Making Blood Pressure Visible – working with Salford Royal Renal Unit.
Design is moving in new directions. We know this, we've seen it adapting, shifting and transforming in different sectors and in areas that our Industrial Design (with a capital D) predecessors left untouched. I've been lucky to be included in this movement, swept up in it in fact, but it can sometimes be difficult to explain why design is now operating where it is.
Design is moving in new directions. We know this, we’ve seen it adapting, shifting and transforming in different sectors and in areas that our Industrial Design (with a capital D) predecessors left untouched. I’ve been lucky to be included in this movement, swept up in it in fact, but it can sometimes be difficult to explain why design is now operating where it is.
Never has this fact hit home more than it did on Friday evening; I was on the phone in Preston station, waiting on a delayed train to take me on my homeward journey from Manchester to Glasgow and explaining to my father why I had spent the day in the dialysis unit in Salford Royal Hospital.
Snook were invited down to Manchester to take part in an ongoing project with Martin Bontoft and Janet Hegarty, a Consultant in Kidney Medicine. This relationship is about Dialysis patients better understanding/managing the levels of Sodium and Potassium in their diet through effective yet simple means that can later be reproduced by the team in Salford.
The next step was collaboration bringing together departments from all over the hospital to concentrate on issues that raise problems across their various fields. Snook were brought in to help in the area of blood pressure, in particular helping to visualise what it means to patients and how important managing your (invisible) blood pressure is when you are on dialysis.
We mocked up ideas quickly and tested them out with staff in Salford. My day in the hospital with Martin brought lots of ideas to the surface which I then brought to life with paper, scissors, glue and cardboard (our favourite type of prototyping!)
I met a lot of amazing people, who deal with A LOT. The nurses who work on the units, with 170 patients coming in to the thrice-daily shifts, the technicians who maintain these complex machines, and can show you a variety of interesting and informative data with their combinations on the buttons and the dietitians (who I spent more time with in my following trips) who help to shed light on the intricate balance that your diet rests on between dialysis cycles.
Speaking to some of the patients was eye-opening and, if I am honest, not entirely what I was prepared for. Watching one particular patient having his needles set up it became apparent that although I had been completely fine with the amount of blood on show; pumping and hissing around the spinning and bleeping apparatus, I was very quickly uneasy when witnessing the pain that was caused by the insertion and subsequent maneuvering of the needles.
Sitting at the nurses’ station, clearing the fog in my head and getting my hearing back it seemed that, at times, I can be a little too empathic (I wonder if I’ll lose this?) I really hope that the work and ideas that come out of this project will do something to make the patients lives even a little easier. It’s a tough life when you are on dialysis, spending up to 4 hours, 3 times a week hooked up to the machine – and having to manage every portion of food and every drop of liquid intake in between.
Design is capable of transforming, and it is places like this where it’s needed. That’s what I told my Dad on the phone in the station on the way home.
Look after your kidneys!
My second trip down to the Renal Unit had an entirely different feeling around it. Having spent time back in the studio creating prototypes and graphic ideas to feed back to the team I was very confident in holding detailed conversations and building ideas with the team in the unit. I’d also made my way into the considerable amount of reading that surrounded the growing project. This is a part of working in design that I love; the fact that we jump from project to project means that we are constantly needing to become knowledgeable in different areas, we collect all sorts of eccentric and intricate stories around us all the time.
Snook’s second day spent in Salford Royal was spent mainly with Helen and Sadia; two of the dietitians working across the Hospital, but specialising in the Renal Unit. I began the day by meeting the entire team before Helen, Sadia and myself talked through the existing tools used by the team on the wards. We discussed the patient’s reactions to these; what works well, what comments they have had back, and crucially, how different approaches work well for different people. One key point that was really driven home was the fact that design has a part to play in this situation, but there is really no way of supplementing the hard work that is required to change behaviours. These patient’s lives are hard. Clever tricks and incentives are really just quick fixes, we need to think deeper.
Talking to the dietitians it becomes immediately clear that they know their patients extremely well. The nature of their work means that they spend considerably more time with the individuals than other hospital staff. They talk about patients using their first names; the dialysis patients can be coming to the hospital for years, and they really get to know them. As a result, dietitians really are experts in the lives of these people, they know their background stories, habits, how they react to things, what they are likely to take to; they can predict their behaviours. They truly are an amazing team, they juggle a lot – that much was evident to me as I spent a day drawing, talking and reading in their fruit-filled office. I would like to say a huge thank you, Helen and Sadia really helped to broaden my thinking and understanding on the subject.
My previous days in the hospital had been spent considering the written material and information available to patients to help them understand and manage their diet and fluid intake; re-designing and planning implementations to aid in the general knowledge of blood pressure and living with Haemodialysis.
Quite early on on the first day of research, gathering and observing it became clear that to base a project around the visualisation of blood pressure would require taking into account all that surrounds Haemodialysis; Potassium, Phosphate, Salt, Heamoglobin, ETV, fluid intake, diet, lifestyle, cooking, shopping lists, family support, transport, wellbeing and atmosphere in the wards. There is no way of singling out a particular aspect. It is all mixed up. It is very difficult for patients to consider each element individually when they all play a part in their daily lives, and when their lives themselves exist in a constant rotation of dialysis and non-dialysis days. Worrying and waiting and measuring and counting.
I set up a small station in the dieticians office where I was making new forms , graphs and ways of presenting information to patients. We know that as a first step, we needed to concentrate on the time that people coming in for dialysis are able to use to listen and learn. That might be the first 15 minutes or so of their session before they get sleepy. It might not be every session. The idea is to use the smallest amounts of time effectively.
This means taking a slightly different approach. Salford Royal already have an amazing system of breaking down their teaching of salt intake, for example, into different meals. This means that the patients are only ever concentrating on one section of their routine at a time, and can immediately start to think about how this teaching relates to their everyday life. You then move on to the next meal, and continue in a rotation as many times as necessary. Through this project we have found that the best way to approach this way of learning is to discuss and idea with someone eight times in eight different ways.
This is where design comes into its own.
The next steps for this project was to design and test these 8×8 steps. We considered about how patients read information, how they might present it to each other, how they can hold conversations with each other (dialysis patients are often on the same rotation as each other for quite a while, they get to know each other.) Snook designed the questions that would be most helpful for the staff to ask and for the patients to ask. We worked very visually; asking patients to make video diaries so that they could begin to learn from each other, using flash cards to swap recipes and fluid tips. We encouraged people to share their defence mechanisms, how their condition affects their everyday life and how they have found ways of dealing with it, overcoming it. Snook would love to explore more of the personal stories; patients learn best from each other as they immediately relate to the other persons situation.
We would really like to start working with dialysis champions, sharing their stories for others to learn from.
This project has really opened our eyes, and stretched our thinking. We would like to say a huge thank you to all the staff at Salford Royal and to Martin Bontoft, you’ve made us feel very welcome – we have really enjoyed exploring with you.