The Context

In 2015 Starship Child Health was in the process of refurbishing their orthopaedic outpatients’ department. As part of the refurbishment they were looking for opportunities to improve the experiences of children and families visiting the department to get x-rays, see doctors, have casts removed, or have new casts applied. With hundreds of children passing through the department during a typical fracture clinic afternoon, the corridors and waiting rooms bore witness to a variety of complex and often frustrating user experiences. I worked with Starship managers, play specialists and clinicians to understand the context and develop a design solution.

Understanding the Problem

Over the course of three weeks I used observations, in-depth interviews with hospital staff, and anonymous surveys to build an understanding of the experiences that take place in Starship's orthopaedic outpatients' department. The goal was to understand:

1. What people's (in particular children's) experiences of visiting the department were like.
2. How external factors like the physical environment, appointment structures, and organisational systems shaped those experiences.

Behaviours

Observing people and talking to staff revealed that children and adults alike routinely displayed visible signs of boredom in the waiting rooms. With long wait times and nothing to do, people stared into space, tapped their toes, and swung their legs to pass time. While some brought toys and technology from home to entertain themselves, others created their own entertainment by dancing, climbing over furniture, or racing family members down the corridors.

Physical Spaces

Observing the characteristics of the physical spaces also gave valuable insight into visitors’ experiences. The features that differentiated Starship from the adult spaces within Auckland Hospital were largely superficial. Things like stickers, cartoon murals, bright colours, and children’s artwork were used to make the department look kid-friendly but didn’t actually help children understand or contextualise their healthcare experiences. Perhaps because of this, children were seldom seen to interact with or even notice most of these elements.

Information

There was very little information available in the waiting rooms explaining what to expect from an appointment. The only information I found on display was this series of small posters explaining the process of cast removal. The posters attempt to reassure children that the machine used to cut the cast won't hurt them. Unfortunately the posters were positioned high on the wall above most children's line of sight. The lack of thoughtful attention to their design also prevented them from drawing children's attention. Furthermore they explain just one of several treatment processes that children and families visiting the orthopaedics department might want to know more about.

Despite the presence of the posters children are often frightened by the noise of the machine as they wait outside the treatment room. Once inside the treatment room healthcare assistants  reassure children through verbal explanation. While verbal explanations are an important part of giving children positive treatment experiences, they often take extra time when children are particularly frightened or unprepared which can mean longer waiting times for other patients.  

Journey Mapping

To contextualise the insights that came from observations and interviews, I wanted to map patients' emotions and behaviours against the various stages of their journey. To do this I needed to understand the structure of their appointments in relation to the physical spaces within the department. I asked families to track their visits by weaving a piece of string through holes marking key locations on a cardboard map.

Of the 10 journeys sampled no two were the same and the only touch point common to all was reception. While some maps marked off just three touch points, others created more complex webs, weaving across the department. Because journeys varied widely it was difficult to create any generalised journey map that would adequately represent the diversity of experiences. The activity did however demonstrate that interventions that focused on a specific physical location would have a limited impact on children's experiences.

Personas

Next I generated personas representing three different children’s experiences, each shaped by a different emotion. One explored the experience of boredom in the waiting room, one was about the fear of having a cast cut off, and the third looked at a child's curiosity about how X-rays work. I chose these three emotions because my research indicated that each, if unmanaged, may lead to negative treatment experiences The personas were fleshed out in short narratives with illustrations depicting monster figures as visual representations of the child’s emotional state. They helped bring life to the pain points in the existing experiences that I wanted to address through design.

Mapping Pain Points

This map captures the full range of pain points identified through the research process that offered opportunities for improvement through design. Through discussion with Starship managers we decided to set aside the areas that would require large scale infrastructural or systemic changes, and instead focus on those that could be meaningfully addressed within a limited time frame. The selected focus areas were also closely aligned with the needs highlighted in the persona narratives.

Sketching

Having selected the design focus, I generated ideas for improving children’s experiences by providing them with information to satisfy their curiosity and alleviate their fears while giving them something engaging to do while they waited for their appointments.

Chosen Concept

From the pool of brainstormed ideas I worked with Starship managers to select ideas that could be further developed with a view to implementation. Ideas were judged by how fun, informative, and interactive they were, whether they would interfere with or enhance staff roles, the breadth of their age appeal, and their capacity to encourage positive interactions between children, staff, and family members. The chosen concept took the form of an informative picture book to guide children through an orthopaedic visit with interactive components like stamps that would mark each phase of the treatment journey.

Development

I worked on developing this concept in close collaboration with Starship staff through a series of prototypes and character development sketches. The narrative, structure, characters and style were developed iteratively in response to feedback from staff and families visiting the orthopaedics department. We knew we were onto a good idea when children in the waiting rooms asked to take the prototypes home to keep.

Design

The picture book concept was developed into five short booklets for children to collect as they progress through their treatment journey. Each describes the experiences of a girl named Lin as she goes through the different treatment processes that children might experience as part of an orthopaedic appointment. The narrative serves as a tool to satisfy curiosity and alleviate fears by informing children about what to expect from their appointments. It also facillitates conversations between children and their family members about their experiences and gives children permission to ask questions.

Supported by friendly illustrations, the narrative content of the picture book explains orthopaedic treatment in a way that is accessible and interesting to children. In doing so it reduces the opportunity for children to imagine the experience to be more frightening than it actually is. The depiction of different emotions in the form of monsters adds an element of fantasy to the story to keep children engaged while helping them explore their own emotions. Aspects of the illustrations are left uncoloured allowing children to make the books their own and beat waiting room boredom by colouring them in themselves.

Each booklet includes a page with a space to be stamped once the child has completed the relevant stage of treatment. This provides another interactive element that encourages children to take an active interest in the experience by offering a sense of reward.

Once children complete their orthopaedic treatment, the booklets become a keepsake of the experience, personalised with stamps and their own colouring.

Implementation

Following overwhelmingly positive feedback on the design from families visiting Starship for orthopaedic appointments, the design has been further developed with Starship Child Health to reach a cost-effective design for implementation. The five separate chapters have been compiled into a single book to simplify production and the stamp pages replaced with prompts for children to interact with the book by drawing or writing about their own experiences. The updated version has been published with sponsorship from Starship Foundation and is now given to children as part of their orthopaedic outpatient appointments at Starship.