DESIGNING THE WAITING EXPERIENCE of IU Health Methodist PeriOperative Services
OVERVIEW
This project was developed over the course of one year, by the Herron School of Art and Design Visual Communication Design program in partnership with the Purdue School of Engineering and Technology’s Interior Design program, in collaboration with IU Methodist Hospital.
DESIGN THINKING PROGRAM, VISUAL COMMUNICATION DESIGN
IU METHODIST HOSPITAL
Faculty Supervisor
Coordinators
Youngbok Hong
Diane Bellamy
Associate Professor
Brandon Stuck Christine Barber
Researchers
Collaborative Participants
PHASE ONE
Shuhua Lin
Diane Bellamy
(Fall 2012)
Megan Mirro
Diane McGregor
Josh Watson
Dr. Sherman McMurray Julie Barton Carolyn Krombach Nancy Holladay Patient Visitor Representatives Patients & Patients’ Families
PHASE TWO
Ashley Bailey
Diane McGregor
(Spring 2013)
Sara Trempe
Diane Bellamy
Jinny Petrovsky
Gary Life Kheterina Kitkas Patricia B Thurgood Patients’ Families
WHO IS IU HEALTH IU Health Methodist Hospital is a state wide health system treating trauma. This hospital is looking to improve aspects of its operation, to better their patients overall experience. IU Health reached out to IUPUI’s programs in Visual Communication Design and Interior Design, to assist in the project of reevaluating the waiting room experience that exists and provide our insights to improve the current situation. In this study, we specifically explored opportunities within the PeriOperative services area.
WHO ARE WE As graduates of the Visual Communication Design program, we focus on designing meaningful service experience from people’s point of view. By adopting a people-centered approach, we use design research for collaborative problem solving. Design research methodologies provide us with a deeper understanding of the perspectives in formulating solutions, through understanding and engaging in contextuallysignificant ways. Through design thinking and design leadership we strive to facilitate collaborative problem solving toward the development of relevant and appropriate solutions.
PROJECT DEVELOPMENT PROCESS
This study was developed over the course of one year, with the objective of redesigning the waiting room experience of Methodist’s PeriOperative Services, specifically from the emotional perspective.
PHASE ONE
How might we redesign the waiting room experience?
Framework Development
Objective
Data Collection
Data Analysis & Synthesis
FALL 2012
OBJECTIVE: In phase one of this project, our focus was adopting a holistic point of view with the aim to define opportunity areas for enhancing the waiting room experience.
Outcomes
PHASE TWO
How might we create an emotionally sensitive waiting room experience?
Framework Development
Objective
Data Collection
Data Analysis & Synthesis
SPRING 2013
OBJECTIVE: In phase two of this project, our main focus was adopting emotion as our primary perspective, and narrow down to specific opportunities that address the emotional aspect.
Outcomes
phase one:
How might we redesign the waiting room experience?
PROCESS OBJECTIVE
BEGINNING THE STUDY We began this study by learning about the broader scope of the hospital waiting experience. Understanding the differences and similarities between Methodist’s PeriOperative Services and other models, we were able to identify the common experience, and were then ready to understand the experience specific to PeriOperative Services. Next, we focused on the role of PeriOperative Services within Methodist Hospital, which allowed us to move forward in identifying who and what made up this waiting experience.
BROADER SCOPE OF THE CONTEXT To understand IU Health PeriOperative Services it is important to look at the broader elements and influences that are guiding current changes in health care. By looking at these broader elements and influences, our research on the specific area is contextualized.
Global Level Hospitals are looking to innovate their practice based off of socio-dynamic changes.
National Level Hospitals are aiming for a holistic experience with this revolutionary time in American healthcare based on policy changes.
Hospital Level Hospitals have to meet high expectations because there is a focus on the clinical and personal service for patients.
UNDERSTANDING CONTEXT OF PERIOPERATIVE SERVICES As a Level I Trauma Care Center, people from across the state of Indiana visit IU Health Methodist Hospital to receive quality care. The hospital was built around trauma and its PeriOperative Services, or surgery unit, is a key component of the hospital. According to the PeriOperative staff, they treat an average of 60 patients every day. “About 75-85% of patients knew they were coming to receive care, while 10-15% are here on nights and weekends and had no idea they would be here today,� describes Dr. Sherman McMurray, Medical Director of PeriOperative Services. These 10-15% of patients are mostly emergency cases, while weekday cases can be outpatient, impatient or emergency cases. During our research we found that there are many different types of surgery that occur in the PeriOperative unit. The surgeries are divided into five main core areas; neurosurgeries take place in the 1st core, orthopedic trauma surgeries occur in the 2nd core, general surgeries (such as OB, plastics and outpatient) happen in the 3rd core, urology surgeries occur in the 4th core and cardiovascular surgeries take place in the 5th core. Surgeries can take anywhere from 2 to 20 hours and families could be waiting for several hours or for several weeks for their loved ones recovery. Regardless of the type of surgery a patient is receiving, there is one waiting room where their loved ones wait, which has become the focal point of our research.
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PHASE ONE
PROCESS
OBJECTIVE
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PHASE ONE
PROCESS
OBJECTIVE
FRAMEWORK DEVELOPMENT
KEY PERSPECTIVES Throughout the PeriOperative Service Experience, there were several staff members and patients families with valuable insights. These key people were important to this research because of their integral role in the overall experience for the patients and the patient’s families. Their involvement was meaningful to capture a holistic view of the experience.
Patients & Patients’ Families
Throughout this document, we use the term “families” to group relatives of the patient as well as friends and guests. We use this term to relay a more intimate relationship with the patient.
Diane McGregor
Project Coordinator IU Health Methodist Hospital PeriOperative Services
Diane has worked at Methodist for over 30 years and is involved with communicating the clinical staff needs with design construction teams. She was most recently involved with the successful renovations of the neurology unit. Diane Bellamy
Facilitator of Patient Experience PeriOperative Services
Diane has been a nurse, instructor, and manager for 22 years. She is an expert on patient experience and is in charge of communicating patient needs and care to the staff. Dr. Sherman Mcmurray
Medical Director for PeriOperative Services and Anesthesiologist
Julie Barton
Manager of PeriOperative Services
Sherman has been the Medical Director for over 25 years and is in charge of making the physicians happy.
Julie has been in healthcare for 30 years and has worked for Methodist PeriOperative Services for 12 years. She has experience with outpatient, inpatient, OR, managerial services and has been in her current role since July. Carolyn Krombach
Manager of Post-anesthesia Care Unit, PeriOperative Services
Carolyn has worked at Methodist for 3 years and makes sure everything runs smoothly with staff and visitors in the PeriOperative recovery rooms. Nancy Holladay
Nurse Liaison
Nancy’s role is to be the line of communication between the nurses and the waiting room. She plays an important role in updating the patient’s family on their loved one’s experience. Patient Visitor Representatives
Thomas, Mike, Tony, and many others
Their main role is to provide information to the patient’s families and to ensure they are having a comfortable experience in the waiting room. They are the human contact for the patient’s families to answer questions as best they can.
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PHASE ONE
PROCESS
FRAMEWORK DEVELOPMENT
TOUCHPOINTS The framework for this research is to understand the waiting experience for patients and patient’s families through multiple stakeholders perspectives. Patients and their families experience different touch points throughout their journey in the hospital. At these touch points, they have a relationship with the space, as well as each staff member they interact with. Below is a visual that describes the touchpoints of the surgical process and who is present and interacting at each step of the journey.
Guest Relations: Nancy Holladay: Doctors: Nurses:
PARKING Visitors drive to the hospital and park (typically in parking garage one.)
Patients: Patients’ Families:
ENTRANCE Visitors enter through the front door and encounter the information desk where they get directions from guest relations.
ADMITTING They continue to check-in at “admitting” and receive additional directions. In some cases they are escorted up to the surgery waiting room on the second floor.
SURGERY WAITING ROOM They are then checked-in again by a patient visitor representative (PVR) at the front desk of the waiting room.
PRE-OP The patient and his or her family wait until the patient is called to enter the “preop” phase, which entails going back to the “assessment” area.
Guest Relations Nancy Holladay Doctors Nurses
PRE-OP VISITATION
OPERATING ROOM
POST-OP UPDATE
After the nurse has gathered necessary information and labs from the patient, a limited number of family members may go back to visit with the patient until it is time for surgery.
When the appropriate staff and operating room is prepped and ready for surgery, the patient is transported to the appropriate operating room and their family goes back to the waiting room.
Updates may occur throughout the surgery, but generally the next interaction families get with staff is when the surgeon comes back to the waiting room at the conclusion of the surgery. The doctor reports the state of the patient to the family and may also describe what to anticipate for the rest of their journey at the hospital.
PACU-1
PACU-2
Most families will have an opportunity to briefly visit their loved one in the ‘PACU-1’ recovery room.
After this phase of recovery, patients and their loved ones may be moved to the ‘PACU2’ nursing unit (located down the hallway in the PeriOperative area) or they will be transported to ICU or other specialty recovery rooms throughout the hospital.
