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Innovation projects in clinical settings
Development of a design process for the Sister Kenny Research Center
KataRIna LunD
Master of Science thesisStockholm, Sweden 2009
Innovation projects in clinical settings
Development of a design process for the Sister Kenny Research Center
Katarina Lund
Master of Science Thesis MMK 2009:30 MCE 178KTH Industrial Engineering and Management
Machine DesignSE-100 44 STOCKHOLM
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Godkänt
2009-03-23Examinator
Margareta Norell BergendahlHandledare
Margareta Norell Bergendahl
Uppdragsgivare
Sister Kenny Research CenterKontaktperson
Lars Oddsson
Examensarbete MMK 2009:30 MCE 178
Innovationsprojekt i en klinisk miljöUtvecklandet av en designprocess för
Sister Kenny Research Center
Katarina Lund
SammanfattningSister Kenny Research Center är en del av Sister Kenny Rehabiliation Instititue, som återfinns på Abbott Northwestern sjukhuset i Minneappolis, USA. Sister Kenny Rehabiliation Instititue behandlar mer än 70.000 patienter per år.
Sister Kenny Research Center strävar efter att optimera servicen till patienterna genom att främja innovationer inom rehabiliteringsmetoder och rehabiliteringsteknik. Forskningsprojekten på Sister Kenny Research Center drivs i interdisciplinära så kallade Clinical Innovation Teams. Eftersom Sister Kenny Research Center nyligen startades hade man innan detta examensarbete ingen designprocess att arbeta efter.
Resultatet av detta examensarbete är en heltäckande strategi för innovationsarbete, innehållandes ett antal verktyg för att främja innovationsförmågan på Sister Kenny Research Center. Strategipaketet innehåller tre delar som är kopplade till varandra:
En design process speciellt utformad för situationen på Sister Kenny Research Center, som skall säkerställa att forskningsprojekt utförs på ett strukturerat och innovativt sätt.
En handbok i innovationsarbete som beskriver designprocessen för medlemmarna i Clinical Innovation Teams och därigenom ger instruktioner steg för steg i hur man utvecklar produkter. Handboken är skriven för personer med liten eller ingen tidigare erfarenhet från utvecklingsprojekt.
En rapport med rekommendationer till ledningen på Sister Kenny Research Center om hur man bäst kan stödja designprojekt. Rapporten innehåller tips om utformning av den fysiska arbetsmiljön, rekommendationer om hur man ska tackla de osäkerheter som kommer av att flytta mellan sjukvårdsarbete och forskning, samt förslag på hur man kan säkerställa patientkvalité och produktivitet.
Detta strategipaket tillhandahåller Sister Kenny Research Center en bra grund för utförandet av innovativa och framgångsrika projekt.
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Approved
2009-03-23Examiner
Margareta Norell BergendahlSupervisor
Margareta Norell Bergendahl
Commissioner
Sister Kenny Research CenterContact person
Lars Oddsson
Master of Science Thesis MMK 2009:30 MCE 178
Innovation projects in clinical settings Development of a design process for the
Sister Kenny Research Center
Katarina Lund
AbstractThe Sister Kenny Research Center is part of the Sister Kenny Rehabilitation Institute located at the Abbott Northwestern hospital in Minneapolis, USA. The Sister Kenny Rehabilitation Institute provides rehabilitative services, treating more than 70,000 patients a year.
The Sister Kenny Research Center strives to optimize the service to patients by nurturing new innovations in rehabilitation care and treatment. Research projects are conducted in interdisciplinary so-called Clinical Innovation Teams. As the Sister Kenny Research Center is recently started, it did not prior to this thesis project have a design process or structured way of working in design projects.
The outcome of this thesis project is a comprehensive innovation strategy package with a set of tools to enhance the innovativeness at the Sister Kenny Research Center. The strategy package consists of three interlinked parts:
A design process adapted to the work environment at the Sister Kenny Research Center ensuring projects are conducted in a structured and innovative manner.
An Innovation Handbook describing the design process to the Clinical Innovation Teams and providing step-by-step guidance to designing. The handbook is written for people with little or no previous experience from design projects.
