Hospital incidents often include falls, medication errors and infection control—and patients often find it hard to speak up.
Emily Carr’s Health Design Lab and Fraser Health collaborated on a research and design project considering patient engagement in healthcare—specifically on increasing patient safety in hospitals.
Fraser Health asked the Health Design Lab to provide a fresh perspective to help uncover and design innovative, perhaps even provocative, modes of encouraging a safety culture in their hospital settings.
Through a series of co-creation sessions, literature reviews and ethnographic probes, Keeping Patients Safe! campaign was born. The campaign aims to change the culture of safety in hospitals by providing the tools for patients and care teams to work collaboratively towards improved safety. This includes a safety briefing video, a tablet based App for patients, and designs for facility-wide interactive smart boards.
The research process
In order to best understand the inner workings of care facilities such as those at Fraser Health, our team took great care in learning from those individuals working in the field. We conducted co-creation sessions with various members or the public and the FH staff (from hospital administrators, to RNs, to managers), ethnographic probes with current patients, and phone interviews with current physicians at Fraser Health.
Through our research, it also became evident that the topic of patient safety in hospitals was not limited to the walls of healthcare facilities. The factors extend beyond hospitalization to include the education and attitudes of caregivers to the protocols surrounding patient discharge and aftercare. The goal of the project was to change the culture of safety in the hospital and provide tools to encourage open dialogue between doctors, nurses, and patients.
We found that establishing a culture of safety in hospitals can be achieved through three overarching concepts: building positive partnerships, facilitating patient empowerment, and establishing rituals. These three concepts work together to increase patient safety in hospitals by making the patient an active participant in her own care. By having knowledge about their care, patients will feel more in control of their own health, thus, instigating a new culture in which hospital hierarchies are flattened and partnerships built.
The three overarching concepts
To develop a culture of safety in hospitals, patients, family and the healthcare team must work together and trust each other to take responsibility for the patient’s health and safety. These positive partnerships need to be encouraged and worked towards as a goal, to encourage patient participation in their care.
As the basis of forming positive partnerships, we aimed to create a sense of belonging to an existing team–a team in which the patient would be an active participant at the centre of what became the “Keeping Patients Safe!” initiative.
In order to communicate this sense of patient empowerment and team building with patients at the centre, we visualized a patient at the centre of an imagined Circle of Trust. The Circle of Trust illustrates a circle with the patient at the centre and with their entire care team on a level plane around them.
We propose to develop a culture of trust where success is celebrated in a feedback loop among the patients, family, staff, and hospital, to show and understand the benefits of such change.
We felt the best way to facilitate patient empowerment was to begin by educating patients on their care. Patients would begin every hospital admittance with a patient briefing–which would ideally take place at the patient’s bedside. This ensures the patient is comfortable, relaxed and is hearing the briefing from one of the members of their Circle of Trust.
By shifting the responsibility in hospital safety to both the patient and their care team, it allows the patient to start understanding that they are at the centre of their own care.
Rituals are a powerful way to develop and implement a new culture. Because rituals are tangible and physically manifested, they support culture and are a key foundation to build upon. Once rituals are implemented and become part of everyday life, participation can be more comfortable and become the new norm of interaction and a part of the hospital policy.
The patient briefing video offers a presentation of hospital rituals and expected patient behaviour by offering a concise and standardized brief.
The briefing video is intended to encourage positive partnerships between the care team and patient. The video functions as an educational tool to promote patient engagement, involvement and responsibility through the animated graphics and live content.
The content informs the patient of various safety protocols to be aware of in order to promote a sense of empowerment and responbility before the start of care. It offers a presentation of hospital rituals and expected patient behaviour by illustrating a concise and standardized brief.
The video begins by introducing the mandates of the Fraser Health Authority. Each of the points then briefly touches on the primary safety issues affecting patients within Fraser Health and describes possible options for the patient to individually follow to maintain a safe hospital environment.
An analogue whiteboard allows for immediate implementation of a communication tool for the staff, patient and family.
Hanging in the patient’s room, it would include the patient’s name, language, mobility, a plan for that day, and an area for messages. Staff, family and patients would be able to contribute to the whiteboard, creating a sense of partnership between all those involved in the patient’s health and well-being.
