The Problem with Hospital Gowns

THE PROBLEM WITH HOSPITAL GOWNS The Dignified

Erik Reiblein 2016 Thesis Research

Hospital Gown

Can hospitals help patients feel comfortable with a more dignified medical gown design?

Creating a Dignified Hospital Gown Preserving patient dignity through the use of transitional gown design

Erik Reiblein Syracuse Industrial and Interaction Design 2016

1

Introduction

2 4 8

Why hospital gowns?

My project goals Planning

2

History

14 16 18

Evolution of the hospital gown Why are hospital gowns still terrible?

Recent attempts at improved gown design

3

Background Data

24 26 28 30 32

Gown blood strike-through value User-centered design process Framework for hospital gown design Guidelines for hospital gown design Perceptions of using a “breast gown�

4

Interviews

36 42 48

Ann Sedore Nancy Williams Angel Ashley

5

User Testing

54 60 66

Analyzing existing gowns Collecting participant feedback Designing new pattern pieces

6

Final Prototypes

72 74 78 80

Deliverable explanation Ambulatory gown Transitional gown Intensive care gown

7

Conclusion

88 92 94 96

What have I learned?

The future of hospital gown design Appendix Photo credit

Section 1

INTRODUCTION

ABOUT THE PROJECT

Why hospital gowns?

Over the past year, my mom has spent a lot of time in and out of hospitals. Due to several health complications, she’s had to deal with two fairly invasive surgeries within a relatively short period of time. Despite the fact that she’s had to face stressful diagnoses, unreasonable insurance policies, and physical trauma, one of her most common complaints about the overall experience concerned the gowns she was required to wear. She noted the lack of dignity she felt when wearing these hospital gowns, and also took major issue with their inability to provide warmth or comfort. It didn’t take much research to find out that the public’s general perception of hospital gowns aligns closely with my mom’s. Uncomfortable hospital gowns make the healthcare experience worse for millions of patients every year, and yet no one seems to be talking about how to improve them. Could it be possible to improve the hospital experience for patients by making a few small changes to the gowns they are provided with?

2

Introduction

3

EM CO B A LD RR A

SS RT A I PO N S B I T G N L SE R E D E D SS EC FU EN L T

EX

M FO

CO

N

U

PROJECT GOALS

Design goals The new hospital gown designs incorporate feedback from current healthcare professionals. Interviews with hospital workers provided me with insight into the reasoning behind current gown designs and illustrated how specific pattern features address medical issues. Similarly, many of the studies I have collected feature snippets of interviews with patients and doctors, which help to establish what dignity means to everyday people. While designing this new hospital gown, I tried to strike a balance between the emotional needs of its direct users, and the more technical needs of the healthcare professionals around them.

The overall, broad goal of this thesis is to reevaluate the role of dignity in the hospital. I believe that rethinking current hospital gown designs could potentially open up a discussion that may result in a subtly better hospital experience for distraught patients.

4

Introduction

LOW-QUALITY THIN DIFFICULT BAD CONFUSING DRAFTY 5

Research goals Healthcare has existed in the United States for hundreds of years, and while a myriad of amazing advances have been made in the realm of treatment and medical science, there continues to be a surprising lack of dignity afforded to patients. Cold, embarrassing gowns contribute to a profound sense of unease for patients.

This serves to diminish what is an already unpleasant experience for most. Not only does this make life just a little harder for patients, it also impedes their recovery by increasing stress levels. At a time when health and recovery should be top priority, patients should not need to worry about feelings of embarrassment caused by a bad hospital gown design.

My first goal was to evaluate the role of dignity within current hospital environments, and how a strategy to increase patient dignity could be developed based on those findings.

My main focus was on current hospital gowns and the ways they

6

Introduction

fail to provide dignity and comfort for hospital patients. I also paid great attention to the technical aspects of hospital gowns, and spent time learning about the materials used to produce them, as well as the methods used to launder and distribute them. Knowing about the costs and materials associated with current hospital gowns will help to make a new design viable within existing hospital environments.

Many of the journals and studies that I have collected focus on how different manufacturing techniques and fabric types affect the gown’s ability to resist the growth of pathogens. These studies were invaluable when it came to learning about how hospital gowns are built to defend against contamination. My primary goal is to create a hospital gown that preserves dignity through its form and style.

However, ensuring that the new design effectively blocks infection will be important as well.

BN O

G

U

N PE O

T EN

G

IN

CT RI ST N CO

CI FI

S LY

U

IO

X O TE A H

EF IN

7

ABOUT MY WORK PROCESS Research phase planning To approach a solution to this problem, I investigated a combination of secondary and primary sources, as well as evaluations of existing gown designs. Secondary research consisted of previously written materials, primary research consisted of interviews with various people, and gown evaluation consisted of personal benchmarking as well as observations of other people using hospital gowns.

Based on information gained from these various sources, I determined that it would be necessary to keep three constraints in mind when designing a new hospital gown: a new gown design must be functional in the eyes of medical professionals, feel comfortable on the bodies of patients, and be viable to manufacture and purchase in mass quantities.

Ideation of new gown designs was informed by the recorded user experiences of those testing existing gown designs, and was also informed by current technical

8

Introduction

and cost limitations. Any new gown pattern should integrate features that will increase the comfort of whoever wears it, but will also need to be cost effective and be usable on a variety of different body types.

Prototyping of new gown designs started with basic sketches, followed by the generation of a pattern piece whose dimensions were informed by existing gown patterns. After cutting the pattern piece from a piece of plain muslin, the pattern is then sewn and any hardware (ties and snaps) are added. User testing was used to determine which parts of the prototype needed to be modified.

