Sunday, October 19, 2008

Value-Sensitive Design and Hospital Waiting Rooms

Jason Zalinger
Value-Sensitive Design
Conceptual Investigation

Socio-Technical System:‭ ‬Hospital‭
Problem Space:‭ ‬Waiting Room‭
Values:‭ ‬Empathy and Empowerment‭
Stakeholders:‭ ‬Patients,‭ ‬Family and Friends‭
Possible Solution:‭ ‬ Mobile Phone Game‭

Socio-Technical System:‭ ‬Hospital‭
Hospitals represent a strange paradox.‭ ‬ Their sole mission is to save lives and relieve pain.‭ ‬ However,‭ ‬they are also spaces that create intense anxiety and fear among patients,‭ ‬family and friends.‭ ‬ I do not blame hospitals.‭ ‬They must find a balance between‭ ‬helping humans and‭ ‬processing patients.‭ ‬Still,‭ ‬it is precisely this tension between helping and processing that causes anxiety among patients.‭ ‬This Value-Sensitive Design conceptual investigation describes and explores that tension and offers a possible solution to help relieve some of the anxiety hospitals unintentionally produce.‭ ‬Since hospitals are obviously complex systems,‭ ‬I am focusing my energy specifically on hospital‭ ‬waiting rooms.‭ ‬The direct stakeholders are obvious:‭ ‬Patients and their family and friends.‭ ‬The indirect stakeholders are the doctors,‭ ‬nurses and hospital staff whose interactions with patients might be easier if the waiting room environment helped direct stakeholders feel a stronger sense of empathy and empowerment.‭ ‬ ‭ ‬ ‭

A Brief Hospital Story‭
I went with a friend to the local hospital before she had surgery.‭ ‬We were there for almost three hours while various departments and nurses and information workers poked,‭ ‬pinched and processed her body and her medical records.‭ ‬Looking back,‭ ‬I realize the entire system actually‭ ‬worked.‭ ‬However,‭ ‬with each new department we journeyed to,‭ ‬we both ended up in a waiting room...waiting,‭ ‬with little information about what to expect or what we should be doing because in the waiting room,‭ ‬it seems like human nature dictates that you ought to be‭ ‬doing something besides sitting.‭ ‬Sometimes they let me in the exam rooms with her.‭ ‬Most of the time,‭ ‬I distracted myself with my laptop and tried not to look at the other people waiting.‭ ‬One of the waiting areas was large,‭ ‬with light pouring in from great big windows above.‭ ‬The natural light felt good,‭ ‬safe.‭ ‬But,‭ ‬insane as it sounds,‭ ‬it was the only waiting room I had been in that day‭ ‬with windows.‭ ‬Since this waiting area was a major hub of activity,‭ ‬it would have seemed like madness to cram lots of people into a windowless space.‭ ‬Although I believe that face-to-face communication is always more powerful than technologically mediated communication, ‭all the other people in that large waiting area did not make me feel a sense of communion:‭ ‬We are the waiting people.‭ ‬We wait as one‭!‬ Rather,‭ ‬I got the feeling of being nothing more than a member of the data herd,‭ ‬each patient branded with a unique hospital identifying number.‭ ‬ In the small,‭ ‬windowless waiting rooms the lights were dimly lit with bland chairs and wallpaper and carpeting.‭ ‬The rooms were clearly institutional, with a twist of Walmart chic.‭ ‬They made me sad.‭ ‬They reinforced the notion that this hospital—despite it's brilliant reputation for saving lives—was also unable to afford environments which could support the values of‭ ‬empathy and‭ ‬empowerment.‭ ‬It is only with the‭ ‬deepest respect that I offer some potential solutions to helping people immerse themselves in a game which could give them a deeper sense of empathy or empowerment.‭

