Designing Learning into a Space: Health Hunt
ED303X: Designing Learning Spaces
June 5, 2006
Karin Chapin, Kristle McCracken, Sam Ogami
The Need
Going to the hospital is scary for many of us. But imagine how much more
frightening for a young child, and for the family of that child. At Lucile Packard
Children’s Hospital (LPCH), they strive to provide “a nurturing environment for
the children who come into the hospital.” This “nurturing environment” attends to
the emotional well-being of patients.
According to the mission statement, LPCH values “Advancing a familycentered approach to treatment.” Handouts and fliers say that "quote from
handout." Similarly, Duke Children's Hospital recommends to parents
Encourage your school-aged children to share their questions or concerns
so that you can help alleviate their fears and anxieties. Respond honestly
and assure them that children of all ages, and with many different
illnesses, are treated in the hospital, and that many people there are
working together to help them get well. If you are unable to answer some
of their questions, be sure to call your child’s doctor or the hospital directly.
There appears to be consensus in these communications that parent and family
involvement is a crucial step in helping children to learn to deal with the anxiety
of being in the hospital.
The Approach
Based on these needs, we decided to find a way to would help patients
and their families learn to communicate about their needs, feelings, and
questions, while also facilitating learning about and using the resources available
in the hospital space. According to Vygotsky, "robust knowledge and
understandings are socially constructed through talk, activity, and interaction
around meaningful problems." (HPL p.184) According to Lave and Wenger,
novices learn by observing others in “Communities of Practice.” If we wish
children to learn to deal with their feelings and questions in a constructive way,
we believe it is best to model that for them in an interactive forum.
<something about the museum readings -- learning must be at the right
level and engaging for all users? Make the hospital a fun place to explore?>
Our design takes the form of a board game, which we call “Health Hunt.”
Loosely based on the game Candyland, Health Hunt is game in which two to six
players progress down a path. Each player in turn picks a new card and follows
the instructions to move forward (or occasionally backward). The first player to
reach the end wins.
The cards turn Health Hunt a learning game. Some of the cards are
informative, telling players about different parts of the hospital. Others prompt a
discussion among the players about feelings and questions relating to the
hospital and procedures. And to create interaction between the game and the
physical space, special cards can be collected from personnel at various
locations in the hospital, encouraging patients and their families to visit new
places and learn about their services.
Ideally, patients would be able to experience this game before they arrive
at the hospital for the procedure. For this reason we propose that a low-cost,
traditional board game be sent home with families after an orientation visit.
Playing this game would build comfort through communication about feelings and
encourage familiarity with the hospital space. Although a first version would be
fairly generic for all children, regardless of their health condition, future versions
could have cards with different themes (cancers, transplants, etc.) and age
levels. The patients could begin collecting cards from various locations at LPCH
even before their procedure.
Once they are at the hospital, however, there are exciting possibilities for a
high-tech version of the same game. Imagine a tablet computer, small enough to
perch easily on a bedside table. The game board appears on the screen, but
instead of being generic, it is personalized with the patient’s name and
information about age, condition, preferred language, and even family members’
names. Questions and prompts are illustrated with photos, video clips, diagrams,
maps, and current events. Even photos of family and staff could be included. All
is dynamically updated through a wireless connection, with the potential for new
cards to be created and added to the “deck” as appropriate for a particular
patient.
Scenario:
Six-year-old Lucy opens a tablet laptop on bed. Launches Health Hunt,
one of several "fun" activities. She and her brother and mom each put a piece on
a square and type their names next to the pieces, which ID's them for the game.
The game "recognizes" them from the customized profiles downloaded at the
hospital.
The game board appears on the tablet. Because Lucy doesn’t read well
yet, the audio is turned on. The game (should there be a character?) "tells" them
to put their pieces at the start, and then asks Lucy's brother Ted (first player
chosen randomly?) to click on the card pile. Following the instructions read to
him from the card, Ted asks a question about what it feels like to have cancer.
