Ambulance treatment space ergonomic layout

This was the first time a multidisciplinary team employed an iterative co-design method to determine the ergonomic layout of an emergency ambulance treatment space. Fusari’s original contribution to the project was to develop a process which allowed the research team to understand how treatment protocols are performed and analytical tools to reach an optimum configuration for ambulance design standardisation. In leading on the ergonomic layout of the ambulance interior, Fusari, researcher with Harrow (RCA, PI) and Ed Matthews (RCA, CI), conducted participatory observations during 12-hour shifts with front-line ambulance clinicians, hospital staff and patients to understand the details of their working environments in relation to urgent emergency calls. A simple yet accurate 1:1 mock-up of the existing ambulance was built for detailed analysis of these procedures through simulations. Paramedics participated in interviews, role-playing and co-design methods using visual cards to demonstrate how tasks are performed, equipment is used and current limitations overcome. In parallel, Fusari exhaustively audited (logging and photographing) all equipment and consumables used in ambulances, to define space use; 12 layout options were refined using CAD modelling, which were presented to paramedics. The preferred options and features were developed into a full-size test rig and appearance model. A full-size mobile demonstrator unit featuring the evidence-based ergonomic layout was built for clinical testing through simulated emergency scenarios. Results from clinical trials clearly showed that the new layout improves infection control, speeds up treatment, and makes it easier for ambulance crews to follow correct clinical protocols. The research was finalist in the 2011 Design for the Real World Redux International Design Competition; Winner, Design Museum Designs of the Year 2012 Award – Transport Category; Winner, Silver in the category of Research for the 2012 International Design Excellence Awards; and Notable Award Core77 2012 Design Awards in the Strategy & Research category

Ambulance prototype design – Digital Diagnostics and Communication (DDC) system

During the development of a new treatment space for the UK emergency ambulance (Fusari REF Output 1) participatory observations with front-line clinicians revealed the need for an integrated patient monitoring, communication and navigation system. Fusari identified the different information touch-points and requirements through modes of use analysis, day-in-the-life study and simulation workshops with clinicians. His research was a further development from the 2007–2010 EPSRC-funded Smart Pods to Reconfigure Urgent Healthcare Delivery project, which investigated treating patients in the community. Emergency scenario building and role-play with paramedics identified five distinct ambulance modes of use which informed the development of the Digital Diagnostics and Communication (DDC) system. Information flow diagrams were created and checked by paramedics. Digital User Interface wireframes were developed and evaluated by clinicians during clinical evaluations. Feedback from the latter further defined the User Interface design specification, leading to a design proposal that demonstrates a new system of communication between ambulance crews and the hospital. The resulting interactive prototype was co-designed in collaboration with ambulance crews and provided a vision of what could be achieved by integrating well-proven IT technologies and protocols into a package relevant in the emergency medicine field. Critically, it anticipated through research a time when electronic patient records can be accessed inside an ambulance en route to emergency. The system was reviewed by over 40 ambulance crews and is part of a newly co-designed ambulance treatment space

Medical bag – Medical Bag for General Practice

Fusari’s research addressed practice-related problems from a medico-legal perspective with the aim of providing a working tool that aids GPs to comply with best practice protocols. The resulting bag was developed in collaboration with General Practitioners, clinicians and members of the Medical Defence Union (MDU). Using proven methods to establish an evidence-based brief (as developed within the Helen Hamlyn Centre for Design Healthcare and Patient Safety Lab), this research used task, equipment and consumables analysis to determine minimum requirements and preferred layouts for task optimisation. The research established that clinicians require three distinct functions in their workspace: laying out, organisation, and information retrieval. Feedback from clinicians indicated that this working tool allows them to access information and equipment wherever they may be: a marked improvement on current practice. It has been shown that lifestyle and demographic changes such as the ageing population and increased prevalence of chronic diseases require more consistent standards of primary care, and that this is well coordinated and integrated (Imison et al. 2011). Many guidelines exist relating to general practice and the doctor’s bag (NSLMC 2008, RACGP 2010, RCGP 2008 and Hiramanek 2004), but there is no standard in the UK that regulates the shape and materials of the bag or its contents. Doctors may use any sort of vessel to transport their equipment and consumables to a patient’s location. Furthermore, treating patients in their own homes, outside an ideal clinical environment, presents its own complications. A looks-like, works-like bag prototype and information system were developed that will be used in clinical trials, the results of which will determine the manufacturing of a new, standardised bag for clinical treatment for use by members of the MDU