Potential Solutions:‭ ‬Video Games‭
The immersive,‭ ‬imaginative quality of video games seem to be a good fit for supporting a sense of empathy or empowerment for anyone stuck in a waiting room.‭ ‬Thus,‭ ‬I propose a video game for mobile phones as a potential way to help stakeholders feel more supported.‭ ‬Many‭ “‬serious games‭” ‬exist which are aimed children and medicine.‭ ‬However,‭ ‬very few games seem to exist which deal with the hospital itself as a socio-technical environment.‭ ‬One example would be Hospital Tycoon published by CodeMasters in‭ ‬2007.‭ ‬Hospital Tycoon is a business simulation,‭ ‬however,‭ ‬the publishers included a story mode to add interest.‭ ‬They call the game a‭ “‬Medical-based soap opera.‭” ‬This type of simulation might be fun to play,‭ ‬but it does not address the specific values of empowerment and empathy in a waiting room.‭ ‬First,‭ ‬it is a PC game,‭ ‬so players would need their laptops.‭ ‬What I envision is a mobile phone game simply because of the ubiquity and convenience of the phone platform.‭ ‬In addition,‭ ‬a phone is,‭ ‬arguabley,‭ ‬less likely to be left at home than a handheld game system like a DS.‭ ‬Sitting in a waiting room requires periods of waiting,‭ ‬followed by burst of activity when your name is called.‭ ‬A mobile game can be quickly,‭ ‬easily paused or closed and put into one's pocket.‭ ‬Besides platform,‭ ‬I believe that the‭ ‬Waiting Room Game should be a series of mini games within which players can easily jump in and out.‭

In the hospital that day,‭ ‬my friend said to me,‭ “‬When they talk to you it makes you feel less helpless.‭” ‬Talking is the key to supporting a sense of empathy,‭ ‬thus talking‭ (‬or is it‭ ‬listening‭?) ‬must be built into the game.‭ ‬One way to do this would be for players to create a somewhat detailed profile before the game begins.‭ ‬When the player redesigns a waiting room,‭ ‬for example,‭ ‬a nurse would come out and cheer you on saying,‭ “‬the new carpet looks great,‭ ‬Jay‭!” ‬And if you select green as your favorite color in your profile,‭ ‬the doctor could be wearing a green tie and say,‭ “‬I wore this green tie for you‭!” ‬The goal is to humanize the patient-doctor-waiting room experience.‭ ‬Now that I have detailed the philosophy behind my conceptual investigation,‭ ‬here are some examples of possible mini games based on my experience that day in the hospital:‭

Waiting Room Designer:‭ ‬In this game,‭ ‬the player gets to design and decorate a waiting room.‭ ‬They can browse and choose from a variety of possibilities,‭ ‬such as,‭ ‬carpeting or hard wood,‭ ‬artwork,‭ ‬couches and chairs,‭ ‬lighting,‭ ‬flat screen TVs and so forth.‭ (‬the publisher of this conceptual game could probably make a lot of money using product placement from Pier‭ ‬1‭ ‬or Crate & Barrel) ‬Time limits could also be an option if,‭ ‬for example,‭ ‬a patient is told they will see the doctor in about five minutes,‭ ‬they could set a game for that time.‭ ‬The goal here is to empower patients in waiting rooms so that they feel a stronger sense of control over their environment.‭

Department Shuffle Puzzle:‭ ‬In this game,‭ ‬the player must solve a puzzle somewhere in the waiting room in order to get through to see the doctor or nurse.‭ ‬This could help stakeholders alleviate the nagging sense of‭ ‬feeling like they should be doing something.‭ ‬This gives them a chance to take control of the environment.‭ ‬It gives them a chance to solve the‭ ‬mystery of waiting.‭ ‬It makes the mystery more tangible and thus makes the patient feel more in control.‭

Paperwork Blaster:‭ ‬This game could be a side-scrolling shooter where flying‭ ‬paperwork‭ ‬monsters aggressively assault the player who is armed with heavy guns and special weapons.‭ ‬Paperwork monsters could include insurance forms,‭ ‬medical record items and,‭ ‬of course,‭ ‬hospital bills‭!‬
Obviously,‭ ‬there are many ways to expand upon this possible solution.‭ ‬For example,‭ ‬how do we account for children who are not worried about paying hospital bills or insurance forms‭? ‬Maybe the game could ask the players age,‭ ‬and if they are under eighteen,‭ ‬the game provides an alternative to‭ ‬Paperwork Blaster.‭ ‬This is where field work would be necessary for the game designer to create elements that kids would enjoy fighting their way through—without implying that these objects are necessarily evil or bad.‭ ‬They are simply part of the ecology of hospitals that most of us,‭ ‬at some point,‭ ‬have to deal with.‭ ‬If games can help direct and indirect stakeholders feel more empathy or empowerment then we ought to play.‭


Matt Rolph said...

I love the elegant brevity of this treatment, and wish I'd had it to study before I wrote my own VSD paper. Great paper!

Matt Rolph said...

Oh, and I want to play this game already.

Anonymous said...

I agree - Directly to the point. Fun idea too.