Adaptive Environments for Healthcare & Beyond! Guest: Alex Tan, Philips (Season 4, Episode 2)

Adaptive Environments for Healthcare & Beyond!
Guest: Alex Tan, Design Innovation Director, Philips

(Music / Open)

Janet: In this series we will be discussing specific examples of design techniques that make a positive difference for people living with certain human conditions.

Carolyn: The more a designer understands the client and or the community the more effective and respectful the design will be.

(Music / Intro)

Janet: Welcome to Inclusive Designers Podcast, I am your host, Janet Roche…

Carolyn: and I am your moderator, Carolyn Robbins…

Janet: Carolyn, we have such a wonderful show today! But first, we are thrilled to announce that we are still in the top 20 on Feedspots’ list of “Best Design Podcasts on the Internet”— whoo!— and a big thank you to you, our listeners!

Carolyn: yes, and it doesn’t surprise me at all, but I might be a little bit biased… and I think this episode should definitely keep us on that list. And with that news aside, we welcome you to our first podcast of 2023.

Janet: Yes, moving right along, our guest today is Alex Tan, who is indeed creating a difference within the built environment, and using a collaborative and evidence-based approach to design. The ground-breaking work he and his design innovation team at Philips are doing is changing how hospitals envision the future of both the NICU— which is the neonatal intensive care unit— and adolescent mental health care emergency rooms.

The way they research and implement these next generation spaces, using adaptive research and ambient technology, is truly terrific for any designer for whatever environments they will be creating. We are thrilled to interview him and discuss his process.

Carolyn: But first, let me tell you a little more about Alex Tan, who is the Design Innovation Director at Philips. According to his own bio, Alex is…. ‘a visionary thinker and leader with a diverse background that spans across many industries and design disciplines. His leadership style is very hands-on; he leads through example and inspiration. He and his multi-disciplinary design team collaborate with research scientists to invent and set the design vision and direction for the future of Healthcare, through a co-creation design process and prototyping’.

In his own words; ‘We are the tip of the spear that pushes the boundary of the possible. Our solutions combine hardware, software, environments and services, and aim to solve key challenges in Healthcare.’

Janet: Alex will introduce us to the innovative tools they created and how these human-centered design solutions are making a difference in their pilot emergency room spaces today.

Carolyn: And we even learn about his side project, a design of his own invention, a plush toy that is ‘brightening’ the lives of little ones everywhere.

Janet: (laughs) That is a pun that will make more sense later… but we’ll let Alex tell us about this as well as some important insights that will be of benefit to all of us in the inclusive design field…

Carolyn: And with that, here is our interview with Alex Tan… designer, creator, and innovation director…

(Music / Interview)

Janet: Well, hello and welcome to Alex Tan here on Inclusive Designers Podcast. Thank you so much for joining us today, Alex.

Alex: Yes, thank you for having me on board.

Janet: Thank you. So, why don’t we just jump right on in, and I know that there’s a couple of projects that you’re working on. I think what’s kind of interesting is that there’s so many different parts of dynamics about your process and why don’t you tell us a little bit about how you created these types of things with Philips.

Alex: Yeah, we have, there’s definitely several projects that we work on in Philips, and I think the two that will be worthwhile to talk about this, of course, the Lotus NICU of the future. So that’s one. And the other one, we don’t really have a name for it, but it’s really how to reimagine behavioral health actually, in the emergency department. So I think those are the two projects that were, you know, it’s worthwhile to talk about (Janet: Right), that we can, you know, yeah, look into the process of how we do it and yeah review a bit more.

Janet: One is within the NICU, and one is within the emergency room in terms of behavior… is there one that you want to showcase in the, on the top of the hour?

Alex: Yeah. We can start with the NIC actually as one of the examples.

Janet: Yeah, why don’t we start with the NICU, and this is a pilot program right at this point?

Alex: This is actually, it started off as pilot program, but it’s actually been installed in hospital, actually in Florida, in one of the NICUs actually. So it is, you know, we strive to bring everything into the market because that’s, I think, you know, where it makes the impact actually. Although, you know, I work in the innovation department, we do a lot of research, front end research. We strive to test it out and implement it in the market, so, you know, to really have that impact.

Janet: Right. So why don’t you explain to us a little bit about this particular product, because the piece you’ve got in the NICU is really quite fascinating. You’re looking at all the like different senses— touch, smell, taste, sound, and light— all the things that as inclusive designers, I encourage designers to really kind of look at. So why don’t you talk a little bit about that and then the process and get our listeners into what those particular projects are.

Alex: Yeah. So again, definitely can talk about it. So the project I think started as one of these, you know, of course Philips, you know, we have products in the NICU, you know, we have different things like, you know, monitors, we have, you know, ventilators for the baby.

And, you know, all these are very, very much right now, kind of very separate elements, right? They don’t inform each other. They don’t work together as a complete kind of system. So we kicked off this project, you know, this is, I think several years ago, I’d like to say 2018, where as a project to really try and understand the space of the NICU and how can we create a kind of complete solution to address all the different needs, right? Because with all these individual products, you don’t really connect them together to deliver, you know, more value for the users. In this case, the clinicians, the nurses, and you know, ultimately the baby, themselves.

And in this project, we were very lucky to have worked with some of these thought leaders within the NICU space. And we were introduced to this whole integrative developmental model actually. So meaning that, you know, the idea that you want to, when you look at the baby or treating the baby, you want to be as inclusive as possible in terms of looking at not just your physiological aspects, but also some of the psychological aspects or knowing where sound comes in, where you know, their sensory perception of pain, you know, lights, you know, heat, all these, you know, sort of, temperature, touch even.

And there was this kind of, yeah, model that was created that we kind of worked closely together with the clinicians to really look at how we can create solutions along this kind of, you know, this whole circle actually. So this, yeah, integrative developmental model that we were working on.

And it’s kind of interesting. I think in the aspects of talking about inclusivisity is that, you know, that the parent was also very much part of that solution, right? So we had to include not just the baby and all these different needs of the baby, but the clinicians, the physicians, the neonatologists, the nurses, and the parents, and how much the parents actually played a part in the baby’s, care actually impacted the results. And there’s lots of evidence right, (Janet: Right). So having skin to skin contact with the baby, talking to them, you know, being present and being engaged in this whole process of, in the stay NICU really helped improve the outcome.