Research timeline - 2015 September 1 Sep 1 – Sep 13 Initial concept ideation and research

Sep 14 – Oct 4

October 1

Secondary research (data, journal, and book collection)

Oct 5 - Nov 1 Primary research (planning, interviews, cost data collection)

November 1

Nov 2 - Nov 22 Evaluation and prototyping (test planning, gown analysis)

December 1

Nov 23 - Dec 18 Data consolidation and writing (book organization, formatting)

January 1

9

Prototype production planning Prototype development consisted primarily of feature and material experimentation.

After collecting data about hospital gowns and learning about the sewing process, I felt prepared to begin the final prototyping process. Compared with the research phase’s tightly scheduled nature, the prototyping phase was a bit more free-form and loose. During the final phase of the project, I focussed on the creation of usercentered designs.

The majority of this phase was spent designing pattern pieces, sewing them together, and testing their efficiency. This also included ideating new gown features to be added. I also used this time to finalize the planning for what my deliverables would be at the end of the project. Once I gained a general idea of what I wanted to make for my deliverables, finishing my thesis became fairly straightforward.

Finally, I gave myself time at the end of the semester to collect, organize, and document my work in preparation for future interviews and presentations.

10

Introduction

Prototyping timeline - 2016 January 1

Jan 1 – Jan 31 Prototype / feature experimentation

February 1 Feb 1 – Feb 15 Begin ideating final prototype gown designs

Feb 16 – Feb 30

March 1

Researching the needs of three primary patient types

Mar 1 – Mar 15 Plan out final three gown prototype designs

April 1

Mar 16 – April 15 Final gown prototype production

April 17 – May 1

May 1

Documentation and organization

11

Section 2

HISTORY OF THE HOSPITAL GOWN

HISTORY OF HOSPITAL GOWNS

Evolution of the hospital gown (or lack thereof) Humans are living longer and leading healthier lives now more than at any other point in history, and it’s all thanks to the many medical advances that have been made in the past few centuries. Advanced hospital equipment has made surgeries safer and faster, while more intelligent practices have reduced the spread of sickness within intensive care environments. However, despite the many changes to how healthcare is administered, not much has changed in the realm of patient comfort – especially with regards to hospital gown design.

The hospital gowns used today are virtually identical to the ones used 100 years ago. The current designs seem to be derived from the nightshirts that were given to patients in the late 1800s, and incorporate features that made it easier for doctors to treat their patients. However, many of these features sacrifice patient dignity, and often only help doctors in minimal ways. With fewer limitations in sewing technology, along with a more advanced sense of fashion trends, it should be possible to create a new design that better facilitates patient/doctor interactions, and also preserves a patient’s sense of dignity and modesty.

14

History

Modern hospital gown designs evolved out of the nightshirt garb that was used by hospitals 100 years ago.

Pictured here is a hospital gown from the beginning of the 20th century. Its overall design is very similar to the hospital gowns used today.

15

Why haven’t there been any major changes?

The reason behind the lack of innovation in hospital gown design is unclear.

Since patients who are being treated in hospitals often have to face such stressful situations, their focus is not usually on what they are wearing but rather on what steps they must take to improve their health. As a result, they may not be consciously thinking about how uncomfortable their gown is, resulting in fewer complaints about the provided patient clothing. However, there is a clear lack of satisfaction with current gown designs: ask anyone who has had to spend time as a patient in a hospital, and you will likely hear very few positive comments about the provided clothing. Essentially, the hospital gown is a product that no one is happy with. This means that hospital gowns are the perfect target for a redesign.

16

History

Patients often have to deal with stressful situations in hospital environments, and may not be consciously aware of how an embarrassing gown is affecting their psyche.

17

RECENT INNOVATIONS

Diane von Furstenberg’s hospital gowns On the whole, hospital gowns in most hospitals seem to be as poorly designed as they were a century ago. However, there have been several recent, small-scale attempts to create a more dignified gown design within a handful of hospitals.

The prolific fashion designer Diane von Furstenberg took a stab at creating a new and improved hospital gown. Furstenberg is known for her stylish wraps and detailed textile designs. Her design utilized a side opening instead of a completely open back, and featured colorful prints that helped give the gown a more inviting look. Furstenberg’s design is a step in the right direction, but still only addresses a limited number of design problems.

18

History

Furstenberg’s gowns offer patients more options and improved designs, but don’t address many of the larger issues that plague current patient gown designs.

19

The Ford Institutes’s “Model G�

The Henry Ford Innovation Institute recently collaborated with Carhartt to design and manufacture an improved hospital gown design. The resulting design certainly addressed some of the main weaknesses of current gown design, but left many others unaddressed. Its cut is also fairly unflattering, and the design could go further towards preserving patient dignity. Most importantly, the gown design has been implemented in only a small handful of hospitals; the majority of hospital gowns still use the embarrassing, undignified open-back design.

Despite these individual attempts to design a better hospital gown, no solution has been effective enough to be utilized across the majority of healthcare environments.

Furthermore, most of these designs only address surface level concerns, and fail to properly assess the human usability of the gown. By taking an in-depth look at the sources of discomfort felt by wearers of modern hospital gown designs, it should be possible to create a new design that preserves patient dignity more efficiently.

20

History

The Ford Institute examined the doctor/patient relationship to inform the design of their gown. Unfortunately, their design only addresses a small number of hospital gown issues. Additionally, it is not widely available.

