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QUT Designers in Healthcare - HEAL 2021 report

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Healthcare Excellence AcceLerator (HEAL) is a collaboration hub, co-led by the QUT Design Lab and the Healthcare Improvement Unit at Clinical Excellence Queensland over 2020-2021. HEAL is designed to act as a bridge between the QUT design and innovation community and Queensland Health, accelerating healthcare improvement efforts across the state.

This summary report outlines some of the key projects over 2020-21, and the impact of designers, working in collaboration with consumers and clinicians to transform healthcare.

Suggested citation: QUT Design Lab (2021). Healthcare + Design = Innovation. QUT

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QUT Designers in Healthcare - HEAL 2021 report

  1. 1. Acknowledgements Acknowledgements    At the outset, we would like to acknowledge the Turrbal and Yugara people, the traditional owners of the lands where much of this design-led research was conducted and the report written. We pay respect to their elders past, present and emerging, and extend that respect to other Australian Aboriginal and Torres Strait Islander people reading this.  Thank you to all the consumers who have engaged with us, so honestly and generously sharing their experiences, hopes and expectations for the future of healthcare. We would also like to especially acknowledge and thank the staff of CEQ, and the 7 Hospitals and Health Services across Queensland Health we have worked with over the past year - we have been fortunate to work alongside exceedingly smart, creative and committed people who share a passion to improve healthcare. We also thank and acknowledge CEQ, for funding and supporting HEAL 2020-2021. Suggested citation QUT Design Lab (2021). Healthcare + Design = Innovation. QUT
  2. 2. INSIDE
  3. 3. FOREWORD FOREWORD___________________________________________ ___________________________________________ 1 1 Designers as Agents of Change in Healthcare ....................... 4 Design Dictionary ......................................................... 12 PARTICIPATORY HUMAN CENTRED CO-DESIGN PARTICIPATORY HUMAN CENTRED CO-DESIGN __________ __________ 18 18 Virtual Outpatient Integration for Chronic Disease - VOICeD ... 2 0 Cancer Wellness ........................................................... 26 Stroke Network ............................................................ 30 DESIGN THINKING DESIGN THINKING ____________________________________ ____________________________________ 34 34 Co-designing a Healing Environment in the PICU .................. 36 The Pain Pressure Cooker: A Rapid One-Hour Co-design Sprint .. 42 PROTOTYPING PROTOTYPING ________________________________________ ________________________________________ 46 46 Protecting our Children: Co-Designing Child Friendly PPE ..... 48 Designing out Diabetic Foot Problems ............................... 52 A Pain Metric in Paediatric Admissions .............................. 56 Interactive CPR Manikin for Community Training ................. 60 DESIGN DOING DESIGN DOING _______________________________________ _______________________________________ 64 64 Journey to Fun: Playful Wayfinding and Placemaking at QCH ... 66 Improving Cultural Safety in Queensland Hospitals ................ 72 Increasing use of Interpreter Services at Metro South .............. 78 Reducing Urine Sample Contamination in the ED .................. 82 DESIGN VISIONING DESIGN VISIONING____________________________________ ____________________________________ 86 86 Delivering Virtual, Integrated Care in Central Queensland ............ 88 Connecting Rehab Services across West Moreton ....................... 92 Emergency Room Entrances and Exits .................................... 98 CEQ Project Management Framework 2.0 . ............................... 102 THE HEAL DESIGN TEAM THE HEAL DESIGN TEAM_______________________________ 105 105 FURTHER READING FURTHER READING ....................................................... 116 116
  4. 4. FOREWORD
  5. 5. It gives me great pleasure to write an introduction for the 2021 HEAL symposium report. This year’s HEAL Symposium marks a watershed moment for the story of Design in Healthcare – in Queensland and nationally. Less than twelve months into the first formal partnership of its kind in Australia, we now possess of a substantial catalogue of case studies that demand deeper integration of Design disciplines and expertise within healthcare. I say Design with a capital ‘D’ to signpost a key difference between the HEAL model and the more common usage of the term ‘design’ in healthcare. As an occupational therapist, I can vouch for the deep humanistic principles that many clinical colleagues abide by. Yet, there is often a chasm between a ‘co- design sympathetic mindset’ and actually executing well on these priorities.  As legendary designer and cognitive psychologist Don Norman wrote in The Design of Everyday things, “original ideas are the easy part. Actually producing a successful product is what is hard.” Whilst healthcare has steadily embraced the philosophy of co-design and there is growing familiarity with many design-led approaches - the HEAL model takes us into a far more innovative space. First, it recognises and works with the diversity inherent the creative design professions. Matching clinical improvement projects with identified specialists from various design disciplines has been critical to HEAL’s success and has showcased methodologies that HEAL projects are exemplars of a far more customised, problem-specific, expertise- infused approach to collaborative design innovation in healthcare settings. PAGE 1 PAGE 1
  6. 6. go far beyond the application of generic codesign principles. HEAL projects are exemplars of a far more customised, problem- specific, expertise-infused approach to collaborative design innovation in healthcare settings. This is largely made possible by the unique nature of the QUT Design Lab and the vast capability base it is able to draw from.  Giving clinicians the hands-on experience of applying design methods at pace has proven transformative for many improvement practitioners who have chosen to work with us. Second, HEAL’s approach has been adaptive and agile. While these can be sometimes nothing more than throwaway buzzwords, agility and adaptability are part of HEAL’s very DNA. Many clinician partners have voiced amazement at how quickly proposals for support were actioned (mere days between submission and commencement in some cases), and how effortlessly design teams iterated and extended on initial priorities when the goal posts shifted. Third, the HEAL model is ecological. We sought to support initiatives where design relationships had the best chance of taking root and a substantial fraction of projects have already spawned secondary collaborations, drawn leadership to the cause, and uncovered new sources of funding future work. Our model has steered away from top-down control and towards empowering designers and clinical teams to have sufficient freedom to move and innovate. Letting these teams address problems in context is creating buy-in and sustainability up front. Finally, the HEAL model is all about ‘design doing’ – rapid cycles of prototyping, testing and solution iteration. Giving clinicians the hands-on experience of applying design methods at pace has proven transformative for many improvement practitioners who have chosen to work with us. This report compiles many of these PAGE 2 PAGE 2
  7. 7. remarkable stories. There are the illuminating narratives of true innovation – where clinical teams and health services have unlocked whole new ways of thinking, doing, improving, improvising and creating when partnered with capable creative professionals. There is the larger story of discovery - where two communities with very diverse perspectives have rapidly and repeatedly discovered synergies and common purpose. Finally, there is also the implicit story of what successful industry-academic partnership can look like when organised around translational and impact at the sharp end of healthcare.  I commend these stories to you and hope you will discover ideas, insights and links to weave into your own. We are thankful to have you along for the journey. Dr Satyan Chari, PhD Dr Satyan Chari, PhD Program Director – CEQ Bridge Labs  Co-Director – HEAL Healthcare Improvement Unit Clinical Excellence Queensland PAGE 3 PAGE 3
  8. 8. This collaboration between designers and Queensland clinicians started in 2019, at the QUT Design Lab’s inaugural “Design Week” – with a theme of “Change by Design”, we worked with Clinical Excel- lence Queensland Fellows to re-envision and reimagine healthcare in a design sprint. The outcomes of the event were so inspiring, we knew that we had to continue the journey. Healthcare Excellence AcceLerator (HEAL) Healthcare Excellence AcceLerator (HEAL) Over 2020-2021, HEAL – a collaboration hub co-led by the QUT Design Lab and the Healthcare Improvement Unit at Clinical Excellence Queensland – has acted as a bridge between the QUT design and innovation community and Queensland Health. Designers from the QUT Design Lab - with their creative mindsets, skillsets, and participatory human centered co-design approaches - have worked in collaboration with clinicians, consumers and improvement teams across Queensland Health to drive design-led innovation and accelerate healthcare improvement efforts across the state.  HEAL has been a successful experiment, testing a novel idea: that engaging with and embedding designers into healthcare as agents of change might help tackle persistent evidence-based practice gaps, positively disrupt the system, drive innovation, and trigger transformative change in health services.  Designers as agents of Designers as agents of change in healthcare change in healthcare HOW THIS JOURNEY BEGAN PAGE 4 PAGE 4
  9. 9. HEAL designers and design researchers have collaborated on 20+ projects across 7 Queensland Hospital and Health Services, from Mt Isa to Cairns, Ipswich, and urban Brisbane. That these partnerships have triggered deep design-led trans-disciplinary dialogues, collaborations and innovations during the time of COVID-19 is a testament to the support of our project partners - the consumers, clinicians, local communities, policymakers, health system leaders and managers who are all committed to improving healthcare and excited about the potential of a design-led approach. We thank all of our partners for their enthusiastic support and look forward to continuing and growing our collaborations. Our human-centred approach to collaboratively redesigning healthcare is grounded in design thinking, design doing, and design visioning. Why Design? Why Design? Design - the “transformation of existing conditions into preferred ones” (Simon, 1996, p. 11) - is a creative, systematic problem-solving approach that develops better ways for humans to interact with technology, services, places, and products. A design-led approach is agile; it embraces uncertainty, complexity, and rapid iteration, thus offering a unique approach to tackling the ill-defined, complex, and wicked problems facing healthcare. While healthcare has been early to recognise the potential of design methods as a tool for collaboration and innovation, with elements of design (such as design thinking and experience-based co- design) increasingly common-place, the integration of professional designers and design researchers into healthcare – with their unique processes, mindsets and skillsets of empathizing, ideating, problem- solving, co-creating, innovating, prototyping, envisioning, visualizing, and iterating – is rare. PAGE 5 PAGE 5
