Designing the Hallway Bed Patient Experience

This project is the result of a partnership between the Michigan Medicine Emergency Department (ED) and the University
of Michigan Stamps School of Art & Design, Masters of Design (MDes) in Integrative Design program. I co-designed alongside
a cohort of five Master's students over the course of a four month semester during the fall of 2017.

Problem

Approach

Observations

Journey Map

Pain Point
Analysis

Staff Survey

HMW

Insights

Conclusion

Our objective was to investigate the current practice of treating patients in hallway beds at the University Hospital Adult Emergency Department at Michigan Medicine. Much research has been dedicated to finding a solution to ED overcrowding. However, minimal, if any, research has been conducted regarding how we might improve the care and experience of hallway bed patients.

Staff

Experience

Patient

Experience

Optimal Care

Conceptual model of problem space.

We utilized a human-centered design approach to explore our problem space including interviewing on-site observations, conducting secondary research, and leveraging design methods. For our design process we utilized the Double Diamond method focusing on developing and designing interventions to be implemented within the ED to improve patient experience.

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On-site
Observations

Secondary
Research

Journey
Mapping

Pain Point
Analysis

ED Staff
Survey

Data
Synthesis

Ideation &
Prototyping

Our design research included 120 hours of observations within the ED. We considered hallway bed care at different locations, times of the day and week as well as interactions between care providers, patients and others. Through our observations we identified three areas of concern including communication, environmental factors, and privacy.

COMMUNICATION

Barriers arise when staff are reluctant or unsure how to discuss the hallway bed process. This leaves patients uninformed and confused which creates anxiety and frustration.

ENVIRONMENTAL FACTORS

Patients and staff can encounter pain

points due to the physical space and the sensory experience (light, noise and sound) in the hallways. This environment differs in each of the

specific hallway bed locations.

PRIVACY

Multiple times during the ED process,

the lack of privacy (either physical or personal information privacy) is painful for both patient and staff.

Working from our observation notes, we mapped patient and staff “pain points” over time to deepen

our understanding of the process of care and barriers that arise for both a patient and staff during
the hallway bed experience.

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Identifies barriers of ‘pain points’ encountered by patients and staff, and maps according to stage of process.

We considered the pain points collected in the Patient-Staff Journey Map in tabular form, according to the categories identified in the Affinity Mapping. This analysis assisted in determining the opportunity areas in which we believe interventions would have the most impact.  We found that most pain-points occur within the communication about "process” row and the “waiting” column. Patients do not know what to expect within the hallway bed process and staff are uncertain how to communicate to patients.

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The pain points according to the ED process.

We formulated an 8-question survey to gather staff feedback regarding our three main areas of concern. 158 staff responded. The goal was to gain insight into the staff perception of the hallway bed process and validate our pain-point analysis.

What do you say when assigning, transporting, or caring for them about

the hallway bed context and process?

23%

No choice, rooms full

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37%

Acknowledge Trade Off

8%

Other

7%

Minor Injury

25%

Apologize

Do you speak with patients when assigning, transporting, or caring for them, about the hallway bed context and process?

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61%

Yes

11%

No

28%

Sometimes

Based on our understanding of the problem space we developed the following "How Might We..." statements to begin ideating possible interventions.

How might we help patients feel confident they are being well cared for through the whole experience?
How might we help staff provide optimal care to hallway bed patients?
How might we help patients feel the hallway bed “belongs” and is an appropriate site for care?
COMMUNICATION
Patients are often confused about the purpose and process of hallway bed care.
Staff communication is inconsistent and can reflect ambivalence about the practice.

Opportunity: Create a communication tool to assist staff in explaining hallway bed care to patients, appropriately set patient expectations and create more clarity and sense of control for patients.

The ED process map can both be given to patients on arrival to the ED and used by triage staff to

facilitate and standardize the conversation when assigning a patient to a hallway bed.

Concept and design by Prachi Bhagane.

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ENVIRONMENTAL FACTORS
Hallway beds are currently located in four significantly different environments that create a range
of patient experiences. As a result, the impact of varied hallway bed environments is not factored
in to patient location assignments.

Opportunity: Relocate hallway beds and rethink sequence of use, as possible, to minimize use of less suitable spaces and positively impact patient experience and care.  Maximize patient comfort by matching patient sensitivities and needs with appropriate bed locations.

We recommend identifying which patients are most appropriate for each hallway considering the sensory environments of each location. Personas can assist staff in developing protocols for hallway bed assignments that consider specific patient conditions to minimize negative environmental factors.

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triage

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triage

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Concept developed collaboratively and design by Kady Jesko.

Hallway beds feel out of place and disconnected from the ED operational flow.

Opportunity: Create a sense of place and intentionality with signage that delineates and identifies
a specific location.

Signage, fabricated in removable vinyl, can be added to the walls to delineate spaces for hallway beds.

A system of color and number coding (ie., G3 = the third bed in the green area) creates a unified visual presence in the location and aids navigation.

East Current
East Current

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East Proposed
East Proposed

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Main Proposed
Main Proposed

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East Current

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Concept developed and designed by Katherine Jones.

Simple patient requests create disproportionate burdens for staff because of hallway bed locations.
 

Opportunity: Reduce staff workload and give patients a sense of agency with hallway comfort carts. 

A dedicated patient comfort cart can be placed in each hallway and stocked with blankets, water, ‘quiet kits’ with eye covers and ear plugs, and phone chargers. Patients are able to access or request items
as needed.

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Hallway Cart Concept. Designed by Kady Jesko.

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Hallway Cart Concept with Placemaking.
Designed by Kady Jesko & Katherine Jones

PRIVACY
Lack of privacy — both visual and auditory — leaves patients feeling exposed and keeps staff
from being able to do their jobs properly.

Opportunity: More functional screen coverage can improve care and make patients more comfortable.

Our short-term privacy solution recommendation would be to buy two models of screens — a single and double panel — that could be used separately or in combination. Both screens offer good mobility, stability and ease of storage. Our long-term privacy solution recommendation would be to develop a new screen specific to the needs of a hallway bed.

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Concept and design by Bruna Oewel.

We presented our final recommendations to our partners with the University Hospital Adult Emergency Department partner and stakeholders from Michigan Medicine including ED Service Chief Steven Kronick. Recommendations were taken into consideration and shared widely with ED staff to attempt possible implementation.