1 FEBRUARY 2015 Process Description PSYCHIATRIC CARE BED
2 2 / PROCESS DESCRIPTION PSYCHIATRIC CARE BED / 3 PROJECT MOTIVATION A CROSS REGIONAL PROJECT Across the Danish regions there have been identified a need for a new bed for the future psychiatric patient room. On some points, there are other requirements for a bed to be used in psychiatry. It is therefore not appropriate, in several cases not possible to use the beds, which are basically designed for use in the general hospital. The main feature that makes the needs differently, is that the bed should be able to meet a number of safety concerns. These considerations must ensure that the patient feels comfortable and safe but also that staff have a good working environment. The goal is to create a bed that optimizes the patient hospitalization and sleep experience, which meets safety and hygiene requirements and at the same time helps to provide a good working environment for employees. The project is the only one of its kind in Denmark, all regions have been interested in participating in the project. However, the level of participation varies: Project owners The Region of Southern Denmark and The Capital Region of Denmark are running the project in collaboration. A cross regional innovation team is carrying out the development work and communications with collaborators and business partners. Project contributors North Denmark Region, Central Denmark Region and Region Zealand have all contributed with user contact to patients and employees for co-creation workshops. PATIENT COMFORT 20 % of psychiatric patients are hospitalised for more than 30 days. This places great demands on the experienced comfort and patients security. SAFETY In relation to the patient, the bed should prevent self-harm and suicidal acts. In relation to the employees, the bed should prevent workrelated injuries and violence from challenging patients. EFFICIENCY Regarding physical restraint, the bed should be easy to use and efficient. The procedure should be convenient for the patient as well as employees. Project owners Project contributors
3 4 / PROCESS REPORT #1 / FEB 2014 PSYCHIATRIC CARE BED / 5 APPROACH The keywords for the project are open innovation and co-creation. During the development process, ideas and knowledge have been shared between companies, regions, users, and medical professionals. This knowledge is what carries the project and shapes the future psychiatric bed. For putting together all the bits and pieces, an anthropology and design team has been established. Their job is to gather insights and transform them into valuable solutions that solve the problems experienced by the respective stakeholders. Since the expected output of the project is a number of manufactured beds, ready for implementation, the industries play a large role as well. Therefore, different bed manufacturers have been involved in the project from the beginning, so that the developed solutions pay regard to production methods and possibilities. ANTHROPOLOGY AND DESIGN TEAM PSYCHIATRIC CARE BED Have a coordinating role between the different stakeholders. Collect needs from all users through qualitative research and workshops, and convert them into valuable solutions. PATIENTS Contribute with own experiences and needs through interviews, observations, prototype tests, and focus groups. INDUSTRIES Develop the designer team s concepts into one model ready for production. The industries are responsible for the actual production process. PROFESSIONALS Contribute with specialised knowledge within psychiatry through interviews, workshop participation, and prototype tests.
4 Sengen skal kunne stå fast Muligheden for elevation så patienten kan ligge i forskellige stillinger Det skal være nemt at fjerne eller gemme tilbehør til seng, eller skal der overhovedet være noget? Kun delvise makspositioner mulige for patienter selv at betjene (sikkerhedsstopper) Mekanisk seng er mere sikker end elektrisk seng Hæve-sænke funktion (mekanisk eller elektrisk akturator). Vigtigt for portør, rengøring og og plejepersonale Sengen skal kunne få patienter ud af sengen Sengen skal være nem at køre, selv med en patient i sengen Let at betjene, sætte hoved og sengegærde på. Ikke let for patienten MATERIALE MATERIALE Let adgang til madrassen Sengen skal kunne køre under