So this was a very well-known study, but there were not actually any products or solutions here for the parents, actually. So what we strive to do is just kind of a holistic solution that looked at “How could we create something for all the different stakeholders within this NICU space?” (Janet: Right). So we have, you know, some of the solutions were really looking at a dashboard, for instance, for the physicians to be able to track all the different aspects of the baby’s development, right? So like, like I said, not just the heart rate and the breathing and these kinds of things, but also the temperature of the room, the sound levels, you know, are they getting enough sleep? Are they in pain? Those, all these kinds of things.

And also, we provide a dashboard for the parents as well so they can actually participate in the care of their baby. And being able to be informed “Hey, how’s the baby doing?” And be able to, you know, have almost like a calendar or agenda that they could collaborate with the clinicians to deliver care. So, “Hey, look”, you know, this is maybe a good time, for instance, for them to come in to do kind of this kangaroo care, so this skin-to-skin contact with the baby. And that really, you know, helps their development. So we’re looking, yeah, very much a holistic solution and look at how this room could really facilitate all these folks coming together, all the technologies coming together to work in concert as one.

Janet: Yeah, I think that’s, like it’s really key in the fact that I think it’s fascinating that it took us until 2018 you said, to think like maybe we should be asking the parents, like, who spend the majority of time there, how, what they’re thinking, what they’re feeling, and how they’re behaving within the built environment as well. Right? (Alex: Yeah). Now are you saying that the, so it’s basically, explain it to people that maybe are in the car that are not able to look it up right now. What, like what is this? What, you know, it’s, it’s a touchscreen, right?

Alex: Yeah, so yeah, if I could, to describe what it is, I think it’s definitely, it’s several things. So, it’s firstly the whole room design and the lighting and everything together. So we actually designed the space itself to determine where, how the equipment’s laid out, right? (Janet: Right). So, you know, because in a neonatal ICU, there’s lots of equipment for the baby, there’s a lot of clutters. So how can you design the optimal space for the clinicians to work in there, for the parents also to stay over, right, and provide care for their baby.

So that’s one of the first things is really the environment, spatial design. So looking at the positions of the light, looking at where the monitors needs to sit. So that’s, I think the first thing.

The second thing is this, the dashboard actually. So this is a piece of software that would actually bring in all the different disparate, electronic medical records, all the different monitors, all the equipment data that’s being produced around the baby and bring it together in one place. Because right now all the, you know, doctors and clinicians need to go to different computers, different screens to search up this data and kind of combining in their head to form a picture or diagnosis of the baby. So we’re actually bringing it together in a dashboard that makes it very apparent to get a quick overview of what’s happening, right.

The other part is that we also based the design of the organizational information around this integrative developmental care model, which looks at this 360-view of the baby, you know, through all the, the body organ systems and the kind of, softer care aspect. So that was also something very prominently displayed in our dashboard. So I think that’s, that’s the other thing.

And then the other part of the dashboard that I said is a piece of software, at least for the parents to be able to then come in and be able to view, change that same dashboard, that big screen in the, the baby’s room to a different, let’s say, rendering of the information so it’s more friendly for the parents actually. So it’s not, you know, the clinical jargon. It has been translated and helps them, you know, track how their baby’s doing, that helps them almost kind of suggest education or training videos for them to learn about the development of the baby. So these are the main key aspects, right? So the environment and this kind of what we call the collaborative dashboard. (Janet: Right). So those were the two key elements.

There were some other, you know, let’s say elements that we design as well. So looking at smaller things in terms of around the incubator, having a camera that would basically look at the baby and use that camera technology to sense the vital signs. So you don’t have to put these, patches on the baby’s skin, which are very painful because kind of when they’re premature, their skin is like paper thin. And every kind of electrodes that they put on it and you take off it really tears their skin. So we try to also create a better way of sensing the baby’s vitals. (Janet: Well, that’s interesting). So this is, you know, basically part of that bigger research project. (Janet: Right). Yeah.

And I think also to your point earlier, you know, about clinical care not involving parents or even just the family of patients, I think that’s something that, it’s still a challenge, right? You know, I think a lot of science are now beginning to kind of see that the more the family members are involved in the care of the patient, the better the outcomes and the, you know, better the, the faster the healing is. Right.

And you already have, you know, I’ve kind of seen two schools of, let’s say, practice. Some doctors are really much about “Hey, we want to open up the patient’s chart to the family so they can see everything” right? The family can know everything, so they can be more informed and help with their care journey and the care decisions. And others that say “No, no, no. We don’t want, you know, the families to see that because they just ask more questions and there’s just more work for us to do”. (Janet: laughs). So, you know, there is definitely this kind of, you know, two sides to it (both laugh).

Janet: Right, it’s a complete two sides to the coin, (Alex: Yeah, yeah), for sure. Well, I mean, again, I do think it, you know, I mean, just the word inclusive designers, I mean, that’s what we try to do. And I think getting that family input was really beneficial for you guys. Like, do you remember, was there any particular thing that really stood out to you when, I mean, were you doing interviews with them or were you following them? What was the, what was your process?

Alex: So we definitely, the team spent time in the NICU, and we did a lot of shadowing, right? So going to the NICU, we got permission to kind of observe and just almost be a, like a fly on the wall to observe the staff at work and where the family gave permissions we’re also in the room. And we, we kind of spoke with the staff members and interviewed the families to just kind of get to understand what their thoughts were. Right?

And it’s kind of also striking that this whole new way of looking at this family centered care, this developmental care for the babies. It’s also not something that, in medicine, is being practiced, right? So it’s unequal. We went to hospitals that were very much embracing this, and some hospitals that’ll say, “No, no, we want to keep everything, away from the parents.” So that was the two sides. So we kind of observed this (Janet: Really?). Yeah. (Janet: Wow). And that was kind of eye-opening.

We were actually lucky and not so unlucky in that one of our team members actually, during the project was, you know, she actually had a premature birth (Janet: Oh really), and she spent a long time in the NICU. (Janet: Wow). So she was actually able to provide us a very good, first-hand insights, right. And she also helped drive a lot of the, you know, thought and thinking about, “Hey, look what are parents looking for”, you know, so that was very lucky for us, for our project, but of course, not, not lucky for her.

