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A thesis project about waiting rooms Claire Hamilton INDS-4007-004 - ID Major Design Project 2 Advisors Renn Scott and David Quan April 2018


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Discovery (3) My personal experience with (5) Problem Intro (6) Key Issues

2. Problem Definition (7)Theoretical Framework/ Research (8-10) Insights 3. Research (12-26) Stakeholder Analysis (27) Archetypes (33) Design brief (36) Market analysis 4. Creation (37) Ideation (42) Prototyping (51) Validation of direction 5. Finalization (54) Service Blueprint (55) Final Prototype (56) Specs (57) Renders 6. Project Summary/ Sources

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In 2013, when I was 21, I was diagnosed with two ovarian tumors. My subsequent surgery and brief stay in the surgical oncology ward at Sunnybrook Hospital as well as the follow up monitoring procedures had a deep impact on how I frame patient experience, service design in healthcare and cancer treatment in women. I strongly believe that there is a place for design strategy and research in hospitals and that there is huge potential for an empathetic reconfiguring of the way patients moves through healthcare spaces. This project developed out of a focus on a touchpoint, the waiting room, which I personally associate with dread and anxiety. Luckily, if only in the sense of this project, I have had ample time to study it first hand and with my thesis in mind, reflect on my exposure to many many waiting rooms as practical research to explore a design opportunity.

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Who among us has never had a miserable time waiting to see a doctor?

“The environmental sterility characteristic of the modern medical setting can contribute to the experience of patient dehumanization” (Outcomes of Environmental Appraisal of Different Hospital Waiting Areas by Leather, Beale, Santos, Watts and Lee)

“While waiting can be a solitary, private activity, often it is intensely public, involving numerous people in a confined space, in a potentially emotionally charged atmosphere, in a situation of enforced intimacy.” (Surveying “The Waiting Room” by Peter Bishop)

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KEY ISSUES Waiting rooms are a classically undervalued touchpoint in the healthcare journey which often expose patients to long periods of “perceived dead time” (Bishop) in unhospitable rooms leading to environments of stress and discomfort.

Patient users are not given the resources to make their time spent waiting comfortable, productive and ready to accept care. They are often forced to spend a large amount of time in cramped, ugly, dated, poorly lit, distracting and exposed area with no sense of privacy or that their time is precious.

Clinic and hospital staff understand that their facilities are less than ideal but feel overwhelmed at where to start upgrades, especially if the budget for furniture updates is limited or if it comes out of the owners own income.

Source: Peter Bishop (2013) Surveying “The Waiting Room”, Architectural Theory Review, 18:2, 135-149, DOI: 10.1080/13264826.2013.814558

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Luckily, even though my personal experience felt contradictory, there actually exists a large amount of literature on the waiting in medical contexts. I started with a general overview of the environment in terms of the effects observed on stakeholders. In Peter Bishop’s Surveying The Waiting Room, he goes beyond pointing out the obvious, that sitting in cramped chairs in poorly planned space can be annoying, but rather boils it down to the idea that “waiting can simplify identity” (Bishop 138). Or rather that we can be robbed of our sense of self which validates our individual needs and motivations. In their paper The waiting room “wait”: From annoyance to opportunity, the authors deduct that this same frustration over losing one’s time is actually directly correlated to a patient’s sense of having their needs fulfilled and therefore carries the most weight when reflecting back on the experience as a whole (Shervin et al 479). However, the authors’ suggestions as a research group are mostly formulated around using wait time to be proactive planning time for patients and not as much related to the special implications of the designed environments patients are expected to wait in. Many medical researchers tend to take the same approach, that the wait time is more about the activity rather than the designed space, which as a patient, I do not exactly agree with. In the British Journal of General Practice, Rice, Ingram and Mizan’s article “Enhancing a primary care environment: a case study of effects on patients and staff in a single general practice”, relies heavily on questionnaires to track a patient’s emotional output when faced with periods of wait but the article also parses through existing literature on how staff feel about their waiting facilities to come to the conclusion that “poorly designed healthcare buildings increase stress among staff, reduce efficiency and impair job satisfaction” (Rice et al. 7). In terms of implementing concepts of service design like flow and stakeholder needs in waiting areas, the resources I found were limited to literature overviews or overarching guides which didn’t have a participatory aspect that would guide a non-design professional towards to right probing questions. One such guide which offers a good overview of all the aspects to consider is The Picker Institutes’s “Designing GP buildings: staff and patient priorities for the design of community healthcare facilities in Lambeth” published in 2007 (Sheldon, Sinayuk, Donovan). I used this as a guiding text because it discussed the outcomes of focus groups of patients and staff. Patients placed the highest amount of value on “functioning and efficiency”, “delivery of a broad range of services” and “ease of movement” while staff emphasized their needs around “access and safety” followed by “privacy, confidentiality” and “communication between staff members” (Sheldon et al., 6-7) Bishop, Peter. "Surveying "The Waiting Room"." Architecture Theory Review 18.2 (2013): 135-149. Rice, Gillian, Jenny Ingram and Jacques Mizan. "Enhancing a primary care environment: a case study of effects on patients and staff in a single general practice." British Journal of General Practice 58 (2008): 552. Sheldon, Helen and Lily, Donovan, Sally Sinayuk. Designing GP Buildings Staff and Patient Priorities For The Design of Community Healthcare Facilities in Lambeth. The Picker Institute . Oxford: Picker Institute Europe, 2007.