21

Section 3

BACKGROUND DATA

Blood strike-through value One of the main purposes of a hospital gown is to protect users from airborne diseases. Depending on the type and make of a gown, its ability to protect against disease may vary. Blood strike-through refers to the passage of disease-carrying blood through protective material. Hospital gowns can be judged on their ability to protect against blood strike-through.

Tulane University conducted a test that measured the blood strike-through value of three different kinds of hospital gowns. They tested a disposable cover gown, a brand new reusable gown, and a previously used and laundered reusable gown.

Surprisingly, the disposable cover was shown to have the greatest blood strikethrough protection, followed by washed reusable gown, and then the new reusable gown. It should be important to keep this in mind: just because a material is more worn does not necessarily mean that it has diminished protection capacity.

24

Background Data

(Granzow, Smith, Nichols, Waterman, & Muzik, 1998)

25

Buurman’s user-centered design process Keeping the user-centered design process in mind when producing these gowns will be very important. Since my goal is to make a hospital gown that preserves the dignity of its users, their needs must be put front and center. Buurman’s design process involves gathering information about users and context, and refinement over several iterations.

This process especially makes sense for the creation of a new hospital gown design.

Small improvements will build over many iterations of the same product, eventually resulting in a gown that is truly built around the needs of users.

26

Background Data

(Buurman, 1997)

Problem analysis criteria List of criteria

Main problems, functions and structures, principles, concepts Concepts/sketches

Over-all form refinement

Observation; testing

Preliminary design model/dummies

Optimization, cost price, description

Observation; testing

Design/prototypes

Detailed engineering production

Observation; testing

Realization

27

Framework for functional hospital gown design Even though I am not including patient or doctor feedback in my project right now, the following framework provides a nice set of guidelines to keep in mind when developing hospital gown designs. Cho essentially took Buurman’s user-centered design framework and adapted it for use in the creation of a hospital gown.

Following this framework in a general sense will allow me to create an organized road-map towards finalizing a user-centered hospital gown design.

28

Background Data

(Cho, 2001)

Problem acknowledgment Exploration of user-situations Literature search

Site visit

User interview: patient

Market research

Needs assessment Literature search

User interview: patient, nurse, doctor

Design criteria development

Ideation and selection Conventional clothing analysis

Garment development

Ideation and selection Conventional

Prototypes

Design guideline development

29

Enhancing end users’ satisfaction In a follow-up study, Cho looked at the reactions of several test participants to different varieties of hospital gowns. At the end of the study, she established a set of guidelines for the purpose of developing better hospital gown designs. The guidelines are based off the results of her study, and are informed by the reactions of the test participants from said study. These guidelines will be hugely helpful due to the fact that they are informed by user testing.

30

Background Data

(Cho, 2006)

The following design guidelines are recommended for hospital gowns: a

All design features should accommodate activities in lying as well as standing and sitting posture

b

The location of openings in a hospital gown should be featured to provide the wearer with privacy and dignity (body exposure from openings should be minimized and should be considered in moving and lying as well as in a stationery posture)

c

Openings and fasteners in the hospital gown should be easy to reach and to open for the convenience of donning and doffing (the front was found to be a better location to place openings and fasteners than the back)

d

Fasteners on a hospital gown should be easy to grip and to manipulate

e

Fasteners should not create any sensorial discomfort in sitting and lying postures

f

The seam finish used in the hospital gown should not create fabric thickness

31

Patient’s perceptions of using a “breast gown” This study looked at a small group of cancer patient’s perceptions on using a breast gown. During the study, the group was asked to identify themes of importance to them. Half the group identified dignity (the focus of this project) as an important theme, however more people identified choice as an important theme. To me, this indicates that it might be important to integrate some form of modularity or customization into the new hospital gown design.

32

Background Data

(McLean & Hodgson, 2006)

Identified themes

Number of patients (%)

Dignity and privacy Exposure Choice Patients emotions Possession and attachment

50 70 70 40 50

33

Section 4

INTERVIEWS AND ANALYSIS

ANN SEDORE INTERVIEW Background Ann Sedore is the Chief Nursing and Clinical Services Officer at Crouse Hospital in Syracuse. She holds a PhD and an RN, and used to be a practicing nurse. In addition to overseeing all of Crouse’s nursing services, she also is responsible for the rehabilitation, pharmacy, respiratory therapy, and radiology departments.

She is responsible for keeping their services and technology up to date based on information extrapolated from medical journals.

Crouse’s new ED Dr. Sedore and I spent some time talking about Crouse’s plans to renovate their Emergency Department. She talked a lot about the different kinds of experts needed to plan different aspects of the renovation. Emergency department experts, who have studied how new spaces should be designed, collaborate with facility experts and architects to create designs for the new spaces. There is also a patient advisory group that provides input about the strengths and weaknesses of these new design ideas.

I asked Dr. Sedore about whether or not a revised gown design had been considered along with this renovation. She responded that most hospitals choose to focus on environmental factors such as architecture and building management during renovations and area redesigns. Things such as hospital gowns and patient clothing are not usually considered as a candidate for redesign in most hospitals.

36

Interviews

Even when renovating sections of their facilities, hospitals rarely consider hospital gowns as candidates for improvement. They are generally more focused on making architectural changes.

37

Talking about hospital gown design One reason for the open back is that the gown material gets bunched up when patients lie on their back, which creates pressure points on the skin of the bedridden patient. The pressure can affect patients with sensitive skin, and create sores. By leaving the back open, the fabric is less constrained, and therefore less likely to become bunched up when a patient lies down.