transport på afdeling og mellem afdelinger. Hjul skal være af god kvalitet, en ordentlig størrelse og køre godt Bløde, runde former og varme afslappende farver Seng skal udvise humanitet og menneskelige værdier. Den må ikke minde for Ikke stå midt på gulvet meget om hospital Hoved og fodgærde er kun installeret pga. tradition, men giver nogle patienter Sengen skal være nem at flytte en følelse af tryghed når de ikke ligger i rundt i en patient stue en hel åben seng. Sengen skal kunne omdannes til en sofa. Nogle har svært ved at andre Det skal være en ganske sidder i deres sengetøj normal seng Den må ikke lugte af sygehus Sponplademateriale med lamineret overflade skal have god kvalitet. Ellers suger det vand og laminaten Der må ikke være beslag eller lign der stikker MATERIALE falder af. Grimt og svært at rengøre op så patienter kan slå hovede og hænder. når sponpladen er blottet. Risiko for Bløde og runde overflader er at foretrække yderligere vandsug Ikke for mange mønstre, buler i overfladen. Homogen glat overflade er at Der må ikke være huller/ sprækker hvor patienter kan få MATERIALE foretrække fingre ned i Undgå aluminium. Bliver plettet Det skal være nemt at fjerne evt tilbehør til seng, ved kemi. Stål er at foretrække. eller skal der overhovedet være noget? Men hellere malede overflader end stål. Fedtfingrer ses på Alle fjernbetjeninger skal kunne MATERIALE strål. Meget svære at få væk gemmes væk Kabler, ledninger, skarpe kanter osv. er uhensigtsmæssige i forbindelse med psykiatrisengen Den snoede ledning på fjernbetjening er dødfarlig. Trækkes den rundt om halsen, låser den sig selv og er umulig at få viklet ud. Må bruge saks for at frigøre patient Sengen skal være god at sove i, god komfort, ikke give ondt i ryggen eller give anledning til dårlige liggestillinger Større og blødere seng Skal kunne bruges til at læse i Sengen skal være bredere Sengen må ikke larme Vil gerne have et sengebord og sengen må ikke være på hjul fordi den ruller (selvom den er låst) MATERIALE Den danske kvalitets model skal være overholdt Hjulene skal kunne holdes rene Sengen skal overholde DS Sengen skal kunne flyttes hvis nødvendigt Hav kun de ting på sengen der skal bruges. For meget tilbehør forsvinder Bælter og låse skal være mere hygiejniske Sengen skal være nem og rengøre. Jo færre flader og hjørner jo bedre. Samlinger og sprækker er skidtsamlere Skal kunne rengøres mekanisk og på stuen ved traditionel vask Mulighed for at rengøre madrasser uden at sende dem til rens MATERIALE MATERIALE 6 / PROCESS DESCRIPTION PSYCHIATRIC CARE BED / 7 THE PROCESS FIELD RESEARCH ANALYSIS IDEA & CONCEPT USER TESTS PRODUCT SPEC. LIMITED TENDER DETAILING PRODUCTION 20 observation studies and 85 interviews at psychiatric hospitals with employees and patients Focus group interviews Body storming; hospitalising members of the anthropology and design team Translating user insights into user needs Developing personas to understand different user groups Co-creation workshops Converting user needs and problems into solutions Internal and external idea generation sessions Idea workshops with employees, patients and bed manufacturers Rapid prototyping of concepts Testing prototypes Selected functions are implemented and tested Tests conducted at four psychiatric units Findings and experiences are collected into requirement specifications for the psychiatric bed The specifications are precise and measurable, and ready for a manufacturer to use as a checklist The provider encourages suppliers to bid for the development and production job Up to five suppliers are chosen for the actual bidding Based on the assignment criterias, one supplier is chosen for delivering the task. Improving and combining concepts into one qualified concept Adjusting concept to employee and patient comments The detailed and thoroughly tested bed is matured for production Guaranteed production number is 500 pieces. FALL 12 FALL 13 FALL 14 SPRING 13 SPRING 14 SPRING 15 SENG TIL PSYKIATRIEN SENG TIL PSYKIATRIEN & Dilemma! Overvægt er et stigende problem, er sengen tiltænkt dette? VS. Sengen er for bred, og kan ikke komme gennem dørene ind til stuerne Sengerammen mangler runding. Den er meget bred og dyb, hvilket kan give blå mærker på ben/hofte ved kropsfiksering Nogle patienter er bange for at falde ud af sengen, når der ikke er