Large Interactive Displays in Hospitals – Motivation, Examples, and Challenges

In this paper we reflect on our research into the design and deployment of large interactive displays in hospitals. First, we introduce lessons from studies of the use of large displays to coordinate hospital work in a hectic and critical work environment. Then we present some of our current research, especially focusing on our current design of large displays at an operating ward in a large Danish hospital. Finally, based on our research and experiences we discuss some of the challenges that we find in the design and deployment of large interactive displays in hospitals. 1. LARGE DISPLAY SURFACES IN HOSPITALS Large display surfaces, like whiteboards and notice boards, are absolutely crucial in achieving work in a modern hospital [1, 8, 7, 9, 2]. In a recent interview, the managing physician of a large Danish hospital stated that the best way to make a modern hospital come to a complete halt is to remove all whiteboards – then everything would be chaotic. In light of these observations, it is particular interesting to observe that the deploying of electronic health records (EHRs) and scheduling and booking systems in Denmark and other countries has the consequence that what once used to be large visible information, displayed on large whiteboards is now being restricted to 17 inch monitors. Are we in the process of fulfilling the prophecy of the hospital manager? Whiteboards in hospitals play a core coordinative role. For example, in an operating ward the operating schedule is often displayed on a large whiteboard which is clearly visible for all personnel (see figure 11). Some of the core roles of such large display surfaces in hospitals can be summarized to: Visibility – the main reason for using e.g. whiteboards and other large wall mounted boards in hospitals is clearly their visibility to relevant personnel. They are situated in places where clinicians often come by and where information related to the information shown on the display is available. The typical whiteboard for operation scheduling (e.g. the one in figure 1) is situated in the so-called The picture and the work setting is further described in [1]. Figure 1: The operation schedule on a large operating ward. The schedule contains information on operation room number, scheduled time, ward, patient name and social security number, type of operation, involved personnel, and notes. ‘coordination room’ which is located central on most operating wards. This is the central hub of coordination while the operations in the different operating rooms are executed and all involved personnel, from orderlies, assistants, operating nurses, and surgeons, constantly enter this room in order to coordinate their work with others. Overview – large displays at hospital is designed to provide an overview of the flow of work. Detailed information is often extracted, summarized, and abbreviated in the transfer from information sources to the boards. This means that these boards often contain a concentrated distillation of highly detailed information. In figure 1 the surgical procedure, names, notes, and status information is highly condenced and it takes a skilled clinicians to read and interpret the boards. Status – the displays are designed to reveal important status information concerning the flow of work. This status information is, however, often very subtle and not visible to the trained eye. In figure 1, for example, status information is revealed by small marking on the left-hand side of the board, using signs like ‘–’, ‘!’, ‘X’, ‘O’, and similar symbols (see also [1, 9]). Coordination – Status information is central in order to ensure a smooth flow of work in hospitals – a common observation is that all personnel rely on these status markers by peeping into the coordination room, checking the status, drawing their own conclusion with regard to their own work, and silently carry on. For example, the surgeon will regularly monitor the board to look for the sign indicating that the patient is asleep and ready for the surgical procedure. Often the surgeon will not enter the operating room before this status has been marked at the board. Communication – In addition to the silent kind of coordination described above, boards in hospitals are also used for more explicit communication. In these instances, the boards are used as message or bulletin boards. However, it is important to realize that most boards in hospitals are not general purpose bulletin boards (even though they of course also exist) but are specialized boards (like the operating schedule in figure 1) where short, concise messages are written or attached to specific items on the boards. Hence, communication is tightly linked to a specific clinical context like a surgical procedure on a specific patient. Contingency management – Finally, in a critical environment like a hospital, the large display boards are used for handling acute situations, crises, and general contingencies occurring during e.g. surgical procedures. Even though clinicians prepare very carefully for each procedure, and much effort is made to foresee any kind of potential problems, problems and acute situations do occur. Clinicians know this and they are always prepared for handling such situations. Large boards often play an important role in conveying information to others that a crisis has occurred, that surgical procedures are delayed and the reason why, and who is in charge of solving the problem. Often information on a whiteboard is re-arranged to reflect the management of such contingent situations. In figure 1, for example, crisis situations are made with special signs and acute patients are highlighted using a special color code. The presentation above only gives a glimpse of the complexity of the use of large displays and boards in hospitals, but we hope that we have been able to provide the reader with a minimal understanding of the core role that these displays play in a hospital an understanding which is crucial in our design of computer technology for hospitals, which we shall turn to now.