The snaps along the sides of hospital gowns are mostly used to fix various tubes and wires into place.

Dr. Sedore noted that the costs of the hospital gowns are included with linen costs. This may be another reason that not many hospitals have attempted to improve their gown designs. Many hospitals are actually fairly removed from the process of choosing their gown designs. In Crouse’s case, the gowns are provided by an external company called Clarus that is also responsible for laundering them.

This means that Crouse’s choice for hospital gown designs is limited to whatever selection the laundering company has provided.

38

Interviews

Dr. Sedore noted that hospital gowns are designed for bedridden patients who are extremely debilitated, but not for patients who are able to move around on their feet. In other words, they are designed for worst-case scenario patients but not for ones in better health. Nurses will often give patients who can stand and walk pants, although this can be difficult too, since patients getting up for the first time in a while may be unstable.

Dealing with bariatric patients (obese people) is also a difficulty.

It is important to note that having many different options of hospital gowns for a single hospital is likely to increase costs. The double hospital gown technique used by some nurses is an attempt to create a makeshift robe with the available resources (since there is not currently such a thing as a hospital robe). Marketing robes (robes that have the hospital’s logo embroidered on it) can be used as a possible way to decrease costs through advertising.

Hospital gowns are designed primarily for bedridden patients, with very little consideration for patients who are able to walk. They also do not account for patients who are transitioning from a bedridden to an ambulatory state.

39

Analysis The most important point that Dr. Sedore brought up was the fact that current hospital gowns are really only designed for bedridden patients. This means that ambulatory patients are not considered when creating a gown design. To me, this is a highly questionable mindset. Hospital gowns should help patients transition from sickness to health, instead of reducing their dignity once they become able to walk.

40

Interviews

Key insights

• Many hospitals do not actually have any control over what variety of hospital gown is available to them • The selection is often decided by the laundering company that provides the gowns for the hospital • The hospital gown’s back is open to prevent fabric bunching, which can irritate the skin of more sensitive patients • Hospital gowns are usually designed for the worst-case scenario patient, and do not facilitate the transition between bedridden and ambulatory states • Any sort of variety in terms of gown options will increase each unit’s price • Using branded hospital gowns can be a way to offset manufacturing costs

41

NANCY WILLIAMS INTERVIEW Background Nancy Williams is the director of patient and guest relations at Crouse. Her job is to keep in touch with the patient experience within the hospital, and address any needs or concerns the community may have. She facilitates a council of community members which helps her learn about what improvements are needed from the hospital. Speaking broadly, her main function is to figure out what patients want from their healthcare experience.

Gown problems As a registered nurse, Williams has been around hospital gowns for a very long time and has seen how uncomfortable they can make patients. She talked about the double gown solution – where a nurse would give a patient two gowns to wear at the same time, essentially creating a robe. The double gown method is a workaround that deals with the embarrassing open back of most modern gowns.

The shortness of the gown is also a weakness, as the gowns ride up on patients’ bodies when lying down in bed, resulting in an uncomfortable level of exposure.

Hospital gowns also do not currently accommodate the needs of religious people, such as Muslim women who wear hijabs.

A new gown design would need to work for people of all body types, and also address different cultural sensitivities. It would need to encourage movement, and help patients transition between different levels of activity. Also, the material would need to be fairly durable: most hospitals launder their gowns which get more worn down with every wash cycle.

42

Interviews

The fact that so many hospitals utilize the “double gown� strategy to provide patients with greater coverage shows that there is a serious problem with current hospital gown design. The strategy works but seems very inefficient.

43

Hospital gowns and viability Williams seemed excited at the possibility of a hospital gown redesign. She noted that despite the recent attempts at the creation of a better hospital gown design, an improved design had not caught on.

She emphasized the importance of making the gown user-friendly, costeffective, and clinically sound.

A surprising fact she shared was that while there had been some advancement in the realm of hospital bed linen material engineering, the same sort of improvement could not be seen in the realm of hospital gown materials. She gave the example of blanket warmers which have started to become increasingly common in hospital environments.

Williams discussed the Furstenberg design and conveyed how it was an improvement over other gowns. Aside from the use of nicer-feeling material and more colorful patterns, the Furstenberg gowns took into account patients who needed to expose certain parts of their body. For example,

44

Interviews

the gown allows for a healthcare professional to provide a sponge bath in bed to the patient without the complete removal of the gown. This allows the worker to access specific parts of the body without completely exposing the patient.

Nancy talked about how Crouse had started to consider a gown redesign around the time that Furstenberg collaborated with the Cleaveland clinic. The hospital chose not to pursue a redesign, citing the increased cost of the newly designed gowns. However, Williams did say that considering the current poor state of hospital gown design, many hospitals may be willing to consider a more expensive gown.

She also mentioned that a Syracuse fashion student had looked into doing a hospital gown redesign as a project some years ago. Unfortunately, I have not been able to find any information about this project.

A good hospital gown design should allow healthcare professionals to access most parts of a patient’s body without forcing them to completely disrobe.

45

Analysis I think Nancy’s point about the lack of a robe option was very interesting. Since the double hospital gown solution can be seen in so many hospitals, there is a palpable desire for a robe-like hospital gown in the healthcare community. It isn’t clear why this niche has not yet been filled, but it might be a good idea to think about integrating a robe design into my main design.

