Pulse
Briefs
Message on a Bottle
Better design is making its way into medicine cabinets. In 2005, Target Corp. gave its prescription bottles a face-lift, replacing the generic amber cylinder with a bright red container.
The redesign took place after a survey commissioned by the company found that nearly six out of 10 adults in the United States do not take medication correctly.
Consumers and safety experts aren’t the only ones who’ve admired the genius behind the new bottles. The Museum of Modern Art in New York also took note and featured them in a 2005 exhibit on products whose design reduces risk.
The Interpreter
Terri Zborowsky has a foot in two worlds: health care and architecture. As a registered nurse who once worked in a large teaching hospital in Winnipeg, she knows how the physical environment can affect patients and staff. As a doctoral candidate in interior design at the University of Minnesota, she understands the challenges of constructing facilities that are attractive, functional, and within budget. And as director of health care education and research at Ellerbe Becket, a Minneapolis architectural firm, it’s Zborowsky’s job to help designers and health care professionals see things from each other’s perspective.
“I’m a translator in many ways,” she says. “I try to help the staff here understand how we use research in making informed decisions in health care, and I work with clients to help them understand what we’re doing from an architectural perspective.”
Zborowsky is one of a handful of health care professionals who have found second careers in architecture and design. She decided to study interior design after seeing how some of the construction projects at the hospitals where she worked served neither patients nor staff well. “I could see that I understood the different parts better than people who were coming in from the outside,” she recalls.
In addition to helping health care clients figure out how to create spaces that are functional yet user-friendly, Zborowsky educates Ellerbe Becket staff on topics such as how to read a clinical study and conducts studies on the effectiveness of design ideas. In one study of nursing station design, she and her client observed nurses on the job and surveyed them about what was important in a work environment (personal safety, location of supplies, ability to complete tasks efficiently, privacy). They then showed focus groups blueprints of various layouts and asked each group to come up with a design of its own. “Ninety-nine percent said they wanted the same thing,” she says. All wanted a decentralized layout with clustered work areas.
One of Zborowsky’s primary interests is making design—like medicine—more evidence-based. “The built environment has a profound effect on health, and there’s documentation that supports that,” she says. “This heightens our need as designers to embrace research and understand the role it plays in design decision-making so our clients can make better, more informed decisions and we as designers can make better, more informed decisions.”—Kim Kiser
Conversation Starters
Endocrinologist Victor Montori, M.D., lead investigator in the Knowledge and Encounter Research (KER) unit at Mayo Clinic, knows that doctors can recommend treatment, but patients may not always follow their advice. He thinks that’s partly because physicians don’t always present information in ways that patients can understand. As a result, patients don’t ask questions and may not be aware of or understand the consequences of their options.
So Montori’s KER researchers have been working with a creative team from Mayo’s SPARC Innovation Program, a laboratory that tries to find innovative ways to deliver health care, to design materials that help structure the conversations a physician and patient need to have about treatment options. So far, they’ve designed colorful cards to help patients understand diabetes treatment and statins, and they’re working on materials for osteoporosis treatment and colorectal cancer screening.
Montori, who emphasizes he’s a clinician and not a designer, says the KER researchers bring a problem to the SPARC team, which then works up an idea for a decision aid. A prototype gets presented to a patient advisory group. “If they [the patients] think something is completely useless, they’ll just tell us,” Montori says. He notes that the final version of the diabetes cards was far from where they started. “We thought patients could fill in a matrix … by aligning pieces of Velcro,” he says. “It was a disaster.” Three or four iterations later, they arrived at six cards.
Each compares metformin, insulin, glitazones, exenatide, and sulfonylureas with regard to one concern a patient might have. Each is a different color and presents the information in a way that makes sense for the topic. For example, when and how you take each drug is expressed with pictures, the likelihood of weight gain is expressed as a graph, and the level of A1c reduction a patient might expect is expressed as numbers.
According to Montori, research is showing that patients are more likely to start and continue taking medications when doctors use the cards.—Carmen Peota
Joint Commission Promotes Safe Design
Joint Commission Resources (JCR) has launched a consulting program to help health care organizations understand how facility design affects patient safety. Services include project assessment and preparation, analysis, and implementation.
JCR also published a book that explores the topic. Safe by Design: Designing Safety in Health Care Facilities, Processes, and Culture offers lessons learned from health care professionals who have applied safe design principles and involved caregivers and patients in the process. Information about the program and book are available at www.jcrinc.com.