Patients Patients’ Families
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PHASE ONE
PROCESS
FRAMEWORK DEVELOPMENT
DATA COLLECTION
METHODS AND TOOLS There were several methods we implemented to better understand the PeriOperative experience of patients and their families. After our preliminary observation, we noticed that the PeriOperative environment was a sensitive space due to the high emotional levels from the patients families. We wanted to be relatively invisible and sensitive to the circumstances of visitors during our research, therefore, we selected particular methods accordingly.
Observation
We used observation to study the behaviors between people and their social interactions. We focused on every individual in the waiting room and their roles and reactions to certain elements in the waiting room. Observation gave a better sense of the behavior patterns among different types of people, along with their overall experience.
Interview
We interviewed several patients, families, and staff within PeriOperative Services. Questions were arranged to be open-ended to allow for the sharing of descriptive information and freedom of opinion without set parameters. The purpose of this method was to gain personal insights from a variety of insider perspectives and to learn about the individual and social experiences.
Shadowing
We shadowed Nancy Holladay several times as we considered her to be full of vital information about the experiences of PeriOperative patients, families, and staff. Understanding her role as communicator between these different perspectives, we have found her critical in understanding the relationship between patients’ families and the medical team.
Other Models
We researched two other hospital models – Mount Carmel in Columbus, Ohio and Parkview Regional Medical Center in Fort Wayne, Indiana- that are addressing patient and family experience. Using observation and interview, we looked at the experiences provided by these other models to compare and contrast those experiences to IU Health Methodist Hospital.
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PHASE ONE
PROCESS
DATA COLLECTION
DATA ANALYSIS & SYNTHESIS
ANALYZING THE DATA Analysis is the organizing and interpretation of data in order to see patterns and make connections. By categorizing all of our data to find themes, we developed a full understanding of what makes up the waiting experience.
SYNTHESIZING THE DATA Synthesis is making sense of the patterns and categorizing them in a way that reveals new information about the data. Through synthesis, we identified the opportunity areas to be improved upon, and specific statements to express prompts for action. The statements are discussed on the following pages, in the ‘outcomes’ section.
OPPORTUNITY AREAS Environment
Waiting Room, Assessment Area, PACU-1, PACU-2
Communication
Information Design, Communication Through People, Communication
Emotion
Understanding Patients And Their Families, Understanding PeriOperative Services Staff
OPPORTUNITY AREAS Environment Waiting Room Assessment Area PACU-1 PACU-2
Communication Information Design Communication Through People Communication Through Tools
Emotion Understanding Patients And Their Families Understanding PeriOperative Services Staff
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PHASE ONE
PROCESS
DATA ANALYSIS & SYNTHESIS
OUTCOMES
OPPORTUNITY STATEMENTS Throughout the analysis of our research findings three main opportunity areas, which were Environment, Communication, and Emotion. Within these areas, we reexamined each of our findings, framed them as opportunity statements within the “How might we” format. “How might we” statements act as verbal triggers to explore the possibility of change. In this document we include our insight for change as well as a space for your exploration.
EMOTION Understanding Patients and Their Families How might we better respond to the emotional quality? How might we utilize IU institutional knowledge into designing information for the patients? How might we develop a emotionally sensitive system? How might we contextualize the information according to the journey? How might we provide a holistic understanding of the process?
Understanding PeriOperative Services Staff How might we design an environment that allows emotional outlets? How might we create a healthier environment for the staff? How might we incorporate context based assessment with universal assessment? How might we show appreciation and recognition for the staff members? How might we design an inclusive decision making process?
For details, please see page 44.
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PHASE ONE
OUTCOMES
OPPORTUNITY AREAS
ENVIRONMENT 1. Waiting Room How might we reconnect patients and their families throughout the process? How might we better utilize the resources? How might we better meet the basic needs? How might we provide a meaningful waiting experience? How might we design a better emotional experience? How might we improve the health and hygiene within the waiting area?
2. Assessment Area How might we better prepare patients and their families?
3. PACU-1 How might we improve the emotional well being in this area? How might we better design the information system? How might we better optimize the space in PACU-1?
4. PACU-2 How might we create a better tracking system for patients belongings?
5. Hospital How might we design a better way finding system based on the patient experience?
For details, please see page 16.
COMMUNICATION Information Design How might we contextualize the information according to the journey? How might we provide a holistic understanding of the process?
Interaction Through Tools How might we improve the tracking system? How might we better design the paging system? How might we improve phone service in the waiting room? How might we make the computers more accessible? How might we create a unified language system? How might we make the PACU-1 white board more efficient? How might we make the visual information human centered? How might we make charting easier for the staff?
Interaction Through Humans 1. Nurse Liaison and Families
How might we leverage human resources to improve the role of nurse liaison? How might we improve the empathetic practice? 2. PVR and Families
How might we create a better identification system? How might we improve a safer environment? How might we improve the flow of information? 3. Nurses and Patients and Families
How might we provide an alternative source of communication so patients and families are attended? 4. Doctors and Staff
How might we design a unified communication system? 5. Doctors and Families
How might we improve communication between doctors and families?
For details, please see page 28.
Environment The physical space has the ability to direct and guide the individual who exists within it. Every interaction with the space communicates a tone or feeling. There is embedded meaning in the size of a space, and the placement of objects and people, shaping the experience of whoever enters. When there is a genuine understanding of what people need, the ideas to meet these needs will shape a meaningful and rich experience for each individual’s journey. Although the PeriOperative Services waiting room was the main focus in this research, it was important to have a holistic view on the environment that the patients and their families experience during their visit. The areas of study include the waiting room, assessment room, PACU-1, PACU-2, and outside of the PeriOperative Services area.
one:
WAITING AREA
There is one waiting room for all of PeriOperative Services. According to Dr. McMurray, open-heart surgery and lung transplants are some of the longer cases that can last up to 20 hours, and in 2011 there were 165 cases that lasted ten hours or longer. When patients undergo these more extensive surgeries, such as heart or lung transplant, patient and their families can be here for 2-3 weeks. Based on the collected data, we have identified two ways for approaching environment improvements to the waiting room experience; one being reconfiguring or realigning the resources embedded in the current environment, and second through providing individual needs based services.
THROUGH RECONFIGURING THE RESOURCES WAITING ROOM
How might we design an adaptable environment? For securing privacy. Family members said that privacy is a big area for improvement in the waiting room. “The furniture is arranged in pods, so families have an illusion of togetherness that excludes others outside of family,” says Dr. McMurray about the arrangement of the waiting room. This arrangement allows family members to personalize their space, moving chairs into clusters to be social or to pull away when needing alone time. However, this is not enough to provide the level of privacy desired by waiting family members. An open floor plan doesn’t allow families an appropriate amount of distance from other waiting families.
What if...
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Moveable or foldable walls were available for use when patient families sought privacy?
For preparing unpredictable volume of visitors. The volume of visitors per patient varies, making it difficult to comfortably accommodate for numerous large parties simultaneously, resulting in a tight and overcrowded waiting area. An overcrowded waiting room can contribute to anxiety leading to tension and restlessness for those waiting. What if...
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PEDIATRIC ROOM
The first floor courtyard-like area were used during busy hours to minimize crowding, and reconfigure the flow between the two segmented spaces?
How might we utilize the pediatric room? By utilizing sound quality. Utilizing the sound quality and selection of entertainment would greatly enhance the experience of waiting families, parents and children. The open ceiling in the pediatric waiting room allows sound to escape, disturbing the experience in the main waiting room. Minimizing sound travel would be a step toward a more peaceful and serene wait.
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PHASE ONE
OUTCOMES
ENVIRONMENT
Currently, there are no service programs, or activities available in this room, and functions as another sitting room. What if...
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We design service programs that take advantage of the sound quality in the room and activate the experience of people?
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By providing self-entertaining materials. In addition, providing options to keep children entertained will help lower a feeling of restlessness while they wait. Providing an updated selection of toys and educational movies would create positive distraction and a more meaningful experience. What if...
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We providing specific toys or activities that could be both fun, and educational to entertain kids?
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CONSULTATION ROOMS
How might we re-activate the consultation rooms? By developing the comprehensive and consistent protocol. Patients’ families value privacy when receiving news from doctors, yet the consultation rooms are rarely used. Families anticipate bad news when they are asked to speak with a doctor in a private room. Doctors are aware of this stigma and cater to the patients’ families emotional state by speaking to them in the waiting room. Little use of the consultation rooms enhances the perception that they are used for receiving bad news.
What if...
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Developing a protocol for communicating with patient families could ensure consistency and eliminate the fear associated with the consultation rooms?
THROUGH RESPONDING TO THE BASIC NEEDS WAITING ROOM
How might we better meet individual basic needs? By providing options for positive diversion. There are several televisions throughout the waiting room. People can change channels and angle the televisions manually or by asking PVR for help. Most of the families interviewed mentioned watching the news on the television while they wait. However, during our observations, we noticed families talking to one another more often than watching the television. One family member suggested that there be an area in the waiting room with no televisions playing. Providing various options for personalizing diversions would provide patients’ families with the possibility of a meaningful waiting experience. One family member said playing Sudoku relieved stress, helping them to feel more relaxed. Physical activity is another opportunity to shape a meaningful experience; one family member said walking helped them to pass time. The concept of providing interactive engagement through activity would ease the anxiety of patient families by distracting them from the tense circumstances they are in. However, many family members mentioned they were so worried about their loved one that they were unable to focus on anything else. Perhaps there are less distracting, and more soothing options that could be provided to accommodate these circumstances.
