By Professor Julie Bernhardt, Dr Ruby Lipson-Smith, Dr Aaron Davis
Julie is Professor of Neuroscience at the Florey Institute of Neuroscience and Mental Health and has a background as a rehabilitation practitioner. Julie is passionate about the role of the built environment in healthcare and about combining the evidence-based practice of neuroscience with design.
Ruby is an environmental psychology researcher and leads several projects within NOVELL Redesign.
Aaron is an architect by training and an expert in living labs and co-creation. He leads the NOVELL facilitation team and helps us to meaningfully engage with our co-researchers.
Conversations spark ideas…
Diverse views, experiences and opinions make these conversations richer and bolder. As a clinician and a neuroscientist, Professor Julie Bernhardt began the Optimising Health Environments Forums at The Florey Institute of Neuroscience and Mental Health in Melbourne in 2013 because she wanted to meet people from a diverse range of fields who were interested in built healthcare environments. For Professor Bernhardt, healthcare environments should be considered part of our ‘intervention arsenal’ to improve patient outcomes, not simply a space in which care is delivered.
She hoped to have robust conversations about how we might work collectively across multiple fields of neuroscience, research, clinical care, building planning, designing and execution to optimise healthcare environments. Recognising the challenges inherent in trying to innovate during the designing and building of commissioned healthcare spaces, Professor Bernhardt and a team of likeminded clinicians and researchers decided to focus on creating an innovation project, grounded in research with a strong stakeholder engagement focus to redesign a healthcare facility and service.
Some time later, NOVELL Redesign, or the Neuroscience Optimised Virtual Environments Living Lab, was born. The demonstration project of NOVELL Redesign explores rehabilitation spaces for people with brain injury, especially stroke, because as a group, we know a lot about this aspect of healthcare.
The project team
The core project team includes experts in Neuroscience, Architecture, Rehabilitation, and Living Labs from the Florey Institute of Neuroscience and Mental Health, Swinburne University, Griffith University and industry partners including Silver Thomas Hanley (STH) Health Architecture. We work with a broad range of experts and collaborators from across Australia and the world.
As a Living Lab, stakeholder engagement and the bringing together of diverse groups of people is central to NOVELL Redesign. To this end, we are assembling a team of co-researchers, that range from people who have worked in rehabilitation environments, to stroke survivors with lived experience and their families, and designers and architects who shape the world around us. We are working with people who are interested in the healing power of sensory garden experiences, with people who help others find their way by wafting scents through the air, and with people who are passionate about improving the experience and outcomes of rehabilitation processes and facilities.
Our team are always looking for opportunities to engage, and to bring together diverse groups to build fascinating and insightful collaborations. If you’re interested in finding out more or in getting involved, drop us a line through our website or follow us on twitter.
The NOVELL Redesign project is funded by the Felton Bequest and the University of Melbourne and has four main aims. These are to:
- Optimise stroke rehabilitation through design
- Develop technology, education and research opportunities
- Create strong partnerships between government, healthcare, industry, academia and community, and
- Generate a new and rigorous design process guided by a Living Lab framework.
The Living Lab concept
We are using the concept and framework of the Living Lab because the questions we are trying to answer are incredibly complex and can’t be tackled through traditional research processes. Here are just a few of the reasons why it can be difficult to create innovative designs in healthcare:
- Complexity: Hospitals are complex places, with intricate and sometimes rigid clinical processes, all of which must be supported by the building in which they are housed. There needs to be a match between the processes and the building – it would be counterproductive to innovate the building without also changing the processes.
- Multiple user groups: As any healthcare architect will tell you, every hospital must be designed to satisfy multiple user groups, including healthcare planners, policy makers, clinicians, patients, and families. Sometimes these user groups have conflicting priorities, but all need to be met.
- Cost: Every hospital must be built within a (usually tight) budget and timeline, which often doesn’t leave much wriggle room for out-of-the-box or innovative thinking.
- Information silos: It’s difficult to learn from past design projects. Post-occupancy evaluations aren’t always conducted and, if they are, are often not made public. There is also often a translation gap between healthcare research and design practice, made more difficult by the tight timelines mentioned above.
The Living Lab methodology can help us to address these problems by giving us a space where we can explore, and where we can dare to think differently. By (temporarily) setting aside some of the roadblocks, we can see what happens when we bring together a rich variety of co-researchers, experimenting and exploring using a ‘yes, and’ mindset rather than defaulting to ‘no, because’.
Starting a living lab during a pandemic
As with just about everyone, everywhere in the world, we had to pivot and adapt to working in the time of COVID-19. For a Living Lab, the inability to meet face-to-face presented a unique and very significant challenge, but our facilitation manager Dr Aaron Davis was able to lead our transition to a digital model of engagement. This meant building interactive online activities that we could work through with our co-researchers both in real-time in virtual workshop sessions, and asynchronously for those who were not able to participate in the fast-paced digital workshop environment.
The workshops built on past research of NOVELL researcher Dr Ruby Lipson-Smith, and explored concepts of safety and security, navigation, adaptability and flexibility, and blurred boundaries. You can see a short time-lapse of the activity in one of our workshops here.
We have had rave reviews about the process and are so excited that this is just the beginning of bringing everyone together to tackle this unique challenge. With any luck, in 2021 we hope to be able to meet each other face-to-face to continue the rich and exciting conversations we have started, but know that the digital collaboration skills we have developed are also invaluable.
Next steps – designing and testing in a virtual environment
Now that our Living Lab is established and growing, our next step is to begin the design and innovation process. We’ll be running a co-analysis process with our co-researchers in the first half of 2021 to organise and synthesise all the information that was generated in our virtual workshops.
This will culminate in the definition of an experiential design brief for stroke rehabilitation facilities which we will use to design immersive virtual prototypes that can be tested through computer modelling, and with a broad range of potential users and stakeholders. We’ll use the feedback we gather to refine the designs, before we bring them back to re-test again in an iterative design innovation cycle.
Ultimately, we are hoping that the insights we gain along the journey, as well as from the final prototype(s), will help to inform and radically shift the way we conceive and construct rehabilitation environments both in Australia and internationally.
Why are we focusing on stroke rehabilitation environments?
Stroke causes a loss of blood supply to the brain, and, if not treated immediately, can result in death or severe disability (do you know how to recognise a stroke – remember to think F.A.S.T). There is predicted to be 1 million Australians living with the effects of stroke by 2050, and, after they have received acute care, many of these people will need some form of rehabilitation. The purpose of rehabilitation is to help people who have had a stroke to live a full life; to regain the skills or abilities that they may have lost as a result of stroke (e.g., re-learn to walk, talk, or use their arm), or to learn to adapt to their changed abilities (e.g., learn to use a walking frame).
While in rehabilitation, stroke survivors are encouraged to participate in repetitive practice – working to build new connections in their brain. Stroke survivors are also encouraged to be physically, cognitive, and socially active, as this can help brain recovery.
Rehabilitation is a unique and under-researched healthcare environment. Most of the past research and innovation in healthcare design has focused on acute care environments such as surgery or intensive care. People in acute care are often confined to bed, and the clinical priorities are diagnosis, infection control, bed rest, and ensuring that vital signs are stable.
In rehabilitation, however, patients are more alert and are required to be active, motivated participants in their care. The findings from acute healthcare contexts therefore might not be applicable in rehabilitation. We therefore chose stroke rehabilitation environments as the first demonstration project for the NOVELL Redesign Living Lab process.
Partner with the NOVELL Redesign project
Living Labs are all about working together. We welcome partners and co-researchers from industry, academia, government, and the community who are interested in contributing to the project, and in making rehabilitation environments better and more effective places.