PIVOT

The design journey began during the observation of my grandfather’s wheelchair transfer experience while he suffered from dementia. When the wheelchair was pushed from behind, his paranoia and anxiety increased due to the inability to see who was pushing him or know where he was going. Conversely, when someone walked alongside him while another pushed the wheelchair, he appeared visibly more comfortable and remained seated. Having visited the Monash Children’s Hospital, I met with nurses who reported frequently pulling wheelchairs backward for patients who were flight risks and noted the difficulty in communicating and bonding with their patients while pushing from behind. These parallels in experiences led to an exploration of how human connection can enhance the user experience and improve the transfer system.

To establish features, the requirements and limitations of current wheelchairs, the hospital setting, the transfer system, staff, and patients were clearly outlined. Methods such as system, process, and user journey mapping, competitor analysis, product autopsies, precedent studies, and empathy mapping were used in the early design stages. This research defined the proposal and problem statement more clearly.

Ideation focused on features, mechanical systems, components, and parts, iterated through sketching, mock-ups, and early-stage prototyping. Benchmarking and stakeholder feedback refined the options. Human-factors engineering and universal design principles were integrated into the workflow.

HumanCAD software simulations, based on ergonomics, biomechanics, proxemics, and anthropometrical data, defined the chair’s measurements. 3D modelling tools developed the design and mechanical subsystems. Continuous validation by product design engineers and manufacturer insights on components like the modified castor system addressed challenges of size, weight, manoeuvrability, and changing centre of gravity. A full-scale prototype validated the final design through the nurse and patient testing sessions. Mood boards guided aesthetic development, and user journey maps highlighted system improvements.

PIVOT is a direct substitute that addresses the identified problems and sets a new standard for human-centred design in healthcare. This original design, confirmed by a patent search, incorporates multiple novel innovations. PIVOT showcases design excellence through features that work together to provide a holistic care-delivery experience, validated by extensive research, stakeholder feedback, and rigorous prototyping.

HumanCAD simulation data informed the specifications, promising safe and comfortable interactions for all staff-patient pairings. Each component that is interacted with by users, is based on accurate anthropometric, ergonomic, biomechanical, and proxemic data and recommendations. Although staff face the patients, they are still able to navigate safely.

PIVOT’s bi-directional design provides patients with tailored transfer experiences. It meets the functional requirements of the transfer system and hospital environment, supported by features such as specialised castors for improved manoeuvrability through hallways, and dual IV pole mounts that cater to both transfer methods. Attendant-facing transfers allow staff to observe patients, read visual cues for faster reactions, and reduce flight risk without restraints by positioning staff in front of the patient.

Staff can make quick adjustments as activation points are located on one side. The design reduces friction by minimizing the number of steps and additional aids needed. In the case of bed-to-chair transfers, patient falls and nurse musculoskeletal damage are alleviated by aligning the chair with the bed, lifting the seat to mattress height, and rotating the armrest down for easy patient entry. Ergonomic vertical push bars relieve staff strain and assist capable patients in safely exiting the chair.

Traditional healthcare colours, in pastel tones, blend PIVOT into the environment, refocusing the experience on the users. PIVOT’s rounded features and soft edges are designed to emulate homely furniture, enhancing patient comfort. The materials reduce the spread of bacteria and allow for easy cleaning.

PIVOT, the first general-purpose, attendant-facing transfer chair, addresses user and system-wide pain points. PIVOT reduces workload and risk, enabling staff to focus on the patient experience to improve care outcomes. PIVOT’s design includes various sub-inventions and employs user psychology for seamless adoption. It accommodates staff-patient pairings from the 1st to 99th percentile in height. HumanCAD scenario and patient-staff simulations verify that PIVOT is universally suitable. Staff can better respond to patient cues, use body language to engage, and overcome previous communication barriers through attendant-facing transfers.

The fully mechanical design ensures that PIVOT is readily available. Staff controls are centralised on one side to minimise staff efforts. The backrest moves easily between sides and automatically angles for optimal eye contact and comfort.

PIVOT has no removable components, eliminating any cause for lost parts. Each element is colour-coded for easy identification: yellow for staff controls, green for patient areas, white for moving parts, and blue for stationary components.

The footrests automatically adjust to varying patient leg lengths. Flip-out footplates enhance bi-directional support and reduce patient fall risk when exiting the chair. When switching between transfer methods, an integrated bevel-gear system allows both footrests to move to the other side simultaneously

Staff can follow proxemic (personal space) recommendations due to the extendable push bars. They feature numerical indicators for precise extension and auto-lock. The vertical design provides an ergonomic pushing position for staff and aids patients when entering and exiting the chair.

The brake system employs a unique fifth wheel for smooth deceleration, it can be activated at any point along the push bars to accommodate any staff height. The customised castor arrangement, controlled by a single pedal, offers versatility in maneuvering. Adjustable seat height, retractable accessory mounts and dual IV pole support, further enhance functionality.

PIVOT represents a significant advancement in hospital wheelchair design. By adopting a creative approach to problem-solving, PIVOT exemplifies how thoughtful design can lead to higher quality and more effective healthcare solutions. PIVOT demonstrates value in promoting human-centred design to enhance healthcare outcomes within Victoria and beyond.

Unique features, including the specialised braking system, showcase how constraints are overcome through iterative ideation. The versatile design allows for a seamless transition into existing workflows with minimal staff training. Attendant-facing transfers mitigate underlying hazards, such as flight risks, which contemporary transfer chairs cannot do without restraints. Designing for intuitive reactions allows staff to focus more on the patient. By aligning with best practices, staff can finally meet the expectations demanded by mandated interaction protocols, specifically non-verbal communication.

In response to the growing aging and mental health patient population, which increasingly strains hospital resources, PIVOT optimises staff and patient experiences. It minimizes transfer time, thereby reducing resource waste. The design limits staff load bearing, reducing the risk of musculoskeletal injuries among nurses when transferring patients. Additional hospital costs and extended patient stays are lessened through decreased likelihood of patient falls. PIVOT reduces capital acquisition costs for hospitals by lowering the reliance on additional bed-to-chair transfer aids and tools.

PIVOT’s widespread applicability within the healthcare sector highlights its potential to impact end users significantly. PIVOT can be adapted for specific settings or user groups, such as aged care homes, paediatric, and bariatric patients. Derivative designs can offer PIVOT at varying price points to accommodate the budgets of facilities, ensuring broader access to its benefits.

PIVOT contributes to the principles of a Circular Economy by decreasing the need for additional transfer aids, hereby reducing overproduction. The symmetrical design and the use of off-the-shelf components advocate for ‘design for manufacturing’ methods to achieve sustainability goals.