Design + Nursing Innovation in Healthcare: Solving Health Care Problems from the Grassroots

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1 Design + Nursing Innovation in Healthcare: Solving Health Care Problems from the Grassroots Steven Doehler, Assistant Professor Industrial Design, University of Cincinnati Evelyn Fitzwater, Associate Professor Emerita Nursing and Associate Director of the Center for Aging with Dignity, University of Cincinnati Roberta J. Lee, RN, MSN, MPH Assistant Professor of Clinical Nursing Charles Puchta: MBA, CSA, Director of the Center for Aging with Dignity, University of Cincinnati Abstract As premier public urban research institution, the University of Cincinnati is transforming health care through an innovative and collaborative design process. Students and faculty from the School of Design s Industrial Design Program and the College of Nursing, together with advisors from the Center for Aging with Dignity, came together to address health care problems affecting the 50+ year old population. Considering public health concerns, environmental issues in health care settings, and product design limitations, the University supported a unique design and nursing collaboration focusing on product and services development that applied translational research. Translational research has been a hot topic for the past several years and is being heavily endorsed by the National Institutes of Health (NIH), which defines it as: PEER-REVIEWED PAPER Translational research includes two areas of translation. One is the process of applying discoveries generated during research in the laboratory, and in preclinical studies, to the development of trials and studies in humans. The second area of translation concerns research aimed at enhancing the adoption of best practices in the community (NIH 2009). The collaboration explained in this paper will primarily focus on the second area of translational research, more commonly known as T2 translation, using a community-based participatory research approach. Origins Our collaboration at the University of Cincinnati began with an exploratory meeting between Assistant Deans Cynthia Cook from UC s College of Nursing (CoN) and Craig Vogel from the College of Design, Architecture, Art and Planning (DAAP). Discussions revealed that the T2 goals of the CoN could be advanced and enhanced through a partnership with DAAP s School of Design and the Procter & Gamble/University of Cincinnati joint venture Live Well Collaborative. During this initial period, the University s then-president Nancy Zimpher allocated research and development funding for university initiatives intended to accelerate innovation on campus. Our proposed collaboration meshed with this objective; the result was Design + Nursing Innovation in Healthcare program. This new venture between three entities faced many obstacles. The pedagogy differed between design and nursing. While specific scientific parameters existed for both disciplines, we approached problem solving differently. Our university is divided into two campuses, east and west. The east campus is home to the university s Academic Health Center and the west campus is home to all other university disciplines. Although both campuses are near each other, most students took shuttle buses between them. We also faced obstacles in 1