A report with recommendations to the management at the Sister Kenny Research Center of how to best support design projects. The report includes aspects of workplace design, recommendations on how to deal with uncertainties that come when moving between clinical care and research and ideas of how to ensure quality of care and maintain productivity when clinicians engage in research activities.
This innovation strategy package provides the Sister Kenny Research Center with a good foundation for conducting innovation projects.
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AcknowledgementsI would like to send an expression of gratitude to all that have supported this thesis project. A large number of people have contributed by sharing their knowledge and experience, or in other way inspired or supported me during the scope of this project.
First of all, my tutor at the Sister Kenny Research Center, Dr. Lars Oddsson, and my tutor and examiner at KTH, Professor Margareta Norell-Bergendahl, who have both served as both support and inspiration throughout the project.
Mary Radomski, Matt White, LeAnne Hammer, Maggie Whiteman, and other clinicians at the Sister Kenny Rehabilitation Institute who participated in the interview study and gave me an introduction to clinical work and research at Sister Kenny, as well as American culture - Thank you!
I would also like to thank for the support from the City of Minneapolis, the Product Innovation Engineering Program (PIEp) and Allina Hospitals and Clinics.
Lastly, I would like to thank Torsten Dahlin, Professor Bodil Jönsson and Hans Frisk who have all contributed with valuable literature and inspiration during the project.
Katarina Lund
Stockholm, 2009
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Table of content1. IntroductIon............................................................................... 12
1.1 Background information .................................................... 121.3 Project frames ........................................................................... 141.4 rePort structure ...................................................................... 15
2. theory ............................................................................................ 162.1 structured design Processes ............................................ 162.2 team Psychology and management ............................... 182.3 creativity tools ........................................................................ 222.4 the creative workPlace ....................................................... 24
3. Method ............................................................................................ 263.1 Project Protocol ...................................................................... 263.2 literature study ....................................................................... 293.3 interview study ......................................................................... 293.4 Pilot Project ................................................................................ 303.5 evaluation criteria for design Process ...................... 30
4. eMpIrIc results .......................................................................... 314.1 interview study ......................................................................... 314.2 Pilot Project ................................................................................ 32
5. project outcoMe ...................................................................... 365.1 innovation strategy Package ............................................ 365.2 design Process ............................................................................ 365.3 innovation handBook ............................................................. 385.4 recommendations rePort ..................................................... 49
6. dIscussIon ...................................................................................... 516.1 setuP of master thesis ........................................................... 516.2 the strategy Package in context .................................... 546.3 interdisciPlinary designing ............................................... 556.4 design Process ........................................................................... 556.5 innovation handBook ............................................................. 576.6 Physical worksPace ................................................................ 57
7. conclusIon ................................................................................... 59
8. recoMMendatIons .................................................................... 608.1 imPlementation of results .................................................. 608.2 future Projects ......................................................................... 60
9. references .................................................................................... 62aPPendix a: interview Protocol ............................................... 67aPPendix B: evaluation of Pilot Project ............................. 68aPPendix c: work model illustration .................................. 69aPPendix d: recommendations rePort .................................. 78
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Introduction1. This chapter gives an introduction to the setting at the Sister Kenny Research Center and the goals of this thesis project. It contains information that is important to have to best be able to benefit from the rest of the report and is recommended as initial reading. The reader will be introduced to terms like Clinical Innovation Teams and interdisciplinary designing, which reoccur throughout the report.
Background information1.1
Sister Kenny Research Center1.1.1
This thesis project has been carried out at the Sister Kenny Research Center in Minneapolis, USA. The Research Center is part of the Sister Kenny Rehabilitation Institute, which in turn, is part of Allina Hospitals and Clinics (Figure 1). Allina has more than 23,000 employees and is a not-for-profit organization comprised of hospitals, clinics and other health care services.
Allina Hospitals & Clinics
Sister Kenny Rehabilitation Institute located at Abbott Northwestern hospital
Sister Kenny Research Center
Five other Sister Kenny Rehababilitation Institutes, with sta� that might particiapte in Sister Kenny Research Center activities
Figure 1: An overview of Allina Hospitals and Clinics.