en sengehest Tryghedsskabende element Generelt er patienterne meget positive overfor puden Godt redskab til stimuli for patienterne Indeholder mange gode funktioner og muligheder, og brugskonteksten er let at gøre individuel Den er mere hyggelig end kædedynen Den vil være rigtig god til at få patienten til at mærke sig selv Den gør at patienterne selv kan bestemme, hvordan de vil indrette sig i sengen Godt ryglæn til når vi skal se fjernsyn, eller være lidt alene De små kugler som fyld gør den let at forme Pudens former er sjove. Bør være synlige med betræk Ønsker og behov fra medarbejdere & patienter Feedback fra tests af prototypen fra medarbejdere og patienter Sengens form Godt at sengen ikke har et hospitalsagtigt udtryk Den er hyggelig og føles hjemlig Det visuelle udtryk virker tiltalende og neutralt Det er godt at sengen er lav. Mindsker muligheden for at patienterne kan vælte sengen under fiksering Sengen er for bred, og kan ikke komme gennem dørene ind til stuerne Tryghedsskabende dialog på prototypen Kræver speciel vaskemaskine når hele puden skal vaskes Puden kan have to lag betræk. Et inderst der er vand afvisende, og et yderst der føles rart. Derved skal puden ikke vaskes, men i stedet blot de to betræk Den bliver hurtig meget varm når man ligger med den Eventuelt en manual der beskriver pudens muligheder for patienten Betragtes delvist som et eksternt element og ikke som en del af selve sengen, hvor ved den vil kræve meget opbevaringsplads hvis/når den ikke anvendes Hjulene skal kunne låses separat Kan patienten selv styre elevationen? Det er vigtig at de får selvstændighed Positive over for ideen om at lave et motorrum som indkapsler alt teknik Smart at fjernbetjening til elevation ikke har en ledning, men stadig sidder fast på sengen. For hvis den ikke sidder fast på sengen bliver den ødelagt og smidt væk Sådan en vil jeg have der hjemme - Medarbejder Skal jeg ikke tage puden med hjem - Patient Oktober 2013 Godt at den er længere end den nuværende seng Der er langt ind til madrassen når man sætter sig på sengen, pga. den brede ramme Fint kompromis mellem udtryk, sikkerhed og hygiejne De nuværende senge tager ca. 15 min at gøre rene, og det ville være rart hvis rengøringen kan klares på kortere tid.
5 8 / PROCESS DESCRIPTION PSYCHIATRIC CARE BED / 9 USER NEEDS: PATIENTS Psychiatric diseases are complex, and the condition of patients vary a lot. In order to take all these different needs into account, six personas illustrating different patient types have been developed. The six imaginary personas are based on a large number of interviews and observations, and therefore represent real patient needs. These needs and insights have been guiding for the design of the bed. Sometimes I just need to let the world out. A good way to do this is to sit in my bed and listen to music while I write down my thoughts. NIELS, 39, PSYCHOPATH Better sitting options in the bed would be nice - especially when I get visits. Maybe if the bed could be transformed into a sofa? I have had my battles with the personnel. Once, it resulted in an overturned bed, because it was elevated too much. I don t like that the bed emphasises illnes. When I feel completely useless, it sometimes helps to cut myself to release the pain. But afterwards, my room is a mess. I have stuck pictures of my cat and family above my bed - that way, my room gets more personal and safe. FREDERIKKE, 16, DEPRESSIVE & SELF-HARMING If the bed looked normal, I think I would feel a little more normal as well. I need some place where I can feel safe. The bed is a good place for that, because I can curl into a ball and let the world out. The personnel is not to decide what I keep in my room. If I don t want them to confiscate items, I would just hide them in my room. JESPER, 19, PARANOID SCHIZOFRENIC I enjoy to sit in my bed and look at pictures or read a magazine. But sometimes my back hurts, because my back and legs are not supported. In my age, it can be difficult to get in and out of bed. But height adjustable beds help a lot. ALMA, 82, DEMENTED I would feel more in control if I at least could adjust the bed myself. RIKKE, 32, PARANOID SCHIZOFRENIC HANNE, 44 MANIC-DEPRESSIVE Loud noises really distract me and disturb my sleep. If I was to decide, my bed should be completely silent. Even when I turn over.