46

Interviews

Key insights

• Hospitals often use two gowns to cover one person to create a makeshift robe • Despite the obvious need for a robe-like hospital gown, no such product is offered on the market • Doctors often need to access specific parts of their patients’ body, and a good gown design might let them do so without forcing the patient to disrobe • Additionally, a new gown design could offer religiously sensitive variations • Given the current poor state of hospital gown design, hospitals may be willing to pay more for an improved design

47

ANGEL ASHLEY INTERVIEW Background I spoke with Chris Scribner, who handles the purchase and circulation of linens and hospital gowns at Crouse. He put me in touch with Clarus Linen Systems, the company that Crouse uses to clean their hospital gowns. This company handles the linens for over forty hospitals and nursing homes. At Clarus, I spoke with Angel Ashley, the operations manager for the plant in Syracuse. Angel’s main job at Clarus is to handle inventory flow and make sure that the volume of hospital gowns coming in and out of her facility is enough to meet the local hospitals’ needs.

Hospital gown circulation and wear Clarus Linen Systems does not produce their own gowns, and instead buy from a separate manufacturer.

Clarus places employees in many of the local hospitals who are responsible for receiving shipments of laundered gowns and circulating them throughout the facility. After receiving the gowns from the manufacturer, Clarus launders and packages the gowns. They are then transported via truck to the hospital, where the workers unpack the gowns and distribute them to the floors that need to be restocked.

Angel estimated that most gowns have a lifetime of about thirty washes, at which point they begin to deteriorate.

Certain factors can decrease that

48

Interviews

lifespan. For example, doctors will often leave pins in the gowns which may create rips and tears earlier on.

The person who receives the gowns to place into the folding machine is the one who inspects the gowns for damage. If the worker notices that the gown has rips or tears, she will send the gown to a mending area. Gowns that are stained get washed through a chemical formula to disinfect the material and remove any stains. If a gown cannot be mended and is deemed unusable, the material will be sent to a rag distributor. The gown material will often be donated to various animal shelters around the area to be used as bedding.

Clarus employees receive shipments of soiled linens from local hospitals.

Workers launder and package the linens, and send them into circulation.

The employee who loads the gowns into the folding machine is the one who examines the material for stains or rips.

49

Analysis Learning about Clarus’ operations provides some useful information to keep in mind when choosing materials to use for a new gown design. The material should be able to survive at least 30 washes without deteriorating. Additionally, it would be worth finding out exactly how doctors are modifying the gowns so that the features they want could be implemented in a way that would not decrease the lifespan of the hospital gown.

50

Interviews

Key insights

• The average hospital gown has a life of about 30 washes • Doctors sometimes make modifications to the gowns that can cause damage (like inserting pins to hold a tube or wire to the gown) • A worker at the Clarus plant is the one who decides whether or not gowns are of a good enough quality to return to circulation • Clarus will attempt to mend ripped gowns, or wash stained ones • Gowns that cannot be mended are sent to a rag distributor

51

Section 5

USER TESTING

ANALYZING EXISTING GOWNS

Figuring out what needs to be changed After the bulk of my research was completed, I turned my focus towards the testing and prototyping process. In order to understand what improvements should be made, I began by purchasing several existing hospital gowns. I also obtained the hospital gown design that is currently most widely used throughout local hospitals. This gown, which is manufactured by Fashion Seal Healthcare, is a good representation of the hospital gown you would be given while being treated at a local Syracuse hospital.

For the first round of testing, I simply had a user wear the Fashion Seal hospital gown model. I had him perform various tasks that a patient might need to deal with, and photographed his progress through the tasks. I made personal observations of the gown’s effect on his movements, and also asked him to relay his personal thoughts to me.

54

Prototyping

Pictured is the Fashion Seal manufactured hospital gown that was analyzed during this test.

The gown uses side ties in an attempt to keep the backside of the gown mostly hidden.

55

Testing This test had two main goals. Obviously, I wanted to gain some insight into the functional problems that plague current hospital gown designs. However, I also used this test to better understand which testing methods would be more or less effective. By paying attention to my own reactions during the test, I was able to figure out how to more efficiently interact with the test subject. By taking these observations into account, I was able to refine both the hospital gown design, and my own testing process.

Feedback Nicholas, whom I had chosen as my subject, was very communicative about which parts of the gown made him uncomfortable. By communicating with Nicholas through the testing process, I gained some insight into which specific parts of the gown-wearing experience were undesirable.

56

Prototyping

My classmate Nicholas agreed to help me perform this test. I observed Nicholas and noted how the gown affected his behavior and movement.

I had Nicholas perform activities that patients have to deal with in hospital environments.

57

Observations • Nicholas thought that the gown had the overall feeling of a large, flowing dress • He had a natural tendency to flatten the gown beneath legs when sitting down • Nicholas felt a sense of relief when putting his normal clothes back on • He did not realize how uncomfortable he was until he changed back to normal clothes • He felt the same as when he put his clothes back on after a doctor’s appointment

58

Prototyping

It took some time for Nicholas to figure out why the gown had multiple ties

The gown did not initially feel cold, but became more uncomfortable as drafts of air could be felt through the gown The side ties stress the fabric in a certain direction, making the gown feel “uneven� as if it is leaning across the body in a strange way The gown felt loose when standing, but became tight around the legs when sitting down

Nicholas had a tendency to tug at the neck area of the gown When putting on the gown, it was not immediately obvious which side was front or back

Nicholas noted that the most uncomfortable part of the experience was the removal of his shoes due to how strange the floor texture felt on his bare feet

59

INITIAL PROTOTYPE TESTING

Collecting participant feedback Observing Nicholas gave me some new insights into the negative aspects of current hospital gown designs. For my first prototype, I made a simple gown that facilitated the data gathering process. I sewed a new hospital gown that was identical to the Fashion Seal gown, but used plain white material instead of patterned cloth.