Janet: Right. (Alex: Yeah). I understand. (Alex: Yeah, I know). Right, it’s a little hard to say lucky in that particular situation, but it there is, I mean, it was advantageous. (Alex: It was advantageous), I guess maybe that’s a better word or something. (Alex: Yes, exactly). So what was her take away? That she was like, you must have, like or this must be, or…

Alex: Yeah, so the one big thing, and we kind of suspected it already, and she kind of emphasizes that, just the sheer amount of information that she had to absorb, right. So she was at a hospital that did not really practice this family-centered care as much, and basically, you know, at the start of her NICU stay, they just gave her a big binder, really, and just say here, that’s all the information there, read it. And there was, you know, it’s just like brochures, all kinds of information, not organized. So that was one of the things that was really overwhelming for her, right, trying to just keep track of “Yeah. You know, what do I need to know?” It’s important, you know.

Janet: Right, I mean, when her brain spinning anyways, right? Her child is in the NICU, like, will they survive, all that stuff and (Alex: Yeah), now try to absorb all of this information.

Alex: Exactly. And actually, one thing I would like to say, her baby’s now doing really well, (Janet: Awww), yeah, he’s, he’s doing great (Janet: That’s good). And one of the things I would say is that, yeah, it is overwhelming, right? As parents, you, you know, the last thing you kind of expect when you’re, you know, you have a pregnancy is, “Hey, I’m going to bring a baby back and a nice nursery”, and that’s kind of just kind of you know, (Janet: Out the window), yeah, (Janet: Right), out the window, exactly. And, you know, you are then spending months in the NICU. So that was one of the, the key things, right?

And I think the other thing was just trying to balance work and, you know, work life with the, you know, having to visit the, you know, the NICU. Because as parents, you want to be there to spend as much time as possible with the baby. And every moment that was away was, of course, you know, yeah, you know, kind of frustrating, right? (Janet: Right). So you have to balance that.

And each time she came back, she’s like, “okay, what are some of the updates? Right? What has happened to my baby?” What, you know, so she wanted to know all these things, and that was very difficult to also discover, you know. So that’s one of the first things that we did in our dashboard was to be able to almost list out as a summary for the parents, “Hey, what happened while you’re away?”

Janet: What happened while they’re away, oh, that’s great. (Alex: Yeah). Yeah, right.

Alex: And, they also had a kind of a, a planning calendar to say, “Hey look, what are the plans for the baby today? You know, are we going to do some, you know, kangaroo care? Are we going to give medications? Are we going to do certain procedures or go for a scan?” So that was kind of very nicely laid out which helped, you know, parents feel more comfortable.

And we also of, of course, incorporated this camera idea for parents to be able to remotely look into the NICU. And this is already existing right now, (Janet: Right), some hospitals have that, to see their baby and, you know, be able to, yeah, just kind of connect with them, see how everything’s doing. But we extended it to include all the dashboard elements so that, you know, on an app on their phone, or a tablet, they could basically, be able to track progress with their baby. So this is really the ambition of what we’re looking to do.

Janet: Right. Yeah. No, I mean, it’s interesting that whole work balance, right, because we don’t really have really good family leave in the United States. (Alex: Yeah), so, I got to think it would be awfully hard to leave, right? (Alex: Yeah). Like, to top it all off, but you know, that everything is sort of planned out and thought out and that you don’t have to maybe go through a binder or something, (laughs), to try to find it, I think is really kind of terrific. So those were a few of the takeaways that you had. (Alex: Yeah). So then the, and you talked about the design implementation of what you did to help to correct that. (Alex: Yeah).

I wanted to say there was something else that you had mentioned at the top. It was that there was the, just kind of fascinated about what I was listening to, (laughs) and then all of a sudden, I was like, I wanted to come back and ask and circle back on that question.

Alex: Was that about the spatial design…

Janet: …the spatial design. Yes, it was about the spatial design. And I wanted to kind of expand on that. Maybe you could talk a little bit more about that and what were your discoveries and how your process came to be for those spatial designs?

Alex: Yeah, absolutely. I think one of the things we looked at, you know, again, in NICU, you know, throughout the country, different hospitals also have the very different philosophy. So, you know, you have the, let’s say the open bay concept, right? So where you have lots of babies in little pods in this one big open room. And the new model of it is really moving towards a single-family room, meaning that you have the baby in the room by themselves, you know that this room is enclosed.

The advantages of that is that, you know, it reduces the disturbance right from other babies crying or other things. So you kind of create this more sound, (Janet: Calming), calming environment. (Janet: Right). So I think that’s one of key, aspects, I, you know, we, we saw that there’s a trend actually. So many of the new NICU built in the US are all single-family rooms.

So with that right in the design of room, we also wanted to accommodate all the different functions of the room, right? So in a sense that, at certain times, you know, because it’s, it is in the hospital, there needs to be medical procedures happening.

So sometimes, you know, babies do crash, and they need to, you know, and there’s an emergency, they want very much the bright lights on and be able to, you know, do an intervention, right. And other times when the mother is there, maybe with, with her baby, and as I said, performing kangaroo care. And this is sometimes they’re trying to encourage, you know, for many hours whereby they sit in the chair with the baby, you know, from 2, 3 hours to 5, 6, 7 hours, you know, just lying there with their baby.

So you want to create this calming, relaxing environment. So we wanted to be able to adjust the lights to that. And also during more just, you know, daily rounding of the physicians to check up on the baby, you maybe want a different type of light, or they’re doing charting and caring for the baby, such as changing the diapers or, you know, changing out the sheets and things like this. You want different lights. (Janet: Right).

So we actually created this, you know, the concept of this adaptive environment that would change and flex according to the different workflows, the different needs and desires for, you know, the people in there to the aspect of, hey look, you know, when the baby is maybe vacating the room and the janitor or the cleaners need to come in, you want also really nice, bright lights, so they will clean the room nicely. To be when the baby’s sleeping, yeah, keep everything calm the lights down. (Janet: Right). And also, they have, yeah, kind of digital signage out there to say “Hey, baby sleeping, do not disturb”.

Janet: …that’s actually cute, right? (Alex: Yeah), I mean, that makes so much sense though, right? (Alex: Yeah).

Alex: So, yeah, and as a company and Philip coming in with you know, to try and use some of these technologies to be able to give indication outside the room about the status of the room. Because with the rooms and the closed doors, you don’t know what’s really happening in there, right, so if you don’t to kind of barge in on the mother and the baby or know something’s happening. So using those technologies to project, you know, that information outside was again, one of the things that we try to look at holistically. How this room could perform as a, you know, as a well-oiled machine in a sense, right?