  10. 10. As the diverse projects in this report illustrate, designers: have a mandate to be creative, expanding both the problem and solution space; focus on what the future ought to be, rather than what was; draw people in with empathy, vision, passion and rich, memorable storytelling; are natural disruptors, comfortable with uncertainty and change. While healthcare has a rich tradition of improvement and innovation, the reality is that many established tools and thinking are increasingly ill-suited to addressing pressing complex challenges - escalating costs, the increasing burden of chronic disease, an ageing population, systemic inequities in healthcare access and outcomes for First Nations communities, under-utilisation of primary care and high levels of system fragmentation. A design- led approach provides a novel, action-orientated way of facing complexity while systematically conceiving, developing, and driving forward new practices for undertaking large-scale transitions – an approach that compliments implementation science, knowledge translation frameworks, and consumer-oriented clinical service innovation models.  Design Thinking, Doing & Visioning Design Thinking, Doing & Visioning As the projects in this report illustrate, HEAL leverages the unique disciplinary training of designers - in collaborative co-design with consumers and clinicians - to solve one of the most intractable problems facing healthcare: knowledge translation, enabling the application of evidence and theory into local practice.  PAGE 6 PAGE 6
  11. 11. Our human-centred approach to collaboratively redesigning healthcare is grounded in design thinking, design doing, design thinking, design doing, and design design visioning visioning.. In addition to the well-known design thinking design thinking processes that underpin Experience-Based Co-Design in healthcare, what makes our approach distinctive is that we extend that to design design doing doing (co-creating and enacting design-led change initiatives), and design visioning design visioning (future-focussed scenario-based speculative design). I encourage you to approach reading this report with a flexible, designer’s mindset - flip back and forward, and start where you need to! Whether it is codesign methods, a focus on a specific healthcare challenge or population (from telehealth to cultural safety) or prototyping, our intent for this report is that it provides insight and inspiration about experimenting with design-led approaches. We are always keen to collaborate, so please connect with us - and visit QUT Design/HEAL for the most up-to-date information on projects. Professor Evonne Miller Professor Evonne Miller Co-Director – HEAL Director, QUT Design Lab PAGE 7 PAGE 7
  12. 12. EQUITABLE HEALTHCARE          INEQUALITY   COLLABORATION           BOUNDARIES CONSUMER EMPOWERMENT            ‘SICK-CARE’ SYSTEM KEEPING PEOPLE HEALTHY              CHRONIC DISEASES INTEGRATED/ VIRTUAL CARE            LIMITED DIGITAL TRANSFORMATION VALUE-BASED CARE COMPLEX SYSTEMS  CHANGE MINDSET UNCERTAINTY / PATTERNS / CLUES A FUTURE-READY SYSTEM CHANGE FATIGUE THE FUTURE IS NOW
  13. 13. Whole system change is not linear or simple. There are no quick fixes. But a design-led approach to supporting locally-led initiatives facilitates innovative responses to the wicked problems in healthcare, & creates a critical mass of change agents. PAGE 9 PAGE 9
  14. 14. PAGE 10 PAGE 10
  15. 15. IMAGE DESCRIPTION: Where it all began, QUT Design Week 2019. DESIGN WEEK 2019 PAGE 11 PAGE 11
  16. 16. Design Mindset Design Mindset A mindset is a way of being and thinking. Design mindsets are action-orientated, solution-focused, positive and imaginative – focused on creating a desired, improved future. Design Thinking Design Thinking A creative, human centered structured approach to complex problems, defined by five iterative steps: Empathize – Define – Ideate – Prototype – Test. Design Doing Design Doing As Don Norman preaches “we need more design doing” – design thinking is not magic and does not free us from actual design doing: creating and implementing change in collaborative partnerships. Design Visioning Design Visioning By nature, designers are futurists: we create ideas that do not yet exist. We use that ability to shape our collective imagination and to inspire optimistic future-focused dialogue about “what might be”. DESIGN PAGE 12 PAGE 12
  17. 17. DICTIONARY Participatory Human-Centered Co-Design Participatory Human-Centered Co-Design Designing with, not for, people means participatory engagements, sharing power, prioritising relationships, and building capability – and such participatory partnerships often lead to breakthrough innovations. Design Prototyping Design Prototyping A prototype is the tangible representation of an actual idea. Design prototypes vary in their degrees of fidelity – the level of detail and functionality. Low-fidelity prototypes may be made from paper and cardboard, while high- fidelity prototypes are closer to the final version. PAGE 13 PAGE 13
  18. 18. 11 MONTHS 7 QLD HOSPITALS & HEALTH SERVICES 250+ CLINICIANS, CONSUMERS & LEADERSHIP TEAMS 20+ PROJECTS 30 DESIGN RESEARCHERS PAGE 14 PAGE 14
  19. 19. DESIGN DESIGN STARTS WITH STARTS WITH CHANGE CHANGE PAGE 15 PAGE 15
  20. 20. DESIGN
  21. 21. THINKING PROTOTYPING DOING VISIONING PARTICIPATORY
  22. 22. PARTICIPATORY HUMAN CENTRED CO-DESIGN
  23. 23. Designing with, not for, people recognizes that health service users - consumers and staff - are experts of their own lived experience, and this expertise, knowledge and ideas is critical to innovation.  Engagement and participation, and related concepts of co- production, co-creation, co-design and co-innovation is the “new Zeitgeist – the spirit of our times in quality improvement” (Palmer et al., 2019, p. 247), for as Don Berwick (2003) wisely suggested nearly two decades ago, healthcare “workers and leaders can often best find the gaps that matter by listening very carefully to the people they serve: patients and families”.   Participatory human-centered co-design methods emphasize first- hand investigation, understanding who you are designing for - and designing in partnership with them - alongside an iterative, experimental approach of collecting data, making discoveries, and organizing ideas. Critically, the process emphasizes discovering the right problem to solve, by investing in both problem-finding and problem-solving to understand - at a human and systems-level - where and how we might have the most leverage.  All HEAL projects are guided by a user-centered approach, with the following projects demonstrating participatory human-centered co- design in practice.  UNDERSTAND CREATE PAGE 19 PAGE 19
  24. 24. Virtual Outpatient Integration for Chronic Disease (VOICeD) QUT HEAL TEAM: Evonne Miller, Jessica Cheers PARTNERS: Statewide Diabetes Clinical Network – Gaurav Puri, Brent Knack
  25. 25. Hours spent in waiting rooms, long commutes to the hospital, conflicting medical advice, indecipherable medical “gobbledygook”, no parking, covered windows and sterile white coats – these are just some of the things that can make the face-to-face healthcare system less than desirable. Fortunately, emerging digital health services can promise more efficient, accessible care, but may also spark feelings of distrust and isolation, or create barriers for those with low digital literacy. When Dr Gaurav Puri, Chair of the Statewide Diabetes Clinical Network, asked Mike from Thursday Island why he couldn’t attend his diabetes appointments, Mike replied that he simply didn’t have the time to come to them all. For those managing chronic disease and multiple co-morbidities, regular appointments with multiple practitioners can become an incredible burden on their quality of life. Realising that this was a problem faced by many Queenslanders, Dr Puri envisaged what would soon become VOICeD – Virtual Outpatient Integration for Chronic Disease. The telehealth service was designed to meet the needs of people with diabetes, by allowing them to see multiple healthcare practitioners in one virtual appointment. This would help ease the burden of the current medical model, with some patients travelling for hours to attend each appointment, and bring consistent, accessible care to patients anywhere. The team wanted to foreground the patient experience, streamlining and humanising the transition to the digital platform as well as recognising the diverse needs of people with diabetes and their practitioners. PAGE 21 PAGE 21
  26. 26. Through a series of experience-design sessions, a participatory design workshop, and user testing, the HEAL team aimed to: 1. Understand the healthcare experience of people with diabetes using traditional face-to-face services 2. Explore their relationship with telehealth / digital health technologies, particularly how this has been impacted by COVID-19 3. Understand the needs, barriers, and current points of tension for patients and clinicians prior to introducing a new design solution 4. Collectively imagine the future of healthcare, ensuring that VOICeD embodied their vision for the future. The participatory co-design process in action The participatory co-design process in action This collaboration involved six design phases: mapping, visualising, mapping, visualising, collaboratively designing, implementing, user testing, and continued collaboratively designing, implementing, user testing, and continued improvement. improvement. 1 MAPPING 2 VISUALISINGw 3 COLLABORATIVELY DESIGNING 4 IMPLEMENTING 5 USER TESTING 6 CONTINUED IMPROVEMENT PAGE 22 PAGE 22
  27. 27. The team began with a number of intensive journey mapping sessions, followed by a simple wordmark that could work within the visual constraints of the government context and a series of illustrations to bring the personas to life. A slogan was created to capture the intention of the service, plain and simple: Bringing you care, anywhere. Once the entire service was mapped from a practitioner perspective and visuals had been created to communicate the initial concept to stakeholders and potential patients, the team conducted a three-hour Participatory Design session with five people who had experienced chronic disease – potential future VOICeD users. They used a well- known Participatory Design method called a Future Workshop to envision possible and imaginary futures, critique present practice, and imagine potential utopian and dystopian visions of healthcare. The resulting outcomes The resulting outcomes Implementation focussed particularly on functional aesthetics – combining the human factors with the visual design to produce a version of the service that was user tested by the participants from the first workshop, closing the loop on their input by enabling them VOICeD Participatory Design Session PAGE 23 PAGE 23
