Carin van Bolderen, Senior Technical Writer at Allied Telesis Labs Ltd., reports on the Christchurch branch’s recent visit to Canterbury Health System’s Design Lab.
What a privilege it was to visit The Design Lab!
The Design Lab is a very large warehouse space where clinicians, engineers, architects, and user groups can come together to rethink how services are provided. The blank space is used to mock up new concepts for work spaces and ways of working, and participants are urged to leave old ways of thinking at the door.
The Canterbury District Health Board (CDHB) is currently undergoing a $650 million redevelopment, utilising the Design Lab. This is the biggest ever investment in public health facilities in New Zealand, and it requires “whole of system” thinking and design input to create work spaces of the future.
Richard Hamilton and Cushla Mahoney of the CDHB Business Development Unit personally guided us in two groups around the lab, explaining the facilities rebuild and design processes, and telling the story of CDHB’s health system and transformation journey. Literally thousands of people from all parts of the health system have been involved in the design process.
The CDHB’s journey began back in 2007 when the Canterbury health system was in difficulty, with many patients on very long waiting lists for surgery, and accelerating demand for care of the aging population (Canterbury has the largest total population aged over 75 of any District Health Board). Patients with skin lesions were sometimes waiting for up to 18 months to get potentially cancerous skin lesions removed. The system was letting patients down and something needed to be done.
Richard explained that hospital wards have traditionally used the Nightingale design – one large room without subdivisions, beds in rows, and a nursing station located away from patients. The Design Lab interviewed patients and uncovered the issues with this style of ward layout. They include difficulty sleeping, lack of privacy, loss of dignity, and communication challenges – to name a few. However, the patient-centred research also challenged the widely accepted solution to multi-person wards – single rooms also have their problems. They can leave patients feeling socially isolated and unsafe. The team at the Design Lab combed the global evidence and realised that some of the issues that single rooms were trying to solve, can be solved in better ways.
Richard showed us mocked up cardboard wards that incorporate angled parking for beds pointing towards a nursing station; a pod-like overhead shell for each bed that reduce noise and provide a feeling of privacy; and design layouts with specific movement flows for staff, doctors, and visitors. Bathrooms are placed directly behind each group of two beds – no more wandering down the hall past other patients or visitors with a gapping night shirt. Still under design is a clear glass room divider that, at the flick of a switch, will turn the glass opaque – eliminating the need for problematic curtains… The features were innovative, clever, and somehow very obvious. Why has it taken so long to get to here?
Cushla outlined the lab’s strategic goals – to get people to take greater responsibility for their own health, develop support systems that always focus on what is best for patients, and create a sustainable system of healthcare that eliminates waste. The overriding goal is to make the system patient-centric, as opposed to putting the hospital at the heart of the health system.
Research has shown that people stay well in their own homes and communities. Getting back to that 18 month waiting list I mentioned earlier, through the Canterbury Initiative, GPs have been upskilled by plastic surgeons to triage skin lesions at their own practices and remove the straightforward ones. As a result, patients who need it are getting specialist care much faster.
The Canterbury DHB has also introduced other schemes, including a leadership programme called “Xcelr8” which gives clinicians permission to change the healthcare system. Participating clinicians are given a blue ‘business card’ with a list of permissions printed on the back, such as: Value the patient’s time, keep the person at the center of the service, take the waste out of the system. The aim is to empower staff – allowing them to shift staff expectations and adjust clinical interventions and care methods to a ‘whole of health system’ perspective. While the business card concept might seem gimmicky, it has had lasting impact and given power to the recipients.
I loved this field trip! Richard and Cushla took a very complex topic and turned it into an engaging and inspiring journey for all of us. I was amazed at how much common sense has been allowed to lead the design process by empowering the very people who use the health system – and that’s all of us.