ICU Experience
ICU Experience
Design Research and Strategy
Duration
2 months
Role
Design Researcher
This project aimed to explore the experience of patients in the Intensive Care Unit (ICU) of the local hospital. Using observations, contextual inquiries, surveys, and focus groups, we identified and addressed their pain points in the complex medical ecosystem.
Unfortunately, due to the pandemic, access to the ICU was restricted, and the project had to be paused after the research phase. However, with the rich research data, research results contributed to the partner’s plan to build a concrete patient experience support system through Lifespan patient feedback sessions.
Overview
Hospitals do not consistently monitor long-term patient experiences, especially in ICUs. ICU patients often cannot communicate due to critical conditions, and once they recover and move to another unit or are discharged, they rarely discuss their ICU experiences. Caregivers prioritize treatment over experience, making it difficult to address these issues. Therefore, it is crucial to collect this data by creating tools to track and understand patient experiences post-ICU, especially given our partners' interest in improving patient care even after discharge.
As a researcher, I framed survey and interview questions with a cognitive scientist and built observation protocols with team members. Additionally, I conducted observations, designed surveys, and facilitated focus group sessions.
Jilian Cai Team Lead
Sejin Hwang Researcher
Felicia Renelus Cognitive Scientist
Clare Lin Front End Engineer
Gabby Hoefer Researcher
Project Background
Kicking off
While reviewing documents on ICU spaces, actors, and general patient experiences, we specifically focused on:
-
Organizational structure of hospitals, where ICU stands
- Public patient experience data
- Patient behavior in ICU or ED (due to limited resources around ICU, we also looked into ED)
- Common patient journey in ICU
Building upon the secondary research, we conducted four interviews with medical experts from various healthcare sectors (healthcare professionals, delirium reduction campaign director, medical device designers, and CAPS & referral programs). We specifically asked about:
- ICU delirium (a term we learned from secondary research)
-
Stimuli affecting patient experience in the ICU
-
Common patient interactions (to learn more about potential stakeholders)
-
Existing staff training to improve patient experience
- Identified patient struggles and current hospital measures to address them
Research Question
How do ICU patients perceive and describe their overall experience and emotional support during their stay?
What environmental and interaction factors within the ICU significantly impact patient comfort and well-being?
Hypothesis
2. ICU patients feel they do not receive adequate emotional support from healthcare professionals (HCPs).
3. Improving communication between patients and staff will enhance the overall ICU experience.
Methods
Observation
Witness and understand real-time interactions, behaviors, and environments in the ICU specific to our partner, providing context not captured through generalized documents found during secondary research.
Main focus was to identify pain points, environmental stressors, behavioral patterns, and human interactions affecting patient comfort.
Contextual Inquiry
Within the lived ICU environment, we aimed to grasp the 'ongoing experience' that shapes staff thoughts and attitudes toward patient struggles. We originally planned to conduct surveys with hcps, but due to a low participation rate, we arranged contextual inquiries. This method provided rich data on their lived experience, adding on to the secondary research and observation results.
During the discussions, we focused on understanding communication flows, task sequences, and interactions between people and space.
Survey
Due to limited access to current ICU patients or their families, we decided to gain quantitative data representing their experiences through surveys of those who had previously been ICU patients or caregivers.
The goal was to gather data on patient perceptions of care, communication with staff, and overall comfort.
Focus Group
During data collection, we faced challenges in uncovering hcps' perceptions of their empathy toward patients' struggles. To address this, we added focus group discussions in the format of design workshops.
The main goal was to understand how hcps empathize with patient struggles and understand pain points in everyday ICU experiences, as reflected in their communication about tools that might improve patients’ experiences.
Data Collection
Observation - Initial Visit
- Observed the most interactive spaces (patient rooms, main hallway, and nurses quarters)
- Focusing on potential stimuli possibly impacting patient discomfort
- Identified interaction points for the following observation
- Following Observation
- Shadowing doctors during overnight shifts
- Each team member had specific observation areas using a checklist (human interactions and sensory stimuli linked to issues identified in secondary research)
Contextual Inquiries
Building on previous research data, we conducted contextual inquiries with a doctor and two nurses in the ICU.
Focus Area:
- Day-to-day tasks
- Interactions and relationships
- Challenges
- Knowledge of hospital support for ICU patient experience
- Perception and empathy regarding patient struggles
Survey
We recruited patients/families with prior ICU experience through community portals, social media, and connections from our SME interviews. A total of 33 responses were collected over 2 weeks.
Focus Area
- Survey Design:
- Divided the ICU experience into 4 stages and used it as a reference for easier responses.
- Questions focused on:
- Challenging stage, factors affecting it, and reasons why
- Satisfying stage, factors affecting it, and reasons why
- Improvements desired for the ICU environment and healthcare professionals
- Divided the ICU experience into 4 stages and used it as a reference for easier responses.
Focus Group
Format
- Setting: focus group session resembling a design workshop to explore HCPs' perspectives indirectly.
- Topic: brainstorming products to improve patients' ICU experiences.
- Tool: patient journey map from previous research, shared with participants to ensure everyone was on the same page.