What if...
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There were various options of diversion and entertainment available for patient families to access during long waits?
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By developing programs for long stay visitors. Dr. McMurray suggests providing visitors a variety of activities to do while they wait, as many visitors may have to stay for several weeks. What if...
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There were programs guiding different destinations around downtown Indy?
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PHASE ONE
OUTCOMES
ENVIRONMENT
By accommodating comfort. We heard from PVR that many families come unprepared for the fluctuating temperatures of the waiting room and need to be somehow notified to wear multiple layers when they visit. Sitting in one place for a long period of time is uncomfortable and can become painful for some patient families. Improving physical comfort is important in settling the nerves of family members in the waiting room. Even before reaching the waiting room, comfort could be addressed. A family member suggested a place to sit in the elevator for their bad knees. What if...
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Offering footrests and more comfortable seating with support for areas of the body like necks and backs, relieve both physical and mental stress? Providing thoughtful placement of canes and wheelchairs near the front desk or elevators would display more careful attention to a comfortable waiting experience?
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By creating a space for resting. It is common for family members to rest during the duration of their wait. Lack of privacy in addition to the fluctuation of noise in the waiting room can make it hard for someone to rest. One family member suggested a more private area designated for sleep. Within the waiting room, improving sound quality would provide a quiet area for waiting family members to find a sense of peace and serenity. The privacy walls and curtains found in PACU-2 is an example of how this need could be met for those who don’t wish to leave the hospital.
What if...
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Preparing movable divider walls provide the seclusion necessary to allow rest? Designating a section of the waiting room as a permanent quiet area, marked by sound protecting walls, and more rest appropriate furniture?
By providing options for food. Inside the hospital there are five options to choose from for a meal or snack - Au Bon Pain, the cafeteria, Hubbard and Cravens, vending
machines and snacks from the gift shop. However, finding these options can be struggle, according to some family members. The lack of signage and information regarding options and locations for food causes confusion, leaving family members to wander the hospital. Between the hours of 3:30am - 6:00am, all hospital food vendors are closed, leaving the closest vending machines as the most convenient option. Family members are not provided with resources or information about nearby restaurants if they wish to leave hospital grounds.
What if...
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Improving accessibility, availability, and the information provided about food options would better meet the need for food?
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By creating a secure environment for belonging. PVR gives out plastic bags and locker keys for patients and their families to store belongings. We observed family members storing items next to and under their seats, creating an unorganized and unsafe storing system. Providing secure compartmentalized storage for personal belongings could optimize the space around the seating area. Organized storage that is close in proximity will not only be efficient, it will also allow for a controlled waiting experience by allowing patients’ families the opportunity to personalize and structure their space. This would assure patient families that their belongings are secure if they need to leave the waiting room, granting them some peace of mind. What if...
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Locker-like safes were available under the chairs in the waiting room?
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By creating a secure environment for personal safety. Within the hospital environment, safety is critical. Staff has expressed that no criminal screening process for patient family members is in place. Without knowing the individuals within a family or the dynamics between its members, there have been occasions where security has been an issue.
By encouraging good hygiene and personal care. A clean environment in the waiting room is not only important for the
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PHASE ONE
OUTCOMES
ENVIRONMENT
health and hygiene of family members, it could also be perceived as an indicator to quality of care their loved one is receiving. With the right amount of planning, the restrooms could a potential platform to communicate care, cleanliness, and prestige in the waiting room. Currently, the restrooms are dimly lit with fluorescent lights, and clinical soap sits next to a sink covered in water. They do have a changing table, but are not wheelchair accessible. The current state the restrooms are in feels impersonal and does not reflect the quality in care the hospital strives to provide. Suggestions we’ve collected include warm lighting, enclosed space to allude to a sense of privacy, providing wheelchair access, installing hooks or shelves to hang or set personal items, and restroom checks to ensure cleanliness.
What if...
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Renovating the restrooms to reflect a more home-like feel made visitors feel more at ease?
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By creating a cohesive way finding system. The signage in the hospital does not navigate visitors to their destination if they are in the wrong section of the hospital which often causes confusion. The way finding system has the opportunity to be more integrated, creating a cohesive system for the entirety of the hospital from a patient experience centered perspective. From this perspective, a system including maps and human interaction would provide multilayered navigational support for visitors.
By providing outlets for charging personal devices We observed several instances where family members were sitting on the floor next to the closest available outlet to charge their electronics. Increasing the number of outlets provided and placement in relationship to the seating arrangement would allow family members to comfortably charge their electronic devices during their long wait. What if...
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Charging outlets were available towards the middle of the room, or even installed into the furniture?
two:
ASSESSMENT AREA
The assessment room is the first area where patients and their families wait prior to surgery. It is a small room full of little cubicles and curtains. It is here where patients have to disrobe and get in a hospital gown and are vulnerable, says Carolyn Krombach. Assessment usually takes 45 minutes to an hour. Patients are separated from family until the nurse is done gaining her information and taking labs. At this point a limited number of family members can come back and visit their loved one before surgery. Depending on the severity of surgery, a chaplain, priest, or social worker may join the patient and family prior to surgery in the assessment room. When the staff is ready for the patient, an anesthesiologist will usually take the patient back to surgery. The assessment area was not explored in this study. In order to develop an integrative service experience, this area should be studied in future.
How might we better prepare the patients and families? This area is where the surgery process begins, causing patients to experience anxious anticipation for the events ahead. Because of the high anxiety levels, it is important to develop a program to prepare the patients and their families. What if...
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OUTCOMES
ENVIRONMENT
three:
PACU - 1
PACU-1 is a recovery area where patients are very vulnerable, says staff, and staff members take precautions to protect the patients’ wellbeing in these areas The PACU-1 area was not fully explored in this study. In order to develop an integrative service experience, this area should be studied in future.
How might we optimize the space in PACU-1? The space for staff in PACU-1 is a tight arrangement that doesn’t allow for a comfortable workflow. An ergonomically friendly layout would optimize efficiency and create a comfortable space for staff to work. What if...
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How might we improve privacy in this area? Patients spend a short duration of time, between one to one and a half hours, in PACU-1. Vulnerability is heightened in this area, where 28 beds lay side by side while nurses track vitals and escort family members to and from the waiting room for quick visits. Carolyn puts the safety of the patient first and values patient privacy by treating the patient as an individual instead of a number. One family member suggested retractable privacy walls that could offer privacy when needed but could be adjusted in times when nurses needed to care for multiple patients at one time. What if...
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four:
PACU - 2
PACU Phase 2 at PeriOperative services is a recovery room typically for patients who will not be staying the night at the hospital. It is a newly renovated area with retractable walls and comfortable seating for families to stay and visit at their leisure. There are 9 beds total (plus one isolation room if there are too many people, but have not had to use this yet according to Carolyn.) At this point, staff can have longer conversations with family members about what to expect about their loved ones state. There are other Phase 2 recovery rooms located throughout the hospital. Intensive care patients and other inpatient recoveries take place at other specialty areas around Methodist hospital. The waiting room for cardiovascular surgeries is located on the same floor as PeriOperative services and PVR is in tune with telling families where to find their loved one after surgery. The PACU-2 area was not fully explored in this study. In order to develop an integrative service experience, this area should be studied in future.
How might we create a better system for keeping track of patients belongings? When a patient is finished with surgery and stable enough to see visitors they are placed in PACU-2. The retractable walls and comfortable seating allows for long visits with loved ones. But when a patient is finished with surgery they might not feel presentable for visitors without having access to some of their personal items such as make-up, dentures, or accessories. This presents an opportunity to improve the tracking system for patients belongs to allow them access to important items when they need them. What if...
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OUTCOMES
ENVIRONMENT
Communication If communication is not precise, efficient, consistent, and empathetic at every stage of the surgery process, tension and miscommunication are bound to occur. Viewing waiting experience from communication lens, we found that there are several opportunity areas to improve the waiting room experience: How to design information, how to communicate information through human interaction, and how to communicate information with tools. Human interaction should be a carefully crafted element of the waiting room experience, because this is the foundation of a patient and patients’ families experience, as they are relying on the care of the PeriOperative staff. Interactions with tools should be designed from integrative system point of view. As current communication tools are networked, tools and technologies enable us to optimize flow of information.
one:
INFORMATION DESIGN
How might we contextualize the information according to the journey? Trauma families hear about 5 percent of what you tell them, staff members say. In a state of fear and anxiety, it is very important to relay information as clearly and simply as possible at every stage of the surgery process. Staff members try to minimize confusion by repeating their information slowly. However, there are often many questions that arise after that doctor or nurse leaves. Guest Relations are doing a great job of answering their questions as best as possible, but are not allowed to share medical information. What if...