2 PEER-REVIEWED PAPER setting up times for classes; each program had established course schedules, leaving few options for flexibility. And, most importantly, the student populations were at completely different academic levels. The CoN students were all practicing nurses, with some pursuing advanced degrees. Most DAAP students were undergraduates still learning the fundamentals of design. Since the levels and schedules did not match, our course objectives had to be different for each. Finally, we had to be creative about getting productive interactions among the students. To overcome these obstacles, the faculty and advisors had to get innovative. For example, when conducting projects where nursing students could not be involved, CoN faculty and advisors stepped in. While this was not the most effective method of collaboration, it got the program up and running. In these circumstances it was clear that in the absence of CoN students, the intimate exchange of information and weekly working of an integrated team would be lost. To lessen this effect, our advisor and faculty created photo-storybooks that provided details and background on each proposed project. These storybooks set the stage and helped students understand issues, problems, and design opportunities. They also enabled students to use them as reference material throughout the development process. Many times this material was used to confirm findings and validate design solutions. In other cases, the experience was embedded in a Community Health Nursing course. This was a particularly apt fit and enabled a true student collaboration. Due to the rigid curriculum of DAAP programs, the CoN s Community Health course was called on to adjust its overall schedule and provide times when nurses and designers could meet. This was a critical compromise made by CoN. Without a common meeting time, all collaboration would have had to be conducted outside of class and without faculty supervision. Because of this schedule adjustment, nursing students were able to play a larger role in clinical advising on a real-time basis, and their direct input could be integrated during the class time. The time adjustment also allowed for stronger bonds to develop between students as they grew to appreciate each other s disciplines. In this model, the center of the collaboration was the studio. Design students treated this as their primary project, with all efforts going towards its completion in the form of a product or service. On the nursing side, the collaboration was accomplished by embedding it within a public health nursing practicum. This is a senior level course for all BSN nursing students, with the title of Community as Partner. To meet course requirements, students worked with community members to develop interventions dealing with health issues and problems. The focus is on health promotion and disease prevention. The following is an example of how nursing students participated in the Assistive Mobility project. Experienced RNs completing their BSN degrees were selected for the studio project on improving the designs of crutches, canes, and walkers. Mobility is an important health issue regardless of age, and it extends from the hospital setting into the community. Students worked together in the studio in groups focusing on elders, children, adults, and also youth with sports injuries that immobilized them. The nurses advised design students in all aspects of the development of these improved mobility devices from interviews in hospitals, long term care, and home visits, to focus groups and community members at homes and on the street. They identified demographics such as the numbers of people affected by various immobility problems, and analyzed the impact of problems in relation to health. They helped with related anatomy and physiology, and disease patterns affecting mobility such as cerebral palsy in children and arthritis in the elderly, both of which compromise mobility. They worked with design partners in the hospital, where they analyzed patients negotiating walkers and canes through equipment-cluttered hospital rooms or getting on and off hospital elevators. Working together, the students developed designs for improved mobility. Our collaboration also had a mismatch in student numbers. Typically we had twenty design students to approximately six to ten nursing students. To broaden the nursing influence on the design students, we partnered one CoN student with two or more design students. This arrangement proved to be very successful, as it enabled nursing students to more effectively spread their knowledge. It also enabled the design students to utilize nursing input in a just in time fashion while design faculty could not lose valuable time needed to teach critical design fundamentals. Throughout the process, design and nursing students learned what each other had to offer and how to solve real world problems with the practical knowledge they gained. This method also allowed collaboration on a level at which nursing students could contribute without disrupting their clinical schedules. Methodology As a T2 collaboration, the Design + Nursing initiative concentrates on public health and community-based participatory aspects of translational research. Our projects originate in the College of Nursing, where faculty and staff brainstorm to identify significant areas of concern in the field of health care. Based on research findings and personal experiences in health care settings, the CoN identifies projects that require a product or service component that may also have a significant impact on the community. The Assistant Deans from the CoN and DAAP then review and prioritize the opportunities. Once a problem/opportunity topic is selected, meetings are held to determine resource requirements and to identify the key faculty and staff members who will participate in the project. 2 The design innovation course is physically located in the college of DAAP. This location is used due to its conduciveness to creative problem solving. The classrooms are referred to as studios, comparable to lab spaces used for research and development. The studio is filled

3 with work surfaces on which to develop and build iterations of concepts. Its walls are designed to allow the display of product concept ideas, research data, and inspirational material. At the College of Nursing, clinical labs and classrooms are also available for testing and refining concepts. PEER-REVIEWED PAPER Figure 1. Design Studio To begin, the class faculty and advisors from CoN and DAAP prepare a project description and required course deliverables. Again, these descriptions and deliverables vary greatly between nursing and design students. Although they collaborate, each group of students is enrolled in a separate class and is graded according to the criteria set by their respective faculty members. Classes consisted of as many as ten nursing students and twenty-six design students. The following are examples of recent project statements that are purposefully broad in scope: Bedside Buddy: Redefining space and surface, a functional solution for health care and home. Mobility Assistive Device Studio: Re/designing assistive mobility devices such as canes, crutches, and walkers, the user profiles covered the life span (e.g., child with a birth disorder, stroke victim, frail older adult) in various environments (e.g., community-dwelling residents, long-term care patients), and devices posing many limitations. Elders Abused Financially: Re-thinking financial elder abuse; engaging the financial network with the right value proposition. By keeping the scope directed but open, we gave students the ability to select directions they had a passion for while still staying in the realm of the original research. Groups are formed once a topic is presented and design students select an area of interest. These groups help to unify design students with similar interests and enable nursing students to see what groups coincide with their expertise. For example, the Bedside Buddy project produced a group of designers who were interested in hospital settings, assisted living environments, and home settings. These students partnered with nurses/advisors with experience and expertise in these settings. As the groups formed, we began the product development process as executed by the Industrial Design curriculum. This process consists of four main phases: Research, Conceptualization, Validation, and Finalization. In the research phase, design and nursing advisors/students work closely as a team within their group. They conduct literature reviews, competitive benchmarking, ergonomic studies and, most importantly, on-site observations and face-to-face interviews with users and stakeholders. In this phase, our mission as faculty members is to get students immersed in the topic. When students develop sympathy for groups for whom they will design products, they have a greater understanding of the design criteria needed to produce a product or service that addresses user needs results. 3