Lucy thinks for a while and then answers his question, describing how much she
hates the taste of her medicines. Lucy's mom makes a note to ask the doctor
about flavoring the medicines next time they go to the hospital. Ted clicks “I’m
done” and his piece moves on. The game then presents a card for Lucy.
Assessment of Learning
It is important to determine whether playing “Health Hunt” actually
encourages learning. If not, it is a great expense without corresponding benefit.
But how do we measure the actual change in patients’ comfort levels and abilities
to express their needs? How do we know if they explore the hospital and
whether they discover a service they wouldn’t have otherwise?
One method would be to add a question to the questionnaire currently
collected by Patient Relations after the patient has been discharged from the
hospital. Parents would be asked whether they played the game, and what effect
they felt it had on their child, if any. Separately, a number of affect questions
could test correlations between the patients’ comfort level at the hospital and
their level of play.
Another measure would be less formal, and yet fairly eloquent. Because
the game can incorporate interaction through "bonus" cards available from
various resources in hospital, a simple tally of the cards collected would indicate
whether or not patients are playing the game. The current measures of patient
utilization of resources should capture whether there is an increase in access
after the game is put in play.
As with all interventions, informal, anecdotal assessments will occur
through staff conversations with families. If care providers note learning
advances in patients’ charts, that data could be used to determine the
effectiveness of this learning environment.
Our Process
We had an unusual challenge in working with the hospital setting, in that
we could not access actual "users." The privacy issues around patients' rights
meant we really couldn't gather information from the target population. Instead,
we used input from staff, web sites, a healthcare consultant and our own
experiences to inform our design process.
Lucile Packard Children's Hospital (LPCH) in Palo Alto has it all. A
beautiful building with soft contours and lush gardens make it feel calm and
comfortable. A dedicated staff provides access to the latest research and best
techniques available. A donor base and volunteer corps translate their generous
impulses into tangible care.
What could we add to such a space?
When we toured LPCH we noted three things. First, in trying to make the
space less intimidating, the hospital also made the services less obvious. The
library is hidden in a corner of the second floor, the cafeteria is in the basement,
the parent lounge is tucked away behind a door with a small sign. Second, staff
reported that the information packet listing all the resources was ineffective in
bringing families into contact with those resources, meaning that the real
information was transmitted through word of mouth. Third, the hospital is full. The
spaces are all spoken for with dedicated purposes, and although there is some
limited room for improvement, we needed to think of ways to bring learning into
the existing spaces.
Through conversations and readings we determined that talking about their
hospital experience was an essential skill for patients to learn. We decided to
attack the design from the perspective that the families would be actively
involved in the learning process. Because the patients are often so young, we
knew that the information they receive needs to be tailored to their personal
readiness, and we felt the parents would be best able to determine that level.
We also felt that a physical “space” would be more compelling than a virtual
“space” for children of this age. And finally, whatever learning goal we had would
have to be motivating enough to engage a child with a great many distractions.
All these considerations led us to develop the idea of a board game as a vehicle
for learning.
References format
LPCH Mission http://lpch.org/aboutus/HistoryAndMission/
How People Learn
Appendix A:
Things we thought of but didn't do
Learning about procedures
kid-friendly robot with computer screen that can be used to show videos
of facilities, simulations
Learning to talk about procedures, feelings
teddy bears
to use as pretend patients; special friend for younger kids
online personalized web space lets older kids learn about topics they are
interested in; share their thoughts, feelings, art
graffiti wall allows patients to express their feelings
Learning to take care of family members’ needs; connect with other
families.
movie nights in auditorium give entire family a break
intro to walking trails around LPCH. Helps families relieve stress
monthly “party” on a Friday night, in the cafeteria
Learning to overcome helplessness, take control
remote control garden allows kids to care for something outside the
hospital
Learning to get around the hospital
Map
Treasure hunt given to patients to collect clues around the hospital
Appendix B:
Highlights of our Process
hospital tour with foundation director
initial ideas brainstorm
meetings
phone interview of Child Life Service Director
prototype one: toys, reports
phone meeting: game
prototype two: cardboard mock-up
class meeting: feedback from Deb and Dan
progress updates
final touches