This white material enabled test participants to draw directly on the gown using a sharpie marker, allowing them to mark up the sections of the gown that proved to be most problematic. The marked up gown provided a visual map that would inform my next set of gown redesigns.

To get feedback written on this design, I had a single user wear the gown while other people in the group commented and marked notes directly on the gown. By observing how participants interacted with the gown user, I hoped to learn about whether or not this would be a viable way to get feedback about gown designs.

I also tried to gauge whether or not this would be a good way to visually see the changes that should be made in future gown design iterations.

60

Prototyping

I disassembled the Fashion Seal gown to replicate its pattern piece. After using the pattern to figure out the gown dimensions, I cut and sewed the new gown using plain white muslin material.

61

Group testing When used in a group setting, the mark-up gown received a lot of comments and participants were very active in making notes directly on the gown. Both the wearer of the gown and the people around her were able to make comments about which parts of the design were successful and which parts failed. Being able to write on the gown allowed participants to respond quickly and directly to the user’s verbal comments. Comments were shorter and more concise, since participants did not have to actually write out which part of the gown they were referring to.

One possible way to improve this prototype would be to have several people in mark-up gowns interacting with each other. This way, they could draw notes on each other’s gowns. By providing different participants with different pattern variations, I would be able to gauge which gown patterns were more effective at preserving dignity for the user.

62

Prototyping

63

Observations • Observers of the gown immediately noticed its less desirable aspects • They were quick to mark which parts of the gown seemed the most uncomfortable • The wearer of the gown was also quick to verbally note design flaws • Since they were wearing the gown, they were not easily able to mark up the cloth • All participants wanted to see more pattern piece variations

64

Prototyping

“This area is pressing up against her back”

“Is this the best shape for the collar?”

“Arm openings feel very loose”

“The neck opening is very long”

“Should the ties have straps?”

“The gown feels tight underneath the arms”

“Could the gown have a removable bottom?”

Flattened mark-up gown

65

CREATING PATTERN PIECES

Pattern production I planned the patterns with purely analog techniques. Using the original Fashion Seal gown pattern as a base, I traced, retraced, and cut new pattern pieces. By using simple tracing paper, I was able to mix and combine patterns to create new results.

After creating various patterns, it was a simple (though fairly laborious) matter of sewing everything together and adding any necessary features, such as snaps, ties, slits, and darts.

66

Prototyping

67

Planning a new pattern The previous two tests allowed me to gather some data about what problems people have with hospital gowns. For the next prototype, I attempted to create a new pattern piece that addressed some of these issues.

This new gown design possesses a smaller neck opening, which many test subjects felt was overly large. This design also has looser arm openings, which previous subjects thought felt very tight and constricting.

While I was hoping to create a new hospital gown that improved upon the Fashion Seal design, I also viewed this prototype as an opportunity to learn about the challenges associated with pattern modification. Becomming a better sewer at this stage helped me produce prototypes and gown featres at a much faster rate later on in the project.

68

Prototyping

Original Fashion Seal pattern

User has more room to move their arms

A smaller neck hole leaves less skin exposed

Modified pattern piece 69

Sewing result The resulting hospital gown did a good job of addressing the two issues I was trying to solve. I also decided to add slits in the sides of the bottom area to provide more freedom for the user’s leg movement. Sewing the modified design gave me a good sense of how small pattern piece changes can drastically alter the feel and fit of a gown. Obviously, this represents a very small modification. However, by making only small changes to each new iteration, it becomes easier to ensure the efficiency of every additional feature.

By adding incremental features with each new design iteration, and then testing those new gown designs on users, I quickly determined the efficacy of several potential features. Like the previous tests, this process should allow me to improve both the testing process and hospital gown pattern designs with each new iteration.

70

Prototyping

Original Fashion Seal gown

Modified gown

71

72

Prototyping

Section 7

FINAL PROTOTYPES

71

PROTOTYPE FEATURES

Explanation of gown prototypes To provide a physical roadmap of how hospital gown design can be improved, I produced three prototypes that introduce features specialized for different kinds of situations. The three prototypes are respectively intended for use by ambulatory patients, recovering patients, and bedridden patients.

Each gown has a pattern and color that corresponds to its intended context. This allows doctors to easily identify what level of care a patient should be treated with, or inW which department of the hospital they are staying.

72

PROTOTYPES

73

AMBULATORY GOWN Patient Types

Patients who have mostly recovered or are receiving less invasive surgeries

Environment

Intended for use during cosmetic surgeries or surgeries not taking place near the torso

Priority

Emphasis on patient comfort and privacy

Shoulder area of pattern is produced with a softer flannel material than the rest of the gown.

74

PROTOTYPES

Tie holes allow for gown belts to be tied around the front of the body, resulting in greater back coverage and overall fit.

Single snap ensures further back coverage, while also allowing doctors to access the area when necessary.

75

FRONT

Softer flannel material is used to provide greater comfort to the patient’s shoulder and back areas The soft, blue color was chosen to indicate to doctors that patients wearing this gown type are ambulatory and at less of a risk Front wrapping ties are easier for patients to manipulate, and also result in a more fitting form

76

PROTOTYPES

BACK

Single snap ensures a comfortable fit and form for most patients, and also provides greater back coverage

Side holes allow ties to wrap around the front of the gown

77

TRANSITIONAL GOWN Patient Types

Patients who are transitioning from a bedridden state to an ambulatory one

Environment

Intended to be used after a surgical recovery period has passed

Priority

Slits sewed around the bottom of the gown allow for greater leg movement then current gowns.