4 PEER-REVIEWED PAPER Figure 2. A role-playing exercise enhances students empathy for patient needs. As previously stated, the research phase was conducted in teams. This is the only phase in which designers interact in a team format. Once the research phase is completed, each designer applies the team s findings to a personal project. When this transition is completed, the conceptualization phase begins. Design students disseminate all research information and develop innovative product concepts that address user/community needs. Also during this phase, nursing students evaluate and validate concepts based on their intuition and clinical expertise. The core of this phase has the students developing a multitude of product concept iterations. These are conceived using paper and pencil, computer aided design, and by building models. At the end of this stage, the product is a set of three to five solid concepts that best represent the original design requirements established in the research phase. These concepts were then used in the validation phase. 4

5 PEER-REVIEWED PAPER Figure 3. Research and Conceptualization Phases In the validation phase, students present their product ideas to the subjects they interviewed as well as to their nursing partners and advisors. This is a short phase, but highly beneficial to the project. Students receive direct feedback from those who helped them form their design requirements. Here they find out if what they are developing has hit the mark, missed the target, or landed somewhere in between. After validation, students interpret their user feedback and choose a final direction. This is the finalization phase. Quite often the results of the validation phase are hybrid solutions based on several concepts. In the finalization phase, students bring their final concepts to life by ensuring all mechanical, aesthetic, and usability details are addressed and semi-functional prototypes were produced. During this entire process, the nursing partners, advisors, and design students work continually together. Nursing students answer questions via discussion boards, blogs, and group chats. They provide feedback and offer clinical perspectives on concept images through the same digital communication methods. The result from this four-phase process has been four collaborations that have gone beyond the teams expectations and have gained the attention of several corporations and venture groups. Figure 4. Low-Tech Bamboo Walker Figure 5. High-Tech Powered Walker 5

6 PEER-REVIEWED PAPER Figure 6. Over Bed Table for Home and Hospital Findings and Results In little over a year since the Design + Nursing collaboration has been formed, we have produced over forty product and service solutions that address real user and community needs. We have formed a solid bond between two colleges that in the past had virtually no relationship or communication. We have gained university recognition we were featured in the UC magazine and we are gaining momentum with our local investment community. From a student prospective, we are getting testimonials such as this that sum up the impact this collaboration is having on our students and faculty: The collaboration between Design + Nursing provided a new perspective on the design process and a new approach to design research. Learning about a new field each group may have never delved into such areas as Epilepsy or Industrial Design. Crossing two worlds not only helped me as a designer to better articulate and communicate with non-designers but I think it helped the nurses in much the same way. Crossing the barriers allowed us to realize just how close our two fields can really be. This an experience worth having for many years to come. Below are examples of project outcomes as they relate to the Bedside Table and Assistive Mobility projects. Sustaining the Collaboration To date, our Design + Nursing Innovation in Healthcare collaborative has conducted four 10-week projects. These projects have focused on bedside and over bed tables, assistive mobility devices, financial elder abuse, and childhood diabetes in Asian American youth. Through these projects, we have continually fine-tuned our Design + Nursing alliance and have found the flexibility in our curriculum to overcome many of the obstacles discussed above. This has allowed our Design + Nursing Collaborative to hit its stride. While we are having positive outcomes, we are not yet satisfied with our results. Our goal is to produce testable prototypes and compete product lines that would have the potential to stand on their own as independent companies. To assist in reaching this goal we are working closely with the university s intellectual property office. We have established a product evaluation team that reviews and ranks products and services produced in our collaboration. This team consists of intellectual property experts, industry consultants, and university advisors from both DAAP and CoN. In the area of grants, we have used the results of our initial projects a springboard to compete for funding that will assist in further development of our completed research and development. To help reach our ultimate goal of actually seeing one or several ideas to market, our university s office of intellectual property is playing an integral role. They are in the process of using their vast network of industry contacts to make known our efforts and the potential for commercialization. References National Institutes of Health Translational research: Overview. 6