Theoretical Framework/Research Insights 7


Waiting Room Stakeholders Desire to keep flow of patients moving, avoid line ups

Frustrated at longer than anticipated waits

Primary user

Administrative

Desire for high level of care

Facilities Willing to wait within reason (how long?) Easy to clean around, under, lift, wipe down, sanitize

PATIENTS SUPPORT STAFF

large scale furniture producers

Specialist doctor

CLINICIANS/ CARE PROVIDER hired

MA

PATIENT SUPPORT

RS NUF E R AC T U

Family Doctors/Primary caregivers Nurses

Family

highly complicit in the primary user’s healthcare journey, often acts as an advocate*

Browning, Gloria and Nancy A. Warren. "Unmet Needs of Family Members in the Medical Intensive Care Waiting Room." Critical Care Nursing 29.1 (2005): 86-95.

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High Hospital board, governing body who deal with donors and funding

Patient Primary User

Support Staff Administrative Staff Facilities Staff

Clinician Healthcare Provider

Keep Satisfied

Manage Closely

POWER

Health and safety ethics board Patient Advocates

Monitor

Keep Informed Manufacturers, Suppliers, Fabricators

Patient Support and Caregivers

Low

INTEREST

High

Power/Interest Grid

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1. Patients receiving treatment 2. Clinicians and healthcare providers 3. Support Staff

Electronic Medical Records

Hospital administrative board Manufacturers producers and sellers of healthcare furniture

Core Target

Direct Stakeholders

Indirect Stakeholders

Core Target Group Identification

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PERSONAS

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Bonnie is 53 year old rheumatologist who, since graduating from medical school has chosen to keep a private single-doctor clinic at Younge and Sherbourne in the Rosedale Medical Building since 1989. She employs a single administrative assistant in her condo complex clinic which consists of a waiting room, an enclosed reception desk, a filing room/kitchenette and an examining room. The waiting room which she walks through every morning when she opens the office which consists of five chairs she bought from an office supply depot when she signed the lease on the condo. Like many doctors at the beginning of their practices, money was tight when she was thinking of furbishing the space, but as a rheumatologist she took certain precautions to choose chairs with high backs and sturdy arm rests that a patient could theoretically lower themselves into or hoist themselves out of. The other upgrades she has made to the space over the years have included ripping out the broadloom and installing harwood floors as well as switching from paper files to Electronic Medical Records (EMR). Otherwise, she has left the lighting and walls untouched. Next year she will scale back from full time hours for the next ten years before retiring.

Needs

Opinions

For her patients and their support to have a comfortable place to spend time as she juggles the dayst responsibilities

That calmer and more at ease patients are easier to treat and that a waiting room should not have to agitate them

For patients with joint soreness and mobility issues to be accomodated - to be able to rise and sit comfortably

Art is a personal interest of hers and she takes joy in choosing pieces from her own collection to decorate her space

Goals

Expectations

For workflow to move efficiently. She can do her paper work later but during the day seeing the patient is the priority

That investing in furniture will be a one time thing and that the pieces will be built to last and withstand daily use

A waiting room that won't aggravate ill patients further so they do not bring that stress into the examining room

That the materials need to accomodate a healthcare setting and shouldnt contribute to the spread of disease

Thoughts/Feelings

Pain Points

That a dreary space reflects poorly on her as a clinician and this is her space that she owns and she should be proud

That sometimes because of her small team patients will be left waiting for over an hour and that the exam time will be short

The government does not give her any money to furbish her waiting room she she has to be finiancially responsible and pick something that will last

Often patients are in a lot of pain and it is difficult for them to spend prolonged periods of time in a waiting room

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Dictates

Leaves home in car drives 45 min.

Arrives at work,

3rd patient apt.

Phone consult

Answers emails reviews charts

Takes a phone call with drug rep

Reviews new chart

1st patient of day - physical examination, oral discussion of history and treatment issues

8th patient

6th patient

2nd patient - physical exam, drains joint, injects cortisone, discusses symptoms

5th patient

LUNCH

Paper work and dictation, catches up on ignored emails

4th patient, drains both knees

drives 45 min.