  28. 28. to evaluate the developed product. Participants were given the same experience as a patient of the service, receiving instructional documents by email in advance, attending their appointment and transferring between practitioners. Following their “appointment”, each participant then spoke to the HEAL team individually over the phone to gauge their response to the process, following the typical feedback questionnaire that new patients would receive, while also allowing for more open-ended discussion. Participants had a few issues to improve the experience of using the service, largely reiterating changes the VOICeD team intended to implement long- term. From the outset, the VOICeD team had committed to continue to improve, test and evaluate the service long-term, and are continuing to implement recommendations from the HEAL collaboration. They are also collecting qualitative data from patients on an ongoing basis to better understand the patient experience. The VOICeD launch was successful, and patients continue to respond positively to the service – 100% of users surveyed would recommend the service, and 83% described it as a “very good experience”. In addition, patient’s time in clinics has been reduced by 350% over a 12 month period, while maintaining patient satisfaction with the service they are receiving. Three times less routine appointments are now needed, and three new VOICeD services are currently being developed after the initial launch of Diabetes Renal Cardiac – Maternity, Diabetes Transition, and Child Development are all underway. PAGE 24 PAGE 24
  29. 29. Mapping the Stroke Network PAGE 25 PAGE 25
  30. 30. Cancer Wellness QUT HEAL TEAM: Evonne Miller, Jessica Cheers PARTNERS: Princess Alexandra Hospital Cancer Wellness Initiative team – Jodie Nixon, Elizabeth Pinkham, Emma McKinnell
  31. 31. The conversation around wellness as a crucial compliment to medical cancer treatment is ever- growing. Yet, in Queensland there is currently no public cancer centre specifically designed to holistically treat all aspects of the self –mind, body and spirit. The Cancer Wellness Initiative (CWI) was established by Princess Alexandra Hospital’s (PAH) Cancer Services and funded by the PA Research Foundation to “advocate and innovate towards the provision of integrated, streamlined wellness support to all cancer patients receiving care at the Princess Alexandra Hospital” (Cancer Wellness Initiative, 2020). Initially, the vision was to establish a physical centre where wellness programs and support could be delivered. However, when the sudden and unexpected wide-spread shift towards online modalities occurred in 2020, the team needed to reimagine the service delivery model to meet the wellness needs of people with cancer at the PAH without the ability to provide in- person care. Given the over-abundance of cancer information online, conflicting advice and potential to lead people down online rabbit holes, the team wanted to create an authoritative, evidence-based, virtual home for PA patients seeking wellness information, programs and services. Multiple workshops were run by the Cancer Wellness Initiative prior to the engagement with HEAL, which had begun to scaffold ideas for the initial service design, ensuring a truly collaborative design process throughout. The collaboration between HEAL and the CWI involved four phases: Mapping, Visualising, Co-designing and Evaluating. First, the team imagined their outcomes and mapped out the future of the service. It was immediately clear that the team needed to re-connect with end-users – people with cancer and patients at the PAH – to better understand how their current and emerging needs could be met with an online offering. PAGE 27 PAGE 27
  32. 32. Creating a new brand Creating a new brand Prior to engaging end-users in a co-design workshop, the HEAL team felt that creating a cohesive brand identity would help to cement the aspirations of the project – a visual that could help delineate the CWI as a unique service while celebrating its ties to the PA Research Foundation and hospital, derived from the shapes contained within the PA Research Foundation logo to reflect their support, using the flower motif to allude to themes of wellness. This branding was used in the participatory co-design workshop with five people who were at various stages of their cancer treatment and recovery. A key lesson from this collaboration was the importance of engaging with end-users throughout the entire design process, especially when the initial goals change or new limitations are imposed throughout the life of the project. Six key themes were identified from the workshop: 1. 1. Cancer wellness information should be digestible Cancer wellness information should be digestible - - We’re given so much information at once that it gets overwhelming 2. Cancer wellness information should be consistent and 2. Cancer wellness information should be consistent and reliable - reliable - I didn’t know until one of the other patients told me about... 3. Cancer wellness should be presented in a way that is 3. Cancer wellness should be presented in a way that is normalising normalising - I need reassurance that what I’m experiencing is normal 4. Cancer wellness should be site-specific 4. Cancer wellness should be site-specific -I want to know what’s happening at the PAH 5. The platform should support the shift in mindset, from 5. The platform should support the shift in mindset, from cancer treatment to wellness cancer treatment to wellness - In the beginning it was all about the cancer, then my mindset shifted 6. The platform should support supporters of people with 6. The platform should support supporters of people with cancer cancer- Half of the battle was communicating all of this information to “the committee” –my partner, family, and friends PAGE 28 PAGE 28
  33. 33. Delivering nuanced information Delivering nuanced information After this initial work with HEAL, Jess was brought on by the CWI team to design and develop the new online platform based on workshop recommendations, implementing feedback and conducting user testing to iteratively improve the website. The ongoing collaboration between HEAL designers and CWI had a profoundly positive impact on the direction of the project. The project was founded on the notion that patients at the PAH were craving a unified source for reliable and supportive wellness information. However, given the overwhelm experienced by many people with cancer, it was crucial that the nuanced delivery of this information was carefully considered. By engaging with people with cancer directly and clearly documenting the knowledge translation process into actionable outcomes, the HEAL team were able to support the CWI in re-imagining the future of the initiative. Participatory co-design workshop PAGE 29 PAGE 29
  34. 34. Stroke Network QUT HEAL TEAM: Jessica Cheers PARTNERS: Statewide Stroke Clinical Network (SSCN) – Catherine Jacques
  35. 35. Stroke care in Queensland is complicated by the heterogeneity of the condition, the limited time available for a positive intervention, and the state’s geography. The goal of the Queensland Statewide Stroke Clinician’s Network (SSCN) is to improve equitable access to stroke care, regardless of geographic location. Decision-makers within Queensland Health and Hospital Health Services often did not have a full understanding of the variation that currently exists in access to and delivery of care, including how each element of the patient journey impacts on the next. This participatory design project visually illustrated the complexity of the system – this was designed to assist with communication and advocacy at all levels of the Department of Health, as well as in clinical environments, where it could be used to help clinicians identify local opportunities for improvement. Mapping complexities and variations Mapping complexities and variations Following four human-centred co-design workshops involving clinicians from across the state (both virtually and in-person), the visual designer created communication tools highlighting the complexity of the system, and identifying areas where variation exists broadly across Queensland Health in the provision of stroke care. The SSCN Steering Committee provided feedback, as did the broader SSCN network at a Clinical Forum. These were opportunities to explore three different infographics that were designed, using the persona of Jenny, who had suffered an ischaemic stroke and required an endovascular clot retrieval. Seven patient journey maps were developed, showing the difference in care and the timeline of delivery depending upon where our persona - Jenny - had her stroke and which hospital she was transferred to. Across the state, more than a seven-hour difference in initial treatment time PAGE 31 PAGE 31
  36. 36. for the endovascular clot removal was described in the patient journey maps, depending upon the referring and receiving sites for treatment. The final infographics will be freely available from the SSCN intranet page to all clinicians across Queensland, to use in their local settings to support and enhance understanding of the variation in existing systems of care for stroke patients, and to assist them in identifying local areas for improvement. PAGE 32 PAGE 32
  37. 37. Patient Journey Map for the Stroke Network PAGE 33 PAGE 33
  38. 38. DESIGN THINKING
  39. 39. Design is “learning by doing”, with the hands-on user- Design is “learning by doing”, with the hands-on user- centered design-thinking framework is a problem-solving centered design-thinking framework is a problem-solving tool designed to spark innovation. Best conceptualized tool designed to spark innovation. Best conceptualized as three processes - 1) understand, 2) explore, and 3) as three processes - 1) understand, 2) explore, and 3) materialize, the popular Hasso-Plattner Institute of materialize, the popular Hasso-Plattner Institute of Design at Stanford (d.school) model of design thinking Design at Stanford (d.school) model of design thinking breaks the process down into six iterative stages:  breaks the process down into six iterative stages:  1 EMPATHISE use empathy to understand;  use empathy to understand;  2 DEFINE bring clarity and focus to the design process, crafting bring clarity and focus to the design process, crafting a meaningful and actionable problem statement;  a meaningful and actionable problem statement;  3 IDEATE collective minds brainstorm multiple collective minds brainstorm multiple creative ideas; creative ideas; 4 PROTOTYPE create low-fidelity (quick, easy, low-cost) prototypes create low-fidelity (quick, easy, low-cost) prototypes to elicit feedback from users and colleagues;  to elicit feedback from users and colleagues;  5 TEST share and test your prototype with users; what works share and test your prototype with users; what works and what doesn’t?;  and what doesn’t?;  6 IMPLEMENT implement the vision.  implement the vision.  PAGE 35 PAGE 35
  40. 40. Co-designing a Healing Environment in the PICU QUT HEAL TEAM: Natalie Wright, Anastasia Tyurina, Judy Matthews, Evonne Miller, Leighann Ness Wilson, Sarah Johnstone, Guy Lobwein. Partners: Queensland Children’s Hospital PICU – Jane Harnischfeger, Debbie Long, Alexandra Ferguson, Jane Tilbury, Steven Wood, Leith Lilley, Michaela Waal, Christian Stocker.