The Sister Kenny Rehabilitation Institute provides rehabilitative services at several of the Allina hospitals; both inpatient and outpatient care, treating more than 70,000 patients a year. Some examples of conditions treated are stroke, back pain, spinal cord and brain injuries (Allina, webpage).
The Sister Kenny Research Center strives to optimize the service to the patients by nurturing new innovations in rehabilitation care and treatment. Research has been conducted at Sister Kenny Rehabilitation Institute for many years but recently became coordinated under the Sister Kenny Research Center, which started in 2007 when the first director of research,
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Lars Oddsson, was hired. The building of the research center facilities was still ongoing at the start of this thesis project and was finalized in the beginning of November 2008.
Key organizational elements at the Sister Kenny Research Center are the, so-called, Clinical Innovation Teams (CIT). The clinicians at Sister Kenny Rehabilitation Institute will form these teams together with students, engineers, designers, patients, and other stakeholders. These teams will make the base for most research and development conducted at the research center (Figure 2). Possible outcomes of the development projects are rehabilitation aids, assistive devices (physical products), software to measure training results, as well as new work models for the staff or new services for the patients.
CLINICAL INNOVATION TEAMSClinical
ExperienceTechnological
DepthProject
Structure+ +
Figure 2: Strengths of the Clinical Innovation Teams.
The research facilities include a workshop for experimenting and prototype building, as well as videoconference equipment, testing facilities and areas where the members of the Clinical Innovation Teams can work away from the patient centered context their normal work environment provides. These resources have not been available in previous research projects.
PIEp1.1.2
Sister Kenny Research Center is a contracted U.S. partner for PIEp (Product Innovation Engineering Program). PIEp is a Swedish national program with the aim of increasing the innovativeness of people and organizations (PIEp, webpage). KTH, the Royal Institute of Technology hosts the program.
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Project frames1.2 The following paragraphs summarize the foundation of the thesis project.
Purpose1.2.1
The purpose of the project is to provide the Sister Kenny Research Center with a comprehensive innovation strategy package that will help the Clinical Innovation Teams to develop rehabilitation technology in a way that enhances creativity and innovativeness, yet still efficient and structured.
Problem definition1.2.2
Members of the Clinical Innovation Teams come from different disciplines, such as people from technical or medical background, but also patients and other stakeholders. The clinicians on the Clinical Innovation Teams will work part time in the Research Center and will be scheduled with patients or other activities the remaining time. The teams may include individuals with no previous experience of development projects and people with experience from different kinds of development project models.
Goal definition1.2.3
Develop, implement and evaluate a comprehensive innovation strategy package for the Sister Kenny Research Center. The strategy package should include a guide to innovation projects for the Clinical Innovation Teams and recommendations to management of how to best provide the structure and resources needed for innovation projects to be successfully conducted.
The guidelines should focus on the innovation process including prototype development and testing. It should include practical steps, as well as team dynamics tools and recommendations of necessary resources. In addition, the work model should provide an overview of the whole process stretching from the research on improvement possibilities in the own work to a working prototype ready to be targeted to investors for a future commercialization process.
Project delimitations1.2.4
The project stretches from September 12th to February 24th, and specifically
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focuses on the field of medical technology. The work model briefly addresses elements of patent process, marketing, manufacturing and long term evaluation, but the depth of the study and emphasis of work model is on user research, innovative work, prototype building and evaluation.
Report structure1.3 This report consists of nine chapters (Figure 3).
1. Introduction2. Theory
3. Method4. Empiric results
5. Project outcome6. Discussion
7. Conclusions
8. Recommendations
Report Structure - Chapter Overview
1 3 5 72 4 6 8
Figure 3: Report chapter overview.
Introduction1. – presents background information about the company and thesis project.
Theory2. – presents some of the most known theories in the field and gives an introduction to previous research.
Method3. – explains the methods used when conducting this thesis project.
Empiric results4. – presents the results from the background studies conducted as part of the thesis project.
Project outcome5. – describes the Sister Kenny Research Center Innovation Handbook (Lund, 2009), Design Process and Recommendations Report that are the outcome of the thesis project.
