Características de los lugares de estudio 1 Fase Experimental

Apart from just walking through the virtual prototype of the facility, participants in the task-based condition also followed a series of steps from a patient dialysis scenario. The scenario involved finding the dialysis machine, taking it to the patient bedside, going towards the sink and finally following up with charting on the computers outside within the virtual prototype. These set of dialysis patient tasks helped the end users better envision how their typical daily tasks are tied to the space. The scenario led to a higher level of engagement with the virtual prototype compared to the walkthrough condition, where participants merely walked through and focused on the design faults.

6.5.3 Recommendations

Based on the evaluation results of the user study, it is recommended to embed appropriate task-based scenarios in interactive virtual prototypes if detailed, specific and healthcare process- based feedback is desired from the end users. Moreover, using the EVPS that combines task- based scenarios with interactive virtual prototypes also enables a higher level of engagement with the end users, as they are able to envision the tasks they perform more vividly. Apart from obtaining design feedback, using task-based scenarios also helps the healthcare staff and end users reexamine their current workflows and assess if they need to alter their operations according to the new space layout depicted in the virtual prototype.

Even though using task-based scenarios is more beneficial in obtaining detailed end user feedback, it is important to provide sufficient time for end users to walkthrough the virtual prototype as well. This permits the end users to get a better overall perspective of the design before performing detailed healthcare scenarios.

6.6 CHALLENGES

Certain challenges were encountered during data collection. Because the study was in the live hospital setting, it was prone to unexpected occurrences. Participants for the study were nurses that worked on the same floor so that it did not take them away from their duties for prolonged periods of time. Nurses were only able to participate based on their schedules and availability. One of the nurses had to leave mid-way because she received a call for a patient. A few nurses got calls during the study and recording had to be stopped when a nurse had to talk on the phone for an extended period of time. On the last day of data collection, an accreditation program was taking place in the hospital and it became extremely difficult to recruit nurses to

participate in the study, especially since most of the nurses from the Child Specialty wing had already participated.

Since the study was prone to unforeseen circumstances, it was useful to have multiple reviewers helping during data collection. However, multiple reviewers made it more challenging to follow the study protocol precisely. After data collection there were some missing recordings, but having both screen capture recordings and video recordings ensured there was backup for each participant

In regards to the stimuli used in the study, one of the drawbacks of using the task-based scenario stimulus was that moving virtual objects within the prototype was still tedious for some participants and future effort needs to go into making the user interface for moving objects more intuitive. Observations during the study indicated that more experienced or elder nurses tended to give detailed and relevant design feedback regardless of the condition they were in, although they preferred the walkthrough condition for navigation purposes. Even in the walkthrough stimulus, one of the participants did not feel very comfortable to “drive” and asked the interviewee to navigate and explore the virtual prototype for her while she gave feedback.

Finally, despite using a generic hospital model to develop the stimulus and briefing participants before the actual test session, there was some confusion regarding the purpose of going through the generic space along with clarifications and concerns over whether the stimulus depicted the actual new Hershey Children’s Hospital rooms.

6.7 LESSONS LEARNED

While this evaluation study revealed interesting insights into how participants leverage task-based scenarios in interactive virtual prototypes, there are many lessons to keep in mind for future studies. One of the first indications during data collection was the need for having a better-

defined protocol for the study. Since the evaluation was exploratory in nature, multiple modes of data collection were adopted. Future studies can have more focused questions and leverage the most effective data collection and analysis procedures for obtaining end user feedback.

The post-test questionnaire hardly conveyed any statistically significant quantitative results. One of the reasons for this could be that during the test sessions, considering the bed locations for example, certain rooms were critiqued more compared to others. However, the questionnaire at the end of the test asked for general feedback regarding bed location when participants could be thinking of any of the rooms leading to variable answers. Hence, future questionnaires could be designed to be more specific and focused or the talk-aloud protocol data could be used as a source of analysis to get a deeper understanding of the participants’ views.

In retrospect, getting a greater amount of feedback from the walkthrough condition was expected since participants in this condition spent more time exploring the overall space layout of the corridor and especially viewing rooms that had a higher number of design inaccuracies (Rooms 2, 3, and 4). It is possible that participants in Condition A got more time to give feedback as compared to Condition B participants. Within the equivalent average times allotted for

navigation, participants in the task-based condition also carried out the patient dialysis scenario while spending maximum time in Room 1, thereby leaving them with less time to review the overall space layout.