Paper work at desk in

preps for next patient

7th patient cancels, catches up on paper work

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Ama is a 27 year old freelance graphic designer who was diagnosed with Lupus four years ago when she developped a facial rash. The disease is fairly common in the Sri Lankan community in Toronto and she was able to recognize the symptoms early on because of previous experience with a cousin. However, due to stress in her life in the creative field coupled with a rapidly advancing disease her Lupus has started to flare at an alarming rate and her rheumatologist has suggested a round of chemotherapy to combat her flares. Symptoms include rashes, joint pain and other painful complications. The sheer amount of appointments has caused significant stress on Ama and her partner and the idea of having to start something as terrifying as chemotherapy or potentially having to get additional surgeries in the future has her staying up all night, unable to work and.

Needs Emotional as well as financial support from her partner and her family Full transparency in her treatment, understanding the "why� behind medication, procedures

Goals To be as prepared as possible for the long term implications, to understanding medical jargon Being the most comfortable possible at treatments, as well as the comfort of her family at appointments

Thoughts/Feelings Focusing on healing and mindfulness, using this wake up call to get a handle on her anxiety Extremely stressed out at on the impact this illness will have on her freelance business, anxiouness at so much dead time between treatments where she feels useless

Opinions That sometimes she would like private moments with a family member and sometimes she would like to be tired and alone and there is no way to get both That this approach to the patient experience that does not acknowledge her stress is risking her Lupus to flare

Expectations That having to go through something as terrifying as chemo at a young age will make her the focus of attention That her support from her family will be validated and that hospital staff will include their participation in her treatment

Pain Points When her lupus is flaring she experiences sharp joint pain and her mobility is limited and needs assistance Hot flashes, dizzyness, migraines and dry mouth maker her feel like it would be nice not to have harsh lighting and somewhere to fill up her water bottle or drink from a glass thats not a hospital bathoom

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WAITING IN BLOOD LAB 10 MIN

Life Labs check inboyfriend leaves

Leaves home gets on subway

Meets boyfriend on subway platform 20min

Actual appointment time 20MIN

Checks in clipboard but has trouble

WAITING IN EXAM RM 10 MIN

ARRIVE S

Gives blood sample, pees in cup takes subway home

WAITING IN WAITING ROOM 30MIN

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Sylvia is a 42 year old Lawyer who is divorced with one child. She accompanies her 81 year old widowed father who has just been diagnosed with kidney disease and gout to appointments at a clinic with both a nephrologist and a rheumatologist on staff. Sylvia's father's English is quite good but she finds it necessary to act as an extra set of ears at appointments as her father does not always feel it is necessary to follow the treatment schedule his clinican perscribes. Sylvia has to take time off work and rent an AutoShare to pick up her father from his High Park home and bring him to his appointments at his clinic at University and College. She also often has to liase with the delivery service that maintains her father's in home dialysis machine. She has spent a significant amount of time in and out of waiting rooms but feels lucky to have a strong support network in place thanks to her friends and ex husband but sometimes is stuck bringing her ten year old son to appointments. She often wishes her father was more enthusiastic about taking care of himself and feels like his manager instead of his daughter.

Needs For groups to be accomodated in the waiting room, to be able to sit together and store their things and talk quietly without disturbing others

Opinions That the quality of care does not reflect on the state of the waiting room but it would be nice to be comfortable

To be able to communicate with the clinic staff as a representative of her father, the patient

Goals To act as an extra set of eyes and ears for her father, to take notes and to be as smart as possible to his needs as a patient That her wellbeing as a supportive family member is not being taken for granted and that she is acknowledged

Thoughts/Feelings That she is taking time out of her workday and the time she spends with her son to be here That she is worried about her father's nonchalant approach but accepts that he is an independant adult and these are his choices

Expectations That the clinician will give them an idea about how to prepare for the appointment That her voice will be heard and that her contributions will be acknowledged and validated

Pain Points feeling under appreciated in the healthcare journey That when she has to bring her kid there is extra stress that she is letting him down as well and does not understand why he has to be there

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Picks up car share drives High Park

Waiting in exam room 10 min

makes follow up apoint drives her father home

Waiting Room 45 min

Drives from High Park to uptown clinic, discusses upcomming appointment with her father so they are on the same page with any gaps in his treatment

Actual appointment time roughly 20 min, Sylvia does most of talking

Waiting Room bloodwork 15min

Waiting Room again 30 min

Second apt

Final appointment of the day , tries to remember everything she wanted to cover

Arrives at clinic, tries to find parking gets lost, also building is confusing

Finally checks in

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Tammy is a 67 year old mother of three adult children. She was formerly a pharmaceutical rep based in Toronto but shortly after her retirement last year moved with her husband to a condo in Cobourg. When she is not driving she comes into Toronto on the Go Train roughly every three months to see her Rheumatologist, otherwise she does her bloodwork at a LifeLabs in downtown Cobourg where she can book an appointment in advance and check her results online. Tammy suffers from rheumatoid arthritis and has on occasion needed to have joints in her knees and wrists drained of fluid prior to cortisone injections but has been on a successful run of the biopharmaceutical Enbrel for the past six months. She was diagnosed with rheumatoid arthritis five years ago and has managed fairly well considering the huge amount of pain associated with the illness and actually looks forward to her visits to downtown Toronto as an excuse to shop, connect with friends as and see her daughters.

