Hello, I am a second year doctoral student from School of Architecture. I graduated from Shanghai Jiao Tong University (SJTU) with a B.ARCH and got my Master degree in Shenzhen University (SZU) focusing on Architectural History and Theory. Currently I work as a GRA at Georgia Tech Health System Institute (HSI), applying different tools, such as space syntax, medBPM, and physical mock-up, to the optimization of work process in clinical settings. I took this course since it would help me better understand the US healthcare delivery system and get familiar with the challenges in existing healthcare design and research field. I like traveling with my friends, tasting local cuisine, watching movies, listening to music, and swimming during my spare time.
I am a little bit more familiar with hospitals than my peers since I spent a lot of time in the hospital where my mother has been working during my childhood. My mother is an experienced nurse working at the outpatient operating room. According to my memory, the outpatient operating room used to sit next to the emergency room so that I had the chance to see those seriously injured people who need immediate treatment get treated there, of course, as well as those bloody scenes. However, I do not remember much about the work process for the emergency care then, which would probably be quite different from that in the US. I look forward to the field observations so that I can experience the unique (both scaring and exciting) atmosphere of the emergency room again and understand what is really going on there.
My comments/questions: In this class, we introduced our own and our roommates' closets to other team members. We made quick notes of others' description about their closets as well as their comments, then we grouped the notes into various themes to generate a better understanding of the present problem of closet use. Actually I did not catch the point when I was doing my notes, only trying to objectively record the physical arrangement of the closets described by my teammates. I was think that it was me to judge whether it was good or bad. However, later I was told that the main point of this observation was to minimize the subjectivity of the observer, and to encourage the interviewees to speak out. Still I have some questions: 1. As Jeremy went pretty fast through his lecture, I was not quite clear about the difference among the three notions he mentioned, namely 'observation', 'opinion', 'judgement'. Especially, for the latter two, is the opinion or judgement ours or others? Shall we preserve them or exclude them when doing the notes? 2. As to the problem statement, shall we raise the problem by our own observation combined with our personal experience and judgement, or, rather, we place ourselves as outsiders and pick out the problem in a very cold and logical way?
Outcome of group discussion (with Arun Padmanabhan, Moreed Khosravanipour): We basically grouped the observation notes into three categories: a) Frequency of closet use; b) Physical arrangement; c) Commentary. I found that we actually use the closet differently in the frequency. Closet is just a space to store the clothes and toiletries I won't wear or use in near future, while for some of us, they would take the clothes out their closets on a daily basis. One obvious common thing about the physical arrangement of the closet was that there existed a certain kind of organization based on the properties of stored objects (e.g. 'dirty or clean', 'ironed or wrinkled', 'wear frequently or rarely', 'small stuff or large stuff'). Most of us were initially quite satisfied with our closets, and even thought that there were no space for improvement. However, after the group discussion, some of us thought that their closets did not look perfect anymore.
Dr. Ackerman gave an excellent introduction to the working process of emergency department in this class, which including 'Triage', 'Evaluation', 'Work up', 'Treatment', 'Consults', 'Admit', 'Discharge', and 'Transfer'. The arrow diagram provided a clear processing map of the relevant activities. It would be great if he could briefly review this working process after the site visit, when we would have a better understanding through the observation.
Dr. Zimring showed us a number of amazing examples of how evidence based design could improve the healthcare delivery process and outcomes. Some very interesting issues were addressed when trying to generalizing the evidence observed to a causal relationship, such as the internal and external validity, and so on. Most of the evidence presented were about 'physical designs' (which were related to material, spatial arrangement, etc.), I was also curious that whether there were any evidence showed that designs that address human mind or emotions, or working processes, could impact on the healthcare outcomes?
Great site visit to the Emergency Department of the Grady Hospital. The guide tour gave me a perfect general impression of emergency department setting, however, it would be even better if more detailed information about a patient's visit is provided in the following classes.
The Pecha-Kucha presentations gave us a great opportunity to share our opinions with others on the problems we found during the visit to the Emergency Department, Grady Hospital. Many of the problems/phenomena were presented in a pretty creative way. It was interesting that several problems were frequently addressed by various people, such as noise issue, location of nurse station, hallway congestion, etc.
Another wonderful Pecha-Kucha session. Dr. Zimring again suggested we should not present the problem based on any preconceived solutions, rather, the problem should be directly related to the observation. I agreed with this and found it is critical to avoid bias in observation and the following problem statement.
After the class, we went to visit the Emory Emergency Department at Midtown. To my surprise, the experience at Emory E.D., Midtown was quite different from that in Grady Hospital. It looked quite clean and organized, also much less noisy at Emory E.D., Midtown. However, the nurse who guided us mentioned that there were too many posters and notes stick to the walls and whiteboards, which largely compromised the original intention of providing useful information to people. Since there were so much information there and they really had no time to read them, they ended up paying no attention to them at all and sometimes overlooked the important reminders or notices. Another issue was that the physician who guided us around complained that the physician/nurse offices and break rooms are too far and invisible from their major working area, which discouraged them to get to the rooms and have rests.
In today's class, Dr. Ackerman showed us some great examples of both good and bad problem statements. As he said, the problem statement should be concise and straightforward, or it will either disinterest or misled people. Through some exercises, we got a better feel of what an excellent problem statement should be.
In this class, everyone was asked to write a simple problem statement (3-5 words) on a sticker and posted them on different sides of the room. Basic categories include the patient-centeredness, communication between medical staffs, and others. Interestingly, initial patterns began to emerge from various problem statements and were further organized by Prof. Zimring, Prof. Cowan, and Prof. Do. We were looking forward to further generalizing the problems and finding our teammates.
Initial group were formed based on voting. We were focused on noise reduction in the waiting area. The main issue is that the metal detector equipped at the security pass made occasional ragged sound which could disturb the patients waiting in the waiting area. Dr. Do provided some great ideas including that rather than reduce the active source of noise, one could also use other sound to cover the noise. She took the example of a town street which had heavy traffic and a lot of noise but successfully distracted people passing by through the placement of a loud artificial water fall. This case in my view is a very brilliant way of dealing with the noise issue.
An in-depth discussion about the problem statement was conducted in class.
Each group presented their selected problem statements to the class and a second round of discussion