The ICU team
The new Southmead Hospital Intensive Care Unit (ICU) opened in May 2014 with 48 beds divided into four wards known as Pods (A to D). The unit was huge, easy to get disorientated, there was poor signage, it had large battle ship grey walls and it was a dull place to work. It had no identity. It didn’t even have a name that was easily visible to visitors; it only had an uninspiring location code - Gate 37 level 2.
The waiting room was bland and so was the information- all done in the NHS style of too many facts in black, white and NHS blue. We weren’t giving the right impression of what the ICU stood for. We were proud of the care we gave but the environment was letting us down. We needed help.
We commissioned a design team who skilfully interviewed us about our wishes for the unit noting the deficiencies in using the building. They designed a relatives’ information leaflet in colour with a few well-chosen words on subjects such as looking after themselves, taking a break and asking questions whenever they wanted. It was bright, optimistic and it exuded “care”.
Implementation of this project was complicated as a PFI hospital has a very bureaucratic system so the number of staff that needed to know began to build.
It is important to engage with the Communications Team as they have opinions on font style, permitted NHS colour palette and informative style. They may have access to budgets if your project involved signage, so they are a good team to get on board.
Southmead Hospital has a Fresh Arts team who were very supportive and knew how to get “art” on the wall in the organisation. Facilities Management need to be contacted who could help you with Heath and Safety. The vinyl we applied had to be fire and smoke checked and the certification validated. These are important details and it is best to involve them early.
The application to the walls can be done by an outside contractor but they will need permission, particularly if it is a PFI. Identifying your PFI contact can be done through the facilities team There should be a PFI Support Person to assist in these matters. The PFI lead should organise temporary ID and parking for the contactors.
We made the mistake of steaming ahead with the project and not involving these people early enough so in the end the project was delayed.
The designer’s views
It is well established that the Arts have a clear contribution to make in the delivery of an improved healthcare experience for patients, service users and staff. "Arts and health are, and should be firmly recognised as being, integral to health, healthcare provision and healthcare environments, including supporting staff." Department of Health Working Group on Arts and Health 2006.
The ICU team at Southmead identified a number of challenges, many common to large modern hospitals, from impersonal spaces and long anonymous corridors, to the (very necessary but complicated) way-finding system that can leave visitors, and even staff, disorientated. Other issues included the ‘visual noise’ from the many styles of posters, instructions and signs, and a department that was rather visually impersonal and lacking a sense of its own identity.
Graphic design has a purpose driven approach – understanding problems and using type and image to provide solutions. It is a process of visual communication which joins function with aesthetics.
We identified several areas for ‘intervention’ including signage, information leaflets and wall art. We developed a visual palette, including colours and a clear and engaging style of illustration that would give the work a consistent feel.
These elements were used to design signage, leaflets and diagrams, that together give the department its own visual identity. The goal was to create an environment that would improve visitor experience and help reduce stress levels. Our watch-words for every aspect of the project were to welcome, orientate, inform and engage.
Solutions ranged from a welcoming wall graphic to colour-coded panels at the entrance to each Pod that help visitors to navigate the space. These panels informed visiting doctors of the unit hand washing standards so they would be less frequently challenged by the ICU nurses. Hopefully this would create an improved working environment and potential benefits for patients.
Similarly a decorative panel and simple leaflet in the waiting room now offer a welcoming and easily accessible guide to the most frequently requested visitor information.
For those unfamiliar with the critical care environment the machines and technology can be threatening or overwhelming and can intensify what is already a stressful situation. We designed a visual aid that would give families and visitors a better understanding of the equipment around a patient. This infographic uses simple, iconic illustrations and descriptions of machine function in straightforward inclusive language – to present the information in a way that is clear and easily understandable.
The visual appeal was an important aspect of this work – combing the functional and decorative. The diagram was printed onto large format vinyl (approx 2x4m) now gives the corridor a stronger identity and provides helpful reference point to orientate oneself in this large space.
We applaud the growing appreciation of the role of Art in healthcare, we like to commend the particular approach graphic design brings – the positive benefits of clear information and a well-designed visual environment for patients, visitors and staff alike.
As clinicians, it is difficult for us to be able to fully appreciate how daunting and overwhelming a large intensive care unit can appear to relatives. In order to understand how visitors had received the new info-graphics, we devised a short survey. All of the responses were overwhelmingly positive. One relative described that after seeing the posters they “now feel less out of your depth surrounded by all the machines. I know more about why it’s all there.” Other relatives stated that the posters had helped her to explain what was happening to her children – “My kids and I spent time in front of the posters and we spoke about the different machines and how they were helping their father. They loved the posters!” We received suggestions for how we could improve by adding posters to the waiting room, putting more posters up in the corridors, and to consider creating leaflets that could be taken away to study.
We asked our ICU nurses what they liked about the posters, whether relatives had mentioned the posters and if so, what they had said. We also asked how they felt the posters might be able to help visitors. Of the 48 people who responded to the survey, 100% reported that they liked the posters. A word cloud of the words used by nursing staff to describe the posters.
The feedback in general was extremely supportive. One nurse responded that they thought that the posters “can give relatives an idea of what's going on with their loved ones”, whilst another said that “I think they (the infographics) make the ICU feel more accessible to visitors and help de-mystify some of the things going on.”
Finally, it was suggested that the posters had succeeded in ”breaking information down into understandable chunks”.
Our aim for this project was to welcome, orientate, inform and engage. The overwhelmingly positive feedback that we have received from both visitors and our colleagues is proof that we have succeeded in the above goals. The unit is colourful, clearly signposted and it is not infrequent to see visitors pausing at the posters as they navigate the corridors. Our next challenge is to use the ideas that were submitted to us in the feedback process to further improve upon what we have started in order to create an intensive care unit that is cheerful, welcoming, and helps to make visitors feel less overwhelmed.
Dr Stephen M Robinson MBBS MRCP FRCA FICM., Consultant in Anaesthesia & Intensive Care