Lastly, the lesson learned for using task-based scenarios was that scenarios need to be better tailored to get relevant feedback. While the dialysis scenario was chosen as a generic scenario of patient care that requires unique work processes, it was realized during the study that not all nurses would be familiar with the scenario as is depicted in the following quote:

“…And then pumps, usually I would be more apt to hook a patient up to pumps rather than a dialysis machine which is a specific nursing task…like there is a dialysis nurse. So if you are presenting this to nurses that are actually using the space, it's not really something that I do, I wouldn't even know what I'm looking

for to hook it up. I know what to hook an IV pole up to... or a pump or oxygen and stuff like that.” [Participant 21-task-based condition]

For scenarios of tasks to be relevant in future design reviews, it will be imperative to develop and embed pertinent task-based scenarios in interactive virtual prototypes before they can become effective experience-based design review tools for healthcare facilities of the future. Hence, future EVPS developments for healthcare facility design reviews could be a combination of both conditions. Another area of effort needs to be addition of multiple scenarios that

participants can choose or switch between based on their expertise or preferences.

6.8 SUMMARY

This chapter described a study to evaluate the effect of adding task-based scenarios in interactive virtual prototypes to make them experience-based design review tools. The chapter began with an overview of prior evaluation studies on virtual prototypes used during design review to better inform the approach for design of evaluation study. Next, the study procedure, data collection and analysis methodology are described. Finally, results from the evaluation study reveal that both walkthrough and task-based scenarios are relevant for providing design review feedback. Further, task-based scenarios in virtual prototypes may provide more detailed feedback from end-users of healthcare facilities.

Chapter 7

CONCLUSIONS

This chapter summarizes research outcomes and implications of developing the concept of experience-based virtual prototyping for healthcare facilities. Contributions from this research are discussed through theoretical, methodological and practical implications. The next sections define several limitations of the research and recommend directions for future research. Finally, concluding remarks provide a comprehensive review of the study.

This research originated from the concept of developing a virtual prototyping tool that could enable end users to ‘experience’ a designed space virtually, during design review, before it was actually constructed. Implementation of the idea incorporated theories related to experience- based design from the healthcare design field and virtual prototyping to create an experience- based virtual prototyping system (EVPS). The EVPS was operationalized through the development of interactive virtual prototypes. Finally, the EVPS was tested with nurse

participants in a healthcare facility context. Evaluation of the EVPS revealed that including task- based scenarios in virtual prototypes is valuable to gain detailed feedback from end users on the use of a designed space for healthcare procedures during the design review phase of a project.

7.1 RESEARCH FINDINGS

The virtual prototyping framework and methodology developed as part of this research was implemented at the Hershey Children’s Hospital to assess the impact of using EVPS during design reviews with end users. The user study evaluation demonstrated that EVPS provides an easy visualization tool to understand design, layout and function of the designed facility. While

both task-based and walkthrough conditions were effective in obtaining design feedback from end users, overall, results indicate that task-based scenarios are more effective when more in-depth process-related feedback is required from end users. The importance of having scenarios in virtual prototypes was further confirmed as the evaluation study revealed participants in the walkthrough only condition also envisioned scenarios of healthcare activities they perform while exploring the virtual prototypes and providing design feedback.

Task-based scenarios enabled end users to interact with virtual objects and move them around in the virtual prototype thereby increasing their understanding of the design. Also, task- based scenarios helped ensure that participants focused on each step in the overall healthcare task, did not overlook any design flaws and gave more detailed functionality and process-related feedback. The patient dialysis scenario raised issues concerning the nurse’s work processes to deliver patient care, ensuring patient safety and infection control. Apart from the scenarios, personal experiences of nurses and their tacit knowledge of work processes also played a pivotal role in providing relevant design feedback on spaces.

7.2 RESEARCH CONTRIBUTIONS

The contribution made by this research is centered on the design, development,

implementation and assessment of a novel “experience-based virtual prototyping system” concept that can be used during design review by healthcare facility end users. This research resulted in the development of an overall experience-based virtual prototyping procedure. The goal was to enable rapid development of interactive virtual prototypes as a design review tool for end users of healthcare facilities. Hence, one of the contributions of this research is the development of an original framework and methodology to rapidly incorporate end user experience in virtual prototypes used for design review of facilities. Another contribution of this research is the

significance of incorporating task-based scenarios in interactive virtual prototypes, which is revealed through the results of the evaluation study.