Discussion6. – presents the analysis of the results and outcome and discussion of the thesis project.
Conclusions7. – addresses whether the goal and purpose of the project are met.
Recommendations8. – presents ideas for implementation and future projects.
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“A well-defined development process is beneficial for the quality assurance, coordination of project activities, planning and scheduling of team members’ time”
Theory2. This chapter gives an introduction to the field of structured design, innovation processes and creativity. The theory presented here has served as the foundation for the thesis project.
Structured design processes2.1 The number of design processes available is vast and each new setting for designing calls for specific changes and adaptations to be made. This chapter presents an overview of the most common models, and the impact a structured design process can have on a design project.
Why should we use a structured process?1.
The design of products and services is a fuzzy process with lots of uncertainties and ambiguous input (Dym, Agogino, Eris, Frey & Leifer, 2005). Often there are no clear answers, but success is rather determined
by subjective user evaluations and, in applicable cases, sales numbers (Ulwick, 2005). The human mind strives to find clear answers, and therefore feels uncomfortable when faced with the nature of a design project. A structured design process can help overcome those uncertainties and provide stability to enable the members of a design team to continuously work towards a defined goal.
There are many different design processes available and, in addition, a vast number of variations exist, as well as the use unstructured irrational processes. For a team to be able to work well together they should agree on a common way of working that contains preset goals, milestones and communication structures. A well-defined development process is beneficial for the quality assurance, coordination of project activities, planning and scheduling of team members’ time, management and improvement identification (Ulrich and Eppinger, 2008).
The most common design processes2.1.2
Some of the product development processes that have become most
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recognized over the years are Waterfall model (Royce, 1970), Stage-gate model (Cooper & Kleinschmidt, 2001) and Verein Deutscher Ingenieure 2221 model (VDI). Service design models mainly are adaptations of product development models, such as the Stage-gate model mentioned above. Software development models that have become recognized are Agile software development (Cohen, Lindvall & Costa, 2004), Scrum (Takeuchi & Nonaka, 1986), Rational Unified Process (Jacobsson, Booch & Rumbaugh, 1999).
Generic development process
In an attempt to identify commons elements for product development processes Ulrich and Eppinger (Ulrich et al, 2008) presented a generic product development process consisting of six phases; planning, concept development, system-level design, detail design, testing and refinement and production ramp-up (Figure 4). In general, most development models share these basic characteristics and mainly differ in how iterative they are.
Figure 4: A generic design process. Source: Ulrich & Eppinger, 2008.
User-centered and participatory design
The most fundamental of user-centered design can be summarized by saying that a product is good if the user says so. The elements of long-term use and user satisfaction however also apply and can be summarized in the term useworthiness, coined by Håkan Eftring. The term useworthiness houses utility, usability and the user’s high-priority needs (Eftring, 1999). This approached to user-centered design is shared by Sanders who writes that the products of the future will need to meet the consumers’ needs from three perspectives; usefulness, usability, and desirability (Sanders & Stappers, 2008). Sanders describes that this is best done by engaging in participatory design, that is including the users on the design team developing artifacts alongside with the designers. Participatory design also means including other stakeholders, such as purchasers, service representatives, manufacturers, retailers, market strategists and human factors engineers.
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“To be able to use a design process we need to know about creativity tools, documentation regulations, communication structure, prototyping and other project activities that are part of the day-to-day work”
Translating design processes to work structure
Generic models give little support in actual design projects and normally the intrinsic steps need to be specified and adapted to the conditions of the project to be useful. To be able to use a design process we need to know about creativity tools, documentation regulations, communication structure, prototyping and other project activities that are part of the day-to-day work.
Design for a clinical setting2.1.3
When developing products in, and for, a clinical environment in U.S. a number of regulations apply. Testing with patients as end-users most often calls for a clinical trial to be set up and the identity of test subjects to
be strictly protected according to guidelines and rules.