  41. 41. While advancements in health care provided in Pae- diatric Intensive Care Units (PICUs) have led to fewer deaths, these improvements are unfortunately coun- tered by the emergence of side effects of critical illness, known as post PICU- syndrome (pPICs), which occur because children are often over-sedated and experience long periods of immobilisation in hospital. From PICU Liberation to Partnership From PICU Liberation to Partnership When the HEAL team was invited to work with the PICU at Queensland Children’s Hospital (QCH) in Brisbane, Australia in 2020-2021, the ‘PICU Liberation’ Team were already incorporating an innovative rehabilitation bundle of eight complementary steps to reduce sedation, allow children to awaken and breathe comfortably, encourage early mobilisation, and engage families in their child’s care. However, despite their efforts to ‘liberate’ children from critical illness and improve their recovery and functioning after discharge, there was concern that the quality of their family-centred care (FCC) was being influenced by the constraints of the hospital systems, com- munication tools and physical environment. Driven by the three core principles of FCC (partnership, participa- tion and protection) and utilising design-led methodologies, the PICU Partnership Project aimed to enable the creation of a more therapeutic (comfortable, effective, meaningful and supportive) phys- ical, social and digital environment for parents and families, meeting basic human needs in time of crisis, and providing a positive psy- chological long-term impact on families, their children, and the staff caring for them. The site: the QCH PICU The site: the QCH PICU In the QCH PICU, parents enter the ward through a secure entrance on Level 4 of the hospital and must have pre-arranged access with administration staff or a social worker, as the current reception desk which straddles both sides of this entrance is largely unmanned PAGE 37 PAGE 37
  42. 42. HEAL HDR Intern with a PICU family and unwelcoming. From this central corridor they visit their child in either a Riverside or Hillside room. Parents can freely access a large shared (with staff) balcony providing fresh air at the end of the main corridor, which is also used for end-of-life ceremonies; a small family room including a kitchenette with seating and a dining table in a remote corner of the Riverside rooms; and a tiny enclosed expressing room for nursing mothers. The only room in the ward with a parents’ toilet, shower, and laundry was inaccessible and being used for storage. PAGE 38 PAGE 38
  43. 43. The role of spatial design and visual communication in enhancing The role of spatial design and visual communication in enhancing care care Initial guided observation around the QCH PICU combined with existing data collected from past parents and staff suggested the following issues – focussed on the spatial environment and visual communication - could improve the delivery of family-centred care: Entry to PICU required remodeling to improve the ‘hello’ and ‘goodbye’ experience and signal a culture of support. The spatial layout, visuals and wayfinding did not support easy navigation for parents to rooms, nor any understanding about the spaces available for parents to use for self-care. A central space, which houses easily accessible parental self- care facilities (such as kitchens, bathrooms and laundry facilities), is required, along with more options for both private and public meeting and rest spaces for families to grieve or seek support from other families. The location and lack of storage (leading to clutter) in rooms and corridors makes it more difficult for parents to find anything, including each other. There is a need for storage solutions for parents’ personal belongings and to better locate equipment and supplies in corridors and rooms. The visual communication for the PICU is inconsistent and unclear, and could better assist with (1) navigation of the environment; (2); post-discharge information; and (3) the building of a support community for parents. PAGE 39 PAGE 39
  44. 44. Design-led engagement and storytelling strategies Design-led engagement and storytelling strategies The team instigated four engagement and storytelling strategies to encourage the participation of parents and staff and gain different types of data providing insight into how the design of the space supports (or not) social and emotional needs. - Interactive Static Displays - Interactive Static Displays used to engage both visitors and staff in sharing analogue thoughts and ideas about particular current spaces in ‘real space’ (as opposed to ‘real time’) - Parent Pack - Parent Pack using a self-documentation method where users observe, reflect, and document their everyday lives and experiences. - PICU Marketplace - PICU Marketplace a series of four drop-in activities, hosted in the PICU main corridor adjacent the balcony over two days. - Focus Groups and Interviews - Focus Groups and Interviews Using this data, the HEAL design team is developing recommendations for priorities to formulate design briefs for potential future work on Interior Design, Wayfinding and Signage Design, and Visual Communication Collateral, some of which will be developed by QUT Work Integrated Learning students (see next page). Interactive Static Displays PAGE 40 PAGE 40
  45. 45. During 2021 Semester 1, seven students in the Bachelor of Design (Visual Communication) and Bachelor of Creative Industries majoring in Interactive and Visual Design, were invited to join the PICU Partnership Project team and elected to undertake a work integrated learning (WIL) unit project to assist with the development of visual communication and interactive design collateral to support the co-design of a more healing environment for PICU families and staff. This specifically related to parent/staff engagement and storytelling activities to inform an Interior Design and Wayfinding Concept Proposal to activate and re-imagine key areas of shared spaces, as well as concepts for more long- term strategies for communication to parents and families in PICU and post-discharge, for example materials, posters, flyers, data visualisations and infographics. Bringing the University to the Hospital PAGE 41 PAGE 41
  46. 46. The Pain Pressure Cooker: A Rapid One- Hour Co-design Sprint QUT HEAL TEAM: Evonne Miller, Marianella Chamorro-Koc PARTNERS: Queensland Children’s Hospital - Caroline Macaulay
  47. 47. Design “sprints” are normally 3-5 days in length, enabling a deep dive, with creative and strategic thinking about issues, priorities and responses. Time constraints sometimes call for shorter activities, which can also provide valuable insights. Here, as part of the Queensland’s Children’s Hospital 2020 Ideas Festival, we ran a rapid one-hour co- design sprint to help clinical stakeholders understand, brainstorm, and design better ways to achieve optimal procedural care, reducing pain for children and youth. Procedural pain is short-lived acute pain associated with medical investigations and treatments (e.g., blood tests, immunisations, IVs/Port access, dressing removals/changes, nasogastric tube insertions), with this workshop focussed on how we might “design out procedural pain”. The design thinking process - in one hour  The design thinking process - in one hour  Participants were introduced to the six-step design thinking process: Empathy – Define – Ideate – Prototype – Test – Implement focused on how to create a pain-free journey for two personas: 5 year old Annabelle (in hospital for a MRI with cannulation) and 16 year old Tiffany (who has a chronic heart condition).  Step 1: Empathy: Step 1: Empathy: Picking one persona, teams created empathy maps - bringing Tiffany or Annabelle’s attitudes, behaviours and experience to the front of mind as they noted down what each says, thinks, does and feels, as well as “pains and gains”.  Empathy, as nursing scholar Theresa Wiseman (1996) explains has four key attributes: to see the world as others see it; to be non-judgemental; to understand another’s feelings; and to communicate that understanding.  Step 2 & 3: Define and Ideate: Step 2 & 3: Define and Ideate: The problem statement was defined as “how might we create a more comfortable, calm experience?”, with groups then challenged to generate a minimum of 10 ideas in 20 minutes. Each group PAGE 43 PAGE 43
  48. 48. considered key touchpoints in the patient’s journey map (before, during and after the procedure), with each person instructed to advocate and think from a specific perspective: the patient, the family, the staff, the space, and technology. The rapid pace and purposeful perspective taking was designed to encourage innovative, out-of-the box thinking. After the groups had ideated and brainstormed, they pinned their solutions on around the room and voted for their favourite – dotmocracy (dot-voting) in action! This process generated much discussion and extended ideas, as participants engaged with diverse ideas generated by other groups.  Step 4: Prototyping: Step 4: Prototyping: Having been inspired by the ideas of others, teams were now tasked with generating one preferred solution - their prototype. They had 10 minutes to decide on and prototype one solution to pitch to the room. Prototypes, Brown (2020) reminds us, “should command only as much time, effort, and investment as are needed to generate useful feedback and evolve an idea” (p. 19). Groups voted in the winner, who received a handmade paper hat proclaiming them the “Design Visionary”. While time constraints meant we were unable to complete steps 5 and 6 of the Design Thinking process (Test and Implement), our condensed one hour design-thinking sprint achieved its aim: it brought together a diverse range of stakeholders from across the hospital to discuss different approaches to managing pain, generated much energy and enthusiasm for developing, testing and implementing some of the ideas generated - from distraction games/ techniques during procedures (virtual reality, mindfulness, playing with equipment prior), to redesigning the car park so the journey is Dotmocracy: this quick and simple method of dot voting is a fun way to visually capture the mood, views, and priorities of people in the room. PAGE 44 PAGE 44
  49. 49. calm from the car to the clinical spaces (murals, apps, VR) or tasking a staff member to prepare proactively and thoughtfully for the child’s arrival (favourite music playing or screen showing a topic they love, eg cricket), as well as extending The Comfort Promise.  A critique of design thinking is that it simply takes too long: our approach shows the value of a condensed version (albeit in the first instance with clinicians and NGO service providers). This is just the start of creating a more comfortable and calm experience, and we must continue to innovate and think differently about pain, for as Eccleston et al. (2020) note: “how much of what we do (or fail to do) now for children in pain will come to be seen as unwise, unacceptable, or unethical in another 40 years?” The ‘Design Visionary’ Hat in action PAGE 45 PAGE 45
  50. 50. PROTOTYPING
  51. 51. Prototyping is making a preliminary model of something, from which other forms or products are developed. It is a representation of a design idea, used to generate learnings for the final development or build. Prototyping is action oriented, with the intention of creating a tangible product. It moves people beyond talking into active creating and design doing. Typically, prototypes are built in iterative processes, where the lessons learned from one iteration informs the build of the next version. The design question for prototyping is always: what can be learned from this model? Prototypes are usually cheap (with a minimal investment of money or resources), quick (with a minimal investment of time), and generative (so that there is plenty of learning). PAGE 47 PAGE 47
  52. 52. Protecting our Children: Co-Designing Child Friendly PPE QUT HEAL TEAM: Marianella Chamorro-Koc, Rafael Gomez, Isabel Byram, Erina Wannenburg PARTNERS: Queensland Children’s Hospital – Julia Clark, Kerri-Lyn Webb, Heidi Atkins. Sunshine Coast University Hospital – Clare Thomas, Lauren Kearney.