Needs

Opinions

Somewhere comfortable for someone who suffers from joint pain where she can relax after the commute that will not add stress to her trek

That from her experience as a drug rep she has come to expect dingy offices from older offices and come to accept it as the norm

To prepare in advance for the appointment and to prioritize the points she wants to make

That having to wait too long without knowledge of her position in line as well as how much longer she will potentially be waiting mnakes her feel agitated

Goals

Expectations

To have a meaningful check up as possible and to bring up any points that have been bothering her so she can leave feeling good

That is she makes the effort to come to her appointments on time that the office will not overbook and she will be seen in a timely manner

To get in and out as quickly as possible so she can enjoy whats left of her day

That if there was something that was considered a positive development in the medical field her in terms of technology for patients her doctor would adopt it

Thoughts/Feelings

Pain Points

That she is not managing her diesease well enough and that the pain is taking a toll on her emotional wellbeing

Getting up from chairs, hanging up coats, pulling off boots, picking up all the bags she carries with her from Cobourg is tough

That waiting for long periods of time is stressful and she becomes agitated, like she is being held captive with other strangers

Difficult to not take up a huge amount of space in a waiting room especially in the winter where she travels with a lot and needs to stash bags and a coat and boots

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20 min appointment time with doctor

Leaves apartment in coburg

Gets back on TTC to meet with daughter DT

appointment at Davisville

Leaves apartment in coburg Waiting Room Time 1 Hour

Arrives at doctors

needs to stash coat and bags on an empty chair

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Martim is a 55 year old with osteoperosis and ankylosing spondylitis with swelling and pain primarily in his knees and lower back. He is a mechanic and business owner who immigrated to Toronto from the Azores region of portugal 21 years ago. He speaks both English and Portuguese and has lived in the College and Dovercourt area since his arrival in Toronto. His two daughters who were born in Canada use English as their primary language and often accompany him to his appointments to act as an extra set of eyes and ears and to help him when he needs clarification or is having trouble communicating. Because he has lived in the cultural enclave of Little Portugal where most of his services like banking and shopping are done in his native language he has never had much of a problem but managing a disease that takes him away from work and could potentially force him to retire early gives him anxiety and he has aknowledged he needs as much help as possible with his treatment. Martim has recently had his previous rheumatologist retire and his chart has been transferred to a much younger doctor who does not speak Portuguese.

Needs Assitance from his daughters when he is attending appointments and reminders of his treatment like when to take meds When his knee pain is flaring he needs help getting in and out of the seated position and wears a lower back brace

Goals To eventually manage these new symptoms better and to not let this disease stop him from the active lifestyle he enjoyed

Opinions That managing this disease and the new limitations it imposes is a huge inconvenience for someone managing a business

Expectations That his doctor will be able to speak to him in a way that does not feel patronizing

To become familiar with his new doctor so that he needs less support from his daughters when he attends appointments

Thoughts/Feelings Feels infantalized when he does not understand medical jargon and needs extra clarification He is squeamish about having his knees drained of fluid and injected and dreads having to go to a radiologist about his hips

Pain Points Upset at the side effects that the drugs he is on are causing and feels like he should not be on so many medications Embarassed he relies so much on his daughters and feels guilty that he has to take them away from their daily lives to help him with appointments

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Leaves his shop at Dundas and Ossington

Picks up daughter at her work

Drives to Hospital

Checks into clinic

Time spent in waiting room 45 min.

Time spent in exam room 20 min.

Appointment with Rheumatologist 35 min.

Blood and urine

Blood Lab waiting time 25min.

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Dev Is a 33 year old family doctor who graduated from his fellowship last year after training at Sunnybrook Hospital. Although he is still associated with Sunnybrook he has chosen to join and invest in a private clinic that takes a multidisciplinary and more holistic approach to healthcare. Along with a dermatologist on staff other practitioners include pharmacologists, a psychotherapist and a naturopath all sharing a private facility in downtown Toronto. Dev enjoys the social aspect of the shared clinic and prefers the young energy compared to his previous hospital. He also belives that his new clinic is a more patient-centric approach to healthcare and that for a young doctor starting out, splitting the cost of setting up a facility between many stakeholders offers more possibility for the group to invest in their space and their tech setup in a thoughtful way.

