Mock-Ups as "Interactive Laboratories": Mixed Methods Research Using Inpatient Unit Room Mock-Ups

Article excerpt

Abstract

Objective: To establish evidence-based design (EBD) guidelines for inpatient rooms at Department of Veterans Affairs (VA) facilities.

Background: Simulation allows clients, designers, and researchers to visualize how users might interact with a proposed design before actual construction of the design. This study used mock-ups as a simulation technique during a study of the VA inpatient room standards. The participants used the inpatient room mock-ups as "interactive laboratory" environments to maximize opportunities for participatory design, qualitative research, and quantitative research of projectspecific EBD solutions.

Methods: The research used questionnaires, scenarios, ondemand modifications, and observations to evaluate and confirm EBD solutions for inpatient room mock-ups. A total of 71 participants responded to a questionnaire administered across five mock-up work sessions. These 71 participants consisted of administrators, nurses, physicians, support staff, environment and maintenance staff, and patient and staff safety representatives from throughout the VA healthcare system.

Results and Discussion: EBD solutions were tested, evaluated, and modified for each inpatient room type and were applicable to two or more of the inpatient room types. The latter included the location of patient beds and standard headwall position, technology and spaces for nurse charting activities, clearances (e.g., equipment, wheelchair, and bariatric patient), universal rooms, and patient and family amenities. Also, EBD solutions were tested, validated, and modified to the needs of each inpatient room.

Conclusion: The mock-ups allowed researchers and designers to evaluate and confirm EBD solutions and strategies for the development of VA inpatient room standards. When used as a means for mixed-methods research, mock-ups can successfully integrate research and design during project-related work. EBD research using mock-ups not only addresses project- or organization-specific concerns, but it may contribute to the knowledge base of the healthcare design community.

Key Words: Simulation, mock-up, mixed-methods methodology, universal room

Introduction

Simulation techniques allow designers and researchers to see how users might interact with a design without having to observe or measure user behaviors in an actual setting (Groat & Wang, 2002). Simulation is commonly used in military training and the aviation and retail industries (Bajaj, Mirka, Sommerich, & Khachatoorian, 2006; Macedonia, Gherman, & Satin, 2003). In these fields, determining how people might perform or react to real-life scenarios can help master skills, prevent emergencies, and translate into increased revenue. Scenarios are performed in a neutral setting where error and uncertainty will not cause physical or financial harm.

There has been a surge of interest in simulation techniques throughout the healthcare design industry. Currently, medical fields that routinely use simulation include anesthesiology, gynecology, and obstetrics (Maslovitz, Barkai, Lessing, Ziv, & Many, 2007; Shavit, et al., 2007). Additionally, simulation is used widely for surgery (e.g., endoscopy) and emergency medicine (DeVita, Schaefer, Lutz, Wang, & Dongilli, 2005).

Mock-ups are physical representations of real-life settings. As such, they allow people to experience, experiment with, and revise operations and design challenges within a short inception-revision cycle (Bell, 2007). For example, mock-ups offer settings where events from clinical practice can be rehearsed. Compared to virtual reality simulations, mock-ups are better at simulating repetitive activities, teamwork activities, infrequent events (e.g., emergency code responses), and complex technology (DeVita, et al., 2005). Mock-ups remove participants from their everyday environments, thereby allowing them the objectivity to discover and evaluate aspects of their work setting (Evans, 2007). …