The U.S. Food and Drug Administration (FDA) is responsible for supervising the safety of, among other things, drugs and medical devices. FDA oversees the manufacturing, performance and safety of medical devices and is responsible for their pre-market approval. (FDA, webpage)
All clinical trials must be approved by a local Institutional Review Board (IRB), consisting of scientists, doctors and consumers. The IRB monitors and review all clinical trial at a research institution to comply with federal regulations. (IRB, webpage)
On the American market patient confidentiality and individually identifiable health care information are protected by the Health and Insurance Portability and Accountability Act (HIPAA). This means that anyone who conducts research in a hospital setting must have authority under the HIPAA Privacy Rule to use or disclose patient data in their research. (HIPAA, webpage)
All these aspects complicate user-centered design for a clinical setting, and may make the process of user testing time-consuming.
Team psychology and management2.2 There have been many attempts to map out what makes a team successful
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and to decipher the secrets behind “ingenious” designers (Badke-Schaub, 2007), (Amabile, 1993). There are also several publications stating that they have identified what to strive for in order to gain an organizational climate where innovation flourishes (Ekvall, 1996), (Olsson, 2009) and (Kelley, Littman & Peters, 2001). Some of those findings are summarized below.
Characteristics of successful design teams2.2.1
Some factors of success can be identified in the literature addressing organizational climates and successful teams. The book Innovationsförmåga mentions user understanding, resources, a risk-taking organization, knowledge transfer, a balance between creativity and structure, together with management as the critical factors in creating an innovative company (Norell Bergendahl, 2009). Others stress the importance of recruiting the right staff with the right attitudes towards innovation (Stauffer, 2004), or having the right mix of people (Kelley & Littman, 2005).
According to the Fundamental Interpersonal Relations Orientation model (FIRO) (Schutz, 1958) teams go through three processes of getting to know each other; inclusion phase, control phase and affection phase (Figure 5).
INCLUSIONPHASE
CONTROLPHASE
AFFECTIONPHASE
RESTINGPHASE
RESTINGPHASE
If a new member is included, the process starts over, at the inclusion phase. The process of getting through
all the steps is usually faster in those cases.
Figure 5: The phases a new team experiences, according to the FIRO model. Own illustration. Illustration is the author’s own intepretation of Schutz’ FIRO model.
The three FIRO phases have the following characteristics:
Phase 1: Inclusion. Group members are polite and people often keep a low profile in the first phase of forming a new group. The group needs structure and guidance from the project leader.
Phase 2: Control. People struggle to find their role in the group and conflicts might arise. In this phase it is important to feel that ones competence is
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“Team members should have the right to choose how to perform a certain task, which enhances the perception of self-control, motivation and ultimately creativity”
appreciated and important for the project. It is also important that possible conflicts are brought to the surface and dealt with.
Phase 3: Affection. The group is strong and fights for each other and for the result. The group members dare to show both their strong and weak sides. In this phase the group needs a framework to follow, but too much guidance or control might be harmful.
In innovation projects, due the need for an open environment where everybody dares to air their opinions, creating a good team environment is especially critical. Teams with a high level of creativity, are teams where the members have the confidence to share and debate ideas (Fast Company Magazine, webpage), and where playfulness and humor are well regarded (Ekvall, 1996).
On a more task-based level creativity is enhanced when people are challenged to an extent they can handle (Ekvall, 1996). Team members should have the right to choose how to perform a certain task, which enhances the perception of self-control, motivation and ultimately creativity (Badke-Schaub, 2007).
Interdisciplinary teams2.2.2
Interdisciplinary teams are teams consisting of several disciplines working together on one problem. Teams can consist of for instance engineers, designers, marketing personnel, manufacturers, as well as users, purchasers and others that will benefit from a joint design process (Sanders & Stappers, 2008). Terms commonly used as interchangeable with interdisciplinary teams are multidisciplinary teams and cross-functional teams. Other view those teams as teams consisting of several disciplines, but where different team members manage tasks only in their own field of expertise, whereas interdisciplinary teams approach the problem in an integrated manner. The latter definition has been chosen for this project.