6 10 / PROCESS DESCRIPTION PSYCHIATRIC CARE BED / 11 USER NEEDS: EMPLOYEES The needs of the employees interacting with the bed is just as impurtant as the patients needs. The following quotes are based on interviews and workshops with different involved professionals. Wires shouldn t be lying around. People could trip over them and fall! The bed should respond to human values. It must not resemble a hospital It is bed or look like a restraint important that the bed. bed can be easily adjusted in case of treatment or restraint. For example, the headboard should be removed in a couple of seconds. The physical sizes of patients vary a lot. Therefore, it would be useful with variable places to attach the restraint belts. WORKING ENVIRONMENT REPRESENTATIVE Loose components are deemed to be a security risk - challenging patients might throw them. The bed should be easy to move around, and prevent the personnel from performing incorrect working postures. When you transport many persons in their beds each day, you will find out how important it is with good wheels and a proper grip. We have seen that people use wires to strangle or electrify themselves. So, a wire free bed would be preferable. All surfaces should be smooth and easy accessible - that would make my job a lot easier. Some of the worst dust collectors are cracks and joints. Holes, cracks and ligature points should be avoided. The patients might fill the gaps with items or use them to harm themselves. HEALTHCARE PERSONNEL The wheels on the existing beds won t last, if the patient throws himself back and forth for days. Our experience is that the wheels are worn up because of the heavy load. If there is no space under the bed, it s impossible for me to clean the floors. We should be able to quickly fix a broken bed ourselves. This means that we need a system with short delivery times. Cleaning a room that has been exposed to self-harming or challenging patients is not an easy job. CLEANING & SERVICE
7 12 / PROCESS DESCRIPTION PSYCHIATRIC CARE BED / 13 DESIGN SPECIFICATION The outcome of the total research and analysis process is a design specification for the future psychiatric care bed. The specification is not only based on user insights and field research, but also findings collected through market analysis and desktop research. The design specification dictates the development of the bed and serves as success criteria for the final product. SAFETY OPERATION HYGIENE MATERIALS WELL BEING COMFORT CS All surfaces should be smooth and rounded. Both for the sake of easier cleaning and patient safety It should not be possible for the patient to demount components, as they can be used as weapons The bed must withstand a heavy load. Up to 6 persons may lie/sit on the bed at the same time in a restraint situation Grid points should be avoided, as they can be used to attach tools for suicide (e.g. a cable, a torn up sock, etc.) Patients should not be able to control the bed height, as it can be used for self-harm or overthrowing the bed Operating the bed and matching parts should be quick and intuitive as urgent situations might occur The bed should be portable and pay regard to the employee s working posture The bed height should vary from cm for proper working posture during treatment Cleaning the bed should be easy and effective. This implies materials that withstand strong detergents For the sake of cleaning, 15 cm of free space under the bed is needed All surfaces should be smooth and rounded. Both for the sake of easier cleaning and patient safety The bed should be less institutional and not symbolise hospital The bed should include a reassuring element that can be used for body enclosure The bed should not symbolise restraint It should be possible to elevate the bed at four places; head, back, knees, and feet Guard rails should be developed as an add-on product, as some patients need them while others need a bed with an even surface Patients physical sizes vary. Therefore, the restraint possibilities should be variable as well. The bed should be stable and withstand a restraint situation The bed frame should function as a restraint grip The bed should facilitate a cordless control, as cables can be used for self-harm
8 SYDDANSK SUNDHEDSINNOVATION SYDDANSK SUNDHEDSINNOVATION SYDDANSK SUNDHEDSINNOVATION Designed by Checked by Approved by Date Date Jean-Paul Edition Sheet 14 / PROCESS DESCRIPTION PSYCHIATRIC CARE BED / 15 DEVELOPMENT OVER TIME November 2012 January 2013 February 2013 August 2013 January 2014 August 2014 November 2014 January D D C C B B SENG TIL PSYKIATRIEN KONCEPT I A Spændebeslag / 1 A SENG TIL PSYKIATRIEN KONCEPT II SENG TIL PSYKIATRIEN KONCEPT III
9 16 / PROCESS REPORT #1 / FEB 2014 PSYCHIATRIC CARE BED / 17 LATEST DESIGN The flexible pillow can be used as a backrest or as a cuddly toy Integrated matress elevation At the foot of the bed, the battery room is placed for easy access bed rails and headboards can be purchased A remote control with more functions to the staff. It is stored in the drawer The bed is elevated via a telescope principle Wireless remote control for patients to adjust the rest position. It can be removed as needed. Electric wheels are hidden inside the columns The bed has a button, that brings the bed on wheels.
10 18 / PROCESS REPORT #1 / FEB 2014 PSYCHIATRIC CARE BED / 19 USER FEEDBACK During the entire development process, user interactions are conducted with the aim of continuously improving the solution. The following comments are expressed by patients and employees at the latest prototype test in summer/fall Patient comment Employee comment A click function would quickly be tested and challenged by the patients. Often, they re only restrained around the waist and not around their feet and hands. So, if the belts are not locked, it is possible for them to demount the belts during restraint. It s good that it doesn t scream out Hospital!. The bed is too wide to go through the door openings. Is it possible for the patients to control the elevation? It s important that they feel independent. If the restraint rail is placed low on the bed side, the possibilities are limited as the belts are too short. It takes 15 min. to clean our current beds. It would be great if cleaning the new bed could be done faster. When mounting a belt to the bed, a loud click should confirm that the belt is placed correctly and safe to use. It is good that the restraint rail is the same length as the bed, as it comes with a range of possibilities for individual adjustments. I would prefer being restrained in my own bed. Being locked into a separate room seems frightening, because you re all by yourself with noone around to listen. The pillow is a good stimulus tool for the patients. Can I take the pillow home with me? It s a good backrest when we re watching TV or just want to be alone for a while.
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