Janet: Right. And the whole system, right. (Alex: Yeah). I mean, that’s, other part of it. We talk about it a lot, you know, I mean, you’re helping. the baby with their circadian system too, right? (Alex: Yeah). By changing out those lights. (Alex: Exactly). And, and I saw that you’ve got some biophilia, (Alex: Yeah), projected on some of the walls and stuff like that. (Alex: Mm-hmm). So, more ways to calm, (Alex: Yes), the central nervous system. Right? (Alex: That’s correct). And then, like you said, and then to have that information being projected on the outside so that, you know, there’s no kind of disturbance and stuff like that. I’d be interested to hear from you, we talked a little bit about light, you know, we talked a little bit about sound. And I guess the touch part is that kangaroo, right? (Alex: Yes). You called it….

Alex: Yeah. Kangaroo Care,

Janet: Kangaroo Care. (Alex: Yeah), Right. And having that baby with the parent. And can you talk a little bit more about your design aspects for that particular type of programming, I would call it, I guess.

Alex: Yeah. So I think let’s maybe start along the, the touch part, right? So in the room design we’ve tried to, you know, ensure that it’s kind of optimally set up for the, you know, for the baby, to bring the baby of incubator and to be able to, you know, then transfer that to the mother’s chest. So facilitating that whole process because it’s actually not easy. So a lot of babies, they have the, these kind of cords and things connected to them, life support system, ventilator, so that makes it harder.

So, you know, unfortunately we don’t have a solution for it, a wireless Ventilator that’s still rare. So we had, you know, that’s something that, you know, we had to basically design the room and the space itself to make it easier to that transition from incubator to the mother’s lap actually, or body. And to be able to track that time because that timing also, it’s reflected back in the dashboard. So at the end of the, you know, week or the month, they can say, “Hey, how much kangaroo care has been given to this baby?” And then, you know, in the long term, we’re trying to track that correlation. Right. So again, giving data to that, right? (Janet: Right).

The other things that we also, place in the room actually, is also sensors to measure the level of sound, level of light, even, volatile chemicals and compounds actually. So sensors for that.

Janet: I was going to say how you dealing with the sense of smell?

Alex: Yeah, exactly.

Janet: So, these are all sensors, these are all Philips sensors, is that correct?

Alex: Yeah. These are, this is what we call a, a kind of sensor bar that we place in the room. So we developed that using just off-the-shelf components. Right? (Janet: Right). And, but the idea is that just to bring that together in a unique way. So to yeah, basically measure all these things. And that’s again, a study we’re trying to do to just correlate right in the sense of “Hey, you know, the scent, the smell, you know, if they’re using, you know, these bleach and detergents, does it have an impact on the babies” …

Janet: It hurts everybody (laughs).

Alex: So you can maybe also correlate with the heart rate or, you know, things like this. So these kinds of things where you have all these data coming into one place, that’s where we’re trying to, yeah, look at.

Janet: So you’re doing long-term studies with this as well?

Alex: Yeah, we’re hoping to do, do that, actually. So there is not things, yeah, put in place to try and track those things.

Janet: Right. So we can prove to everybody that you were right. (Alex: Yes). Yeah, right. (laughs).

Alex: We’ll see. (laughs). Exactly.

Janet: I’m going with you were right. (Alex: Yeah), so let’s see, we talked about touch, smell. What about taste? What are you doing with taste? What is that?

Alex: Yeah. So taste is something that’s…

Janet: it might just be something minor…

Alex: yeah. It’s something minor. Yeah. I think, so actually what I learned is that the smell and taste sensory organs are very closely tied together. (Janet: Related). Related. (Janet: Right). And yeah, I wish, Leslie one of our nurses that was really, you know, she gave a whole lecture about this. It was very fascinating. And that is basically also something that’s tied to the smell, (Janet: Right), so, you know, we kind of combine them together. They don’t eat anything at that stage, so, you know, that’s not taste, (Janet: Right).

The position of the baby, actually, is also something very important that we’re tracking. So using the camera as well to look at, because the idea that, the baby, if they’re placed in a, let’s say, a position that’s not, you know, good for their development, they end up with really lifelong kind of issues, right? (Janet: Issues, right),

So the bone structure, like the hips, they might be, you know, splayed open if they are, so they need to be constrained actually to provide the muscle tone, because in the womb they’re kicking against the womb to kind of, you know, (Janet: Get their muscles going), basically push and exercise their muscles, yeah (Janet: Right, right). So if the position is not right, so if they lay, you know, let’s say on their back, you know, the arms open for too long, then you know that will contribute to that development of their bone structure differently. The head shape is very, you know, malleable.

Janet: Yeah, we know about the head, right? (Alex: “Yeah). If you’ve, if they’ve been lying too long on, like a mattress on their back, right? (Alex: Yeah). They get that flat head, right? (Alex: Yes, exactly). Yeah.

Alex: So all these kinds of things. So those are, again, tracking that kind of you know, positioning was, something that we also tracked. Trying to work our way around. Of course, the light we know, so not too much, you know, the light, appropriate levels of lights, you know, (Janet: Yeah). And then yeah, looking at circadian rhythm later on in the recovery, you know, so later on, when they’re old enough.

Of course, parental participation was a very important one. (Janet: Right). The parents, actually also, we are tracking, how much they are kind of at least keeping up on their education. Because the idea is that you want to prepare the parents to be able to discharge of the baby safely, right? So when they go home, they have to maybe do some of the changing of the tubes or, you know, change the diaper, or do the washing and there’s certain instructions. So we provide that set of education material that then we could track, “Hey, have the parents been watching it and you know, how, so how far along that kind of, discharge readiness they are” actually. So those are, those are some of the other things that we were tracking.

Janet: Well, but keeping in that same vein, so you just kind of moving on to the next project, which was behavioral, right, (Alex: Yeah), in the emergency room. I thought that this was kind of fascinating. It was also about, if I understood it correctly, it was mostly about juveniles, right, or is it pediatric…

Alex: Yeah, it’s a pediatric behavioral health. (Janet: Right). And this actually, this project, started actually also with just talking to one of the hospitals, actually that was one of our customers, they came to visit our innovation lab in Cambridge. And you know, they at that time were building a new facility or new emergency department and behavioral, I guess, you know, a behavioral health, mental health was one of the big issues with, you know, many hospitals at that time.

