Emergency Department Futures

This creative outcome delivered within the PhD study is comprised of three parts: a suite of comic stories that highlight future service experiences in the ED, a series of prototype artefacts and associated renders, and an ‘exhibition in a box’ which acts as both a place and method for provoking conversations and thinking into the design of future ED environments.

This creative outcome extrapolates upon the trends present in the contemporary ED, and are grounded within real stories collected through qualitative research. The diverse articulates of design practice were chosen as the format over other methods of communication — videos, theatrical presentations, websites – to make the work accessible, where no other medium or tool is required to interpret the work. The deliberately abstracted and low-fidelity nature of this outcome intends to invite reflection upon the notion that the future of the ED is not yet fixed, and open to multiple interpretations by different viewers.

While the creative outcome can be viewed in the three distinct parts and visuals attached to this application, the project in full can be viewed at the following website: https://emergencydepartmentfutures.com/

The future of the ED is uncertain. How the challenges of the 21st century will be addressed in the ED are as yet unknown. In order to ensure that urgent care remains accessible for all Victorians, our success in meeting these challenges must be simultaneous with our learning. New and careful thinking will be required to ensure that these challenges are adequately addressed. There is a need for speculative thinking in urgent care to imagine how emerging trends - ranging from AI and big data to population shifts - will impact healthcare.

This work provides context of this new world, while being detached from direct market imperatives. The design outcome is formative – not summative – and that value as a contribution lies in its capacity to complement existing design ideology about what a preferable future is for ED waiting room. Like the ‘open-design’ or ‘open-source’ movement, findings from this study might be applied like a seed from which further development and speculation might grow.

While the physical reality of these publications may give the impression that the future is already fixed, ‘new’ things contain unpredictable potential, unanticipated consequences and implications. These publications act as a starting point, and through these stories we might explore the scale of the technological impact on the future ED. The future of urgent care isn’t yet fixed - but in our hands. The technologies we choose to adopt as a society, and those we do not, will impact healthcare of the future. The future for the ED starts here.

While the use of comics to explore possible futures is not new, the ED has been the subject of surprisingly little design attention given the integral role it plays in the Australian healthcare landscape. A visit to the ED is often dreary - filled with loud televisions and out of date magazines - but often a deeply unsettling and disruptive life event. Patients enter a fast-paced emotional environment, that is typified by high volume, high acuity and emotional patients with visible injuries. The intensity of these experiences is often exacerbated, as patients have little time to physically or emotionally prepare for the intensity of the environment in which they enter. How to address these existing challenges, as well as the emerging and unforeseen challenges of the future, remains unknown.

The primary contribution of this work is through speculation on future ED experiences, which probes an alternative waiting experience and explores the role that technology might have in supporting both user experiences and clinical workflow. This work does not set out to solve any of the myriad of challenges facing the ED or the waiting experience, but instead provokes thinking about how these environments might be experienced into the future. This outcome is grounded within data – narratives of contemporary lived experiences. The innovation of this work is that it does not intend to provide a definitive, summative designed outcome, but a platform for further speculation and research; which can be used partially or entirely to inform the design of new healthcare facilities.

As a clinic dedicated to the timely resolution of urgent medical conditions, the ED is a unique and vital component of our healthcare system. The COVID-19 pandemic is the latest in a series of profound challenges that the sector has faced, that will likely reshape how urgent care is accessed, delivered and experienced for many years to come.

This work straddles the broad domains of design, futures and emergency medicine. On the macro-level, the project provided the platform to touch on some big issues in need of transformation; the proliferation of technology (namely artificial intelligence, machine learning and big data) in the ED, the implications of automation on care experiences, the future of work in the ED, how the waiting experience might be manipulated and managed, and the role of speculative design in imagining the ED of the future. Each of these areas has a wide scope for further design research and practice. On the microscopic level, this work provides one articulation of how technology might be implemented in the ED to impact care delivery and waiting experience.

While literature reveals that the design process of new ED’s can take many years, designers, architects, clinicians or healthcare administrators may apply this design work partially or entirely when building, designing, or making decisions about technology in the ED’s of the future.