Ambulance Treatment Space Ergonomic Layout

This is the first time a multidisciplinary team has employed an iterative co-design method to determine the ergonomic layout of an emergency ambulance treatment space. This process allowed the research team to understand how treatment protocols were performed and developed analytical tools to reach an optimum configuration towards ambulance design standardisation. Fusari conducted participatory observations during 12-hour shifts with front-line ambulance clinicians, hospital staff and patients to understand the details of their working environments whilst on response to urgent and emergency calls. A simple yet accurate 1:1 mock-up of the existing ambulance was built for detailed analysis of these procedures through simulations. Paramedics were called in to participate in interviews and role-playing inside the model to recreate tasks, how they are performed, the equipment used and to understand the limitations of the current ambulance. The use of Link Analysis distilled 5 modes of use. In parallel, an exhaustive audit of all equipment and consumables used in ambulances was performed (logging and photography) to define space use. These developed 12 layout options for refinement and CAD modelling and presented back to paramedics. The preferred options and features were then developed into a full size test rig and appearance model. Two key studies informed the process. The 2005 National Patient Safety Agency funded study “Future Ambulances” outlined 9 design challenges for future standardisation of emergency vehicles and equipment. Secondly, the 2007 EPSRC funded “Smart Pods” project investigated a new system of mobile urgent and emergency medicine to treat patients in the community. A full-size mobile demonstrator unit featuring the evidence-based ergonomic layout was built for clinical tests through simulated emergency scenarios. Results from clinical trials clearly show that the new layout improves infection control, speeds up treatment, and makes it easier for ambulance crews to follow correct clinical protocols

ICU Journey: Humanising the patient experience of Intensive Care

Intensive Care Units (ICU) are spaces designed to look after patients with life threatening conditions; they provide life-support, extensive therapies and continuous monitoring aiming to preserve life and return patients to good health. The clinical intensity and invasiveness of this highly medicalised and technology-dependent environment can be intimidating and threatening for patients. This paper details the development of a technology to mitigate against this. Working in partnership with four hospitals in England, the multidisciplinary design team co-developed a tablet-based application - called Senso - aiming to reduce the psychological effects of Intensive Care by enabling clinicians, carers and patients to personalise some aspects of their environment. During the first phase, the team performed primary research in four hospitals in England, developing an understanding of the problem from the point of view of different stakeholders including patients, relatives and clinicians. Further analysis through co-design workshops distilled three design issues: positive sensory disruption, orientation, and information and space utilisation. Through co-design workshops involving a ICU Patient Support Network Group, the team prototyped and tested ideas. After two cycles of iteration, requirements for a minimum viable product were outlined. The outcome is a digital application that provides a personalised sensory experience for the patient named Senso. After onboarding, Senso generates a moodboard from the selected images and videos. This not only provides a familiar view for the patient but can also help staff to engage personally with the patient. A daily schedule helps relatives understand the patient’s day-to-day activities and progress. Senso provides patients with a daily routine, supporting them through their journey from leaving the operating theatre through to the point of discharge from ICU. The hypothesis is that by providing structure to the patient’s day help in orientation and engagement. Initial testing indicates that Senso has potential to improve outcomes

Protocol for a feasibility study of OnTrack : a digital system for upper-limb rehabilitation after stroke

Introduction Arm weakness is a common problem after stroke (affecting 450,000 people in the UK) leading to loss of independence. Repetitive activity is critical for recovery but research shows people struggle with knowing what or how much to do, and keeping track of progress. Working with more than 100 therapists (occupational therapists and physiotherapists) and patients with stroke, we co-developed the OnTrack intervention - consisting of software for smart-devices and coaching support - that has the potential to address this problem. This is a protocol to assess the feasibility of OnTrack for evaluation in a randomised control trial. Methods and analysis A mixed methods, single-arm study design will be used to evaluate the feasibility of OnTrack for hospital and community use. A minimum sample of 12 participants from a stroke unit will be involved in the study for 14 weeks. During week 1, 8 and 14 participants will complete assessments relating to their arm function, arm impairment, and activation. During weeks 2-13 participants will use OnTrack to track their arm movement in real time, receive motivational messages, and face-to-face sessions to address problems, gain feedback on activity, and receive self-management skills coaching. All equipment will be loaned to study participants. A parallel process evaluation will be conducted to assess the intervention’s fidelity, dose and reach, using a mixed methods approach. A Public and Patient Involvement (PPI) group will oversee the study and help with interpretation and dissemination of qualitative and quantitative data findings. Ethics and dissemination Ethical approval granted by the NHS Health Research Authority, Health and Care Research Wales, and the London - Surrey Research Ethics Committee (ref.19/LO/0881). Trial results will be submitted for publication in peer review journals, presented at international conferences and disseminated amongst stroke communities. The results of this trial will inform development of a definitive trial. Trial registration details ClinicalTrials.gov (NCT03944486), pre-results

