Break Time

Inspiration for design challenges come when you least expect them. In this case, there were glasses of bubbly in one hand and hours d’curves in the other. We were together, on the roof top of a building in downtown DC to celebrate some philanthropic work. “What’s it like to be a nurse… really rewarding, right?” The question came from a former Sibley patient. The nurses nodded politely, but there was something behind their nods.

When we were alone, the nurses confided: “Don’t get us wrong, it is rewarding. It’s also really hard sometimes….there are many days I don’t even eat lunch.”

Hold the presses! In the Sibley Innovation Hub, lunch is sacrosanct. How can you function if you don’t eat lunch?. Members of the innovation team and the Sibley Foundation started batting ideas back and forth: How do Airline pilots get meals during flights? What about during marathons, when runners get handed food and water during a race, could we do that?

And so, a design challenge was born.

We set a goal. Let’s see what we can do in 24 hours. Designers from the Hub partnered with the Sibley Foundation’s Andrea Travis. We asked ourselves: How might we ensure every nurse gets lunch every day?

go to where the work is

We started the timer and high-tailed it to Sibley’s main med-surg units. We wanted to understand things as quickly as we could:

  • Do you eat lunch most days?
  • Where do you get your food from?
  • What do you wish was different about your lunch break?

“Oh, I absolutely eat lunch most days! Mrs. Filler makes sure of it!” In fact, of the 12 nurses with whom we spoke, nearly all of them said getting food wasn’t an issue. “What we really need…what would help, is an uninterrupted break.”

Another nurse chimed in, “there are some days when I’m so worried about being interrupted that even the sound of [the break room] door opening makes me want to snap.”

secret

One nurse told us, “I can’t eat on the unit at all, I get interrupted way too often…”

“Eating in the break room? Yeah, it’s like grand central station in there. Sometimes people cut through just because it’s faster…” a colleague chimed in.

We asked him to show us where he normally eats. He took us to a nondescript door, off the unit near some utility openings. Behind the door was a locker-room-turned-private dining room. It was great! It was private, quite, not too bright, and super secret.

secret

plot twist: it’s not about food at all!

We had some expectations going in to the design challenge. We imagined most nurses wouldn’t eat lunch every day. And if they did, it was probably something unhealthy, eaten on the run. We had pre-imagined some solutions: food delivery, stocked refrigerators, push for pizza.

Wow were we wrong.

In fact, the units we visited have a wonderful process. A charge nurse starts the shift by setting the lunch schedule. The charge nurse usually takes lunch first. Then when other nurses take lunch, usually every half hour, and the charge nurse can cover their patients. They cautioned its not a perfect process, but it helps a lot when it works.

The problem, it seems, is getting uninterrupted downtime. Most of us, at least office workers, have ways of getting little 10–15 minute breaks throughout the day. In the Hub we make bespoke coffee with a french press, it takes about 10 minutes. Other people check Facebook for a quick recharge throughout the day. Some people take a walk around the block. But our nurses on the floors don’t often get to do those things.

In fact, they can’t. We timed a trip from the floor, down to the cafeteria, through the line and through the checkout. From floor to table it took us over 20 minutes.

20 minutes

A new challenge

And, well, since we were in the cafeteria we might as well grab lunch and synthesize. We laid out the quotes we heard on post-it notes, (feeling slightly guilty to be working between lunch plates in a relatively relaxed space). We reflected on what we heard and saw and felt.

Now we were asked a different question: how might we give nurses an uninterrupted break to recharge their batteries?

We saw the problem as having three distinct components:

postit
  • plan - you need to be able to prepare to mentally disconnect - you want to know your patients will be taken care of in the manor you’ve established
  • the escape - the actual mental break and recharge needs to feel relaxing, like an escape
  • don’t, unless - there needs to be clear signaling that someone is recharging and shouldn’t be interrupted unless it’s required

Getting inspired

Armed with our inspired direction, we asked one of our favorite questions: who does this well?. We started close to home. With the stealth of ninjas, we slipped into the physician’s lounge. Well, actually, we had to buzzed in - entry is badge-controlled. We took note of the different seating options, the open space and the well-stocked kitchenette.

lounge

“You need to go check out a salon or spa!” A colleague piped up, overhearing our challenge. “When I need to recharge, I go for guilty pleasures. I want to be pampered and taken care of.”

Divide and conquer

In the final few hours of the day, two us sped off to the closest spa….you know, for research’s sake. Another team went to investigate other break rooms around the Hospital. The Foundation had funded the renovation of one in particular. We synchronized watches and agreed to meet back at the end of the day.

A Spa Treatment

“Well, the first thing you need to know is that there’s no talking beyond these doors.” Our host at the local spa was happy to show us around. She quietly led us through dark, cool hallways, painted in muted tones. “This is our relaxation room,” she whispered, “our clients love it!” The walls were padded, there was a thick shag carpet on the floor and it smelled distinctly like tropical flowers.

shhh spa

We noted some other important aspects of the spa. First, like our own physician’s lounge, access was controlled. Being inside felt special. The quietness made it feel disconnected from the busy street outside. There was even a refreshment station with cucumber water and green tea. “Everyone loves the cucumber water,” our host whispered.

hand offs

On the way back to the hospital we decided to try our luck with more research. We called the Federal Aviation Administration. Hey, what can it hurt?. No answer. But we did get someone to pick up at the local airport. “Well, I’m not a controller, but I’ve been in the tower,” he readily told us. “My understanding is when one controller goes to lunch, another comes and sits with her for a bit. They work in tandem for a period before one goes off for a break.”