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How might we provide a holistic understanding of the process? There are certain expectations for how long surgery should take according to family members. As time passes and gets closer to these expected deadlines, family members can grow more and more anxious. It can be difficult to gage these different levels of anxiety and respond to individual needs as a busy staff member. Nurses cannot update patients’ statuses frequently since they are very busy with a multitude of tasks. A different time quality exists between the medical staff, who is on the go and is very busy, and the patient families, who are watching the time and are typically static in the waiting room. Many times the family members are not aware of the multitude of tasks that can arise or exist for any given staff member. They grow uncertain about their loved ones state as more time passes without information from the staff. What if...
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OUTCOMES
COMMUNICATION
two:
COMMUNICATION THROUGH PEOPLE
PVR & FAMILIES
How might we develop a comprehensive patient family identification system? Upon check in, one family member is assigned as a contact person and representative for their family. This representative will be the contact person for PVR to deliver updates to, and they are responsible to share that information with the rest of the family. A pager system is used to alert the representative of the family to meet PVR at the waiting room desk when there is an update. This works quite well to save time that PVR would spend searching for the family, however, in certain areas of the waiting room the pagers do not work. To accommodate these occasions, an identifying quality to describe the family representative is noted (such as brunette woman in yellow sweater) that are used for locating a family when pagers do not work. Identifying a representative for each family is designed to simplify communication, however, if the family isn’t communicating with one another, confusion and strained communication occurs. While the system in place works in most occasions, it does not prove efficient when there are two families with the same last name, or similar identifying qualities. The current system is not error proof, and may be better executed with a more systematic solution.
What if...
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Developing the integrative identification system that links the current pager system and online application? Developing the alternative identification system that is humanized and memorable?
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How might we improve the flow of information? Throughout our research, we identified that the most common complaint was a lack of consistent information. Although the nurse liaison and PVR remain in contact with the patients families, and the patient representatives strive to have constant presence in the waiting room as a resource, the families feel that they need more updates and information throughout the process. The waiting time between the end of surgery and their visitation with their loved is the hardest phase for most families. To care for this, there is always one patient visitor representative in the waiting room to answer questions and to talk with concerned family members. Mike, a patient visitor representative, explained to us that
they act as translators- they simplify the information visitors are receiving from clinical staff into common language, that the patient families can understand. In addition, Chaplains and social workers are available to speak with family members who receive bad news, or are having a particularly difficult time coping. What if...
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Providing comprehensive and transparent information that enable people to find appropriate communication resource based on their need?
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NURSE LIAISON & FAMILIES
How might we leverage human resources to improve the role of nurse liaison? From the observations, we found that Nancy ensures clear communication between the patients and their family members. She offers a sense of comfort by sharing knowledge of a loved one’s post-surgery experience and what the next steps will be in the visitation process. PVR (Patient Visitor Relations) works closely with Nancy in sharing information from behind the scenes with family members inside and outside of the waiting room. Nancy interacts with 35-45 family members per day. Nancy shares an empathetic interaction with families by placing a hand on family members’ shoulders, looking into their eyes, slowing down her speech and repeating what she says in several different ways. She ensures that the family members clearly understand when, where and how they will be able to communicate with their loved one next. Nancy lists her times of communication with family members at the bottom of her clipboard to let her know how much time has lapsed between communications. Through her personal recording system, she ensures that an entire hour never goes by without her presence in the waiting room in case family members have questions for her. Nancy must multi-task and be aware of many different faces and circumstances throughout the day in order to ensure clear communication to everyone. There is usually one contact person per family member and this causes confusion with families who are not communicating among one another. Nancy communicates with 75% of the families checked in and PVR (Patient Visitor Relations) communicates with the rest. Nancy and PVR work closely together, especially during busy times, to make sure patient families are notified and prepared to visit their loved one after surgery. Because the nurse liaison only works three days a week, there is a team that fills her roles on her days off, and overnight between her shifts.
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Circulating nurses, especially those in neurology, occasionally call the waiting room to give families updates, to assist in filling the nurse liaison’s shoes. “Having someone who works at least five days a week would improve communication for the staff,” says Carolyn. What if...
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How might we provide an alternative source of communication so patients and families are attended? Most surgeries occur during the daytime, consequently there are not as many visitors in the waiting room during the evening and overnight. Our design team spent between 8:00-9:30pm one evening observing the waiting room, and during that span of time, there were ten patients on the tracking board. Only one group of patient families was there. PVR clocks in at 5am and clocks out between 8:30pm and 9pm on weekdays and does not work on weekends. Because of the absence of the PVR, patients’ families are given ID badges after 8:30pm. A telephone located at the PVR desk that patients’ families are to use to call the recovery room and notify staff of their arrival. Staff members tend to use this phone to call to the waiting room to deliver information and updates to patient families. According to Diane Bellamy, this phone could be the platform for potential HIPAA violations. What if...
NURSES, PATIENTS & FAMILIES
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How might we develop an empathetic communication practice? After the patient’s surgery, they usually have to wait one hour until their family can visit. This time is helpful in doctors debriefing nurses privately and for nurses to address patient needs before their family arrives. Sometimes after family members visit to PACU-1 unit, Nancy asks them what the patient said so that she can get a better sense about the patient’s experience and improve patient communication. Typically, there is one nurse assigned to every two patients in PACU-1, though some cases require more attention, in which case the proper care is assurred.
Julie Barton, the Manager of PeriOperative Services, described that there is a level of intimacy involved with patient and staff interactions. She is constantly finding ways so patients get the best experience possible. Julie works with Diane Bellamy to improve communication daily because of the urgency of how to resolve incidents that occur on the staff side. Diane Bellamy does staff education to improve interactions with patients. She also offers AIDET training that is necessary for staff to go through in order to have an empathic exchange with the patient and their visitors.
What if...
DOCTORS & FAMILIES
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How might we improve communication between doctors and families? Families typically experience relief upon speaking with doctors, having knowledge of how surgery went, what to expect next, and being assured they would be paged when their loved one is moved to their new recovery room. “Families are very observant in the waiting room,” says Nancy, “and they are aware every time a doctor comes in with news.” While most doctors visit with patient families prior to surgery, not all do. For those who don’t, families feel offended and that they’ve been treated unfairly. When doctors speak with patient families, they visit them in the waiting room. While this visit offers comfort for families, it occurs in a vulnerable space, as anyone sitting nearby can hear. The majority of staff and patient families that we talked to mentioned a desire for doctors to use the consultation rooms that are attached to the waiting room, when visiting families. This would offer respect and privacy to the family receiving news, as well as to those waiting nearby. Carolyn says that when doctors bring them into a consultation room and take the time to sit them down and talk to them privately, it makes families feel more important and that they are taken care of by the physician. Dr. McMurray says that the physicians are encouraged to meet with patient families in the consultation rooms, and he isn’t sure of the reason they are not being used. He assumes that the location of the rooms is inefficient and that the rooms are only used when there is bad news to deliver. Because of this, the rooms are associated with bad news, so they avoid using them.
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What if...
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Please refer Environment Section. Some ideas are addressed under “Consultation Room”
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DOCTORS & STAFF
How might we design a unified communication system? Through a shared communication system. Nurses are often the intermediaries between the doctors, patients and their families. Scrub nurses assist doctors during surgery, circulating nurses communicate with staff and relay messages to patients families during surgery, and other nurses assist with caring for and communicating with patients during pre-op and post-op phases. Currently, all of these interactions happen through one on one conversation. There is not a developed communications system that assists in this process. When scheduling issues and surgery delays occur, the nurses communicate the time adjustments with the patient families.
Through a shared goal. There are nearly 250 surgeons who work regularly within PeriOperative Services and many function as private practices. Because of their independence, it is difficult to develop a cohesive flow of service. When doctors operate independently, they do not have to adjust to any changes enforced. To work around this, Dr. McMurray speaks with them individually to ask that they adapt along with everyone else. When Dr. McMurray speaks with the independent doctors, he is aware that they do not appreciate big change. Although McMurray tries to avoid causing upset, most big changes are unavoidable, as they accommodate government regulations that everyone must comply with. “Until we get to a more unified structure, it is difficult to communicate changes” says Dr. McMurray. What if...
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three:
COMMUNICATION WITH TOOLS
TRACKING BOARD
How might we improve the tracking system? The tracking board is a rather new and successful technology that was added to the waiting room in order to improve communication to patients’ families. It used to be that a circulating nurse would call out to a particular family to deliver news about where the patient was in the surgery process and this was just another duty on the nurses’ long list of things to do. Since the circulating nurse is already on the computer updating patient information, the tracking board is an efficient way for staff to update patient news through a system that is visible to visitors in a HIPAA compliant way. When patient families arrive, PVR gives them a tracking card with their loved ones’ patient number written at the top and explains how to use the tracking system. This card also contains information about using and interpreting the tracking board, and what the different phases of surgery mean. There is a website address on the back of the card and this website can be accessed anywhere. Surgery progression of patients can be tracked with their patient number on this website. This works well for patient families who are not able to be at the hospital or do not live nearby, as they can call to receive the patient’s number. The website is easier to read, and has more personalized information than the tracking board. It is useful even for families who are in the waiting room, as the website can be viewed on any personal device.