And this was pre-covid. Already, you know, there was a single ramping up of (Janet: It’s a problem). Yeah, problems. (Janet: Yeah). Children coming to emergency departments as a last resort, because there hasn’t been any, let’s say, investment in a lot of these, you know, interventions for behavioral health, mental health, you know, lack of investment and lack of infrastructure outside to support these folks. (Janet: Yup).

So what they end up is going to the emergency room and end up clogging up the emergency room. The emergency rooms are not ready to handle these kids, right? And some of them— what they call, psychiatric boarding— will spend days, even I’ve heard weeks in this single kind of room, usually without windows, they have to be really secure. And they’ll spend, you know, hours, days, weeks, depending on their severity in locked up in these rooms actually.

And, you know, at least the thinking is that “Hey, we need to keep these children safe, so they don’t harm themselves or they don’t harm others”. (Janet: Right). So they just basically strip everything from the room, you know, it’s basically a very bare empty room, actually.

Janet: Right. It’s like, it’s a, usually it’s a bed, usually not even like a blanket or what have you. (Alex: Yeah). No, the shoelaces, no belts, no, not nothing. (Alex: Exactly). And I mean, like you just, everything has to go and (Alex: Yeah), and no curtains. (Alex: Exactly). So, so, I’m sorry I didn’t mean to interrupt you, but yes, it’s, it’s, and it’s also very, I mean, how triggering is that for young folks, you know? (Alex: Yeah). And all of your stuff is taken away and right.

Alex: Yeah. And I think it definitely exacerbates the problem, right? (Janet: Right). Being kind of coming into this when you lose control, right, you’re already not feeling well.

Janet: You’re already out of control. Right. And now, like everything is out of your control (Alex: Exactly), and everything is gone, right. (Alex: Yeah).

Alex: And, you know, one of the, the things is that, yeah, you know, if they stand coming there and they have an episode, like, you know, they start acting up, becoming aggressive, then what the hospitals might do is like, restrain them on the bed, right? (Janet: Right), and just sedate them. But then once they come off sedation, again, they’re back to where they are, so it becomes a cycle.

So, you know, this was a problem in the hospital. And they’re building this kind of pediatric wing of this emergency department. And they were looking at our experience lab and we actually have this, a NICU room there. And they saw this adaptive room and they thought, “Hey, look, this might be, you know, a solution that could be adapted to our emergency department space” right? Because at that point they were looking at these holding rooms and they were arguing amongst themselves, “Hey, what kind of mural should we paint on the ceiling, should be the underwater or the jungle scene”. (Janet: laughs)

And the chief experience officer of this department of this hospital was just like, “Hey, no, we should do away with these, kind of very more, kind of legacy way of thinking, right? (Janet: Right). Making a pediatric environment, you know, it means murals, whereas pediatric, a definition of it, it’s like from, you know, zero to 17. So you imagine a teenager, you know, 15, 16, they don’t want to these kinds of  more kind of, (Janet: No), infant, (Janet: Babyish, right?) Babyish. Exactly. Babyish, kind of, decoration. (Janet: Right).

So, basically in during the discussion we thought, “Hey, look, some sort of adaptive environment would be maybe suitable for this kind of space, right?” Of course, but we didn’t know anything about really, behavioral health, you know, this topic is something we never kind of create a solution for.

So I think, you know, the first thing we did is say, “Hey look,” you know, they invited us to their hospital down in Dallas. And we basically went there and, with the understanding that this is going to be a pilot exploration. We couldn’t guarantee we’re going to deliver any results at all actually.

And we just want, you know, we wanted to help right. You know, listening to their situation, the problems, and say, “all right, maybe we can do something, let’s explore this together.” (Janet: Right). So we ended up, you know, spending a few days, myself together with design team, to tour the emergency department and to basically understand the issues, right? So there’s the same kind of shadowing, talking to the staff members. And we were actually lucky enough that one of the ex-patients was willing to volunteer himself to speak with us.

And that gave us, provided us with lots of insights. Because usually that’s more kind of, you know, behavioral health is more of taboo subject. People don’t want to talk about this. (Janet: Right). But this particular young man was very, you know, brave (Janet: Right), and to be able to open up, and gave us his input and gave us, yeah, how he felt actually and what got him into that situation. So that provided us with lot of insights. (Janet: Right),

Janet: Was there any particular part of his interviews, what big takeaway was, did you come away with from those discussions?

Alex: Yeah, I think one of the big takeaways is that, you know, when he came to these kinds of rooms, was that he just felt the loss of control and the loss of, you know, the things that kind of comforted him, right. (Janet: Right). So immediately it was of course, you know, like the mobile devices and things like this, and it’s more than just more mobile device, right. So social media, but entertainment and things like this. So music was, you know, things like he missed (Janet: Music. Big, yeah). Yeah, and also, exercises. “Yeah, I’m locked in this room and I just, you know, couldn’t do anything. I wish that’s a way for me to be able to work out, or at least express myself, get my, you know, something to do, actually”.

Janet: Or even just get my frustrations out. Right? (Alex: Exactly.) We talk about, like, especially when you’re talking about like, even like trauma or whatever, or your brain is kind of screaming. We all do it, right? (Alex: Yeah), you know, people say, “Take a walk around the block” (Alex: Yeah), “or start punching something.” (Alex: laughs). Right? (Alex: Exactly), exactly.

Alex: So, yeah. So that was I think one of the insights to see, you know, that yeah, he wanted this, almost to be normal, right? But you know, of course he knew that he was in, (Janet: Even though he’s there), even when he’s there, right. So to continue to have access to these kind of things. (Janet: Right, yeah). So yeah, I think that was, you know, really interesting part to be able to talk to him. And he definitely had good suggestions of things that were kind of, you know, took into account in our design as well.

Janet: So with this young man, you said that there were a couple big takeaways, was music, and then there was also like the ability to exercise. What did you put in the design in terms of the space that you addressed some of those needs?

Alex: Yeah, so I think the main thing that I think we brought in was, let’s say that the technology element to this space, right? So it’s, you know, it’s pretty much a simple room, you know, standard kind of size that had to be safe for the children. And, you know, usually it’s just bare walls and fluorescent lighting, right? So we looked to change this whole design to bring in this adaptive environment. So using projections both on the ceiling and the walls and colored lighting to be able to just give, paint a different kind of a flavor to the room.