  53. 53. The COVID-19 global pandemic made the term Personal Protective Equipment (PPE) ubiquitous. However, amid supply shortages, access issues and debates regarding the efficacy of PPE in a healthcare context, the voice of one group has remained largely silent – children.     PPE can be scary, unfriendly, and confronting for children, which, in turn, can have a significant impact on the ability of HCPs to build rapport and a safe, trusting relationship with children and their families. Thus, in this project, the HEAL team have been working with the Sunshine Coast University Hospital and Queensland Children’s Hospital to develop less frightening PPE for HCPs to wear. Co-discovering childrens’ and clinicians’ experiences with PPE Co-discovering childrens’ and clinicians’ experiences with PPE The team focussed on uncovering and understanding the experience of children of various ages, their families, and clinicians, of the therapeutic process when PPE is worn. Quantitative surveys asked children, young people and their families about their perceptions of PPEs and their emotional response to them, with clinicians also surveyed about the positive and challenging aspects of wearing PPE while interacting with children. Virtual qualitative field observations were conducted at each participating hospital, to understand the interactions between clinicians, children and their carers while using PPE, and clinicians with their team members, tools, and environment. Virtual qualitative field observations of PPE child-clinician Virtual qualitative field observations of PPE child-clinician interactions interactions Due to clinical protocols, the field observations had to be conducted remotely - smart video tripods collected data via video. One device captured the child’s gestures and emotional response to the clinician during consultations, while the other captured the clinicians’ movements and interactions with others and with the environment.  These field observations were analysed using PAGE 49 PAGE 49
  54. 54. Observer (a specialised software for qualitative analysis in behaviour research) which facilitated the coding of each moment in the interactions. Findings from the survey and field observation analysis informed and generated new opportunities for PPE design, with a design sprint – by the design team – resulted in two early PPE designs: Sunny and Buddy. Sunny: Pilot Solution PAGE 50 PAGE 50
  55. 55. Phase 3: Phase 3: Implementation Implementation will focus on product development, including technical specification documentation, prototyping and testing, with a consideration of manufacturing requirements and testing the prototype against required standards. Buddy: Pilot Solution Phase 2: Co-design Phase 2: Co-design Implementation are in progress. Phase 2 will consist of co-design workshops and focus groups with paediatricians, nurses, children, and their carers to develop new PPE design ideas and design priorities – adopting a hands-on approach where designers and participants can work together in creating new designs. PAGE 51 PAGE 51
  56. 56. Designing out Diabetic Foot Problems QUT HEAL TEAM: Marianella Chamorro-Koc, Isabel Byram PARTNERS: Mount Isa Hospital – Sarah Bohan. Gidgee Healing
  57. 57. This research, currently in the preliminary stage, is investigatingthepossibilitiestoimprovepodiatryservices, particularly for diabetic foot disease (DFD), in regional Australia. Rates of diabetes are expected to double in Queensland, and it is the fastest-growing chronic health disease in our rural, regional and Indigenous areas. Diabetic foot disease in Mt Isa - and the potential of digital, Diabetic foot disease in Mt Isa - and the potential of digital, customised podiatric shoes customised podiatric shoes In Mt Isa, almost a quarter of the population identify as Aboriginal and/or Torres Strait Islander, and many have foot issues, where the focus is on the management of high-risk feet. DFD is often managed through specialised footwear prescribed by a podiatrist or surgeon. However, none of the podiatry care options in Mt Isa (Mt Isa Base Hospital, Gidgee Healing, and Advance Foot Clinic) have the capacity for in-house manufacturing, leading to either referral and travel for patients who need custom solutions, or resourceful ‘make- do-and-mend’ solutions, which are not always ideal. These challenges can mean that compliance with prescribed footwear in DFD tends to be poor, due to long wait times to receive the footwear, or the footwear being impractical to use in everyday activities. The project team are investigating ways to improve podiatry services for DFD in regional Australia by working with Mt Isa Base Hospital and Gidgee Healing to provide better service for clients in the Mt Isa area - focussing on increasing the use of digital technology, by auditing the existing supply chain and exploring the potential of digital, customised podiatric shoes in regional locations. Adopting a transformative service design approach to develop an enhanced supply chain across regional hospitals, industry, specialists and patients in the footwear design, HEAL research intern Isabel Byram spent two days in Mt Isa on an exploratory visit, where she shadowed staff and spoke with patients about their experiences. PAGE 53 PAGE 53
  58. 58. The project identified that current options for podiatric footwear tend to be closed-in shoes, which are not appropriate, either culturally or functionally, for the climate in Mt Isa, which averages above 30-degrees Celsius. Finally, Gidgee Healing have noted that shirts from the Deadly Choices healthcare campaign and NAIDOC are extremely popular and prized within the local Indigenous community. Therefore, there may be opportunities to develop podiatric footwear that similarly reflects Indigenous heritage, and that will make the custom footwear more valuable to the wearer, and thus increase the likelihood that they will keep and use it. Patient receiving treatment PAGE 54 PAGE 54
  59. 59. Moving forward, using design-led methods and strategies, our aim is to advance orthotic design options, creating a service design pathway for work with regional Australia, which will also contribute to Australia’s digital transformation through advanced manufacturing in healthcare. We intend to partner with the local Indigenous community, the Kalkadoon people, on culturally appropriate and desirable designs, and enhance the supply chain to (i) reduce waiting times to receive prescribed footwear and (ii) support the production of footwear that are designed with regional DFD patients’ needs and preferences in mind. Current podiatric footwear available for patients PAGE 55 PAGE 55
  60. 60. Designing with Technology for Empathy in Healthcare: A Pain Metric in Paediatric Admissions QUT HEAL TEAM: Marianella Chamorro-Koc, Rafael Gomez, Erina Wannenburg, James Dwyer PARTNERS: Sunshine Coast University Hospital – Scott Schoffeld
  61. 61. Your child is being admitted to hospital after falling off a swing. They keep telling you they’re fine, but you’re sure they’re in agony and just putting on a brave front. Wouldn’t it be great to have a machine that could tell the clinicians exactly how much it hurt? This project is positioned in the context of Admissions to the Emergency room, in that initial stage or touchpoint when the nurse asks a child about how much pain they have. People experience and express pain differently, and in the context of an admission to the Emergency Room, children might not respond to the protocol of questions accurately. Unlike adults (who can verbally express how they experience pain), young children who are pre-verbal can only express their feelings of pain and anxiety through crying, and older children who are in pain or feeling unwell often revert to pre-verbal communication as well. This project seeks to enhance the decision- making of the nurse in that moment, both (1) with a more accurate and effective way understand how much pain the child is feeling, and (2) by transforming that moment into a more positive experience for the child. Assessing pain in paediatric admissions Assessing pain in paediatric admissions In hospitals admissions, tiredness, business, and the heightened emotions of a child in pain might influence the nurse and clinician’s accurate assessment of that child’s pain. Assessing pain in paediatric environment is a core task that is currently conducted using a 1 to 10 scale or, for younger children, a scale of happy to sad faces. We wondered whether emotional and/or technological design can improve the clinician’s empathetic assessment of pain.  The exploration is positioned in the context of that initial stage when pain is assessed (e.g. triage, at the start or during consultation or procedure).  PAGE 57 PAGE 57
  62. 62. Our strategy is to use a human-centred design approach to understand the complexity of such scenarios and interactions with children experiencing pain. We began with an initial exploration of the paediatric pain assessment process through remote interviews and expert walkthroughs. Following that, we have developed an initial prototype to use as a research tool for assessing the pain level of a hand/forearm injury. The device features: (i) a pain metric, (ii) an anxiety metric, and (iii) an emotional engagement strategy. Pain is measured through sensors that capture data about skin inflammation and temperature, change of colour and size of the hand/forearm. The anxiety metric is measured through sensors capturing heart rate data. The emotional engagement strategy is a feature that aims to engage non-verbal as well as older children in a therapeutic relationship with the clinician. Our next steps are to test the initial prototype through a co-discovery with healthcare professionals, to inform the development of a final prototype. Pain metric initial prototype PAGE 58 PAGE 58
  63. 63. FUTURES          WICKED PROBLEMS  LEARNING SPACE           SOLUTION SPACE PARTNERSHIPS            MOMENTUM SEEING DIFFERENTLY              UNDERSTANDING TRANSFORMATION            COMPLEX SYSTEMS CREATE THE MOMENT
  64. 64. Interactive CPR Manikin for Community Training QUT HEAL TEAM: Marianella Chamorro-Koc, James Dwyer PARTNERS: Royal Brisbane and Women’s Hospital Clinical Skills Development Service – Luke Wainwright
  65. 65. In 2016, a 13-year old boy saved his baseball coach, who had suffered a heart attack, by administering cardio- pulmonary resuscitation (CPR). In 2019, a teenager saved her father’s life by giving him CPR, which she had learned as a child. There are countless examples demonstrating that children can save lives by performing CPR, and studies around the world support the importance and appropriateness of providing children with CPR education and training. CPR saves lives; however, there are several impediments to undertaking CPR training. First, when it comes to teaching children, CPR manikins used in training are often adult size, making it difficult for children to use correctly. Second, simulators and/or clinical manikins used to teach CPR techniques are expensive, as is community access to CPR training. Working with the Royal Brisbane and Women’s Hospital, this project aims to equip future generations and the broader community with CPR skills through developing engaging interactive devices that expedite learning and are accessible from a cost-effective and local manufacturing perspective. Designing child-sized affordable CPR manikins Designing child-sized affordable CPR manikins The project initially began by considering the viability of local manufacturing of CPR manikins, to lower costs and thus make them widely available to the community for CPR training. In doing so, the project started with an exploration of the design of a child-size interactive manikin to teach children the technique. This exploration was done within an Industrial Design unit at QUT, where 55 Industrial Design students were presented with a design challenge. The design challenge required students to apply their design process, manufacturing knowledge, and skills to design a child-size manikin for children to learn CPR. Students were advised that the manikin should be designed to: (i) accommodate an insert PAGE 61 PAGE 61
  66. 66. containing the electronics that support the haptic feedback (interaction) to facilitate the children’s learning, and (ii) demonstrate a local manufacturing and sustainability approach. The manikin design needed to include two main components: (a) the child-size manikin, and (b) an insert with the interactive electronics. Designing people-focussed solutions Designing people-focussed solutions The HEAL team also worked with the Clinical Skills Development Services (CSDS) team at the Royal Brisbane and Women’s Hospital to understand what CPR manikins are and what functional requirements they present. The HEAL team followed a product investigation structure and conducted user research studies with schoolteachers, children and parents. Using a Human-Centred Design approach, the team developed 11 different interactive manikin solutions to teach children how to give CPR to another child. With the use of interactive technology, and underpinned by embodied interaction concepts, the child-size manikins demonstrated and guided a child on how to apply compressions, at the right pace, and at the right depth. The manikin designs exhibit LED lights to indicate facial change of colour, or blood circulation. Manikins were designed considering cost-effective local manufacturing and ease of use in different scenarios (e.g., by teachers at schools, on the beach by lifesavers, etc). Based on the successful child-size interactive CPR manikin prototypes, we selected one prototype solution design and further developed the interactive concept, adding in one more challenge - the addition of breasts. the right pace, and at the right depth. The manikin designs exhibit LED lights to indicate facial change of colour, or blood circulation. Manikin prototyping PAGE 62 PAGE 62
  67. 67. In CPR training and real-life application, breasts present two different types of obstacles for the common citizen: (i) they discourage people from touching them to apply CPR technique, and (ii) they present a physical obstacle in applying chest compression at the right depth and pace. To address this, the team used a research-through-design approach alongside iterative prototyping. The team scaled up the chosen solution and investigated the best possible ways to simulate breasts, in such a way that training with the prototype would help the community to familiarise themselves with the feel of the breasts, and the depth they need to target for a successful CPR chest compression. This manikin is currently in the design phase. Manikin prototyping with breasts PAGE 63 PAGE 63
  68. 68. DESIGN DOING
  69. 69. As Don Norman preaches “we need more design doing” – participatory design workshops and design thinking is not magic and does not free us from actual design doing – creating and implementing change, in collaborative partnerships. In our focus on design doing, we are inspired by the four “D’s” of the Double Diamond design process, popularized by the UK Design Council: DISCOVER: opening up and questioning;  DEFINE: agree on most important issues to tackle; DEVELOP: test responses, prototypes, & ideas; DELIVER: produce & implement practical, solutions.  Of course, the trajectory of change in the complex often bureaucratic context of healthcare is not easy or straightforward.  The often slow and uneven progress from ideas to implementation can challenge morale, momentum and confidence. Protocols, processes, competing priorities, and hierarchical, risk-adverse organizational cultures can make the practicalities of simply ‘doing things’ and ‘getting things done’ difficult (Bowen et al., 2013). However, our design-led approach has focussed on the delivery of tangible outcomes over the past year - as we see in the following projects.  PAGE 65 PAGE 65
  70. 70. Journey to Fun: Playful Wayfinding and Placemaking at QCH  QUT HEAL TEAM: Jen Seevinck, Evonne Miller, Kirsten Baade Gillian Ridsdale PARTNERS: Queensland Children’s Hospital – Lynne Seear, Matthew Douglas, Belinda Taylor, Helen-Louise Usher. Entertainment Precinct partners: Starlight Children’s Foundation (Starlight Express Room), Children’s Hospital Foundation (Kidzone), and Radio Lollipop. 
