Mock-Ups as "Interactive Laboratories": Mixed Methods Research Using Inpatient Unit Room Mock-Ups
Watkins, Nicholas, Myers, Donald, Villasante, Ronald, HERD : Health Environments Research & Design Journal
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). Like a good movie or play, a good mock-up suspends participants' disbelief (Bell, 2007). A participant feels immersed in the mock-up. Careful analysis of mock-ups at preoccupancy prevents the costs associated with any long-term, adverse events that go undetected and occur during occupancy of a final design (Battisto, Allison, & Oka, 2007).
Mock-ups can be simple or detailed (Bell, 2007). A simple mock-up might be an inpatient room made out of cardboard or foam-core without any medical equipment. Detailed mock-ups might have wood finishes and actual medical equipment borrowed from a nursing unit actually positioned in designated places in the mock-up room. Detailed mock-ups are not necessarily better than simple mock-ups (Macedonia, et al., 2003). Detailed mock-ups might result in overkill when simple mock-ups can get the job done at minimal cost. A multiphase mock-up study can start with simple mock-ups and result in final, detailed mock-ups that can be used for showcasing to the community and as references during construction (Bell, 2007).
Healthcare designers and researchers have used mock-ups to explore a variety of design challenges and scenarios. These include toilet and shower placement, patient safety, modes of patient transport and lifting (e.g., bed-to-wheelchair transfers), surge capacity events, equipment placement and clearances, positioning of waste, positioning of supplies, positioning of robotics, workflow, use of electronic health records, color preference, lighting, and visibility of patients (Battisto et al., 2007; Bell, 2007; Garg, Owen, Beller, & Banaag, 1991; Hignett, 2006; Hignett & Lu, 2007; Nelson, Malassigne, & Murray, 1994).
Mock-ups in the healthcare design industry fulfill several important purposes. First, they are used to identify the efficacy of design solutions to challenges in healthcare delivery. Challenges affected by design include: the high costs of certain patient care delivery models; the integration of cutting-edge technology into certain patient care delivery models; shortages in human resources; poor quality in care delivery, customer service, and outcomes; and poor patient and staff experiences (Battisto et al. …