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.

<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 procedureskid-friendly robot with computer screen that can be used to show videos of facilities, simulations

Learning to talk about procedures, feelingsteddy bearsto 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, artgraffiti 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 breakintro to walking trails around LPCH. Helps families relieve stressmonthly “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 hospitalMapTreasure hunt given to patients to collect clues around the hospital

Appendix B: Highlights of our Process

hospital tour with foundation directorinitial ideas brainstormmeetingsphone interview of Child Life Service Directorprototype one: toys, reportsphone meeting: gameprototype two: cardboard mock-upclass meeting: feedback from Deb and Danprogress updatesfinal touches