So, you know, biophilia, as you say, we have nature projections. We actually worked on kind of more calming projections versus something that’s a bit more energizing. Because also, in our research we looked at the cohorts of behavioral health. It’s not just one, one type, right? So there you have the kind of folks that are in more on the autistic spectrum and you know aggression and things like this (Janet: Right), was part of that, you know, behavior. (Janet: Even hyper), yeah.

You have folks that are more suicidal, so they’re very depressed and they’re, you know, in a kind of very down stage. And then you have, you know, a small percentage that were kind of, had psychosis, actually. So, you know, they’re basically seeing things, (Janet: They’re seeing things), or hearing sounds. So you wanted them, (Janet: Right), yeah, so you wanted to have a very low stimulus.

So, working together with the kind of, let’s say, the psychiatrists and in the hospitals and the kind of, behavioral health specialists, we kind of mapped up different archetypes of patients. And that helped us, you know, decide that “Hey, with this adaptive environment, how can we change and adapt the environment to basically, address the different age groups, the different kind types of conditions,” right. So that was definitely one thing that we looked at. (Janet: Right).

Actually, one big part of our solution that we didn’t have was basically a way of controlling this environment, right? So we had the technology of the projections, the making of the content, the lighting. And we actually managed to find a partner— this is a third-party company, that’s not Philips— that created this touchscreen that was basically bulletproof, literally.

And so it was, you know, this is a huge touchscreen. They have different sizes, you know, and they had games in there and they actually developed it for also a behavioral health space, you know, with a different kind of, thinking about it. So we actually managed to connect our systems with desks and use their touch screen as a way to control our system. So, that was one of the ways to then allow the children to have control of their space, right. (Janet: Right).

So now they have this, let’s say tool or, or a portal to be able to change the lighting to suit their needs. You know, with this touchscreen we could bring in, you know, television or radio, music. So that was a really a, a great thing. And we even brought in games actually, and funny enough, one of the games was ‘whack-a-mole’ (Janet: Oh, yeah), and you can basically punch this, the touchscreen to, you know, to play this game. (Janet: laughs, That’s perfect, yeah). And so, you know, this kind of was one of the, let’s say, elements that we partner with another company to create, to deliver this solution. So it’s not just one company doing it, but coming together.

Janet: Yeah, I want to just to make sure that everybody kind of hears what you’re saying here because it’s so important. These particular age groups essentially have their own autonomy, right? They have their own agency over their own environment, (Alex: Mm-hmm), which is just so huge, right? (Alex: Yeah). I mean, like, yeah…

Alex: Yeah. Indeed, actually. And you know, so we also work with the hospitals in the sense of looking at how can you provide, you know, give the children incentive, right? And say, “Hey, look, if you promise to take your medication or behave in a certain way, then we’ll slowly give you privileges in terms of, all right, now you can have television, you can have radio, you know.” So slowly kind of using that incentive to give them what they want, so a working partnership.

We also actually found that the touchscreen was actually really useful as a tool for connecting the nurses and clinicians with the child. So basically, by either playing games or a game of chess or whatever game, you know, puzzles, memory game that they do. (Janet: Right). This kind of having them both sit in front of the screen and participate in having a chat create this bond between the clinicians. (Janet: Right). So it became, you know, this technology piece suddenly it’s not replacing, but it’s actually bringing people in together. And that’s, I think that’s really also important, right? (Janet: Right).

Something that I strive to do is how technology, I mean, frequently, it just gets in the way, and you know, and people just, you know, gets focused on it. But how can it become a facilitator of really human relationships, actually. I think that’s also something really important.

Janet: Of human relationships, right, as opposed to, again, closing the door. (Alex: Yeah). I mean, it’s almost like they’re then forgotten, right? (Alex: Yeah), and they don’t know what’s happening. In this way, they can stay engaged (Alex: Yeah), and everything like that. That’s just terrific, Alex. (Alex: Yeah). I just want to ask you one more question about that particular room, (Alex: Mm-hmm), you had mentioned putting projections on the ceiling, not just on the wall. Was there a reason for the ceiling, (Alex: Yeah), projection as well?

Alex: So actually, it was more of a hypothesis that we started with this. So, you know, it was a pilot room. So we went in there trying to at least have the coverage of looking, “Hey, what are the possibilities”, right? And we did the projection, and we knew that with projectors you can kind of, you know, turn it off and then it’s not there at all. So we are not taking up the space. So we’re building, let’s say, the redundancies to be able to test out different hypothesis. And one of them was really to have the children when they’re lying in bed, to have some sort of visual cue of looking up the ceiling, right? So they’re not staring at this blank ceiling.

And one of the content that we developed for this projection was a starry night sky, actually, to help the children relax. (Janet: Right). And we worked with the psychologist to have this star that would gently pulsate to a certain rhythm so that if you don’t know it’s there, you won’t see it. But then the psychiatrist might tell a child, “Hey, look, see that star, that, focus on that, pace your breathing to it”, (Janet: Pace your breathing) and to help them calm. (Janet: Right, yeah). Yeah, so that was a way of, you know, to help kind of wind down an agitated state to help them calm themselves using the content of the projection. (Janet: Right).

And the other projection that we developed was more of a sunny forest. So it was really, you know, trees, you’re looking at the canopy of the trees. (Janet: The canopy of the trees, yeah), Yeah. The sunlight kind of filtering through. So again, something, you know, very nice that reminded you of outdoors. And in that scene, they were actually butterflies that flew across the screen. (Janet: Aww, oh that’s lovely). And the coaching that the, actually the psychiatrist want to do is that hey, you know, they’ll tell the child, “Imagine all your bad thoughts and terrible thoughts. Imagine these are the butterflies and they’re just flying away, floating away.” (Janet: Right). “So one at a time, just let go of it and let them fly away.”

So, we were basically developing these kinds of content to help, you know, with the therapy as well. So, I think for the first time, you know, we’re trying to now bring in therapy into this space where traditionally, you know, they really couldn’t do, they didn’t have the tools actually to really work with the children, right. They might have some usual coloring books and things like this, and you know, for the kids, but that was basically it, right? So we’re trying to bring in some of these technologies to help create this opportunity.