Needs

Opinions

To feel a sense of calm in the waiting room that translates to the rest of the experience in his new clinic

Working in a nicer place that he invested in and built himself gives him pride in his work and gives him a different set of responsibilities than in a hospital

To be at the most cutting edge of patient centric health care and to really feel like it is making a difference

That a multidisciplinary approach to clinics is the direction that healthcare is moving towards and the clinic's branding is in line with his own personal brand

Goals

Expectations

For his patients to feel like they are not wasting time and that the new equipment is not annoying to use, gimmicky or adding extra steps

That patients will see the need for extra steps as a way of understanding their condition instead of feeling like they are jumping through more hoops

To make communicating with the patient while using the EMR set up to its fullest potiential and the least awkward possible

That new technologies will be accessible to older patients, late adopters of tech, and not just digital natives

Thoughts/Feelings With new communication streams, the need to create distance between himself and his workplace, finding time for his personal life is important as well

Pain Points That when he feels rushed through his day with little reprieve he feels overwhelmed and depressed

Hopes that he is doing as much as he can in his role as a rheumatologist, that he can help people manage their pain

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PATIENT

DR. DEV

Patient arrives at the clinic and checks in

Seeing another patient

WAITING ROOM TIME 30 MIN

to review files

Appointment time spent with Dr. Dev 20 min

shows picture on phone

Appointment time spent examining patient, going over family history and previous medications

Prioritizes patients self described lists of concerns on tablet Reviews patients self declared history on tablet Reviews patients labs on laptop

dictates

speaks to admin ast.

next patient

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Marlee is a 28 year old administrative assitant at the Princess Margaret Hospital Family Health Clinic in downtown Toronto. She describes herself as highly organized but still feels the job is challenging even with a large staff of 5. Balancing the changing schedule and needs of patients within the complex ecology of the hospital as well as having to liase with the doctors and their requests all day can be draining. Marlee studied event planning at George Brown College but found her job here after volunteering for a year and finds it rewarding and satisfying especially on good days. She enjoys the social aspect of working in a team and feels the human connections she is making are deeply touching. Marlee also teaches yoga at a pilates studio in uptown Toronto and on bad days she feels like balancing both jobs where she is forced to interact with people all day is taking its toll on her patience.

Needs For patients to be cooperative and thoughtful and absorb the information she is giving them

Opinions That generally patients are kind and mindful of their surroundings but she is thankful to have a team of co-workers backing her up if things escalate

A way to not always be repeating herself to patients, better wayfinding and information availbility in her ward

Goals To meet the scheduling demands of patients and clinicians as quickly and efficiently as possible To use e-communication in a reasonable and confidential way to decrease the amount of phone calls she makes

Thoughts/Feelings Feels that it is rude when she is interrupted when she is on the phone with a patient but acknowledges it is part of the job

Expectations That sometimes patients and their family members will be over stressed and sleep deprived and need to have a comfortable place to wait That patients will be as sensitive to her needs as she is to theirs

Pain Points She finds herself becomming exasperated and more direct than she used to be and hopes patients do not think she is unsensitive and rude

That wayfinding is lacking and that having to repeat herself all day is draining and not an efficient use of energy

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Answers emails, checks patients in

Leaves work at 7 to get to the hospital when the clinic opens at 8

Emergency - patient passes out and she calls for assistance

breaks for coffee

Breaks for

checks memos and messages, prepares for large inter department meeting scheduled for mid-morning.

Answers emails and deals with hospital wide s heduing

Does any filing that is piling up as well as any scheduling that needs to be handled, fields several phone calls from patients enquiring about their appointments

Breaks for

Works through requests for appointments, follows up on referrals does additional booking

Interfaces with patients, checks them in, navigates scheduling, answers queries etc.

Attends training on security concerns at hospital Braves the rush out TTC to get home by 6:45

Tries to listen and return messages

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Pictured: Not even kidding, this is an actual patinet area at Sunnybrook Hospital.


“ A persona is a profile representing a particular group of people, such as a group of customers or users, a market segment, a subset of employees, or any other stakeholder group. “This profile is not a stereotype, but an archetype based on real research. Personas, although fictional, help make groups with similar service needs more understandable.”

P. 41 in “This is Service Design Doing: Applying Service Design Thinking in the Real World” by Mark Stickdorn, Markus Edgar Hormess, Adam Lawrence, Jakob Schneider (2018)

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User Archetype The Newbie This patient may have had a couple stressful appointments in the past or accompanied a friend or family member to their healthcare provider but when it comes to managing their own journey they are caught unawares and become confused, awkward and anxious. They don’t know if they’re in the right place, they are wondering if the clinician forgot they were there and aren’t going to call their name, they don’t know where the bathrooms are or what to expect after they get moved to an examining room. The newbie has a lot to learn and that’s ok because the healthcare landscape isn’t always self-evident. They key concepts are inexperience and uncertainty.

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User Archetype The Seasoned Pro This is the career patient, who is familiar with the rhythm of appointments and comes prepared. They know to organize their questions in advance, they factor in the best times to get their bloodwork done and how to check their results on the patient portal. They are endurance participants who understand that waiting will often take much longer than the actual appointment and they are ready for it. Their key principles that they employ in navigating the health system are efficiency, awareness and proficiency.

