ICU Experience
ICU Experience
Design Research and Strategy
Duration
3 months
Role
Design Researcher
Involvement
Jilian Cai Team Lead, Design
Sejin Hwang Design Reseracher
Felicia Renelus Cognitive Scientist
Clare Lin Front End Engineer
Gabby Hoefer Researcher
ICU patients often struggle to communicate their experiences due to their critical conditions, and these issues are rarely discussed once they recover. Caregivers focus on treatment, overlooking the patient experience. To address this, our project explored patient experiences in the ICU at Rhode Island Hospital using observations, contextual inquiries, surveys, and focus groups to identify key pain points.
Although the pandemic restricted ICU access and paused the project after the research phase, the valuable data gathered contributed to the partner’s plan to develop a robust patient experience support system through Lifespan patient feedback sessions.
Project Background
Kicking off
While reviewing documents on ICU spaces, actors, and general patient experiences, we specifically focused on:
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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)
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Stimuli affecting patient experience in the ICU
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Common patient interactions (to learn more about potential stakeholders)
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Existing staff training to improve patient experience
- Identified patient struggles and current hospital measures to address them
- 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?
1. Current ICU patients experience discomfort due to various environmental stimuli.
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
We observed real-time interactions, behaviors, and environments in the ICU environment, identifying pain points, environmental stressors, behavioral patterns, and human interactions affecting patient comfort—context that generalized documents from secondary research could not capture.
To understand the ongoing experience shaping staff attitudes toward patient struggles, we conducted contextual inquiries after low survey participation from healthcare providers (HCPs).
This approach provided rich data on lived experiences, enhancing our secondary research and observations. We focused on communication flows, task sequences, and interactions between people and space.
With limited access to current ICU patients and their families, we surveyed former ICU patients and caregivers to gather quantitative data on their perceptions of care, communication with staff, and overall comfort.
To explore HCPs' perceptions of empathy toward patients, we conducted focus groups in the format of design workshops.
The goal was to understand how HCPs empathize with patient struggles and identify pain points in everyday ICU experiences, reflected in their communication about tools that could improve patient 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
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Develop tools to assist patients and families in understanding the medical context before discussions with healthcare providers.
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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
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Create innovative solutions to replace manual, time-consuming tasks such as paperwork and medical coding.
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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.
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How can we build trust amongst patients, visitors, staff, and all involved to improve the intensive care unit experience?
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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.