In the future, the whiteboard would be transitioned into a digital solution that would pair with the app we have designed to provide greater opportunity for partnership and communication among all those involved.
Smart Board System
Each ward would have its own networked monitor system containing its patient and general information. Each patient would have a personal, networked monitor that collects public level information such as messaging between caregiver and patient, Fraser Health-related news and updates, and today’s plan from their Patients First iPad application.
The patient Smart Board would be controlled using the Keeping Patients Safe! iPad app, giving the patient a way to navigate the networked monitor and publicly communicate with caregivers or friends and family.
The unit supervisor would maintain the central control of a ward’s monitor system. The central control would be a computer-based system with drag and drop widget technology that would aid in the organization of information, making it easily accessible for staff.
It would be used to send and divide information into public or designated patient networked monitors and receive feedback from patients. It would consist of two monitors, one for selecting content and the other to preview content. The system would be beneficial for the hospital community as it would be maintained and updated regularly.
For the public Smart Board, we revisited the project goals and selected subjects we deemed appropriate. These included subjects such as patient education, news and updates, and wayfinding to and within a hospital in the form of maps. Information that would also be displayed in the public Smart Boards would be up-votes as recognition and motivation for caregivers, achieved goals by patient as recognition and motivation for other patients or caregivers, and waiting times for patients and their friends and/or family.
The public Smart Boards would allow touch screen interaction, so infection control can be easily maintained. The user would be prompted to sanitize his or her hands before and after use. Both public and patient screens could be easily and consistently cleaned with anti-bacterial sprays or wipes.
The app is an education and communication tool designed to encourage a culture of patient-centered care.
It is designed for bedside use, as the patient becomes physically and mentally available to engage with an iPad in their hospital bed. The team sees the nurse orienting the patient to the app following their shared viewing of the patient briefing video, which can be viewed directly from the iPad. The app would be used for the length of the hospitalization.
The first screen the patient sees after they enter a passcode is the Circle of Trust. The Circle of Trust allows the patient to see herself at the center of her care team, and more closely engage with her health care practitioners, and connect them with their families.
The Circle of Trust is automatically populated utilizing the hospitals scheduling system. Background information would be provided on the team, allowing the patient to feel connected and engaged.
The Calendar section allows patients to see their day at a glance. They can see upcoming appointments, visitors, hospital events, and medication reminders. When the patient taps on a medication reminder, she is able to see a pictorial display of the medication, the quantity prescribed and a description of the pills to be taken at that time.
When the patient taps on an appointment, she is able to see where and when the appointment is, and look at a map of the hospital. The patient can see who their health care practitioner for that appointment is and leave notes on appointments and events. Members of that patient’s Circle of Trust can also leave notes on appointments and events, allowing them to advocate from afar. The medical team can then refer to the notes when meeting with the patient at the appointment.
The patient is able to see her current medication and allergies in the Chart. Medications would be fed through the existing pharmaceutical database, while the allergies tab provides a quick and easy way to add allergies to the patient’s account. Patients can search for a specific allergy and provide notes on what type of reactions they might have.
This section educates the patient on what medication she should be taking, empowering her to ask a nurse to double check the prescription if she sees a pill she does not recognize, avoiding medication error. In the future, this section would be where the patient could see their Electronic Medical Record (EMR).
The patient is also able to message people in her Circle of Trust within the app. When creating a message, patients can select any combination of the following options: Unit Coordinator, Smart Board, in addition to all, or selected members of her friends and family.
All chats within the app appear in a similar manner as iMessage, allowing users to click from a list of contacts and transitions between a chat screen with speech bubbles and a chronological list of historical chats.
Keeping Patients Safe! is the result of a successful collaboration between Fraser Health and Emily Carr University. Without the involvement of Fraser Health, our primary research would have been significantly less robust; their part in this process was invaluable.
Learning from individuals in the field, both as staff and patients, was an informative and thought-provoking experience, and gave us a great level of understanding into the hospital. Keeping Patients Safe! is a concept centred around patient care; by acknowledging the patient as the key element of the health care interaction, we hope that the hospital can become a much safer place.