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User Archetype The Busy Bee This is the money-never-sleeps, high stress high power executive type. She might be a banker or a CEO of a start up or he might be an intern at TD but regardless they want you to know that they are busy, that they are needed somewhere else and that taking time off for a doctor’s appointment is extremely inconvenient in terms of their daily agenda. The busy bee measures and bills their time in fifteen minute increments. They need a wifi line to check their #slack, a spot to update their spreadsheets on their laptops and a stage to make loud calls to their broker team to buy low and sell high.

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(Now we can start making the actual thing. )

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Outside of new healthcare facilities who have budgets for large design firms to organize optimal spaces, Private clinic owners and small hospital department staff might not have the resources to hire a design or consulting agency to advise on the creation of an ideal patient waiting room experience.


Atessa is a service methodology system,partnered with a major furniture brand, which examines the channels and touchpoints of a patient healthcare journey within the scope of the waiting room. Themes are healthcare design, patient centric design, human factors in healthcare, speculative furniture, tech integration and systems thinking. What if we were to give their waiting experience calming experience with like this space has been as the focus.

patient users the tools to make in a clinical context a reflective, features that empowered to feel created with their particular needs

What Else is missing from the generic waiting room experience that could flip the concept of perceived “dead time� and feel like a productive time to prepare or regroup between appointments. How Might we transform the system flow of a waiting room in a way that the user totally disassociates from the standard unremarkable and unpleasant waiting room experience.

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STAKEHOLDERS Patients and their families are coming to expect more than current bare minimim space set ups

Healthcare Infrastructure Patients

Healthcare providers are starting to see a growing demand for human centered design strategy and recognition of the potential value of the waiting room in the healthcare user journey Manufacturers are showing a willingness to tap into a huge international market but need an edge to differentiate their offerings from the strategies of competitive players in th medical furniture industry.

Manufacturers

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Human centric design with long haul waits and access to additional services in mind

STRENGTHS OPPORTUNITIES

THREATS

Large corporations with already established track records of selling conventional but reliable product

Potential for expansion of products in brand family and brand partnerships with services

WEAKNESSES Large conceptual jump from current waiting room set up and large investment

SWOT ANALYSIS

Tw o case studies f r o m w h i c h s e r v e d a s i s p i r a t i o n i n t h i s p r o j e c t , ( 1 ) Yo n a C a r e , a m u l t i d i s c i p l i n a r y t e a m o f w o m e n d e s i g n e r s a n d e n g i n e e r s from Frog Design in San Fransisco and their quest to redesign the speculum which expanded into a refiguring of the gynecological pelvic design. Their principles were Human, Inclusive, Mature, Straightforward and unbiased ( s o u r c e : h t t p s : // y o n a c a r e . c o m /A b o u t ) ( 2 ) T h e 1 9 9 8 r e h a u l o f t h e V i r g i n i a M a s o n M e d i c a l C e n t e r i n Wa s h i n g t o n , Seattle. The CEO basically looked everywhere to find a model of healthcare that he could adopt to revitalize care and instead turned to the hyper s u c c e s s f u l m a n a g e m e n t s y s t e m f r o m t h e To y o t a f a c t o r y i n J a p a n . T h e f i r s t co-design workshops that their sensei’s’ employed were using a ball of blue yarn to chart a typical journey that a cancer patient was forced to take through the hospital and the results for an immunocompromised individual w e r e a p p a l l i n g ( h t t p s : // 9 9 p e r c e n t i n v i s i b l e . o r g /e p i s o d e /e p i sode-30-the-blue-yarn-download-embed-share/)

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Target Users Target users are patients who have appointments in the clinics in the university health network. This group consists of adult patients, their dependents (e.g. children), patients who identify as handicapped or with significant mobility issues (e.g. patients in wheelchairs, walkers, canes, scooters), as well as groups (e.g. families) Secondary Users Users who interact with the product on a daily basis such as clinicians, administrative staff, cleaning and facilities staff, patient health and safety


M u s t every detail on this chair must be purposeful and with intention, no added bells or whistles. Must be light, pared down but strong and accessible to every type of patient who doesn’t need the added stress of getting in and out of a seat. Arm rests are easy to hold, higher and exaggerated than other chairs on the market. Seat is raised so no patients sink down and aggravate their legs when they try and rise. Must be easy to sanitize, made of long lasting and attractive furniture and speak to the importance of aesthetic language in utilitarian furniture. Should

be able to clustered in ways that encourage patients to either their choice of privacy or intimacy with the stakeholders that accompany them. Give facilities staff the means to achieve this.

