However, embracing and reconciling the two for what they are, with their similitudes and differences, made it more interesting.

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Frédérique Albert Bordenave

1. Plan of the actual state of the ward

THE METHODS For the problem definition, the creation of a chart conciliating the different needs depicted the common and recurring themes gathered in the in the problem definition phase. Thereby, the three following themes were formed: 01 02 03

Studies: Inter-Architecture

2. Plan showcasing the moving of the nursing station

The comfort in the ward
 Interactions and identity
 The aesthetic/ decoration


The change to make in the ward had to be coherent enough to be able to have an impact on everything else – meaning the staff, the patients and the state of the ward. In health care facilities, there is usually a nursing station and a nursing office. The first one is more open to interaction with visitors and patients, whereas, the office allows them to work on more private files and to give patients their medicine. 478

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Frédérique Albert Bordenave


Studies: Inter-Architecture

Insight Series #8 Hacking Healthcare

Frédérique Albert Bordenave

Studies: Inter-Architecture

Insight Series #8 Hacking Healthcare

Frédérique Albert Bordenave

3. Plan of the patients’ design of the ward

GGZ inGeest has both in the same rectangular room, limiting the accessibility of the nurses. To move the ward to the living room would intervene on different levels, such as a clarification of the identity of the staff, a center and meeting point, but also by making the nurses more accessible and enhancing the communication between the staff and the patients. On November 26th, with the help of Thieme, the creative therapist at GGZ inGeest, the team had the opportunity to ask the patients to design the ideal ward. From 10.45 AM until 12 AM, four patients out of six were actively participating, using the surface of the table as the ward. The discussion started when Thieme asked the patients: “Where would you like the nurses station to be?” Different opinions and suggestions were given and after 25 minutes debating on the topic of the nursing station, the final decision was to give it a central position in the living room.

The introduction to the “SCAMPER” method shaped our creativity to generate ideas based on the different needs. To focus our brainstorming on the nurses helped us divided their roles and actions under the following bullet points: Movement in the ward’s system • • The interactions with the patients • Caretaking • Guidance On a more clear and refined level of the precedent brainstorming ideas, 480

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Insight Series #8 Hacking Healthcare

Frédérique Albert Bordenave

Studies: Inter-Architecture

Insight Series #8 Hacking Healthcare

6 Components of an ideal nursing station

the following diagram illustrates the five components judged essentials to the nurse station. The next step was to develop those five components into physical stations through sketches.

01 02 03 04 05

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Comfort/support Interactions Flexibility Activity Identity

Frédérique Albert Bordenave


Studies: Inter-Architecture

Insight Series #8 Hacking Healthcare

Frédérique Albert Bordenave

The five components led to a variety of different designs. Based on those designs, the combination of the points and elements that seemed the most coherent to the situation at the GGZ inGeest directed to the creation of what we referred as, a “Frankenstein”. The recurring points being (1) the seating devices next or on the nursing station, (2) the element of transparency for visibility, emergency and safety, (3) the counter to divide the patients and the nurses spaces, (4) a zigzag shape (pattern made up of small corners at variable angles) to embrace the space and create various interaction points and (5) the flexibility of the shape. This “Frankenstein” offered two different, yet complementary designs. A circular and flexible counter delimits the shape of the first one and sliding partitions made of glass delimit the shape of the second one, both embracing the five necessary components of a nursing station.

Studies: Inter-Architecture

07 Counter nurse station 08. Glass walls nurse station

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As human beings, we have the tendency to separate things and to put those things in their respective categories in order to make it more understandable. However, aren’t we more than that? Through that collaboration, I found out that artists and scientists tend to approach the situations they are facing with a similar openmindedness and inquisitiveness. The tools to work on those situations were however different. Translating what is on my mind on paper is usually my instinctive response to a problem, sometimes leading to being stuck in my thoughts. To stand back from what’s on your mind, to look at what has been done in the world through research, articles and studies bring a balance to it all.