  71. 71. On Level 6 of the Queensland Children’s Hospital you’ll find the Entertainment Precinct – home to three separate non-clinical spaces focused on providing children, young people and their families with joyful places for distraction. Kidzone, Radio Lollipop and the Starlight Express Room are independently operated by partner charities with purpose-built facilities for patients and their families to engage, play, learn and relax. The entrance and arrival space at Level 6 did not reflect this atmosphere of play, and these joyful places were difficult to locate. Hospitals are large, complex spaces, which both first-time and repeat visitors often finding confusing and difficult to navigate at a time of physical and emotional stress. The Entertainment Precinct was no exception: our brief was to create a strong visual identity for the entertainment precinct, that more clearly signalled and signposted the paths to Kidzone, Radio Lollipop, and the Starlight Express Room. Our design needed to direct and to distract - and any solution also needed to (1) compliment the hospital’s existing architectural and artistic scheme; (2) meet health and safety requirements, being non-invasive, non-touch, and able to support deep cleaning; and (3) provide appropriate graphic representation for the precinct partners. Wayfinding in Hospitals Wayfinding in Hospitals Wayfinding is the strategy people use to navigate or orient themselves within a physical environment - and hospitals across the globe are increasingly developing innovative approaches to guide and support visitors so that they can easily discover the way on their own (instead of struggling or having to ask for help).  Contemporary approaches to enhance the hospital wayfinding experience include integrating wayfinding visuals on all surfaces, including the floors and roofs; playful wayfinding; integrating PAGE 67 PAGE 67
  72. 72. narrative and memorable landmarks at key navigational decision points; creating journeys that are easily describable in one simple sentence, using basic English (e.g., “I will meet you at the waterfall lift”); and acknowledging diversity, culture and inclusion, as well as using digital technology.  While specific approaches vary according to the user group, local culture, customs, and setting, research constantly shows that connections to, views of, and the colours of nature are calming and healing. Children, across all stages of cognitive development, consistently prefer art with nature – something that resonated with the hospital design and informed our own approach. Current entrance and arrival space at QCH The Design Process The Design Process The HEAL design team visited the site multiple times, did a deep dive into published research and international design exemplars (e.g., Nationwide Children’s Hospital in Ohio; Evelina Hospital in London; Great Ormond Street Hospital for Children), and ran two design workshops with QCH stakeholders (including the precinct partners, who surveyed their users about their interactions with the space) to provide feedback on our design concepts. The design PAGE 68 PAGE 68
  73. 73. ideation process iterated through sketching and photo mock-ups, created in a human-centred design process.  Our initial concept centered on play, art, and the endangered animals of Queensland, with a deep discussion about the value of a broader nature theme (birds, insects and other Queensland animals), as well as responding to the hospital’s unique design: the multi-award- winning building is one of Australia’s largest paediatric hospitals, with the 12 levels intentionally designed to ‘not to feel like a hospital’, with multiple public and private gardens. QCH features a ‘living tree’ design, with a network of trunks and branches that assist wayfinding, alongside a central interior atrium space with different coloured floors. The atrium features large sculptures of Eclectus Parrots, which are visible from Level 6. During the design workshops, the concept of parrots (and the adventures they can get up to!) became our central narrative character in shaping a unified theme for this hospital floor. Feedback from the first workshop was that our parrot needed to complement existing designs, reflect distinct partner identities and the child’s voice, while valuing play, puzzles, stories, nature, the local site and a creative journey. In the next iteration, artist Kirsten Baade created some early parrot designs for feedback, including using different coloured feathers from each parrot to use for wayfinding and mark the journey to fun at each precinct partner’s location. She was embedded with the hospital’s design team for several days, working with the Digital Engagement Manager Matthew Douglas as the designs developed. In addition, the QUT design team engaged deeply with the wayfinding design problem for the walls, floors, and lift areas. Level 6 of the Queensland Children’s Hospital has two main points of access – two lifts – and these became a focus for design consideration, as they would be significant for conveying the atmosphere of play as well as to support memorable wayfinding – “I came in at the forest lift”, or “Go past the waterfall lift”. This design approach makes PAGE 69 PAGE 69
  74. 74. these places easily describable as journeys – consistent with the best practice we found in our review of contemporary wayfinding design. The wayfinding solution – playful parrots The wayfinding solution – playful parrots The second design workshop explicitly tested these ideas, with QCH stakeholders generating activities or stories that the parrots might engage with to drive the design of the final murals for the walls and lifts. There was much excitement about how this concept will enliven the area, enhancing wayfinding but also potentially providing different ways to connect with the parrot theme. These ideas included competitions for children to name the parrots; associated colouring in activities and drawings shown on screens; extending the theme with VR/AR and large fixed items, such as tree and nature themed internal seating areas.  PAGE 70 PAGE 70
  75. 75. The final wayfinding and mural designs are in the last stages of approval at QCH, to be printed and installed on the 6th floor in coming months. In this design solution coloured feather decals populate the floor, while similarly coloured parrots on the walls lead children, their families, clinicians and visitors to the lively precinct areas of fun: the red parrots and feathers to Radio Lollipop, green to Kidzone and purple to the Starlight Express room. Nature scenes and parrots engaged in various activities – singing, reading, flying, listening to music, cuddling chicks – are located along the corridor walls and columns, distracting the patients and families from their troubles. The wayfinding solution - playful parrots PAGE 71 PAGE 71
  76. 76. Improving Cultural Safety in Queensland Improving Cultural Safety in Queensland Hospitals Hospitals QUT HEAL TEAM: Manuela Taboada, Sean Maher, Susan Carson, Thalia Bruner, Evonne Miller PARTNERS: Aboriginal and Torres Strait Islander Leadership Team – Kirsty Leo and Jacinta Thompson
  77. 77. The anxiety of being unwell, the uncertainty about what will happen and what the processes are, coupled with being separated from loved ones and surrounded by strangers can make hospitals uncomfortable places to be. In Australia, First Nations (FN) patients, as well as patients from other culturally diverse backgrounds, experience heightened levels of discomfort, as they often feel culturally unsafe when interacting with the healthcare system. The National Scheme’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020-2025 explains that culturally safe practice is “…the ongoing critical reflection of clinicians and systems knowledge, skills, attitudes, practicing behaviors and power differentials in delivering safe, accessible and responsive healthcare free of racism.” Pathways to overcome barriers Pathways to overcome barriers This project sought to demonstrate and raise awareness of the importance of cultural safety in healthcare settings through creating short, animated videos aimed at clinicians. The videos demonstrate the cultural barriers and anxieties from the clinician’s and patient’s perspectives, provide clear definitions, and suggest a pathway to overcoming these barriers through building cultural awareness, cultural sensitivity and understanding cultural safety. It is envisaged that a set of activities and materials will accompany the videos, to support clinicians in improving their cultural awareness and cultural sensitivity, and thus be able to provide a culturally safe treatment environment. PAGE 73 PAGE 73
  78. 78. After a detailed briefing on cultural safety in hospital settings from First Nations people, the project team created three storyboards and draft animations to capture the existing knowledge, vision and ideas regarding visual representation, animation effects and camera movements, which could be played independently or together: Concept 1: Concept 1: focused on cultural awareness from the perspective of the clinician, showing the barriers that exist between them and FN patients. Barriers were presented as words in a bias curtain between the clinician and the patient. Concept 2: Concept 2: focused on cultural sensitivity, still from the perspective of the clinician, but from a reflective point of view, where the clinician reviews their thoughts and biases about caring for FN patients. Concept 3: Concept 3: focused on cultural safety, this time from the perspective of the patient, showing the anxieties and feelings of being unsafe in the hospital environment and what cultural safety means. Video 1: Storyboard on cultural awareness PAGE 74 PAGE 74
  79. 79. Video 2: Storyboard on cultural sensitiveness Video 3: Storyboard on cultural safety PAGE 75 PAGE 75
  80. 80. Involving clinicians through co-design Involving clinicians through co-design These ideas were tested at a co-design workshop with a reference group of Queensland Health clinicians, who were invited to provide feedback on the storyline and visuals. It was important to involve clinicians early in the development and creation of the videos, to ensure that the voices and perceptions of the intended audience are taken into consideration, and to challenge the designers’ and creators’ own biases and assumptions. Learnings were: 1. The importance of contextualising key arguments. 2. The words on the “bias curtain” and the way it is presented might feel like ‘finger pointing’, causing anxiety. 3. The need for visual accuracy and up-to-datedness about what the treatment room, clinicians and equipment look like. Time is critical Time is critical The workshop revealed that the co-design process itself needs to be culturally sensitive, embracing uncertainty, multiple perspectives, and expectations – and that such profound transformational processes need more time to be delivered and digested. The three short animated videos are currently under development. From an aesthetic perspective, emphasis is being placed on the typographic treatment of words and thoughts in the videos to create familiarity. The videos make use of hospital ambient sounds - such as machine beeps and pulses and the background rush of carts, beds and people. These hospital sounds will be taken over and silenced by biometric sounds from the human body - heartbeat, breathing and blood pumping sounds - to depict the anxiety that may occur when building cultural awareness, cultural sensitivity and understanding cultural safety. PAGE 76 PAGE 76
  81. 81. THE DESIGN JOURNEY AND PROCESS TEACHES PEOPLE TO BECOME COMFORTABLE WITH UNCERTAINTY - A CRITICAL 21st CENTURY SKILL BECAUSE: EVERYTHING HAS CHANGED, IS CHANGING AND WILL CONTINUE TO CHANGE “the illiterate of the 21st century will not be those who cannot read or write, but those who cannot learn, unlearn and relearn” Alvin Toffler PAGE 77 PAGE 77