Meanwhile, back at Sibley…

The home team had a chance to explore other break areas. It turns out many of them had things in common with the break rooms we saw on the floors. The spaces, while functional, were often in busy areas. They are crowded, serving double duty as locker rooms and break rooms. Often refrigerators take up valuable space and walls are almost universally covered in posters and signs. In short, nothing in the space is conducive to relaxing.

The empathy moment

In the Innovation Hub we keep the lights on bright. The walls are covered in post-it notes, signs, prototypes, and white boards. We’re also always on stage. People come through all day, stopping to talk or ask questions. Usually we love it - it’s high energy. But when you need that precious downtime, it’s hard to come by. Everyone in the Hub has a space they sneak away to, a place to relax and get things done. We had a pretty good idea of our nurses must feel. When it’s stressful we’ve talked about going home with a feeling of PTSD, which is exactly the phrase one nurse used when she spoke with us.

Break Time

Brainstorm

The sun was dropping below Sibley’s new bed tower. The Hub’s designers and designers-in-residence, gathered for a quick brainstorm.

How can we help plan for taking a break?

  • Make sure the charge nurse never has patients so they are free to cover
  • Let’s document and publish that process they use, it’s really good!
  • Could we automate how lunch times are assigned?
  • What would our Lean team do?
  • What about what the air-traffic controllers do…could nurses shadow each other for a bit before going on break?

What’s the vision for the ideal break room?

  • Virtual reality goggles with a beach scene
  • A signature scent
  • dim lighting
  • kale smoothies for everyone!
  • a coffee buffet of options
  • badged access so it feels exclusive
  • a meditation app

VR! Joe, testing virtual reality

storm brainstorming is messy business - it requires kale chips and coffee

boards

Ready….break!

Time was ticking. We agreed to meet back at 8:30am Thursday morning. We each had assignments for the evening. There were trips to Whole Foods, signs to be made and interiors to be designed.

Thursday morning started with….well, you know how we roll….lots of coffee. We laid out our supplies and decided which ideas should move forward. It was all coming together.

cart

clubRN

30 minutes to go! We raced up to the 6th floor. Imagine furniture movers…in suits…that was us. We cleared out a small conference room between the nursing units and started to move in our prototype. Andrea blew us away us with her interior design prowess. She arranged flowers and applied a feng shui aesthetic to the room.

We put signs up all over the nursing units announcing Sibley newest, most exclusive break room: clubRN.

clubRN

Who knows where the rumors ended and the truth began. Some say you had to know a secret handshake to get in. Others told of a secret knock. All we know is that this wasn’t a space for just anyone.

door

Spy footage, obtained exclusively by The Hub, suggests clubRN may have been the most relaxing space ever.

fruit recharge

We’re told there was gourmet coffee, an espresso machine and all the cucumber water you could drink. While unconfirmed, there may have also been iPads, pre-loaded with TED talks, Netflix and meditation apps.

digital

the reviews are in…

reviews

“I’ve worked here for 12 years…that was the best lunch break I’ve ever had!”

“It smells sooooo good in there!”

“This is great! I’ve got my feet up… no interruptions!”

“I loved the sound effects [of a babbling brook]…at first I though it might even be a broken pipe! Ha!”

“I feel like I’m recharged and better able to take care of my patients.”

“In 23 years that I’ve been here, there’s never been a space like that for us.”

What’d we learn?

It turns out that space —both mental space and physical space —are what is missing from lunchtime for nurses. Most bring food from home, and like it that way. They work together to ensure their patients are cared for during breaks, but the flow and layout of their break space isn’t conducive to relaxing. The walls and tables and chairs are cluttered, and don’t feel off stage.

When we looked at relaxing spaces they had some things in common. They had controlled access, which makes them feel exclusive and protected. For our prototype, the Hub’s designers wore dark suits and stood guard outside clubRN; we only let patient care services team members in.

Relaxing spaces offer relaxing sounds and signature scents. clubRN had a water effect white noise generator and a lavender essential oil machine. We added fresh flowers too. They also feed the body and soul. Our prototype space had fresh fruit in elegant white bowls along with a basket of protein-packed bars and snacks. The catering added to the special feel.

We also noted that well curated spaces were dimly lit, had gauzy curtains and used muted tones. We tried to mimic those themes with our signs and design. clubRN featured Philips LED lightbulbs that we programed to a warm tone of light.

What’s next?

One nurse suggested, “we really need this in the new hospital [we’re building].” We agree and are going to work with the space planners to incorporate some of these themes into the New Sibley.

We also learned a lot about the importance of truly understanding our end users. For us, the big plot twist was in coming to understand that it’s not the food part of lunch which matters, it’s the mental recharge time.

We also know we only focused on one floor. Like the great process on 6 for scheduling and staggering lunches, we know other units have their own unique, awesome processes. We suspect they also have their own unique challenges. We spoke to one emergency room nurse during the project who had a very different view of the challenge, “for us, being able to eat is all about staffing and how many patients we have at a given time.” There’s clearly a lot of opportunity to keep designing for those who care for our patients.

Illegally obtained security footage of the perpetrators

Illegally obtained security footage of the perpetrators