78

PROTOTYPES

Emphasis on flexibility, efficiency for many different body types, and ease of use

Flannel pattern sewed into the front of the gown is meant to subtly guide patients during the belt tying process.

Multiple snap locations allow for a good fit across many different body types.

79

FRONT

Collar shape is meant to provide privacy while also allowing doctors to access the shoulder and chest areas

Waist level pattern is designed to guide patients during the wrap tying process

80

PROTOTYPES

BACK

Multiple snaps allow the gown to fit many different kinds of body types

Second set of side holes allow patients to use the ties like a normal gown or around the front like a bath robe

Slits cut around the bottom of the gown result in a greater range of leg movements for patients

81

INTENSIVE CARE GOWN Patient Types

Bedridden patients who have just had surgery and are beginning the recovery process

Environment

Intended for use just before and after an invasive surgery

Priority

Use of softer, flannel material around the side and back areas ensure more comfortable sleeping positions.

82

PROTOTYPES

Emphasis on bed comfort and providing doctors with easy access to parts of the patient’s body

Shoulder slits combined with snaps allow doctors greater access to the neck and shoulder areas.

Tie placement allows for gown to be tied similar to a traditional hospital gown, or around the front like a bathrobe.

83

FRONT Top snaps allow doctors to access the patient’s back and shoulder areas

Use of bright red fabric is meant to communicate to doctors that patients wearing this gown need intensive care

Use of softer fabric on the sides ensures that patients will be comfortable when sleeping on their sides

84

PROTOTYPES

BACK

Use of diagonal back ties ensures both back coverage and limited skin irritation

Tie can still be wrapped around the front of the gown for when the patient begins to start walking again

85

Section 7

CONCLUSIONS AND WHAT’S NEXT

CONCLUSION

What have I learned from this project?

Even though I had suspected a general lack of reverence for the hospital gown, my research revealed just how widespread the public’s hatred of current gown designs truly is. The hospital gown is a flawed product that no one is happy with, yet there have only been a few attempts to fix it. It may not be possible to create an improved hospital gown that can be produced at the same cost as current gowns, however hospitals may be willing to pay the extra amount for the promise of improved patient relations.

Alternatively, it may be possible to get new gown designs into hospitals by selling them through the laundering services they utilize. Many hospitals do not launder their own linens, instead choosing to outsource that work to a different company.

Since hospital gowns are often provided by these companies to the hospital, convincing these laundering plants to offer more premium options may be the most efficient method of circulating a new design.

88

Conclusion

Learning about how to cut and sew fabric enabled me to produce new hospital gown design prototypes.

89

Experiencing growth as a designer Compared with the previous projects that I have worked on, this thesis was comparatively self-driven. Unlike previous assignments, I had to define most of my own goals and due dates. While this was incredibly intimidating at first, I soon learned that this level of flexibility was hugely beneficial. Being able to work at my own pace and control how much time I spent on specific parts of the project helped to make everything more cohesive and structured.

Aside from developing a more disciplined work ethic and improved organizational habits, I gained a number of great practical skills. Learning about sewing as a prototyping process was an eye-opening experience, and I definitely plan on incorporating soft goods into future projects. Figuring out how specific pattern features affected the gown fabric was a frustrating, but ultimately educational experience. Learning about hospital gowns has also made me much more interested in the larger world of medical product design.

90

Conclusion

Colors were used on the final prototypes to indicate the patient condition severity.

91

WHAT’S NEXT

The future of hospital gowns?

While my project was very user-focussed, I did not spend much time thinking about the financial aspects of the prototype design, nor their manufacturing viability. If this project were to exist in a real-world setting, considerations would need to be made with regards to production and material choice.

Ideally, at some point I would like to meet with a person who posesses experience in business and economics. I would like to have a discussion about the viability of this project in the real world, and what steps I should take to make it possible.

Additionally, I think it would also be important to meet with a materials engineer who is more familiar with the difficulties of softgoods production.

I do not know if I will ever get the chance to expand this project. However, I hope that at the very least, my prototypes may begin a discussion about the role dignity plays in hospital environments, and how it may be improved through better design.

92

Conclusion

In the future, I would like to meet with people from other disciplines to discuss the viability of improved gown production.

93

APPENDIX Interviews Interview with Ann Sedore - 10/13/15, Crouse Hospital Interview with Nancy Williams - 10/27/15, Crouse Hospital Interview with Chris Scribner - 11/2/15, Crouse Hospital Interview with Angel Ashley - 11/6/15, Clarus Laundering Plant

Studies and articles about hospital gowns Belkin, N. (1999). Evaluating the protective value of hospital gowns. American Journal of Infection Control, 27(2), 178-179.

Birmingham Children’s Hospital gown gives “privacy and dignity” (2013, March 27). Retrieved September 27, 2015.

Blakemore, S. (2009). Praise for revolutionary hospital gown made in HCA’s back room. Nursing Standard, 23(43), 9.

Cho, K. (2001). User-centered design and evaluation of functional hospital gowns (Order No. 3019352).

Available from ProQuest Dissertations & Theses Global. (304698816).

Cho, K. (2006), Redesigning Hospital Gowns to Enhance End Users’ Satisfaction. Family and Consumer Sciences Research Journal, 34: 332–349.