Janet: Yeah. And reduce their stress (Alex: Yeah), and everything, like you said, all the stuff that might be running through their minds (Alex: Yeah), and everything like that. I don’t think I need to see any papers after all of this, I know that what you’re doing is making a difference. (Alex: laughs).

Well as I tell our listeners all the time, as inclusive designers, we look at the biology, psychology, and sociology of spaces, and it really looks like you’ve really tackled all three quite well. So, just to remind our listeners, we will have all this information on our website, InclusiveDesigners.com (Alex: Yeah). Yeah, and is there anything else you wanted to add, was there any last, like takeaways, and what’s the follow up?

Alex: So maybe I think, I would like to end that, you know, at least for this behavioral health room, we’re piloting it and for now, it’s starting to show very good results actually. And I think some of the takeaways that, you know, we created this as a pilot, is that there is definitely some unintended users that, you know, we kind of discovered during our journey.

So there was one anecdote that actually the nurse told us about this child that came into this department. She was basically really aggressive, and out of control. She was basically like, you know, breaking equipment, tearing wallpaper off the walls. And they decided, “Hey, look, let’s try and put the child in this Philips room.” So they brought her over there with restraints and she went to the room, and immediately what she did was she turned on the red lights. You know, she just sat the room to this really intense, bright red. And the staff members were really concerned, like, “Wow, this red light going to aggravate her more.”

And really, you know, so everyone was like really concerned— “Should we just go and intervene?” But one of the head nurses said, “No, no, just leave her alone.” And within an hour, she had really calmed down and de-escalated. They could take off her restraints. And then I think within the, the next half day they could discharge her, and she was already, you know, there for a couple of days being really troublesome.

So it goes to show that, you know, because the red light I remember was one of the things that we said, should we just, you know, block that from happening because that’s really intense, right? But I’m glad we didn’t because I think, children, you know, or our kind of cohorts, find a way of expressing themselves, right? (Janet: Right). And this is something again, we’re still learning, discovering there’s so many different possibilities and who am I to say that red is not the right color, right? And that’s, I think, you know, one of the lessons for me as well, that yeah, there are, you know, different ways of expressing…

Janet: Yeah, but teenagers always have a different way of looking at things anyways, you know? (Alex: Yeah). I might have liked a red light too. (Alex: Yeah). Right? (Alex: Yeah). And again, I think it was in part that she was able to get that agency for herself, right? She was able to have that control. (Alex: Yeah). And be like, yeah, I’m going to have the red light and just not allow anybody to say otherwise, and with, just even with that was probably what helped her to kind of calm down. (Alex: Yeah).

All right. So it’s kind of switching gears a little bit, let’s talk about the innovation lab. (Alex: Yeah). I mean, all this work that you’re doing is just amazing. What do we got coming up? What should we know about as inclusive designers? What do we have?

Alex: All right. So yeah, we have the innovation lab, you know, here in Cambridge, Massachusetts. So this is Philips’ headquarters here. And this is basically a lab where yeah, we, you know, bring together a lot of our different advanced research, right? And we’re trying to bring into this lab, and it’s kind of probing the future of what healthcare could be, right? So we’re thinking about that tomorrow. Thinking about what, you know, is the ICU of tomorrow, you know, what is the cath lab, you know, interventional lab of tomorrow.

So we’re trying to basically bring together these different thinking and groups of designers to build these possible or preferable futures, you know, and we share that with our, you know, customers, the clinicians, and get feedback. So it’s a kind of basically, yeah, I would say, experimentation lab where we bring in technology and we try to, you know, build it in a very tangible way, and invite folks to come and experience it and provide us feedback. And this is how we kind of learn and grow and develop these, these ideas actually. So, yeah…

Janet: Yeah. Well, I think you guys are doing some amazing work. And Alex you also do some amazing work as a sideline. (Alex: laughs). You want to tell our audience a little bit about it, and again, we’ll have all this information on our, on our website.

Alex: All right. Yeah. Thanks. Yeah, so of course, you know, yeah, working in the healthcare, you know, it’s a very kind of serious field. You know, very life and death. And, you know, in my kind of, let’s say spare time, I, you know, do something, you know, other things are more lighthearted, but still in the design area. So, this is something I’ve done is actually a plush toy, nightlight actually. So it is a completely soft, plush toy that also doubles as a nightlight, actually.

So this is something actually I created when my son was born. So that was basically about 15 years ago. For my wife actually, and I for us to do the kind of nighttime nursing feeding. So it gives off a very gentle light so we could basically do our nighttime chores without waking up the other partner.

And then, when he kind of, you know, grew a bit older in the toddler, it became his kind of companion to comfort him at night so he could sleep by himself and have his own personal light that he could control actually. So if you, yeah, the character, that you click its bellybutton, and it glows and then it’s turns off by itself. 15 years later we decided to do a Kickstarter, kind of, you know, a campaign. And it was successful. So now we’ve produced it and I’ve got little side business, at least the selling is…

Janet: A little side business. (Alex: Yeah). I know, and it’s called, it’s called Lumi, right?

Alex: that’s right.

Janet: L_U_M_I

Alex: Yeah, Lumi. Yes.

Janet: What was behind the name? Is that like a children’s book name that I’m not aware of? Is it…?

Alex: I guess it’s because it glows, it’s, yeah, illumination, Lumi. And it does actually come with a storybook as well.

Janet: It comes with a storybook! I didn’t know that. Really!

Alex: Yeah. The life of how Lumi came to become Lumi. And why does he, Lumi, glow.

Janet: Oh, (Alex: Yeah), oh I love that. Well, I can see what I’m getting now, that’s what I’m going to go give a lot of my friends.

Is there, before, as we we’re kind of wrapping this up, our conversation today, (Alex: Mm-hmm), you know, Alex, it seems like you’ve kind of like, kind of conquered the inclusive environment quite, quite well. Is there anything you want our listeners to know, like is there any last parting words? You know, what do you see the future maybe? Or what would you say to yourself if you were a younger designer? (Alex: laughs). Like, kind of riff with me a little bit.

Alex: Alright. Yeah. I wouldn’t say, you know, I’ve conquered the inclusive design. I’m thinking I’m on a journey and there’s always a lot more to learn.

Janet: Well, I know a lot about this stuff, I’ll just let you know right now Alex, and you check a lot of boxes as far as I’m concerned. So, just so you know… (Alex: Thank you). And you’ve written a children’s book, so like, that’s pretty cool, right?

