Abstract

The emergency department (ED) is arguably the most operationally complex clinical setting of the modern hospital, but perhaps the least well understood. A central and persistent element of the ED experience is the phenomenon of waiting, which precedes, accompanies and follows clinical activity. The act of waiting has a profound impact on overall patient experience, but has received relatively little attention in the literature as to how this experience might be improved or mitigated. This PhD study is concerned with how waiting might be experienced into the future and with the contribution that design research and practice might make to inspiring change for these experiences.

In order to explore how waiting might be experienced in the ED in future, this study engages deeply with the Emergency Department waiting room (EDWR) and its design through published literature, design precedent and also contemporary lived experiences of the EDWR by engaging patients, staff and carers through an observational study, interviews and co-design engagements. In order to explore alternatives, this study then used these insights as points for creative extrapolation, exploring alternative ED experiences through speculative design practice. Recognising that the ED waiting experience is a service experience, this research also generated a novel methodological framework, speculative service design (SSD), which aims to integrate approaches in response to the methodological discrepancies between service design and speculative design. This framework was then practically applied in the study to generate the design outcome and provocation, which acts as a toolkit, a place and a method for provoking discussion about ED futures.

The outcomes of this study led to the development of a speculative service design ‘provocation’, which takes the form of a suite of design proposals: ranging from comic-style illustrations, visualisations and plastic prototypes that aim to make tangible one possible future of the ED, in order to inspire and scaffold conversations about the attributes of preferable ED futures. This provocation in its multiple modes of dissemination were then shared with patients and carers with lived experiences of the ED, in order to collate their reflections on such preferable attributes of ED futures.

This study makes a significant and timely contribution to contemporary approaches to ED design, by advocating the value of speculative thinking through design practice; where these approaches might be applied to benefit the design of new healthcare facilities and environments. Designers, architects, clinicians or healthcare administrators may apply the findings of this study partially or entirely when building, designing, or making decisions about the integration of technology in new EDWR’s or ED ‘front-of-house’ systems.

Keywords: emergency department futures, emergency department waiting room, speculative service design