Granzow, J., Smith, J., Nichols, R., Waterman, R., & Muzik, A. (1998). Evaluation of the protective value of hospital gowns against blood strike-through and methicillin-resistant Staphylococcus aureus penetration.

American Journal of Infection Control, 26(2), 85-93.

Hospital gowns that match skin tones could help detect symptoms. (2010, June). Healthcare Purchasing News, 34(6), 18.

Kostelnick, C. (2015). Mosby’s Textbook for Long-Term Care Nursing Assistants (7th ed.). London: Elsevier Health Sciences.

McLean, M., & Hodgson, D. (2006). Cancer patients’ perceptions of using a “breast gown”: A qualitative study.

Journal of Radiotherapy in Practice, 5(2), 97-107.

Sherritze, S. (2015). Chipping Away at Antibiotic Resistance, Hideous Hospital Gowns, and Other Health Care Woes. P&T Community, 40(5), 304-305.

94

Conclusion

Studies and articles about hospital environments Douglas, C. H. and Douglas, M. R. (2004), Patient-friendly hospital environments: exploring the patients’ perspective. Health Expectations, 7: 61–73.

Franklin, S., Thijs, L., Hansen, T., Li, Y., Boggia, J., Kikuya, M., . . . Staessen, J. (2012, January 17).

Significance of White-Coat Hypertension in Older Persons With Isolated Systolic Hypertension. Retrieved September 27, 2015.

Gupta, S., Grant, S., Chandrashekhar, R., & Satpathy, S. (2007). Modern Trends in Planning and Designing of Hospitals: Principles and Practice. New Delhi: Jaypee Brothers Medical.

Lin, Y., Watson, R., & Tsai, Y. (2013). Dignity in care in the clinical setting: A narrative review. Nursing Ethics, 20(2), 168-77.

Ulrich, R., Quan, X., Zimring, C., Joseph, A., & Choudhary, R. (2004, September 1). Role of the Physical Environment in the Hospital of the 21st Century. Retrieved September 27, 2015.

Webster, C. and Bryan, K. (2009), Older people’s views of dignity and how it can be promoted in a hospital environment. Journal of Clinical Nursing, 18: 1784–1792.

Gown design patents Bolla, Leela R. (2011). U.S. Patent No. 20120204317. Washington, DC: U.S. Patent and Trademark Office.

Morrison, Willard L. (2003). U.S. Patent No. US4401712. Washington, DC: U.S. Patent and Trademark Office.

Neal, Jay G. (2003). U.S. Patent No. US6694522. Washington, DC: U.S. Patent and Trademark Office.

Obtained materials Upstate hospital linen unit cost sheet - Obtained from Chris Scribner Luner Deluxe Cut Hospital Gown - Ordered from Amazon Smart Hospital Delivery Gown - Ordered from Amazon Vetmed Classic Patient Hospital Gown - Ordered from Amazon Fashion Seal Standard Hospital Gown - Obtained from Clarus laundering plant

95

PHOTO CREDIT Front and back cover ronjoe. (Creator). Vector Illustration of Hospital Gown [digital image].

Retrieved from http://depositphotos.com/29844191/stock-illustration-vector-illustration-of-hospital-gown.html Eric Gevaert. (Creator). Vector halftone dots [digital image].

Retrieved from http://www.dreamstime.com/stock-images-vector-halftone-dots-image2971394

Introduction section Dan Page. (Illustrator). Hospital gown illustration [digital image].

Retrieved from http://alcalde.texasexes.org/healthcare/

History section Hospital ward [digital image]. Retrieved from http://www.mansfieldadvisors.com/biographies/ A woodcut of medical treatment by the order of St. John [digital image].

Retrieved from http://stjohnambulancewestbengal.org/history.html Early 20th Century Hospital gown [digital image].

Retrieved from https://ehive.com/account/3009/object/120511 Hospital labor delivery mom [digital image].

Retrieved from https://pixabay.com/en/hospital-labor-delivery-mom-840135/ Furstenberg hospital gown [digital image].

Retrieved from https://www.washingtonpost.com/national/health-science/a-new-unusual-diane-vonfurstenberg-gown/2015/03/30/0e9a626e-d313-11e4-8fce-3941fc548f1c_story.html Model G Hospital Gown image [digital image].

Retrieved from http://www.henryfordgalleries.com/Newsroom/Model-G/%20/

96

Conclusion

Interview section Nurses Station, Emergency Department, Rideout Regional Medical Center [digital image].

Retrieved from http://www.skwarchitects.com/portfolio/healthcare-and-research/emergency-departmentexpansion-rideout-regional-medical-center Brian Tietz. (Photographer). Michael Morgan bedridden [digital image].

Retrieved from http://usatoday30.usatoday.com/money/perfi/basics/story/2012-01-05/alimony-lawreform/52642100/1 Hospital gown [digital image].

Retrieved from http://drpaulgriner.com/no-man-is-a-good-doctor-who-has-not-been-sick-himself/ Giving a sponge bath [digital image]. Retrieved from http://www.wikihow.com/Give-a-Sponge-Bath UMMC’s laundry department [digital image].

Retrieved from https://www.umc.edu/News_and_Publications/Centerview/2012-07-23-02_Teamwork_keys_ UMMC_laundry_s_spotless_record_of_service.aspx Family-run dry cleaner [digital image]. Retrieved from http://imgbuddy.com/commercial-laundry-images.asp

Conclusion section Clothing production line [digital image].

Retrieved from http://www.haclothings.com/UpPic/20120802101110-12123341182.jpg

97

Can hospitals help patients feel comfortable with a more dignified medical gown design?