Developing the Double Diamond Process for Implementation

This paper details overarching methodological insights resulting from several Inclusive Design projects in healthcare spanning ten years. A number of lessons have emerged, both practical and methodological, and are applicable to future design work in healthcare and the implementation of innovation. The Double Diamond methodology was used in all projects, increasingly run in parallel / mixed with an agile approach and PDSA cycles, where rapid iterations of the methodology are run in series. The final phase of the Double Diamond concerns delivery. The exact form that ‘delivery’ takes is unique to each project and partnership, but merits careful examination. Implementation of innovation is notoriously difficult in healthcare (Morris et al, 2011). Typically this is seen as post-‘design’, and necessarily requires the commitment of any healthcare project partner. Whilst some of the best innovations win design awards, many award winning designs are not adopted into front line use. There may be more to be done in design terms. The practices of co-research, co-creation and co-design are well used. Co-implementation efforts should start well before the end of the ‘Discover’ phase. These efforts may involve the identification of implementation stakeholders (standard practice in much co-design), but also funding bodies, the development of business cases and the adoption of commercial constraints in the design. Adoption of innovation in healthcare takes time, and is fraught with many complicating factors. Many lauded design outputs are not in use, pointing to poor implementation strategies. The above benefits of the Double Diamond must be applied to implementation in order to help adoption. This not only means involving the relevant stakeholders and identifying the relevant funds for implementation earlier in the process, but crucially designing the output with an implementation strategy in mind. This practice of ‘co-implementation’ will improve future adoption of innovations

“Medical bag for General Practice” Just in Case: redesigning the doctor’s bag (2012)

This research addressed practice related problems from a medico-legal perspective and aims to provide a working tool that aids GPs to comply with best practice protocols. The resulting bag was developed in collaboration with General Practitioners, clinicians and members of the Medical Defense Union. Using proven methods developed within the Healthcare & Patient Safety Lab (e.g. DOME, Ambulance) to establish an evidence-based brief, this research used task, equipment and consumables analysis to determine minimum requirements and preferred layouts for task optimisation. The research established that clinicians require three distinct functions in their workspace: laying out, organisation and information retrieval. Feedback from clinicians indicates that this working tool allows them to access information and equipment wherever they may be and suggests an improvement from current practice. The research is now into a second year where the design of the bag will be refined and tested. Lifestyle and demographic changes such as the ageing population and increased prevalence of chronic diseases require more consistent standards of primary care, and care that is well coordinated and integrated (Imison, et al., 2011). Many guidelines exist relating to general practice and the doctor’s bag (NSLMC, 2008, RACGP, 2010, RCGP, 2008 and Hiramanek, 2004), however there is no standard in the UK that regulates the shape and materials of the bag or its contents. Doctors may use any sort of vessel to transport their equipment and consumables to a patient’s location. Furthermore, treating a patient in their own home, outside an ideal clinical environment, presents its own complications. A looks-like, works-like bag prototype and information system that will be used in clinical trials, the results of which will determine the manufacturing of a new, standardised bag for clinical treatment used by members of the Medical Defence Union

“Digital Diagnostics and Communication (DDC) system” Redesigning the Emergency Ambulance

During the development of a new treatment space for the UK emergency ambulance participatory observations with front-line clinicians revealed the need for an integrated patient monitoring, communication and navigation system. The research identified the different information touch-points and requirements through modes of use analysis, day-in-the-life study and simulation workshops with clinicians. Emergency scenario and role-play with paramedics identified 5 distinct ambulance modes of use. Information flow diagrams were created and checked by paramedics and digital User Interface (UI) wireframes were developed and evaluated by clinicians during clinical evaluations. Feedback from clinicians defined UI design specification further leading to a final design proposal. This research was a further development from the 2007 EPSRC funded “Smart Pods” project. The resulting interactive prototype was co-designed in collaboration with ambulance crews and provides a vision of what could be achieved by integrating well-proven IT technologies and protocols into a package relevant in the emergency medicine field. The system has been reviewed by over 40 ambulance crews and is part of a newly co-designed ambulance treatment space