By redesigning user interface. There is one large tracking board and it is updated in real time. There are often over sixty cases listed on the board within a day, so the screen updates every few seconds. This can make it difficult for families to find the patient number and to track their progression. In order to check for updates, patients’ families have to walk up to screen in order to see the information. We observed people checking the screen repeatedly as the majority of people walking up to the board remained for a few seconds just to see if their loved ones’ status had changed. One day we observed, there were 61 patients on the board for the day, yet 16 places were not filled with any information. What if...
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By considering level of detail. Every family that we interviewed found the tracking system helpful and easy to understand. Some people were very impressed by it and found it to be self-explanatory. However, one family member said that the
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tracking system was not viable to them, as it was never updated during their visit. Also, a few people mentioned that the tracking board does not give much information about the patient. If it’s a 5 hour-long surgery case, the tracking board says “surgery” for 5 hours, so families have the exact same status report and don’t know if they’re doing well or poorly. Staff mentioned that it would be great to give families more accurate or detailed information, but they’re too busy working away. Dr. McMurray says that the tracking board is particularly popular because it gives families some element of control, as they are not dependent on someone calling for them and they can actively see updates for themselves. While the tracking board is a well-received tool for most patient families, the lack of detail is recognized. The tracking board notifies what stage of the surgery process the patient is in, but does not reveal whether things are going well or if there are complications. Staff members have shared that it would be great to give families more accurate or detailed information, however, during the surgery process their focus is on caring for the patient. The tracking board is particularly popular because it gives families some element of control because they are not dependent on someone calling for them and they can actively see updates for themselves What if...
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By integrating internal and external tracking systems. The tracking system for the board is not connected to internal tracking systems used by staff. The surgery control nurse, who works from PACU 1, keeps a cohesive schedule that is ever changing and is the one who locates available recovery beds for patients. The charge nurse uses a tracking system (called “Teletracking”) that is not compatible with “Cerner,” the tracking system that the rest of the PeriOperative staff uses. This PeriOperative staff system is used to update and track detailed patient information. The public tracking system is mostly maintained by PVR as they track the patient’s journey through the staff system, but can also be updated by nurses and Nancy. What if...
PAGING SYSTEM
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How might we better design the paging system? The paging system that notifies patient families that there is news about
their loved one has some noticeable flaws. The pager buzzes for 30 seconds and is very noisy. Because of the noise, it adds stress to the situation, particularly when Nancy is trying to deliver family news and it keeps buzzing. One day during observation, we noticed a concentration of pagers buzzing at the same time and then the front desk became quickly crowded with people awaiting news. Staff members told us that people often do not know how to use the paging system, that there are delays in the system and that there are certain dead zones in the hospital and waiting room where the pagers will not buzz. What if...
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How might we make the computers more accessible?
COMPUTERS
There are computers made available to patient families located in the waiting room. They are useful for families to communicate and share updates with those unable to be at the hospital. As an important amenity to patient families, it is imperative that they are available when needed. When a visitor attempts to access an inappropriate or unacceptable website, the computers automatically shut down and require the attention of an IT expert for restart. Without an IT expert on duty, the computers can be unavailable for patient families for an entire weekend. What if...
PHONE SERVICE
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How might we improve phone service in the waiting room? By families. The majority of families interviewed us cell phones to communicate with family outside of the waiting room. Many visitors have family members who arrive at different intervals and they need constant access to phones and service. Some visitors contact family who cannot make it there for the visit. Many people mentioned texting as their main means for communicating versus an actual phone conversation. We observed that when people do talk on their phones, they usually go by the elevators, bathrooms or just remain in the waiting room to have their conversation. One person mentioned that texting was difficult with their poor phone service, but many others mentioned their phone service working wonder-
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fully in the waiting room. We found that people with Sprint or T-mobile had issues with phone service, but those with Verizon or ATT were fine. One person mentioned not being able to contact their family outside of the waiting room because they don’t have a cell phone. No one mentioned utilizing the pay phone in the waiting room.
By staff. Staff members are also dependent on phones for communication. There are three phones circulating between Nancy, PVR and Carolyn. This triad of communication tools assists the exchange of information between different areas of the front end and back end. These phones can be an issue since there is ten feet of dead space in the hallway outside of PACU 1. There is also a phone placed at the PVR desk when PVR is not working so that doctors and nurses can communicate with families in the waiting room. What if...
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How might we recognize value of metaphoric language in optimizing communication?
LANGUAGE SYSTEM
In order to improve communication and efficiency, the staff has developed various language systems for use internally. In PACU-1, nurses have established a ‘helping hand’ system that reminds nurses to identify opportunities for assistance, which consists of laminated paper printouts that can be lifted up next to a patient file, in order to signify a need for assistance in moving that patient to their next recovery room. Among PeriOperative staff, baseball analogies are used to discuss phases of the surgery process that their patients are in. What if...
WHITEBOARD
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How might we make the PACU-1 whiteboard more efficient? In PACU-1, there is a whiteboard that is maintained by the charge nurse. A whiteboard is the current communication system between staff members to share information about patients’ status. The whiteboard contains 28 spaces (for the 28 beds in the room) to keep track of the patient’s location within the room. Along with the patient’s name, there is often a room number written to signify where that patient will
be transported for Phase 2 recovery. The color green signifies outpatient recovery, red means ICU and black means they will be staying in PACU-1. A star is drawn next to each bed number when it is available to receive a patient post surgery. The charge nurse writes down recovery room assignments onto slips of paper that are left with the secretary in PACU-1. There has been an attempt to improve this system using a computerized tracking system, but the system was lacking intuition making it inconvenient for staff to use. If the communication system between staff members were designed to enhance efficiency through simplifying the steps of sharing information, workflow would become organized, minimizing chaos during busy hours. This starts with understanding the problem areas and needs that exists with current system. Improving the internal communication will consequently improve the communication between staff and family members. What if...
CONTACT INFORMATION
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How might we make the visual information human centered? PVR has little slips of paper containing hospital contact numbers and hours and these are handed out to families who leave the waiting room while their loved one is still in surgery or recovery. PVR has other slips of paper for families who will be relocating to other areas of the hospital. This paper includes unit #, room and elevator. This slip of paper is designed to help families navigate their way to other recovery areas. When a patient is ready to leave PACU-1 to go to ICU, or other recovery rooms, Nancy calls PVR on the phone and they write the room number down on this slip of paper. PVR then calls the family up and gives them directions to their next destination, along with the slip of paper. Sometimes other guest relations will come to the surgery waiting room to escort families to their new waiting area.
What if...
CHARTING SYSTEM
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How might we make charting effective for the staff? Nancy has her own efficient system for charting which families she has spoken with and which ones she is to speak with soon. Every morning,
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Nancy prints out the list of surgeries for the day along with the time estimates for each surgery. She includes a blank page in the back to add additional surgeries that may arise throughout the day. Nancy tracks every time she visits the waiting room. She makes sure she has visited the room at least once an hour. Nancy’s chart is organized by doctors’ room numbers, followed by endoscopy surgeries, then by any additional surgeries added for the day. She places a check mark next to patients name once she has spoken with their family. Nancy updates computer tracking if she notices changes that have not been recorded. Nancy often does research at the computer in PACU-1 to find information about patients who haven’t been tracked in a while by checking the patient’s information within the computer system. By right clicking on “Set events” within the computer system she is able to see the step-by-step continuum of their day with each corresponding time of arrival. Nancy is proactive with this, in preparation for any questions that come her way while speaking with patient families. Nancy mentioned how she wanted to get a tablet to track her work, but there is a 10 foot dead zone on the east side of the building between PACU-1 and the waiting room, which would make the tablet ineffective. What if...
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Emotion “Emotion is such an important element to talk about in relation to designing compelling service experiences. In a healthcare environment, emotion is often at its peak levels, mostly because of the nature of the situation that patients are in when they seek healthcare services. … Emotion is complex. It’s not a rational system. As much as you want to try to design a service or a system that’s reliable and consistent, it won’t be effective if it doesn’t adapt to the many different situations that are present in the complexity of human emotions. But when you successfully design for emotion, it can dramatically influence the outcomes, such as a patients’ health.” Ryan Armbruster, Director of Mayo Clinic Department of Medicine SPARC Innovation Program In this chapter, we have discussed emotional aspect of the current waiting room experience and framed the opportunity statements from the perspectives of patients’ families and PeriOperative Services staff.
one:
UNDERSTANDING PATIENTS AND THEIR FAMILIES
According to Diane Bellamy, Coordinator of Patient Experience, the top four causes for patient dissatisfaction with PeriOperative Services are fear, loss of control, objectification, and confusion. This was confirmed during our field research, where we heard and observed these emotions occurring throughout the families’ experience. These emotional states in the waiting room can lead to high anxiety and stress, impatience with staff, surfacing of family dynamics, and a heightened sense of spirituality. Even though experience is shaped through individual perception, there are general emotional qualities to consider in the PeriOperative Services area.
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How might we develop an emotionally sensitive system? Fear. During our research, we heard that when surgery is occurring, family members fear the worst possible consequences. No matter how much information and preparation patients and their families may have had ahead of time, they cannot escape this fear. Their emotions are intensified as the waiting time is long and anxiety increases as time passes. Diane Bellamy believes that pediatric surgeries, cancer treatments, or complicated surgeries may be associated with fear and anxiety for family members. These types of surgeries occur regularly at IU Health Methodist. However, no matter the level of severity of the surgery, any surgery is serious and therefore every family member must cope with his or her fear while waiting.