  82. 82. Increasing use of Interpreter Services at Metro South QUT HEAL TEAM: Janice Rieger, Sarah Johnstone, Thalia Bruner PARTNERS: Metro South Addictions and Mental Health Team - Karen Beaver, Ruby Chari
  83. 83. Recent clinical incident analysis and data reviews have highlighted an underutilisation of interpreter service for those consumers who have been flagged as “interpreter required”. This creates significant inequality for CALD (culturally and linguistically diverse) patients and others who require ‘just access’ to healthcare. As it currently stands, Interpreter Services are made available to all Queensland Health hospitals and health centres 24 hours a day, at no charge to the patient. All Queensland Government agencies are required to provide and pay for qualified interpreting services for customers who are hearing impaired or have difficulties communi- cating in English. However, preliminary identification of the barriers to using interpreter services has highlighted that some staff believe interpreter services are unable to be utilised due to the associated costs and budgetary constraints. Enhancing access and use of interpreters Enhancing access and use of interpreters This project focused on (1) uncovering ideas for enhancing access and use of interpreters and (2) co-designing an education tool to increase the use of interpreter services (focussing in the first instance on multicultural mental health clients and their clinicians). The overall aim of this clinician-led project was to increase access and use of the existing service from the clinician’s perspective (clinician-led) by identifying pain points and barriers for service uptake and co-designing solutions which addressed these barriers. Assessing the challenges – a survey and online workshop Assessing the challenges – a survey and online workshop The first step in this project was to engage with administrative staff and clinicians from across the Metro South Health region through a short survey which provided insight into their use of interpreter services. The survey results indicated a need for greater clarity around the cost of service (i.e., mythbusting), along with roles and responsibilities for requesting and assessing the need for an interpreter, and fostering a culture of inclusion amongst clinicians. PAGE 79 PAGE 79
  84. 84. Issues included: - The booking process (for those who use it) is quick and effective, but is is unclear who is responsible for bookings - Experiences with interpreters are generally positive, with some concerns about confidentiality - There is inconsistency in the availability of interpreters - There is a belief using the service costs the department - There is a lack of clarity around what should happen if an interpreter does not arrive for a patient’s booking. A selection of survey respondents then participated in a 90-minute online workshop which used interactive quizzes – focused on ‘Mythbusting and Truth-Sharing’ – to clarify some of the findings from the survey, and conversations surrounding possible ideas for ‘Tools & Resources’ and ‘Training & Support’. The HEAL team co-developed a storyboard for an educational animation, the basis of which emerged from a story shared by a clinician in the survey. The last phase of the workshop provided participants with an opportunity to share their feedback on the storyboard - possibly be the first of a suite of new training videos directed at increasing uptake of the interpreter service. The value of interpreters - developing a short animation The value of interpreters - developing a short animation The clinician’s story, and the resulting animation, calls attention to the positive impact that interpreters can have on the client’s experience and level of understanding, and portrays the value of having an inclusive mindset towards creating ‘Just’ healthcare. The animation also provides further education around who needs interpreters, by highlighting that even if a patient may not ‘look CALD’ or can speak some English, does not mean that they could not benefit from having an interpreter present. PAGE 80 PAGE 80
  85. 85. Appointment storyboard Post - appointment storyboard PAGE 81 PAGE 81
  86. 86. Reducing Urine Sample Contamination in the ED QUT HEAL TEAM: Evonne Miller, Lisa Scharoun, Zoe Ryan PARTNERS: Queensland’s Healthcare Improvement Unit  PROV- ED Project (Promoting Value-Based Care in Emergency Departments) coordinators Tanya Milburn and Sarah Ashover.
  87. 87. Have you ever had to provide a urine sample for the doctor? Recent research in a Brisbane Emergency Department found that nearly half – 41.5% of all mid- stream urine samples – collected from women were contaminated. While contamination rates vary by site, institution, collection, storage and transport, poor patient technique – due to inadequate instructions – is a key reason for contamination. Eley and colleagues (2016) developed and tested a graphical illustration to simply explain the process to patients, with this intervention reducing contamination rates from 40% to 25%. But, when the Clinical Excellence Queensland led PROV-ED Project (Promoting Value-Based Care in Emergency Departments) started to explore rolling these posters out to other emergency departments – as the Reducing Urine Contamination in Emergency (RedUCE) initiative – initial feedback from staff and consumers was that the original design was overly graphic, especially for use with children and in different cultural contexts.  The team explored several options to improve the experience of urine collection   – from an infographic, to disrupting the process and designing a different container for urine collection, to developing animations that turned urine collection into a game for children. In the end, we settled on redesigning and simplifying the poster, using a gestural drawing approach (a loose form of sketching that expresses movement by capturing basic form).  PAGE 83 PAGE 83
  88. 88. We combined what had been separate posters for men and women into the one poster, and reduced the number of steps, to further simplify the process. We are still tweaking the final design, which has gone through multiple rounds of iterative design sessions about the images, the number of steps, and the narration – but the images opposite show the original design and the current beta version. Existing emergency department graphics PAGE 84 PAGE 84
  89. 89. Currrent beta version PAGE 85 PAGE 85
  90. 90. DESIGN VISIONING
  91. 91. By nature, designers are futurists: we create ideas that do not yet exist. In design visioning, we use that ability to shape our collective imagination and to inspire optimistic future-focussed dialogue and storytelling about “what might be”.    Design visioning activities provides teams with the time and space to have focussed, reflective, and meaningful discussions around the future - to see new possibilities and think bigger about the impact of changing technologies, processes, and cultures, and gain clarity about the innovation you are striving towards and why. As the following projects show, engaging in design visioning is a critical way to engage, gain clarity about preferred options, and sustain momentum. PAGE 87 PAGE 87
  92. 92. Delivering Virtual, Integrated Care in Central Queensland  QUT HEAL TEAM: Evonne Miller, Shari Read, Lisa Scharoun, Sarah Johnstone PARTNERS: Central Queensland HHS – Kerri-Anne Frakes, Eric Miller, Kelsie West. Clinical Excellence Queensland – Anna Wesselman
  93. 93. Like many hospitals and health services across the globe, Central Queensland (CQ) is turning to virtual, integrated and connected care to enhance the healthcare experience for their geographically and socially diverse community. While the COVID-19 pandemic has accelerated the widespread adoption of collaboration and communication technologies, virtual care remains a different model of care for both consumers and clinicians - and changing healthcare systems and practices is no easy task.  Co-designing the future of care  Co-designing the future of care  The HEAL team worked with CQ to explore the opportunities, learnings, barriers, and best paths forward - alongside multiple online strategic planning sessions, we travelled to Rockhampton for three days in April 2021 to engage with key local stakeholders – clinicians, GPs, allied health, QAS, consumers and strategic leadership teams.  Over a four hour in person and virtual co-design solution exploration workshop, over 50 local stakeholders explored the viability, appeal, barriers, opportunities and best paths forward for potential technology enabled solutions for three specific personas: Anne, who has COPD, her GP Carl, and her specialist, Shona. We started with our vision for the future - asking: what does care look like in 2030, and how could it be improved for these 3 key stakeholders?Participants very clearly saw future healthcare as virtual, connected, and provided in consumers’ homes: patients would be active partners in their healthcare, driving health decisions by drawing on bio-medial data they collected. As a sector, the hope was healthcare would be less risk-adverse and more collaborative - PAGE 89 PAGE 89
  94. 94. The focus then turned to the challenges (the myths, fears, hopes and taboos) of achieving this vision, before exploring what “excited and disappointed” about three specific proposed solutions: 1. virtual care 1. virtual care through remote patient monitoring (drawing on knowledge from a current trial with Phillips, focusing on chronic conditions); 2. how to better connect GPs 2. how to better connect GPs in primary care with specialists; 3. 3. how to reduce the pressure on emergency departments, reduce the pressure on emergency departments, perhaps via an ambulatory emergency care model. Teams then identified - at very practical macro, messo and micro levels - what governments, hospitals, clinicians, and consumers needed to “stop, start and continue doing” to deliver virtual care. Innovation in the Face of Complexity  Innovation in the Face of Complexity  To close, teams pitched their own technology-enabled care vision, focusing on priority actions over the next 12 months. Each group allocated 1.85 Million dollars - in play money - to invest in the winning ideas, which centered on expanding HITH (Hospital in the Home) and  clinicians’ scope of practice. With stakeholders enthused over a shared vision of virtual care, the ongoing challenge is developing strategies, tools, and systems that make this transition as seamless as possible. Driving change and a truly integrated care service - across quality of care, process, technology, governance, diverse personalities, local contextual challenges and priorities - is no easy task, but CQ is committed to leveraging technological innovations to improve healthcare.  PAGE 90 PAGE 90
  95. 95. Personas are fictional characters designed to help us better consider, imagine, and step into the shoes of another- to have empathy and use that empathetic imagination to guide our actions. Personas assist with strategizing and communicating, serving as archetypes. The first step in the design process is Empathize, which be done through creating  personas and/or the completion of empathy maps. Ideally, personas are research-based - created from workshops, interviews, observations, quantitative and qualitative data, or in the medical context, drawing on actual cases to trigger deep reflection and discussion, helping ensure any initiatives resonate.  In the CQ project, the persona of Anne so resonated with one consumer in the workshop that Geoff he shared his wife’s Peta-Anne’s journey of COPD with the group - she actually died in the car outside a regional hospital, was brought back to life, and then spent the next year in and out of hospital, before receiving a lung transplant. Geoff shared his hope that contemporary technologies might have enabled him and his wife to stay at home, rather than have COPD disrupt their lives quite as much. Whether it is through personas, empathy maps or the powerful narratives of real-life consumers, good design - and good healthcare - always starts with listening and deep empathy.  Personas and Empathy Mapping  PAGE 91 PAGE 91