Could

be fabricated in color swatches that calm and soothe patients. Have options for integrating innovation as healthcare develops (i.e. hook up jacks for VR, plug ins)

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BRAND VALUES

CARED FOR PRAGMATIC

CONFIDENT

EMPOWERED

ACCESSIBLE

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P r o d u c t Va l u e P r o p o s i t i o n s Empower patients to feel that this chair is accessible and informed by ergonomic studies that take physic weaknesses into consideration Assure healthcare providers that they will be able to creat a better waiting room for their stakeholders using the building blocks of design thinking and research which are not facilitated in other products available on the market Inspire confidence in clinic owners that they are investing into a well built,empathetic and easy to clean and maintain solution that will make their patient ’s healthcare journey more comfortable.

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My first idea was all about how to make a chair hyper accessible. I explored ideas of a low-fi aid like a teeter toter that would act as a seat assist. Exaggerated arm rests were inspired by gymnasts rings which I thought would make it easer to lift oneself up and out. It turns out their position put pressure on the wrists.

In the first iterations I was playing with the idea of 2� tubing and natural materials like wood veneer but these would prove to be difficult to manufacture.

Because with a fascination with time and time being lost to sitting and waiting I ideated a patient wearable that would act as a pager tandem with a phone. I used elastic bands to simulate arthritis.

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Through experience and observation storage was an issue that came up. Here I was thinking about utilizing the space behind the seat as a way to stash items.

Prototyping the second iteration of the lo-fi seat assist using bicycle inner tubes as a stand in for springs.

A desire for more privacy in a painfully public space led me to think about creating a type of privacy screen tht would have an interactive component. When this was prototyped even the cardboard version seemed bulky and cumbersome and the tester brought up the fact that it would distract clinicians from being able to quickly survey the space as well as stop the line of vision.

Another early prototype idea was a hand held patient beeper that an individual with grip issues could use to aid communication, as well as a screen interface.

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To preserve annonymity patient creates 24 Hour Login ID

Community is a waiting room specific message board for sharing stories, information and useful tips from fellow patients

Countdown timer and patient prompts controlled by office coordinator at their clinic

In the early days of the project I spent a significant amount of time prototyping an app and web based component that the patient user could download as part of communicating with their healthcare provider as well as thir surroundings. When I focused the lense of the project I began to see that this was a problem that was not necessarily part of the accessibility issue I was trying to solve but I think there’s potential to be involved with the long term scope of the idea.

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Frame 11 gauge bent steel + powder coated

Elastic cast polyurethane rubber

Here I finally abandoned the gymnasts rings in favor of a more sloping design. I was still intent on having a rocking chair motion in the seat but in these prototypes discovered that it put a lot of unneeded stress on the core.

Frame Perforated powder coated aluminium

After this prototype in 1� steel tube I had to consider the limitations of the bending materials I had at my disposal as well as how much room the piece was taking up on the ground and whether the exposed legs would be considered as a tripping hazard

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I decided to model the seatin Rhino and base the dimensions off of existing Keilhauer chair steats. Then I divided the piece into smaller printable parts to print and assembled them in a tray from w h i c h I C N C ’d t h e n e g a t i ve o f t h e form.

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Ta k i n g i n t o a c c o u n t m y p r e v i o u s e x p e r i e n c e t r y i n g t o b e n d metal tubing, I decided to 3D print the joinery for the legs out of PLA plastic that would join into the 1� steel tube with a te n o n co n n e c t i o n . I u s e d a co m b i n at i o n o f t wo p a r t e p oxy a n d fibreglass strands to connect them.

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Because of the fragility and brittleness of the PLA printed parts that made up the seat, I decided I needed to reinforce it using fibreglass and polyester resin. This was extremely challenging as I am not a professional corvette body mechanic or something. I did my best.

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Th e exe rc i s e b o o k o f design research challenges that would accompany the purchase of an Atessa furniture piece is around thirty pages long and bound with glue so pages can b e r i p p e d o u t e a s i l y.

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Some more glamorous progress shots.

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VALIDATION OF DIRECTION

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Concurrent to this thesis project, I was invited to work on a service design project by Jennifer Jeon, a systems design engineer and the lead of human factors and patient safety at Mount Sinai Hospital, to conduct research on the Family Health Clinic’s waiting room space. I conducted ethnographic and observational research in the space that mirrored the methodology I was preparing for Atessa On March 27, I was invited by Clarys Tirel, the Administrative Director of the Mount Sinai Academic Family Health Team to present my work at a Patient Advisory Committee meeting. It was an amazing experience to validate not only the work I had been doing in the waiting room but also to confirm that the design opportunity I had built my thesis around was clearly a part of the patient healthcare journey that presented a special opportunity for restructuring.