Alex: Yeah, I think, you know, it’s just, you know, having this kind of naivety, I guess, you know, to come into a space, you know, that you don’t know, to be able to open yourself to learn about it, right? And you know, I always say, you know, yeah, it’s not having that, the arrogance to say, I know everything, and this is the way it should be. You know, so really talking to the, to the folks that you are working with.

And I think also my, you know, definition of inclusiveness is also looking at they’re casting a wider net, right? So just like NICU, you know, the parents were not someone that people focused on, but they were actually equally as important, right?

So in any situation, any solution they’re designing, not just look at the immediate user, but who are the other supporting, (Janet: Supporting), stakeholders (Janet: Yeah). Yeah, even, you know, it could be the parents, it could be, you know, at least in the healthcare, know that some of the decision makers that might buy the equipment, all that. So all these people (Janet: Right), working together in this ecosystem, I think, is one of the things that I think we’re starting to look at more.

And also, I think, at least in my field, in the healthcare area, it’s so complex that not one company can own everything. So we’re starting to look at partnerships of different ecosystems where, one company like Philips might deliver one aspect of the solution, and partner with someone else, you know, maybe even a competitor to deliver something else, right? So, but together, at the end of the day, we’re delivering a great solution that works together for the benefit of all the end users. Right? (Janet: Right).

So I think that’s, that’s a key thing. And that’s where, I guess, you know, that’s the change from when I started my career, you know, many years ago, is that, you know, it’s more “alright, yeah, you know, you only have this nice company, we need to own all the space; we need to own everything.” And it’s that singular user, but now I think that’s a lot more actually, that we need to look at as a system.

Janet: Right. Yeah. I mean, I think that’s an interesting journey that you just referenced, that you’ve gone from this like singular look to like really, I mean, I dare say an inclusive approach to, you know, healthcare. (Alex: Yeah.) So yeah, I think that’s really quite lovely. (Alex: Yeah).

Alex: Yeah, and I think that also, maybe just another quick point. I think that also goes for the design team, actually. I think one thing that I’ve discovered is that there’s so many, you know, designs becoming so complex as well. So for instance, design the NICU room and all that. It’s not just, “Hey, look, I’m an industrial designer, I’m a user interface designer, or I’m  a video specialist.” We’re bringing all these folks together from architects, right, from all the different disciplines working together as well. And I think that’s also on that size, including all the different viewpoints in the creating of the solution. And it’s not just, look, you know, it’s the product marketing guy that’s making that, let’s say specification, but it’s everyone coming together and working more in collaboration.

Janet: Yeah, no, I mean, it’s really quite terrific. I mean, because this is the discussion of not doing these things in a vacuum, right? Like, and it’s about really kind of, the collaboration only brings great minds together, which only helps the better good.

Alex: Exactly, yeah. (Janet: Right). Indeed.

Janet: Yeah, no, I mean, it’s just perfect Alex, and I thank you so much for stopping by and we’re going to have all this information for our listeners on Inclusive Designers Podcast website, which is InclusiveDesigners.com. And Alex, thank you again so much for, for being here and sharing your wisdom with our listeners. And, if there’s anything else you want to, I know we just went over this, if there’s anything else you would like to express, please let our listeners know.

Alex: No, yeah, thank you for inviting me, to this show actually. It was a pleasure talking to both of you and sharing my experience, so I thank you very much.

(Music / Outro)

Janet: Alex is so impressive! He is one of those inclusive designers that is thinking of everything in these highly technical environments for some very vulnerable populations. These pilot adaptive environments are amazing in the way they seek to make the experience better for patients, families & clinicians. Using meaningful human-centered innovations, they are truly reimagining the ER experience for both the NICU rooms, and pediatric behavioral health.

Carolyn: In the NICU, I really like how they are using the software and screens to help the parents be more informed and involved in the baby’s care… and for those parents to be able to more easily navigate the information they need, is so important.

Janet:  Yeah, I also found it fascinating that they were then able to take that knowledge and tools from the pilot NICU space to create an alternate for the sterile rooms usually used for pediatric behavioral patients… This work with behavioral health should be inspiring for designers no matter what their area of interest.

They included interactive ambient elements— like the Tune-able lights, calming sounds, and immersive projections. These seem to calm agitated pediatric patients which we know will lessen the need for sedation, and potentially de-escalate patients who might be unregulated. Not only did it give the patient a sense of comfort and control, the projections could even be used by staff for additional therapeutic treatments.

It is interesting to note that this was already in the works before the pandemic. Making a room that allows for some agency, when they have no agency in their lives— in this case a juvenile, who is in crisis mode— can really help to relax and calm the mind.

Carolyn: I know, I think they should consider creating a home version— who wouldn’t like to use that pulsing star to regulate their breathing, or let a butterfly take the day’s stress away.

Janet: Mm-hmm, well you may want one at home, but there are so many other places that could use a calming zone like this too. When we think about Trauma-informed design, for example, these could be great tools to put in the workplace, or schools.

Carolyn:  …and that is why you are the professional (laughs).

Janet: Well, and speaking of professional, one last point that keeps coming up in all our discussions in our field is the importance of co-design. We need to look beyond ourselves and collaborate to reveal the best design decisions.

Carolyn: And stay tuned, we may even have more on this topic in our next episodes, which are already in the works. And we can’t go without giving a quick ‘glowing’ shoutout to Alex for creating his plush buddy Lumi…

Janet: Yeah, gotta love Lumi…

Carolyn: I admit, I’ve already given one to my niece, Alison, and her little one, Jordan.

Janet: And we will share the link for how to contact Alex, and of course, the links to the innovative work that he and his team at Philips are doing, and also for the many other things that were mentioned along the way during this discussion. All on our website at InclusiveDesigners.com

Carolyn: That’s: InclusiveDesigners.com…

Janet: A big thank you to Alex Tan. And thank you all, as well, for listening.

Carolyn: Along with all the regular places you get your podcasts, you can also find us on YouTube as, you guessed it again, Inclusive Designers Podcast. And of course, if you like what you hear, feel free to go to our website and hit that Patreon Button, or the link to our GoFundMe Page. And now you can also find us on Feedspots’ List of Best Design Podcasts.

Janet: Yes you can! And as our motto says: ’Stay Well… and, Stay Well Informed’…  as always, thank you for stopping by. And we’ll see you next time.

Carolyn: Yes, see you next time.

Music up