Loss of control. We discovered that patient families are often unaware of or forget the many steps and procedures involved in the surgery processes. We found that they often feel misinformed about how long medical procedures should take and sometimes feel helpless and that they cannot do anything else until they hear about the next steps following the surgery process. Families want to feel they have control over the information they are gaining about their loved one. We found throughout our research that it is important to have guest relations associates and the tracking board so that family members feel they have power over accessing information from the back end.
Anxiety. It was brought to our attention that after surgery, three family members are allowed back to the recovery room (PACU 1) and have 5 minutes to visit their loved one. Often times patients are still under anesthesia, are incoherent and do not remember this visitation later. Sometimes patients are still in so much pain that they turn down a visitation from their family members. This post-op visitation can exacerbate the families fears and loss of control as they are sent back to the waiting room with no way to help their loved one. Patient family visitation times are 2-3 hours apart typically, and this is a long period of time between communications with loved ones, which can heighten anxiety.
Objectification. When family members arrive to the PeriOperative waiting room, they are immediately given a card with a number resembling their loved
one in surgery. This number is used to find the patient on their tracking board. We found that patient names cannot be used so as to protect their privacy and to comply with HIPAA (Health Insurance Portability and Accountability Act).
Confusion. We also discovered that surgeons get to pick what time surgery occurs, so they set the schedule for the PeriOperative patients and staff. Family visits are determined by whose surgery is finished first, not by whose family has been waiting the longest, which means that families who have been waiting longer may feel as if they were forgotten about, overlooked or treated unfairly as they observe others getting to visit behind the scenes before them. What if...
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two:
UNDERSTANDING PERIOPERATIVE SERVICES STAFF
There is one waiting room for all of PeriOperative Services. According to Dr. McMurray, open-heart surgery and lung transplants are some of the longer cases that can last up to 20 hours, and in 2011 there were 165 cases that lasted ten hours or longer. When patients undergo these more extensive surgeries, such as heart or lung transplant, patient and their families can be here for 2-3 weeks. Based on the collected data, we have identified two ways for approaching environment improvements to the waiting room experience; one being reconfiguring or realigning the resources embedded in the current environment, and second through providing individual needs based services.
How might we design an environment that allows emotional outlets? According to Julie Barton, Manager of PeriOperative Services, there is an “our patients are not our patients” mentality among the staff members adopt and she would like more sensitivity from staff when talking about patients. Staff members alluded to a certain level of numbness needed to get work done sometimes. However, there is also a great need for empathy if staff is to genuinely improve the experience of patients and their families. The need for self-preservation, along with empathy for others, is a constant inner battle staff members must face on a daily basis. Every staff member has their own way to balance personal emotions in order to sustain their practice. In our research we found that there are moments when staff is emotionally broken and other staff members find this display of emotion inappropriate in a professional setting. Yet emotional openness can also create an open and trusting work environment What if...
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How might we create a healthier environment for the staff? We found that professionalism and dedication is common among staff members at PeriOperative Services. They typically work very long hours and are extremely busy during that time. Nurses work 10-11 hour shifts at a time and frequently doctors and nurses hold off their meals because they are so busy. Fatigue is common among nurses, and yet they are the main source of communication for the patients and their families. In PeriOperative Services there are 14 nurses staffed each weekday and most are stationed at PACU-1 since it requires the most communication efforts. Julie, the manager of the PeriOperative Services, works 65-70 hours a week in order to manage all of her duties along with all of the unexpected tasks that pop up throughout each day. Staff consumes Mountain Dew and other caffeinated beverages consistently so that they stay alert. A fatigued and hungry staff doesn’t allow work to be completed at the level of potential that it could be. Therefore it is important to create a healthy work environment that is strategically planed with the well being of the staff in mind. A system that does this would examine and accommodate from a micro to macro perspective. For example, arranging shifts in a manor that guarantee breaks or providing resources that
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assists with emotional or physical distress.
How might we incorporate context-based assessment with universal assessment? PeriOperative Services at IU Health Methodist has been committed to improving patient experience since 1982, before “patient experience� became such a keyword. Today, federal reimbursement for Medicare and Medicaid are dependent on patient experience scores. In order to collect these scores, a third party randomly sends out HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys through the mail to the homes of certain patients at IU Health Methodist. There are about 15-20 questions and patients have 30-45 days to complete the survey. The survey groups pre-op and recovery experience all in one bucket and it is difficult to dive deeper into the survey to identify which department is responsible for what responses, says staff. We found that the PeriOperative Services team has received 9 out of 10 on their HCAHPS scores for patient experience. Despite their great scores, the team verbalized that they know the questions on the survey and feel they judge patient experiences incorrectly sometimes. For example, one question asks the patient if he or she experienced pain during their surgery and patients say of course they experienced pain during a surgery. So the PeriOperative Services team has proactively formed their own assessment of their service towards their patients. So the hospital sends out their own survey to gage the overall experience of their patients. This survey has been evolving over past 10-15 years and is taken seriously by staff as they try to personalize the experience for their patients. What if...
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How might we show appreciation and recognition for the staff members? Carolyn, Manager of the PeriOperative recovery units, emphasized the importance of showing staff members that they are doing a great job and their hard work is being appreciated by others. Managers are trying to find ways to continuously do this in their busy schedule. During our research it seemed that staff is successful in maintaining a sense of camaraderie and nurses and guest relations seem to look out for one another and have positive communication with one another. Nurses and
guest relations seem to share a common focus on serving their patients and visitors. During our research we found that doctors seemed somewhat disconnected from this close-knit team as they are focused on healing the patient most effectively and efficiently during surgery. We found that there are over 250 private practicing doctors working within the PeriOperative area and this seems like a very large and isolated group that does not necessarily feel a part of the PeriOperative community. Lastly, we discovered that IU Health Methodist Hospital has had over 450 “No Holds Days” which means they have functioned this long without keeping patients without beds or keeping them in recovery units because they had no other place to move them. This achievement means that the hospital is committed to an increase in staffing, an increase in the available rooms to place patients into and that the managers are adaptive to their circumstances. What if...
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How might we design an inclusive decision making process? During our research we found that staff members often do not feel included in big decisions being made about their work environment. For example, there is an entire team developing branding decisions for the hospital without taking staff’s input first. The branding team has decided to change the color of the scrubs to red in order to fit into an IU brand. The bright red scrubs have already dyed one nurse’s clothing in the laundry and several employees vocalized disappointment with the decision. However, there are certain changes being welcomed with open arms in PeriOperative Services. Carolyn Krombach, Manager of PeriOperative recovery units, mentioned there being great changes at the hospital in addressing staff needs. But we also learned that changes are still met with resistance by certain staff members, as it is difficult to get 100% of staff behind changes, and this slows down progress significantly.
What if...
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How might we develop a better communication flow for preparing unexpected situation? During our research we found that nurses and doctors have a different sense of what changes are needed. However, there is no platform to discuss these different senses among one another. Nurses, whose primary focus is patient experience, feel that some doctors should do a better job at addressing patient and patient family needs. When patients and their families are displeased, nurses and other staff members are responsible for smoothing over situations, which can sometimes be caused from the doctor’s end with no explanation. One day, there were four cases canceled or postponed by a doctor and nurses had to move patients back to their rooms to wait, then come up with an explanation to give families for why their loved one must wait again for their surgery. From the doctors’ perspectives, there are constantly unforeseen factors that can contribute to delayed or canceled surgeries. Although there is an estimated length of time certain surgeries should take, there are many variables that can make this set time rather unpredictable, as we found in our research. For this reason, once the surgery takes place, any obstacle that comes in the way of the doctor doing his or her job most efficiently and effectively can generate irritation and delays. What if...
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phase two:
How might we create an emotionally sensitive waiting room experience?
PROCESS OBJECTIVE
CONTINUING THE STUDY In phase one of this study, we identified three areas of opportunity; environment, communication, and emotion. In phase two, we have further examined emotion as an opportunity area, as it is the foundation of all human experiences. Through ideation, we formed the following ‘How Might We’ statement that responds to a number of the opportunity statements identified in phase one.
“How might we create an emotionally sensitive waiting room experience?” · How might we reconnect patients and their families throughout the process? · How might we utilize institutional knowledge into designing information for visitors? · How might we better meet the basic needs? · How might we provide a productive waiting experience? · How might we improve the health and hygiene within the waiting area?
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OBJECTIVE
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OBJECTIVE
FRAMEWORK DEVELOPMENT
KEY PERSPECTIVES After the decision to move forward looking through the lens of emotion, we identified the multiple perspectives that are key to understanding the waiting room experience. Learning the perspectives that surround the emotional experience was essential to understanding the whole picture, and the dynamics that make up the opportunity area. In addition, any changes made will effect all parts of the system, so consulting all perspectives is crucial to developing a meaningful and appropriate solution. Each perspective surrounding the opportunity area offers valuable contribution to solution development because of their first hand experience and role within the waiting room experience. There are four main audiences that we involved in this ideation process, and each carry a position that contributes to our understanding, and to solution development.
