RCA Leads Way in Multidisciplinary User-Centred Design Solutions for Patient Safety
With increasing pressure on the national healthcare system, public services and provisions have to meet ever more stringent financial, resource and efficiency objectives. The Royal College of Art has demonstrated how systems-led thinking and a design approach to understanding the user’s needs can effectively reduce infection and medical error, and improve treatment spaces and patient communication.
Ed Matthews, Senior Research Fellow, said, 'Our early work, tended to address patient safety issues through the design of products, packaging or labelling systems. But current challenges, such as the ageing demographic or 'time bombs' such as dementia, obesity, diabetes and respiratory disease, mean that in order to deliver sustainable healthcare, we must do all we can to prevent so that we are less obliged to cure. This means designing to promote behaviour change rather than simply designing widgets.'
Research projects including Design Bugs Out (2009), Design for Patient Dignity (2010), Reducing Violence and Aggression in A&E (2011) and the Redesign of the Ambulance are among the seminal projects by the Royal College of Art and partners, opening up national debate about the healthcare system.
Early research as part of the EPSRC-funded project Designing Out Medical Error took a fresh stance in tackling patient safety issues. By forming a multidisciplinary culture in which designers, clinicians, psychologists and business specialists collaborate, the RCA revolutionised the traditional, discipline-specific ways of addressing patient safety issues. Focusing on understanding the needs of both users and providers of the service – the patient and the healthcare teams – through extensive observation, rather than focus groups, revealed key insights and opportunities to intervene with design-led solutions.
The Designing Out Medical Error project, which ran from 2009 to 2012, investigated how one in 10 patients who go into hospital in the UK suffer some kind of unintended harm – a vital statistic yet previously under-researched. Several hundred hours observing everyday processes in three hospitals revealed how, by reorganising and overhauling space, tools and process could help prevent infections from spreading between patients, promote proper hygiene practice and administering of medication, as well as ensuring information was not lost in staff shift handovers or the recording of vital signs.
One of the key outcomes of the project was The CareCentre, an all-in-one unit placed at the end of the bed, reducing the time nurses spend walking around wards to collect all the equipment they need. The system included an early warning system, alerting nurses to seriously unwell patients, and a clear and consistent graphic indicating the requirement of hand-hygiene at key places and at key points in the ward duty process.
Further design research into the ambulance in 2011 led to vast improvements in mobile emergency healthcare. A team comprising RCA School of Design programmes Vehicle Design and Innovation Design Engineering, and the Helen Hamlyn Centre for Design, set out to make the treatment space of the emergency ambulance fit for the demands of a modern healthcare system. One of the findings from initial research underscored the difficulty in cleaning and stocking the ambulance interior – problematic for paramedics providing better patient care.
Building on six years of RCA research, the study began with the designers joining ambulance crews on callouts during 12-hour shifts. Key insights were translated into sketch designs and a full-scale test rig was mocked up in cardboard and foam. Front line paramedics, clinicians, patients, academic researchers, engineers and designers then worked together in a co-design process to develop and evaluate proposals, resulting in a full-size mobile demonstrator of the new interior.
The resulting design reconfigured the layout of the patient treatment space ensuring full, 360° access to the patient, which not only improved clinical efficiency but also enhanced patient safety. The overhaul also made the ambulance easier to clean, and incorporated equipment packs containing specific treatment consumables to aid clinical performance, infection control and stock control. A new digital diagnostics and communications system was also presented.
Such revelatory work caught the attention and public imagination. The Design Museum exhibited a full-size mobile demonstrator unit embodying the ambulance redesign research principles as one of its 2012 Designs of the Year, while national and international media coverage, from the BBC’s Culture Show to the World Health Show channelled vehicle manufacturer and healthcare provider interest, helping transform the new, fit-for-purpose ambulance into a commercial reality.
Jeremy Myerson, Director of the Helen Hamlyn Centre for Design, said, 'We were asked to tackle, through design, poorly understood problems in ambulances. The initial work identified key areas where safety and patient experience are improved by better design of the treatment space, and that has led to some ambulance standardisation through better design specification. Subsequent work demonstrated that a properly designed mobile healthcare system, not just improvements in the design of the ambulance, is required to derive full benefit from major improvements in clinical science, and the training of highly skilled paramedics since the 1980s.'
Later research into using design to reduce violence in the accident and emergency department was yet another turning point in RCA patient safety research. Violence and aggression towards staff and patients in emergency departments is a common problem in the UK, which costs the NHS up to £69 million annually. Commissioned by the Department of Health and the Design Council as part of a collaboration with RCA alumni and design consultancy Pearson Lloyd, the project involved three different hospital trusts across England in a co-design process to address the problem through retrofit solutions focusing on prevention and avoiding stressful situations from escalating.
Early investigation showed lack of understanding of the A&E process as the primary cause of public frustration and anger. In response, the team devised a guide for patients detailing information such as how A&E department works and live updates on waiting times. Overall, the improved signage and information reduced aggression in A&E departments by 50 per cent. The work received a top award for social impact from the Industrial Designers Society of America (IDSA) in 2013.
Today, healthcare manufacturers are producing many of the designs based on the RCA’s pioneering design research – Bristol Maid, for example, is commercialising the Helen Hamlyn Centre for Design’s hospital resuscitation trolley concept, the Resus:station. Manufacturers have also been closely involved with the Design Bugs Out and ambulance redesign projects. The research continues to demonstrate a clear economic value and strong business premise.
A&E violence solutions are currently being piloted by three UK health trusts, and a design to improve the practice of regularly changing cannulae to reduce infections is widely available. The medical journal The Lancet best encapsulated such impact, when it wrote in February 2012: ‘The DOME projects suggests a pragmatic approach to care that is efficient, patient-centred, safe and – in its own way – beautiful.’