Learning Goals / Need
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 family-centered 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.
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
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
[pic]
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
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