PATIENTS’ FAMILIES The primary audience we engaged with were the patient’s loved ones (or visitors) within the PeriOperative Services waiting room. In order to capture the ideas from the primary audience, we provided tools for activity which Diane Bellamy so kindly led with those who were willing to share their perspectives.
METHODIST STAFF The staff has a solid understanding of patient and patient families’ experiences through their professional practice. Their perspective is vital to understanding the back end of preoperative services, which serves as a foundation to what patients and patients’ families experience on the front end. Diane Bellamy Diane McGregor Kheterina Kitkas Gary Life Patricia B Thurgood
GENERAL AUDIENCE In order to develop a transferable solution, we engaged with a general audience that have had waiting room experience at some point in their lives. Understanding the common experiences across various institutions helps to identify themes in any given waiting experience. From this we can pinpoint the areas where Methodist’s PeriOperative Services is unique, and the foundational elements that are felt across multiple platforms.
DESIGNERS Alongside the interior design students, our design team worked towards ideas from a perspective with intention to implement a solution. From an external perspective we are able to offer an objective view, which allows us to contribute as facilitators of an internally driven process. We can act to make sense and organize all perspectives involved and turn the information into an understandable direction for moving forward collaboratively.
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FRAMEWORK DEVELOPMENT
DATA COLLECTION
METHODS AND TOOLS Methods of creative engagement are designed as tools to facilitate participatory expression and ideation. They serve as a prompt for inquiry and can accommodate various styles of learning and expression. Physical and visual interaction allow for depth in understanding and communication, and serve as documentation for later analysis. Each method was developed to cater to the four key perspectives surrounding the waiting room experience, and respond to the environment and mood in which we would be interacting, as well as how we could most effectively gather the desired information.
PATIENTS’ FAMILIES Flower Exercise See figure A, page 69.
Mad Lib See figure B, page 69.
This exercise was designed to provide a creative way for patients families to express how they would like to feel during their waiting room experience, and to share ideas that could accomplish this. To know how they would like to feel during their wait, gives insight into how they are feeling, but also gives us inspiration and understanding to the positive emotions that families long for. By questioning how the participants want to feel we hoped to communicate activity towards positive change. The tone of this exercise was meant to offer hope and positivity to guests, giving them an outlet to think of positive emotions, and inspiring creative expression. The Mad Lib, a popular word game for passing time, similar to crossword puzzles, was developed as a fun way for visitors to express both positive and negative elements of their waiting room experience. In addition, there was space for visitors to share ways that the hospital could enhance positive feelings and care for negative feelings.
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DATA COLLECTION
METHODIST STAFF Journey Map See figure C, page 70.
Timeline of Emotions See figure D, page 70.
In order to understand their experience at work, we provided each staff member with a map of the PeriOperative Services area, and asked them to document their daily routine, and attach the tasks and emotions felt in each room that they frequent throughout their day. This gave us an understanding of their responsibilities, what goes on within the space, the relationship between tasks and emotion, and relationship between physical space and emotions. Through this exercise we found clarity in the big picture of PeriOperative Services
Next, we asked the staff to document their daily emotional journey onto a timeline we provided. The purpose of this exercise was to learn their emotional state at each touchpoint of their day between waking up and going to sleep. Even before arriving at work for the day, there are feelings of anticipation for the day, which can reveal some insight into the types of emotions that this type of work can create within the staff.
Ideation Interviews
After having expressed their emotional journey, we asked the staff members to pair up to interview one another about the coping skills they use on a daily basis, in and outside of work, to overcome the negative feelings they experience. This gave us a chance to get insight into the personal strategies that they have developed to cope with what can be a very stressful schedule.
Open Ideation
Lastly, we gathered as a group around a large map of PeriOperative Services for a session of open ideation. With the information we gathered during the Journey Map exercise, we discussed the locations within PeriOperative Services that were commonly associated with negative emotions. With that in mind, everyone was invited to share ideas for addressing these points of stress for the staff, as well as ideas to soothe the concerns of patients and their families.
See figure C, page 70.
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GENERAL AUDIENCE Post-It Note Expression & Ideation
In order to understand the perspective of people with some sort of hospital waiting room experience, a general audience, unrelated to Methodist, was gathered to share their experience. They were asked to write anything they experienced, positive and negative, onto PostIt notes, so that they could be posted up onto a wall for use in the next exercise. They were encouraged to document thoughts, actions, and emotions that occurred throughout their experience. After they expressed their experience, the Post-Its were placed on the wall for everyone to observe. After identifying the Post-Its that were areas for opportunity, the group was encouraged to create new Post-Its with ideas to address these experiences that were in need of solution.
DESIGNERS Word Association
To prompt unique ideas, we used cards with unrelated words printed on them, chosen at random, to use as inspiration for brainstorming ideas. After choosing a card and sharing the word with the group, we expressed how we defined that word personally, what feeling it caused within us, and then expressed an idea that might evoke that same emotion. For example, a card might have the word ‘magic’ on it, which could be personally defined as a feeling of awe and wonder. Inspired by this feeling, we would share an idea that could create awe and wonder during the waiting room experience.
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figure A
figure B
figure C
figure D
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DATA ANALYSIS & SYNTHESIS
DATA ANALYSIS Through interaction with the four key perspectives, our goal was to collect data that helped us to learn both the tasks and physical space that make up the waiting experience, as well as to understand the emotions that contribute and result from the waiting room experience. Our design team used this data to understand the comprehensive meaning behind the data, and to organize the perspectives in a way that reveals the collective experience. This allowed us to narrow the opportunity area, and to identify themes for approaching solutions.
Transcribe Data
Once collected, we transcribed all of the data so that we were able to see each perspective represented in a uniform way, removed from the original form of documentation. This allowed us to move from seeing each bit of information attached to who and how it was said, to raw data that could be moved around to see the bigger picture through relationships between the multiple perspectives present. We placed each piece of data onto a post it note for easy maneuverability, as we began to observe relationships among the data, and looked for big picture meaning from the entire body of information gathered.
Sorting Data By Emerging Themes
With the data on Post-Its, we began to move the information around, noticing themes that emerged, and relationships among these themes. We were looking for common emotions felt, as well as similarities in approaches for solution to resolve the less positive elements of the waiting room experience.
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DATA SYNTHESIS Emotional Qualifiers
To identify the emotions we needed to address, we laid out each emotion that was mentioned by the four key perspectives into a spectrum from positive to negative. Within this spectrum, we looked for the overarching emotions that encompassed those surrounding and related. We were able to identify two emotions that were at the root of the majority of emotions felt, which we refer to as emotional qualifiers. To clarify these qualifiers, we’ve identified sub emotions that contribute to the ways in which the qualifiers are felt.
Strategical Approaches
From the ideation session, we categorized data by the way in which each idea approaches a solution. The themes identified became three strategical approaches to diminish the emotional qualifiers noted through emotional data. Based on the identified emotional qualifiers, we re-examined the meaning behind the individual ideas and identified three strategic approaches in solving the problems.
Qualifiers & Approaches
After having defined strategical approaches, we filtered each idea collected into the emotional qualifiers they specifically addressed, which formed a matrix like structure to house our interpretation of our understanding. This helped us to see meaning through proxy, relational meaning and to interpret deeper meaning based on the relationship between emotional qualifiers and strategic approach. Creating a visual framework provides a platform for understanding and developing a strategical approach for solution development.
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OUTCOMES
MATRIX AS A STRATEGICAL FRAMEWORK In order to develop a meaningful solution, it is imperative to have deep understanding of all perspectives that collectively make up the opportunity area, and the ideas they have contributed. To better grasp the complexity, we’ve developed a strategical framework in the form of a matrix, as a tool for identifying and communicating the relational meaning between the collected data from all perspectives. Ultimately, the matrix provides a framework for developing integrative solutions, with clear direction and purpose.
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OBJECTIFIED
REJUVENATION
4
RELATIONSHIPS
DIVERSION
EXCLUDED
DEVASTATED
AT RISK
CONFUSION
RESTLESS
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NEXT STEPS
MOVING FORWARD Moving forward, the matrix can be used as a tool for developing an integrative service experience through connecting resources and assets. To determine a feasible solution, identification of human resources and manpower should be considered when determining direction and in order to build action team for implementation. Our design team, and the service experience team within the Visual Communication Design program at Herron School of Art and Design, would like to continue to serve as facilitator of your process, and lead your team through using the tools we’ve developed, to perceive potential integrative solutions, and to identify the resources that can collaborate in the implementation process.
INTEGRATIVE SOLUTION The individual ideas that sit within this matrix cannot, themselves, serve as solution. Instead, the process we’ve followed and strategical framework we’ve developed reveal: 1. What are implications of each idea? 2. What is the relational meaning of each idea? and therefore, 3. How could these ideas be developed into an integrative solution? Then, what does ‘integrative solution’ mean? An integrative solution is a strategical action plan for addressing an opportunity with a clearly defined purpose. For example, you will notice ideas such as adding library bookshelves to the waiting room, which can be immediately implementable. However, prior to adding bookshelves, it needs to be determined what books should be resting on them, and with what purpose this addition is being implemented.