Discussion Points
- Which phase needs improvements?
- Why is the projected product/idea needed?
- How the idea would address specific patient struggles?
- Why discussed struggles are critical to address?
Logistics
- Total of 15 participants
- Divided into 4 groups with one moderator
- Conducted all sessions simultaneously due to scheduling challenges
Results
Observation Findings
- Nurses: Nurses discussed patient conditions during sign-outs, focusing on both mental and physical aspects. They remained close to patients, seems visually reachable.
- Nurses and Doctors: There was a noticeable disconnect in verbal communication between nurses and doctors. Most interactions occurred around computers, where updates were entered and checked before being communicated to patients.
- HCPs and Computers: HCPs interacted with computers during each visit to the patient room, focusing heavily on the information displayed.
- Doctors and Patients: Doctors mainly interacted with patients to deliver updates on their conditions. These interactions were brief (around 1-5 minutes). Observer noted that patients and family members seemed uncertain about the information provided verbally but were more engaged when viewing information on monitors. (medical terms!)
- Family Members: Family members played a significant role. Most of the hcps were actually talking to the family member, often acting as intermediaries between staff and patients. They monitored screens with staffs and asked questions.
- Patient rooms were small, lacked privacy, with doors usually open and close to computer areas where a lot staff come and go.
- Nurses' quarters were centralized in the middle of ICU rooms and close to each other.
- Sounds: Constant beeping and frequent announcements were observed. The beeping seemed overwhelming, and announcements were mostly understood only by staff.
Survey Result
Overall, patients face communication and emotional support challenges from staff during the assessment stage.
Contextual Inquiry Findings
Healthcare professionals (HCPs) recognize the importance of involving patients in communication to build trust. They found that actively inviting patients and families into decision-making processes leads to more positive, empowered feelings in patients and fosters a better relationship between patients/families and HCPs.
Communication within the ICU is lacking among all actors. Due to busy schedules, particularly for nurses, communication remains primarily on monitors, sometimes resulting in overlooked patient information. Additionally, the hectic pace contributes to difficulties in delivering accurate and consistent information, impacting patient understanding.
HCPs face numerous tedious and time-consuming tasks, mostly manual paperwork, during ICU treatment. These tasks reduce staff interactions with patients and families, affecting the quality of care provided.
High demands and tasks on hcps, especially nurses, can lead to compassion fatigue, causing them to appear indifferent to patient struggles or deaths. Additionally, doctors prioritize patient improvement, potentially overlooking the need for empathy training among staff.
Opportunities
1. Communication Tool
-
Develop tools to assist patients and families in understanding the medical context before discussions with healthcare providers.
-
Encourage verbal discussion by simplifying medical terminology
- Facilitate more effective communication and participation in decision-making processes.
2. Information Sharing
Implement a constructive system to provide patients and families with real-time updates on patient situations before they meet doctors.3. Automation of Tasks
-
Create innovative solutions to replace manual, time-consuming tasks such as paperwork and medical coding.
-
Streamline processes to free up more time for healthcare providers to interact with patients and families
- Identify areas of workflow optimization and develop automated tools to enhance efficiency and improve patient-staff interactions
Deliverables
1. Stakeholder Map- Primary: Patients in the ICU
- Secondary: Family members, Nurses, and Doctors
Patients
- ICU experience is overwhelming due to the unfamiliar environment filled with wires and equipment.
- Communication problems cause stress and distrust, as patients struggle to understand their situation.
Staffs
- Nurses and doctors face constant pressure and fatigue, often sacrificing rest and empathy.
- Compassion fatigue may lead to a disconnect from patient emotions, especially in doctors focused on patient improvement.
- Communication with families is challenging and crucial, often requiring clear explanations of medical procedures.
Families
- Families make significant decisions for patients but face distress due to the hospital environment.
- Poor translation of medical data leads to confusion and distrust in staff.
Based on our research data, I recreated a patient journey map that matches our partner’s space. The map made it easier for the team to overview different interaction points between actors as well as brainstorm possible improvements that can be taken in patient journey in the ICU.
Based on the research data, we regenerated driving questions of the project that would better direct our ideation phase.
-
How can we build trust amongst patients, visitors, staff, and all involved to improve the intensive care unit experience?
-
How can we reduce anxiety in a patient’s physical and sensorial experience in the ICU?
- How can we create tools that allow patients to feel more connected to the staff?
Impact
Impact on product development
Although the project was unable to progress to the prototyping stage due to the pandemic, the valuable research findings and co-design sessions provided our partner with a comprehensive understanding of the problem space. These insights have equipped them with actionable knowledge for building a patient support system in the Rhode Island Hospital, especially the Lifespan feedback on the website to improve their measure of patient experience.
Impact on UXR
The addition to our research design through focus group sessions expanded our understanding of healthcare professionals' perceptions of patient struggles, highlighting the importance of comfortable environments and discussions beyond traditional methodologies.
After this project, I applied this focus group session in a design workshop format in a project involving traumatized refugee minors and women, facilitating indirect discussions on sensitive topics.