  96. 96. Connecting Rehab Services across West Moreton QUT HEAL TEAM: Evonne Miller, Abbe Winter, Sarah Johnstone, Sam Regi PARTNERS: West Moreton – Sarah Sorensen and Therese Hayes
  97. 97. How do you provide connected, seamless, high-value care across multiple dispersed sites? That’s the challenge facing West Moreton, which manages 5 Hospitals and several health services across nearly 10, 000 kilometres. West Moreton is also Queensland’s fastest growing HHS, with the population projected to almost double by 2036, from 312,000 to 587,600. Planning for such rapid growth in a regional and rural area means West Moreton must radically re-design service delivery - and they worked with HEAL on their first initiative: activating the 22-bed Boonah hospital as a step-down site for rehab, with a focus on creating seamless care transitions with the 392 bed Ipswich Hospital - 50 kilometres away. An Appreciative Inquiry Approach to Service Transformation An Appreciative Inquiry Approach to Service Transformation We started with a workshop: over 50 clinicians and consumers collaborated in a Co-Designing Service Transformation workshop to envision what seamless care transitions between Ipswich and Boonah might look like. The workshop was grounded in a positive psychology-inspired appreciative inquiry (AI) approach, first developed by Cooperrider et al. (2008). AI is a strength-based model that encourages change agents to look at people, systems and their organisation with “appreciative eyes”: instead of the traditional deficit-based model of focusing on “what’s wrong, what’s the problem”, AI shifts the lens to focus on strengths, achievements and opportunities – purposely engaging in a positive, strengths- based dialogue about the future. Sketching and sharing exceptional moments in healthcare Sketching and sharing exceptional moments in healthcare Participants were asked to draw and share a moment of “exceptional practice” – when they were engaged, excited, and proud of their work. Clinicians sketched memories of when a patient spoke for the first time in 6 weeks (saying “I love you, Mum”); of taking a patient – after PAGE 93 PAGE 93
  98. 98. 14 months of in-patient treatment – to visit their rural property for a picnic; the ward Xmas Party (bringing staff and patients together to celebrate); or when staff collaborated to bring a much beloved and missed dog into the hospital to visit its owner. Images were pinned to the wall, gallery style, triggering a collective discussion about “what a great rehab experience looks like at WM”. Empathy Mapping through Storyboarding – Don, Ruby, & Clara Empathy Mapping through Storyboarding – Don, Ruby, & Clara The workshop continued with an empathy mapping task. Participants were given two personas – 82 year old Don (carer for his 78 year old wife, Ruby, who has Diabetes and had a stroke a week ago) and 59-year-old Clara, whose complex medical history and multiple comorbidities included kidney disease, early stage chronic obstructive pulmonary disease (COPD) and frequent falls. A fall from her mobility scooter led to an infected gash, sepsis and a stay in ICU, triggering a referral to Rehab. Outdoor space at Ipswich Hospital Rehab PAGE 94 PAGE 94
  99. 99. After selecting one of these personas (or creating their own), the groups created a storyboard of transitioning between facilities through the medium of a comic - best case and worst-case scenarios, along with what patients, their families, and staff “think, feel and do” as they engage with the rehab system. These were pinned to the wall for discussion, with participants using “callout cards” to add scenes or comments to other groups’ scenarios. System Analysis: ‘Fears, Hopes, Myths, Legends’ Matrix System Analysis: ‘Fears, Hopes, Myths, Legends’ Matrix This next activity unpacked deeply held feelings about the proposed changes, with participants individually listing their ‘Fears, Hopes, Myths, Legends’ – from the perspective of both staff and patients. Hopes, for example, centered on: being able to improve client centered care and outcomes, to have no wait-list for rehab, to expand the service, provide an organized multi-disciplinary approach, develop a mobile rehab team, and use virtual care to positively improve patient care.  Ideation – idea-storming from six different perspectives Ideation – idea-storming from six different perspectives The last hour of the workshop centred on ideation where, with open and creative mindsets developed from the previous activities, participants engaged in a creative brainstorming process – to explore what could be done to create a “positive seamless Rehab journey for Don, Ruby or Clara”, with each person in the group challenged to speak from a different perspective (e.g., the patient, the carer/family, the staff, the space, technology, and communication). Prototype – Designing Change Prototype – Designing Change In the final activity, participants picked one idea to develop and pitch to the room - these centered on ways clinicians could ensure the planned changes supported their shared values of providing a quality, effective and consumer-centered rehab care experience. Groups proposed system-level solutions, such as The Boonah Bus and developing a home-like rehab centre (where multi-disciplinary PAGE 95 PAGE 95
  100. 100. teams work in collaboration in a less clinical, more home-like environment), options which are currently being considered for further development. Arts-based methods and design storytelling Arts-based methods and design storytelling The second part of the project used arts-based methods and design storytelling - a digital story and a photovoice exhibition - to trigger a public dialogue about the experience of rehab at WM. Photovoice (the joining of photography with voice) is a visual research methodology which uses photography to document, reflect on, and promote critical dialogue on important issues.  Here, we asked clinicians, consumers, and their families to photograph their experience of rehab - from the mundane to the momentous. Participants shared in photographs (with accompanying narratives) and cook again, to achievements and dreams for the future of rehab, with these narratives also captured in a short video. The video and images formed part of a public on-site exhibition at Ipswich Hospital – which provided a tiny peak into the hidden world of rehab, the committed clinicians and the stories of locals learning to walk, eat and speak again. Carer Persona Sheet PAGE 96 PAGE 96
  101. 101. PROBLEM          DIAGNOSIS DEEP REFLECTION           ANALYSIS PROVICATION            IMAGINATION EXPERIMENTATION          ACTION OPPORTUNITY          TRANSFORMATION CHANGE THE RULES OF THE GAME, TO TURN PROBLEMS INTO OPPORTUNITIES DESIGNERS
  102. 102. Emergency Room Entrances and Exits QUT HEAL TEAM: Lindy Burton, Jane Carthey, Evonne Miller, Sandra Astill, PARTNERS: Scott Schofield - Sunshine Coast University Hospital. Melanie Forbes - Bond University
  103. 103. Emergency Departments are highly dynamic, stressful environments for both clinicians and consumers, who wait for treatment, often feeling frustrated about un- certain ED processes and procedures. While numerous systems have been implemented to reduce crowding, shorten patient wait times, improve flow, operation and patient outcomes, less research has focussed explicitly on the physical design of the ED. Critically, the COVID-19 pandemic has further focussed attention on the role and design of the ED – spaces which are the first to recognize and respond to public health outbreaks – and the importance of flexible and adaptive space designs in healthcare.  What works (and what doesn’t) in ED design What works (and what doesn’t) in ED design The project team interviewed eight medical, nursing and allied health staff to better understand how they experience their hospital spaces, including any spatial facilitators and barriers to the delivery of positive healthcare in the ED – including entry, admission, triage, waiting and discharge areas, including the staff work areas associated with these spaces. Participants were located in a number of hospitals throughout Queensland, providing an insight into the differences in the workspaces and patients of urban, regional and remote hospital settings. We asked staff to critically reflect on  “what works and what doesn’t” in terms of their work environments’ physical designs. Participants drew on their past experiences of working in other locations, comparing it to their current workplace, the functionality of the workspaces during challenging times, and the diversity of patients coming through their areas, with a focus on vulnerable users, Recognizing that the COVID19 global pandemic (and new protocols of social distancing, clear screens, assigned routes, and increased hand washing) would have an ongoing influence on ED design, we PAGE 99 PAGE 99
  104. 104. also asked how their spaces have changed as a result of the pandemic. Finally, we asked them to suggest how designers could improve the hospital workplace and their ideal hospital work environment.  Conceptually, our research was guided by a desire to create healthcare environments and EDs that are salutogenic (ie., actively promoting health wellbeing for patients and staff), and we were also informed by an awareness and appreciation of biophlic design - that integrating nature and views of nature into the built form enhances wellbeing. Redesigning the ED - where to start?  Redesigning the ED - where to start?  Spatial design decisions were influential. Clinicians described how the design and layout of the waiting room impacted the patient experience - a well-placed triage desk, a children’s play area, screen for ‘health propaganda’, a taxi phone, a phone charger and multiple port adaptors and the addition of a waiting room nurse to improve communication with the waiting public were all initiatives seen to enhance the ED experience.  Wayfinding was often a challenge, however: “currently it is like a maze.  We need to have coloured lines on the floor or walls for people to follow” and “we would like to put these colour coded lines on the ground where we can say to family ‘Follow the light blue line and you’ll find the coffee machine at the end of it ‘or ‘follow the green line and you’ll find the exit’. We can’t do that in this hospital, so it is difficult to direct family and patients … they all have to be individually escorted inside if they’ve never been here before”.  Staff also appreciated consistency in relation to design and equipment set-up as important in the ED setting - “knowing where the buttons are, and not having to really think and look where you are means you can be on autopilot… it makes your job easier to have these uniform sort of panels”. Recalling past workplaces, “the hub and spoke design” was seen an efficient use of space because of the visibility it provides, as well as the time saving in locating patients, PAGE 100 PAGE 100
  • cdnorman

    Jun. 2, 2021

Healthcare Excellence AcceLerator (HEAL) is a collaboration hub, co-led by the QUT Design Lab and the Healthcare Improvement Unit at Clinical Excellence Queensland over 2020-2021. HEAL is designed to act as a bridge between the QUT design and innovation community and Queensland Health, accelerating healthcare improvement efforts across the state. This summary report outlines some of the key projects over 2020-21, and the impact of designers, working in collaboration with consumers and clinicians to transform healthcare. Suggested citation: QUT Design Lab (2021). Healthcare + Design = Innovation. QUT

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