Redesigning the Neonatal Intensive Care Unit

Workshop participants collaborating on prototype of a potential new unit layout.

Timeline February - July 2018

My Contributions

• Project lead

• Conducted in-depth interviews

• Observations and site visits

• Synthesis of research findings

• Design co-creative workshops

• Lead facilitator of co-creative workshops

• Visual communication

• Presentation to hospital leadership

Location University of Vermont Medical Center - Burlington, Vermont

The Team

Colleen Clark (Design Consultant, UVM Medical Center)

Charlotte Safran (Patient and Family Centered Care Coordinator, UVM Medical Center)

NICU Patient and Family Advisory Council (UVM Medical Center)

Project Context

How might we understand and define the current NICU experience?

The University of Vermont Medical Center was looking to renovate and redesign its neonatal intensive care unit (NICU) for the first time in almost thirty years. This NICU cares for approximately 800 infants a year and offers a specialized transport service for infants born at outlying hospitals throughout Vermont and upstate New York. Care is highly collaborative and many clinical staff have been with the unit since its beginning. The pending renovation offered both an opportunity and challenge. To inform the development of the new NICU, I conducted research exploring the current experience and culture of the unit and established key insights.

A workshop participant visualizing the NICU experience

Workshop participants illustrating moments of comfort during their NICU experiences

Research Methods

Interviews: I completed over ten in-depth interviews with parents of former NICU patients, nurses of varying levels of experience, physicians, unit secretaries, and clinical leadership.

Observation: I spent significant time observing the unit and its surrounding environment. Additionally, I traveled around the country with a select group of architects and clinical staff to different NICUs that had recently been redesigned. These site visits featured observations, tours, and group interviewing.

Workshops: After the interviews, I designed and implemented co-creative workshops to visualize the NICU experience with patient and family council advisors. Council members created timelines in response to the following staggered prompts: define the beginning of your NICU experience; add events in chronological order; add non-NICU related events; add words and images to illustrate emotions.

The co-creative workshops with NICU staff each had the same structure and activities listed below:

• Writing: Each participant wrote a 'break-up’ letter to the existing NICU space and system as well as a letter acknowledging the positive elements of the NICU experience.

• Drawing the Dream: Participants created visuals to illustrate their individual preferred NICU. 

• ReDesign It: As a team participants used various materials to create an ideal experience in the NICU. They mapped out the basic organization of elements, their relationships, and the flow of people through the environment.

• Drafting Principle(s): Individuals wrote the principle most important to them and then collectively the group combined their ideas to craft draft guiding principles.

A member of the NICU patient and family advisory council creating a timeline of her experience

Clinical staff combining their ideas for guiding design principles

Insights

• Lacking necessity space: The current unit lacks physical room to grow and adapt quickly to advances in technology and clinical events of patients

• Insufficient room for well-being: There are minimal designated spaces in the current unit to gather and collect oneself emotionally after experiencing traumatic events.

• Other hospitals’ NICUs were designed with significant input across disciplines and with substantial engagement from staff and families to successfully meet both staff and families’ needs, . These units also capitalized on the opportunity for reflection to examine resources and supports, such as designated roles and programming. 

• The NICU clinical staff collectively created the following guiding principle: “Build an inclusive, flexible unit with designated, teamwork-oriented spaces that foster a culture of safety, collaboration, and community”.

Outcomes

Report on insights gathered from sites visits of NICUs in three other states.

Co-design workshops to:

• Demonstrate the value of working co-creatively

• Engage, create buy-in, and highlight mutual understanding

• Leverage staff and families’ experiences and knowledge to identify NICU culture 

Guiding design principle and strategy recommendations to inform the rebuild process.