Studies: Inter-Architecture

Insight Series #8 Hacking Healthcare

Frédérique Albert Bordenave

Studies: Inter-Architecture

It felt complimentary, like an intellectual collision of seemingly disparate subjects. In this particular case study, with the assignment of humanizing hospitalization of people with severe psychiatric problems, it feels like was more about our human side than anything else and how this human approach could influence and weight in our analysis and designs. This following specific excerpt of a transcript of a TED Talk by Mae Jemison, an American astronaut, doctor, art collector and dancer titled “Teaching arts and sciences together” gives an inspiring perspective on the topic of the collaboration of arts and sciences, to which I related to: “They spring from the same source. The arts and sciences are avatars of human creativity. It’s our attempt as humans to build an understanding of the universe, the world around us. It’s our attempt to influence things, the universe internal to ourselves and external to us. The sciences, to me, are manifestations of our attempt to express

Insight Series #8 Hacking Healthcare

Frédérique Albert Bordenave

or share our understanding, our experience, to influence the universe external to ourselves. It doesn’t rely on us as individuals. It’s the universe, as experienced by everyone, and the arts manifest our desire, our attempt to share or influence others through experiences that are peculiar to us as individuals. Let me say it again another way: science provides an understanding of a universal experience, and arts provides a universal understanding of a personal experience.” Mae JEMISON. Teach arts and sciences together. http://www.ted. com/talks/mae_jemison_on_teaching_arts_and_science s_together/ transcript. TED Talks, May 2009.

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Process

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UVA/Inter-Architecture, Gerrit Rietveld Academie

Insight Series #8 Hacking Healthcare

Special thanks

UVA/Inter-Architecture, Gerrit Rietveld Academie

Insight Series #8 Hacking Healthcare

Special thanks

With special thanks to: Our students

Our facilitators

Speakers

Salie van der Wal

Shailoh Phillips

Machteld Huber

Leonie Poelstra

Anna Diepraam

(Louis Bolk Institute)

Yaniv Schwartz

Linda Wanders

Fiona de Vos (Studio d.vo)

Isak Boardman

Rosanne Meulenbeld

Esther Vossen (GGZ Altrecht)

Daniel Schwartz

Marlies Schijven (AMC)

Iris Christine Mikulic

Our case owners

Bart Jacobse & Renee Kolgen

Linde van Vlijmen

Toosje Roel (Cordaan)

(Gupta Strategists)

Sharon van den Bosch

Karin van de Kamp &

Wouter Bergmann Tiest (VU)

Marco Heuvelman

Alex Kolder (GGZ inGeest)

& Henri Snel

Cherie Cheung

Mireille van Reenen & Julia

(Gerrit Rietveld Academie)

Au Kwong Ming

Borst (OLVG)

Anna Dumitriu

Frederique Albert-Bordenaeve

Jeroen Wilhelmus (Odensehuis)

KC Chaviano

Claudia van der Heijde &

Visiting critics

Phebe Kraanen

Peter Vonk (Studentenartsen)

Femke Bijlsma

Paz Ma

Ruben Coronel (AMC)

Jeroen Luttikhuis

Natasha Oduber

Marc van Dijk

Dimitra Xrusovergi

University of Amsterdam

Xuanhong Huang

Bert de Reuver

Student assistant

Mai-Loan Gaudez

Jessica Rodermans

Timo Fernhout

Fernando Dias Gonรงalves

Marie Hoogstraten

Olivia Noe

Pakhuis de Zwijger

Muriel Lindeijer

Gerrit Rietveld Academie

Romy Yedidia

Ben Zegers

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UVA/Inter-Architecture, Gerrit Rietveld Academie

Colophon

Insight Series #8 Hacking Healthcare

Colophon Insight Series #8 Š Gerrit Rietveld Academie & Universiteit van Amsterdam Amsterdam, 2015 Fred. Roeskestraat 96 1076 ED Amsterdam The Netherlands T +31 (0)20-571 1600 www.gerritrietveldacademie.nl www.Inter-Architecture.nl Tutors: Renske Kroeze Tim van de Grift Henri Snel Concept and design: Anja Groten Printing and binding: Edition Winterwork Edition: 100 copies

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Inside series #8, Hacking Healthcare  

Hacking Healthcare is an educational project designed to address some of the many challenges our healthcare system is currently facing. For...

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