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FINALIZATION

AND SERVICE BLUEPRINT


AWARE User is intrigued by Atessa and has become aware of it through multi channel advertising campaign, booth presence at medical design trade shows, website

JOIN Client weighs options, and decides based on clear and transparent examples that there are short term and long term benefits to upgrading their waiting room s and not just within the limits of updated furniture

USE The emphasis of the Atessa packages is that they are designed for empowering non-designer stakeholders. A small scale clinic looking to update the patient experience might have a twenty person capacity waiting room and would like just a few units of product as well as some of DIY service design guides to facilitate their execution while a large consulting firm with i- house service designers might only be interested in the specs of hundreds of units but need no assistance in the execution.

DEVELOP For the Atessa system to be a resilient product, it has to avoid bein a “one time fix�, most clinics, unless they are moving locations or undergoing structural rennovations will only consider upgrading furniture every ten years. Beyond tables and chairs, Atessa has to be constantly studying the changes in patient behaviours, healthcare experience desin and tech innovatioon to stay relevant.

LEAVE After the purchase of the Atessa system, the user is able to access the same insurance policies as covered under Keilhauer.

SERVICE BLUEPRINT

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TWO PART FINAL PROTOTYPE

1. Speculative line of furniture which emphasizes accessibility for patients with limited mobility by way of exaggerated arms, silicone shell for easy sanitization and inclusive clustered seating options like bariatric doubles which validate the patient user’s support system.

2. DIY Service Design Kit which introduces non-designer stakeholders to the basics of conducting design research (e.g. exercises in ethnographic observation, user journey mapping and identifying service touchpoints) and how to implement their new waiting room furniture thoughtfully.

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PROJECT SUMMARY AND LIMITATIONS I believe that a furniture solution with a service design component is an valuable solution to bringing meaningful mass produced items to market as well as encouraging the behaviour of conscious consumption. It is attractive as well as takes into consideration a huge number of different stakeholders. Like any product, once it is purchased, the owner will use it however they please so perhaps the onus is placed a lot on the user to achieve the brand goals of Atessa.


SOURCES

Bishop, Peter. "Surveying "The Waiting Room"." Architecture Theory Review 18.2 (2013): 135-149. Rice, Gillian, Jenny Ingram and Jacques Mizan. "Enhancing a primary care environment: a case study of effects on patients and staff in a single general practice." British Journal of General Practice 58 (2008): 552. Sheldon, Helen and Lily, Donovan, Sally Sinayuk. Designing GP Buildings Staff and Patient Priorities For The Design of Community Healthcare Facilities in Lambeth. The Picker Institute . Oxford: Picker Institute Europe, 2007. Sherwin, Heather, et al. "The waiting room "wait" : From annoyance to opportunity ." Canadian Family Physician 59 (2013): 479-481. Bailey, Joanna, et al. "Supporting Families in the ICU: A descriptive correlational study of informational support, anxiety, and satisfaction with care." Intensive and Critical Care Nursing 26 (2010): 114-112 Browning, Gloria and Nancy A. Warren. "Unmet Needs of Family Members in the Medical Intensive Care Waiting Room." Critical Care Nursing 29.1 (2005): 86-95. Care, Environmental Affordances: Designing for Family Presence and Involvement in Patient. "Choi, Young-Seon; Bosch, Sheila." Health Environments Research & Design Journal 6.4 (2013): 53-75. Leather, Phil, Diane Beale and Angeli Santos. "Outcomes of Environmental Appraisal of Different Hospital Waiting Areas." Environment and Behaviour 35.6 (2003): 842-869. Margolies, Rebecca, et al. "Positioning Patient Status Monitors in a Family Waiting Room." Health Environments Research & Design Journal 8.2 (2015): 103-109. Paul, Christine, et al. "Access to chronic disease care in general practice: the acceptability of implementing systematic waiting-room screening using computer-vased patient-reported risk status." British Journal of General Practice (2013): 1-7. Strathmann, Cynthia Miki and Cameron Hay. "Working in the Waiting Room: Managing Fear, Hope and Rage at the Clinic Gate." Medical Anthropology 28.3 (n.d.): 212-234. All images my own except for render backplates which are licensed from Adobe Stock Images, https://stock.adobe.com/ All icons and silhouettes from The Noun Project (www.thenounproject.com) under creative commons license (People2D by Lluisa Iborra from the Noun Project) Market Research and Comparison Slide image sources: https://www.steelcase.com/content/uploads/2015/01/steelcasehealth_volume1_seating.pdf -https://www.globalfurnituregroup.com/ca http://www.krug.ca/products/healthcare/healthcare.aspx www.ikea.com https://www.staples.ca/chair/directory_chair_20051_1_20001?fids=&pn=1&sr=true&sby=&min=&max=&myStoreId= https://www.nemschoff.com/products/easton-multiple-seating http://www.norix.com/forte-lounge.asp https://www.thisisservicedesigndoing.com/ http://www.servicedesigntoolkit.org/ http://diytoolkit.org/

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Atessa Thesis Book  
Atessa Thesis Book  
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