Look, don’t just see

There’s really very little magic to design research. The techniques are simple and obvious and, as my old IDEO colleague Jane Fulton Suri suggests, a lot of people have them and they can easily be taught. What is harder, and what makes designers different and valuable, is knowing how to use the information these techniques generate. It’s easy to create mountains of data, but really hard to extract some value from them. Or, to put it another way, it is massively beneficial to see what everyone else has seen yet think what no one else has thought. As an example, we thought it might be worth spending some time with a piece of medical equipment that everyone looks at but no one really sees — the humble IV stand.

So we spent a few hours in hospitals, watching and talking with people, listening to their stories and being aware of what was happening around them.

Grime and the grim realities

They are a bit like shopping trolleys, except you don’t have a choice. If you’re unlucky enough to be given one with a wonky wheel, you simply have to learn its errant ways, holding onto the pole at waist height with one hand, perhaps while also trying not to spill a cup of coffee.

The wheels are not spinning freely because of years of congealed and compressed detritus and an almost complete lack of maintenance. Ecologists might call it another ‘tragedy of the commons’ – the ruin of a shared resource through rational self-interest.

This pole is nobody’s. Probably four or five people have some management responsibility for it; the net effect is that no one has. Nobody cares for it, why would they? It’s not glamorous high tech for which he have technicians; it does nothing medical, so why would nurses maintain it; nor is it strictly furniture or infrastructure, for which we have facilities people.

It stands in the corners of wards waiting to be pressed into service. Its ubiquity is its downfall. It is not special, or demanding or even scarce. It is overlooked and underloved.

Rock and roll

Watch people try to walk with their stand and you realise that, despite the wheels, they are not designed to be mobile. If they were, perhaps you could stop the wheels from castoring, to give more control; or one wheel might be fixed in the straight-ahead; or the base would present less of a trip hazard; and there would be a handle or some way to exercise control.

The slightest change in floor level can stop a stand in its tracks. Door thresholds, sealing strips, lift entrances … all have to be approached with care. The wheels are small enough to fall into these slots or to stumble over ledges.

If you are frail – and surprise, surprise, many people in hospitals are – then you might look to this upright piece of metal for support. You would be foolhardy to do so.

We spoke with a gentleman whose saline drip made him need the toilet frequently. He had to take his stand with him but its small, errant wheels were extremely difficult to control. He used the conveniently placed adjustment knob at waist height to gain some control but not designed for that purpose, over time it slackened and the whole structure collapsed to half its original height. The saline bag was now at the level of his heart and promptly filled with blood.

Perhaps you can empathise? In a public corridor, desperate for the toilet, naked except for a thin hospital gown, watching as your blood leaves your body.

To compound matters, this gentleman was told off for walking around and creating this situation. The IV stand, despite having wheels, decreases mobility which somehow people seem to accept. He felt conspicuous walking about, as few other people seemed prepared to battle with their stands. Busy nurses would prefer people to take themselves to the toilet yet find themselves persuading them to stay still and ask when they want help. And at the centre of this dilemma is the humble IV stand, which doesn’t mean to disempower or demean but finds itself doing so.

The wheels are not spinning freely because of years of congealed and compressed detritus and an almost complete lack of maintenance.

How did we get here?

The nurse’s experience is equally bleak. They have to load the stand with fluids and equipment, sometimes to the point of instability and typically in the worst situations as usually the most seriously ill need most fluids and devices – the last patients whose care needs interrupting by a collapsed IV stand.

They are also the most likely to need a rapid transfer to the emergency room, where often a nurse – a motivated and highly trained healthcare professional – is needed to push the stand, manage the wheels and make sure that bags, cables and lines don’t snag on anything they pass.

The nurses’ commentary was about how poorly the stand enables or supports the most basic of tasks, and how they cannot access all of its parts to clean it effectively.

The ward we visited had three different types of stand, each had its own characteristics and disadvantages, and none worked well together. With different numbers of legs they didn’t nest or overlap, they took up room, they got in the way of good care and ended up being kicked and damaged in frustration.

How do we get to a situation in which the most basic requirements of these stands are not met? What does this say about the methods of hospital procurement?

I’d further suggest that the Victorian doctors who pioneered intravenous therapy would probably recognise the IV stand, if little else about modern medicine.

The constant companion

Over all those years, the IV stand remains the one piece of hospital equipment that follows the patient everywhere, in many cases all the way from admission through to discharge.

We heard how the patient would be hooked up to the stand, but not shown how to manage it or the bags and lines. People told of sleeping in a fixed position because they were so concerned that moving might interfere with the security of the lines and connectors.

One man told of waking in the night with a pain in his side from sleeping on top of a connector; when he moved to get comfortable the connector came apart and he and the bed were drenched in his urine.

Tethered to an IV stand, sensitive parts of the patient’s body are attached by thin, strong lines to several kilograms of metal which not only reduces mobility and dignity, but enters consciousness in other ways.

Patients are unaware how the lines from the stand that arc across to their bodies are attached, how they stay in place and what they can or cannot do while they are there; all they know is that a sensitive part of their body might hurt if they make the wrong choice. People tell of the care and attention they focus on these lines, knowing that in a sense they are an extension of their body.

We were also told about the simple joy of fresh clothes after being in a hospital bed for several days, and the contortions necessary to put them on, with the IV stand becoming a staging post in something akin to a public game of Twister.

Peter, one patient we met, shared with us his thoughts about the stand that had been by his side during a long hospital stay. The relationship he forged with this imperfect companion was so strong he felt moved to write a poem about it, and to name it ‘Lucrezia Borgia’.

So what?

If our thinking has any significance it is perhaps that it helps us recognise something of the true nature and importance of the relationship between a user and the designed object. The IV stand may be a piece of metal, but it moved a man to write a poem. It is commonly held to be an unimportant receptacle for important things. It is, in reality, more than that right now, but maybe we can believe it has the design potential to satisfy that bigger role?

It could be reconsidered as a mobility aid, as a support structure for frail people which enhances rather than degrades mobility and autonomy.

It might be conceptualised as a ‘partner’ or ‘supporter’ that shares all the worst times of a hospitalisation. It could carry something of the patient’s identity and personality, and could be customised functionally or personalised emotionally. It might then play a role in socialisation within the sometimes impersonal microcosm that is a hospital ward.

They didn’t nest or overlap, they took up room, they got in the way of good care and ended up being kicked and damaged in frustration.

It at least exemplifies the fractured relationship between the buyers and users of this type of equipment, extending perhaps to the designers and manufacturers. There are design opportunities here too – creating the right processes for involvement and facilitating collaborative design work. Lastly, we would at least make it easy to clean and move – more stable and maintainable.

Design research might be criticised for complicating what is simple, or for confusing the obvious, and there is an element of truth in that. It won’t always generate new-to-the-world, commercial ideas, but it might. It’s the best way I know to help designers and clients look at the banal and obvious and think something never thought of before – and that’s how we innovate.

Acknowledgements

This couldn’t have been written without the massive help of Caitlin Cockerton and Peter Banner, who both spent time in hospitals looking at drip stands from different perspectives.

This article was taken from issue 4 of Insight magazine. Get your free copy of the latest issue here.