EDITION #1 FEBRUARY 2014 Process walkthrough PSYCHIATRIC CARE BED
2 / PROCESS REPORT #1 / FEB 2014 PSYCHIATRIC CARE BED / 3 PROJECT MOTIVATION A CROSS REGIONAL PROJECT Psychiatric patients differ a lot from somatic patients - and therefore, their beds should be different as well. This finding came clear during a project in Region of Southern Denmark where employees were invited to brainstorm on issues concerning the existing psychiatric hospitals. A following national study showed that the need for a psychiatric care bed was nationwide. This was the beginning of the development of a new psychiatric care bed. What caused the need for a new psychiatric care bed can overall be divided into three areas; patient comfort, safety, and efficiency. As 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 In collaboration, Region of Southern Denmark and The Capital Region of Denmark are running the project. A cross regional innovation team is carrying out the development work and communicating 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 1. This sets high demands to the experienced comfort and sense of security of the patients. 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 owner Project contributor 1: Benchmarking af psykiatrien 2012, Danske Regioner [http://www.regioner.dk/~/media/mediebibliotek_2011/psykiatri/tal%20og%20fakta/benchmarking%20psykiatri%202012.ashx]
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.
engen skal kunne stå fast Muligheden for elevation så patienten kan ligge i forskellige stillinger RHED 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 Bløde, runde former og varme afslappende farver Seng skal udvise humanitet og menneskelige værdier. Den må ikke minde for meget om hospital Hoved og fodgærde er kun installeret pga. tradition, men giver nogle patienter en følelse af tryghed når de ikke ligger i en hel åben seng. Sengen skal kunne omdannes til en sofa. Nogle har svært ved at andre sidder i deres sengetøj MATERIALE OVERFLADER MATERIALE OVERFLADER MATERIALE OVERFLADER Sponplademateriale med lamineret overflade skal have god kvalitet. Ellers suger det vand og laminaten falder af. Grimt og svært at rengøre når sponpladen er blottet. Risiko for yderligere vandsug Ikke for mange mønstre, buler i overfladen. Homogen glat overflade er at foretrække Undgå aluminium. Bliver plettet ved kemi. Stål er at foretrække. Men hellere malede overflader end stål. Fedtfingrer ses på strål. Meget svære at få væk ERGONOMI 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 ERGONOMI ben/hofte ved kropsfiksering Nogle patienter er bange for at falde ud af sengen, når der ikke er en sengehest Ikke stå midt på gulvet Sengen skal være nem at flytte rundt i en patient stue Det skal være en ganske normal seng Den må ikke lugte af sygehus Der må ikke være beslag eller lign der stikker op så patienter kan slå hovede og hænder. Bløde og runde overflader er at foretrække Der må ikke være huller/ sprækker hvor patienter kan få fingre ned i Det skal være nemt at fjerne evt tilbehør til seng, eller skal der overhovedet være noget? Alle fjernbetjeninger skal kunne 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 ryggen eller give anledning KOMFORT dårlige liggestillinger Større og blødere se KOMFORT KOMFORT KOMF Skal kunne S Godt agtigt Den er Det vi neutr Det mu se BETJ 6 / PROCESS REPORT #1 / FEB 2014 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 conceptsw Testing prototypes Selected functions are implemented and tested Tests made 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 RIEN & Dilemma! Ønsker meda & pat fra
8 / PROCESS REPORT #1 / FEB 2014 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 acount, six personas that illustrate 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 that 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 In my age, it can be difficult to get in and out of bed. But height adjustable beds help a lot. I enjoy to sit in my bed and watch pictures or read a magazine. But sometimes my back hurts, because my back and legs are not supported. 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.
10 / PROCESS REPORT #1 / FEB 2014 PSYCHIATRIC CARE BED / 11 USER NEEDS: EMPLOYEES Just as important as the patients needs are the needs of the employees that interact with the bed. 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 great 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
12 / PROCESS REPORT #1 / FEB 2014 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 made through market analysis and desktop research. The design specification dictates the development of the bed and serves as success criterias for the final product. SAFETY OPERATION HYGIENE MATERIALS WELL BEING COMFORT ERGONOMICS 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 45-90 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
14 / PROCESS REPORT #1 / FEB 2014 PSYCHIATRIC CARE BED / 15 SENG TIL PSYKIATRIEN KONCEPT I SYDDANSK SUNDHEDSINNOVATION SENG TIL PSYKIATRIEN KONCEPT II SYDDANSK SUNDHEDSINNOVATION SENG TIL PSYKIATRIEN KONCEPT III SYDDANSK SUNDHEDSINNOVATION 20 1......................... ar y Ja nu Au g us t2 01 3 4 3 Fe b ru ar y 20 1 3 20 1 Ja nu ar y N ov em be r2 01 2 DEVELOPMENT OVER TIME
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 A rail along the length of the bed is used for mounting restraint belts At the foot of the bed, the battery room is placed for easy access The bed is elevated via a telescope principle Wheels are hid inside the legs
18 / PROCESS REPORT #1 / FEB 2014 PSYCHIATRIC CARE BED / 19 USER FEEDBACK Patient comment Employee comment 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 2013. 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. If the restraint rail is placed low on the bed side, the possibilities are limited as the belts are too short. When mounting a belt to the bed, a loud click should confirm that the belt is placed correctly and safe to use. The bed is too wide to go through the door openings. It s good that it doesn t scream out Hospital!. Is it possible for the patients to control the elevation? It s important that they feel independent. It takes 15 min. to clean our current beds. It would be great if cleaning the new bed could be done faster. The pillow is a good stimulus tool for the patients. 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. Can I take the pillow home with me? It s a good backrest for when we re watching TV or just want to be alone for a while.
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