How To Use
As demonstrated through the following examples, this is a tool to devise integrative services by combining purpose, resources and relationships within your context and network. This can be done by choosing to focus attention on diminishing a certain emotional qualifier, or by addressing several emotional qualifiers through one chosen strategic approach, as the highlighted matrices display below. OBJECTIFIED
EXCLUDED
DEVASTATED
AT RISK
CONFUSION
RESTLESS
EXCLUDED
DEVASTATED
AT RISK
CONFUSION
RESTLESS
REJUVENATION
4
Designing a strategical plan for diminishing objectification, devastation, and feeling at risk, through rejuvenation.
RELATIONSHIPS
DIVERSION
OBJECTIFIED
REJUVENATION
4
RELATIONSHIPS
Designing a strategical plan for diminishing objectification, through programs that deliver rejuvenation, nurture relationships and provide diversions.
DIVERSION
As you will see in the coming examples, these are not the only ways to decide direction. Our examples were created based on reoccurring services that were mentioned in our collaborative ideation sessions with the staff and visitors of PeriOperative Services. The ways to use this tool for guiding direction are endless, and can be used in any way that assists the process of designing an integrative solution.
Concept Examples
While we are open to discussing, exploring and collaboratively developing other potential solutions, we have created two cohesive concepts towards an integrative solution as concrete examples to suggest a couple of directions we notice to be relevant to the data, as it is revealed through the matrix.
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FOOD SERVICE AS AN INTEGRATIVE SOLUTION Food service within the hospital can be strategically designed in order to encourage visitors to feel treated as individuals through refueling their bodies with appropriate food choices, and in a manner that reveals the care and concern that Methodist has for their positive experience. Within the matrix, food services appears several times, within various quadrants. In response to this, we created a cohesive concept for integrative solution with food services. As an integrative solution, food services can be designed to address the emotional experience of the waiting room from several angles, diminishing the emotional qualifiers through any, or all three, of the strategical approaches we’ve identified.
OBJECTIFIED
EXCLUDED
DEVASTATED
AT RISK
CONFUSION
RESTLESS
REJUVENATION
4
RELATIONSHIPS
DIVERSION
As shown above, ideas expressed by participants of this project that were related to food service, fit into multiple quadrants of the matrix. Food service can be designed to diminish at least four of the emotional qualifiers, and could be applied through all three of the strategical approaches. To diminish objectification through rejuvenation. To diminish devastation through rejuvenation. To diminish confusion through relationships. To diminish restlessness through diversion. Please reference pages 78, 79, 85, and 88 to see the ideas that were expressed regarding food service during our collaborative sessions for ideation.
Late Night Food Trucks
To diminish a feeling of being objectified, accommodations for food would rejuvenate patient families who stay overnight in the waiting room. If local food trucks parked close to the entrances of IU Health offering late night options for hot food, waiting loved ones would have convenient food options available in the case of a long nights stay. A variety of trucks would meet dietary needs and the location would be easy, convenient and, accessible for those who don’t want to leave the hospital. Beyond providing access to food as a basic need, food trucks would serve as accessible, convenient options for individuals to choose from, ultimately allowing visitors to feel a bit of control over their waiting room experience. Expected Outcomes:
Potential Partnerships:
· Hot food options for late night guests · Variety of options for individual preferences · Partnerships with community vendors
·NY Slice ·Old Classic Softee ·Der Pretzel Wagon ·Byrnes Pizza ·Circle City Spuds ·Big Rons Bistro ·Kaffeeine Co. ·Scratch
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Empathetic Food Presentation
To diminish a feeling of devastation, providing comfort with food (packaging, through the presentation of food options) would strengthen the trust patient families have in their relationship with the staff and Methodist team. To strengthen connection, strategic presentation of food could be used as a platform for communication of care, understanding and empathy from Methodist, to its visitors. For example, inspirational messages to families such as quotes, thoughts, and phrases could be placed on food packaging, as little reminders that IU Health truly cares and desires to provide comfort even in the smallest details, to each individual. The front desk in the waiting room could have care packages available for those who don’t have the energy to find dining facilities. In contrast, this platform could be used to create a lighthearted tone, with humorous or unexpected phrases, similar to fortune cookies, or Taco Bell sauce-like massages. Expected Outcomes:
Potential Partnerships:
· Personal and individual care through comforting and uplifting messages · Empathetic practice through providing and reminding visitors to refuel their bodies, even when it does not feel like a priority · Constant communication between staff and visitors, even in through the smallest details
·Au Bon Pain ·Hubbard and Cravens ·Current food service within Methodist
Food & Health Education
To diminish a feeling of confusion, providing culinary education would provide positive diversion, as productive activity to learn healthy lifestyle choices, and as preparation for families caring for patients recovering from surgery. If cooking classes were offered during visitors waiting experience, there would be opportunity to clarify healthy lifestyle habits, for their own benefit, but also as preparation for taking care of their loved one after surgery. This could be an outlet for Methodist to further ensure the full recovery and further prevention for all visitors, patients or not. In addition, during these classes, visitors could deliver the meals made during these classes to their loved ones in recovery. This would be a positive distraction during the wait, that would encourage the families to feel connected to their loved one, and allow a feeling of control to diminish helplessness. This process ensures that all meals are being prepared based off the instructions of doctors, and would meet dietary needs and constraints of each individual patient.
Expected Outcomes:
Potential Partnerships:
· Healthy lifestyle education, for all visitors, not just patients · Providing knowledge to families, who will be caretakers to patients upon dismissal from the hospital
· Nutritionist
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· Chefs · Utilizing Institutional knowledge
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ART AS AN INTEGRATIVE SOLUTION In order to encourage visitors to feel less anxiety, art can be used to divert visitors attention the through positive distraction, release tension with outlets for self expression, create privacy with functional art form. Through art we can create a platform that serves as a way to express oneself and connect with others who have visited the waiting room. Creating a community like feel, and an interactive experience, guests have an opportunity to benefit from the waiting experience through self expression and intellectual engagement.
OBJECTIFIED
EXCLUDED
DEVASTATED
AT RISK
CONFUSION
RESTLESS
REJUVENATION
4
RELATIONSHIPS
DIVERSION
As shown above, ideas expressed by participants of this project that were related to art and creativity, fit into multiple quadrants of the matrix. Art programs can be designed to diminish at least three of the emotional qualifiers, and could be applied through at least two strategical approaches. To diminish objectification through relationships. To diminish objectification through diversion. To diminish devastation through diversion. To diminish restlessness through diversion. Please reference pages 81, 86, 87, and 88 to see the ideas that were expressed regarding art and creativity during our collaborative sessions for ideation.
Performance Art
To diminish a feeling of devastation, artistic performances would enrich visitors with rejuvenation during the waiting room experience. Musical, dance or theatrical performances taking place within the waiting area could be designed to rejuvenate and refuel and lift the spirits of the visitors who are devastated while awaiting updates about their loved one. If the performances were chosen to calm, and uplift the patients families, this service could serve as a way to refocus the attention in an otherwise stressful environment. Expected Outcomes:
Potential Partnerships:
· Positive distraction for visitors experiencing worry and anxiety · Relaxing mood within the waiting room area · Uplifting mood can positively effect healing process · Refocusing staff and visitors to inspiration and positivity
· Butler University
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· IUPUI · ISO · Indy Opera · Dance Kaleidoscope · Indy Ballet · IRT
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Art Classes
To diminish a feeling of restlessness, outlets for creative engagement would provide positive diversion during the waiting room experience. If art, music or writing classes were available within the waiting room, waiting loved ones would have an option to engage in activities that facilitate expression through creativity. Creative expression will provide a means to focus on a given task, and initiate a sense of accomplishment upon completion. Having choices allows a sense of control in how individuals decide to express themselves. This allows an outlet for anxiety and restlessness while promoting interactivity, self-esteem, and personal accomplishment.
Expected Outcomes:
Potential Partnerships:
· Providing a productive and meaningful waiting room experience · Platform to create artwork to feature within the hospital temporarily or permanently, to create a unique environment that reflects the community it cares for · Opportunities for story telling between visitors past and present · Potential gallery within the waiting room as another source of diversion
· Arts Council · Herron School of Art and Design · Harrison Center · Wheeler Arts · IUPUI · Butler University · Indianapolis Public Library
Art Form & Function
To diminish a feeling of objectification, artful and visually pleasing space dividers created by the visitors of Methodist Hospital, would improve the relationships within the environment by providing options for privacy when it is desired. In order to address privacy issues, artistic structure could be created as moveable space dividers. To set a personal and inclusive tone, these structures could be constructed by or from artistic expressions of the visitors of PeriOperative Services. If these structures were adjustable, visitors would have to interact with them in order to adjust them to work for the space they are trying to create, and engaging with something previous visitors have made, may create a community- like feel, empowering visitors to feel that their experience and presence is prioritized. Expected Outcomes:
Potential Partnerships:
· Options for privacy or connectedness · Flexible options for doctors to meet with families in private · Opportunities for story telling and communication between visitors · Encouragement and support between families through creative interaction
· Herron School of
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Art and Design · IMA · Arts Council · Harrison Center · Art Center (Broad Ripple)
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