Amplify Nursing: Pavilion Edition

Interdisciplinary collaboration improves emergency department workflow.

Through an innovative collaboration that brought Penn Nursing together with the University of Pennsylvania’s Stuart Weitzman School of Design and Penn Medicine, nursing and design students parachuted into the Pavilion Emergency Department to find ways to make the space work better for providers. The project’s leaders spoke with Marion Leary RN MSN, Director of Innovation at Penn Nursing, on the Amplify Nursing podcast.

The effort was initiated by Neil Ray MD, clinical assistant professor of emergency medicine at the Perelman School of Medicine. “We had this new emergency department, but it wasn’t quite designed with health care providers in mind,” he said. “We were fitting a space that was already made for us.”

Ray approached Mikael Avery, a lecturer at the design school with a background in health care architecture, who volunteered his students for the “unique opportunity to work in the new Pavilion.” Mikael reached out to Marion Leary, who runs the Penn Nursing Innovation in Health: Foundations of Design Thinking course to partner nursing students with the design students. The team also looped in Jacquelyn Taylor, a PhD student and MSN-prepared nurse who worked in the Pavilion.

“The idea of collaborating with multidisciplinary professors and bridging the gap between Penn Medicine and the University of Pennsylvania was exciting,” Taylor said. “It was a great opportunity to do a research project that could directly benefit everybody.”

Their conversation has been edited for length and clarity.

 

Marion Leary: Talk us through what the project looked like.

Mikael Avery: It began with Neil [Ray] preparing a thorough briefing document. One of the best things for design students when they’re working in a health care space is the language learning that happens and knowing enough to have knowledgeable conversations with clinical staff. They completed many observations in the emergency department, followed by hands-on working sessions with clinical staff. This turned the tide on the way [the students] were viewed. They were no longer outsiders imposing the potential ideas, but partners creating ideas together. [The students] developed a series of ideas and then pitched them to the administrators of the emergency department. They ran some trials to implement some of these ideas. They’ve now handed them off to individuals in the emergency department to [fully] implement. From beginning to end, it was collaborative. One of the design students [mentioned] the amazing benefit of having content experts on the team—not as consultants, but as actual members of the team. It shortens timelines. It gets better outcomes.

Leary: Neil [Ray], you have a background in human-centered design and design thinking. What about these methodologies fits in with health care in general, and as the framework of this project?

Neil Ray: Medicine itself is a very traditional and, in some ways, conservative field that’s hard to budge. Fundamentally, human design is a field that’s trying to shake things up. Inherently, those two disciplines don’t mesh well together. But that’s how remarkable it is when you can take something that’s very stoic and resistant to change and then implement some fresh ideas that stir some conversations and make some changes.

Leary: Can you talk about the steps in the design thinking process, and how that forms the basis for the structure of this project?

Ray: The design thinking process is extensive, but it starts with observation and getting a sense of the unmet needs. That’s important, because sometimes people working in a certain environment might not know what their problems are. Some frustrations are actually opportunities for innovation. Part of these observations [was] discovering the problems and figuring out where we can move the needle. [The students] spent several hours shadowing us. They came across something subtle, which was improving our closet spaces. There are closets around the ER that all have different supplies. There’s no consistency, and often we spend time going from one closet to another looking for supplies. It’s a lot of wasted movement. The students will try to standardize our closets. They came up with a solution that would increase the signage and make it easier for us to track items and reduce the items we don’t use. They did a phenomenal job during their final presentation. They showed that their changes could have huge cost savings and time savings. One of their designs was icons to demonstrate, for instance, where cardiac supplies are versus pulmonary supplies. They’re trying to make drawer labels bigger so it’s easier for us to see them. They also want to standardize labeling across the different closets.

Leary: It seems like a simple idea, but it has a big impact on the work the providers are doing in the ED. Ray: It’s one of those things that can be overlooked. It’s a project in which a design student team can make a huge impact.

Leary: Jackie [Taylor], talk about the conflicts that could come up in these types of projects. We had four students interviewing and observing clinicians in the ED. What was the reception to this project?

Jacquelyn Taylor: The ED went through a massive change in October making the transition to the Pavilion. Everything was different, even though it was done flawlessly. In February, we had [this] project kick off. Health care is constantly evolving. We’re adaptable to that. But there was some frustration that we already changed, and now other people were coming in to implement further change. There was hesitancy from some nurses because the [students] had never worked in an ED. But it was amazing to see the transition from nurses saying, ‘We don’t want this,’ to ‘Wow, they’re bringing up some great ideas.’ It was a nice turnaround. The staff became familiar with the students, and this paved the way for future collaboration.

Leary: Co-collaboration is an important part of human-centered design and design thinking. Can one of you speak to the co-collaboration during this project?

Ray: Jackie [Taylor] was both an ED nurse working clinically and one of the leaders in this project. She helped bridge the gap. Initially there was a bit of weariness when we were first doing observation shifts. But at the design sessions everyone came together at the same table with ideas. The nursing staff and clinicians saw that [the students] were genuinely interested in working with us to come up with the design. There are a lot of reasons to say ‘no’ to something. That’s not necessarily the point of these sessions. The point is to go crazy, to think about what’s out there, and then draw lessons from it. In medicine, there’s so much bureaucracy and regulation that we’re quick to dismiss an idea rather than taking something valuable from it.

Leary: Mike [Avery], from your design background and point of view, why is it so important to have co-collaboration sessions?

Avery: It’s in literature that this collaborative model—where those who will be experiencing the changes that are proposed are actually part of the conversation—is essential. At the end of the day, the designer will move onto the next project. But those individuals who are going to be living with it long term need to take ownership of it. If there is ownership, then it can evolve after the [designers] are gone. Whether it’s an ED or a neighborhood or a building, it will change over time. If the people interacting with it are empowered to understand the process, then the design process continues. It doesn’t die with a five-page write-up or a PowerPoint. It’s a living, breathing thing that changes as needs change on the ground.

Leary: That’s a great point. If we’re not including the people living with these new designs, they’re not going to continue into the future. Speaking of continuing, I know the students created a low fidelity prototype they could quickly implement into the ED. What’s the status of the project now?

Taylor: [We hope] the project will be implemented soon. But just that bit of prototype implementation primarily in the resuscitation bay has been greatly beneficial. It has cut down time [gathering supplies] drastically, especially in critical scenarios.

Leary: The students are excited that the work they did is going to continue and be implemented and tested in the ED. I hope that we can continue working on projects like this into the future. Thank you all for being willing to do this type of innovative project in the ED Pavilion.

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