Interdisciplinary teams have been emphasized as the future of designing and a stimulus for both innovativeness and product quality (Adamsson, 2007). These kinds of teams however encounter challenges that can overshadow the design process if not attended to adequately. It can be for example the clash between relying on solid data contra having visions of future success, as in the case with marketing people and designers (Martin, 2007). When
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“The product may also be forced upon the user in a situation where she is especially vulnerable, unable to speak, or in other way limited in expressing her own will”
marrying the engineering discipline with the clinical area problems like the lack of a common language for communication of requirements, or an insufficient understanding for the real-life situation of the clinicians may cause problems (Jalote-Parmar & Badke-Schaub, 2008).
Integrative mechanisms
To gain a more efficient way of working and a better understanding for the team members in an interdisciplinary team a number of integrative mechanisms may be used. Primarily, people working on the same project should be located close to each other in the physical office (Browning, 1998). Teambuilding and the creation of social events where people from different teams can interact and widen their networks, may increase integration (Dougherty, 1992), and may also have a positive effect on innovativeness (Kelley et al, 2001). The organizational structure may also affect the level of integration between disciplines. Structured design processes, common guidelines, and phase-review meetings are designed to support interdisciplinary integration (Adamsson, 2007).
User involvement
In the case with medical devices, the end-user often has not actively chosen the specific product. The product may also be forced upon the user in a situation where she is especially vulnerable, unable to speak, or in other way limited in expressing her own will. Furthermore users of medical device may have physical or cognitive impairments that limit them in the use of the product. These factors put extra stress on the process of designing such products, and to make sure that the user needs are central throughout the process. The U.S. Food and Drug Administration (FDA) recommends the use of Human Factors, a type of user-centered design, in the design of medical devices (Sawyer, 1997). The International Organization for Standardization (ISO) recommends a user-centered approach to designing of interactive systems (ISO 13407:1999). Some argue that we should take it a step further and include the users on the design teams, as a shift from user-centered design to participatory design (Sanders, 2002). (Figure 6)
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Figure 6: An illustration describing the difference between user-centered and participatory design. U stands for User, R for Researcher and D for
Designer. Source: Sanders & Stappers, 2008.
Creativity tools2.3 Creativity is something we all can learn and it is a process that demands the right work environment. Creativity is for instance aided by having lots of time to come up with ideas and few restrictions and external threats to the
project. Innovation is sometimes assumed work the same way as creativity, but the fact is innovation is actually aided by the very things that hampers creativity, such as external demands and perceived threats (West, 2002). This chapter will concentrate on how we can help the creativity process.
The purpose of creativity tools2.3.1
Creativity can be defined as a human process that enables a person to think outside the pre-assumed scope of what would be expected (McKenna, 2000), and the purpose of creativity tools is to help us reach outside that pre-assumed scope. Creativity is not an activity granted a limited group of people born with a creative mind, but is an activity we all can learn (Badke-Schaub, 2007), (Amabile, 1993). Challenging the learned way of solving problems is well captured in the expression “path of most resistance” by the company Systematic Inventive Thinking (SIT), which is a counter-intuitive approach to innovation (Goldenberg, Horowitz & Levav, 2003). SIT provides a full set of tools to problem solving where the designer is
“Creative behaviour is not the predominant thinking style of human beings; there must be a challenge which forces creativity” (Badke-Schaub, 2007)
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“Creativity tools force us to explore the unexplored or change our mindsets, and trick us into overcoming our mental blocks or fear of speaking in a group setting.”
forced outside her normal thinking patterns and in that way comes up with problems rarely thought of in problem solving processes not making use of creativity tools. Even if not explicitly stated, most creativity tools are built upon the idea of breaking thought patterns and forcing us to take the “path of most resistance”. They force us to explore the unexplored or change our mindsets, and trick us into overcoming our mental blocks or fear of speaking in a group setting.
Function follows form or form follows function
A distinction that can be made between creativity tools is whether they encourage innovation of new devices, or new use of existing devices. A creativity tool using the “form follows function” philosophy, such as brainstorming (Osborn, 1963) based on product requirements, or cultural probes (Gaver, Dunne & Pacenti, 1999), will encourage us to analyze user needs and consequently develop a solution that fits that need. In contrast, a creativity tool using the “function follows form” philosophy, such as Scamper (Eberle, 1997) and SIT (Goldenberg et al, 2003), will mainly encourage us to redesign or find a new use for an existing product.
Categories of creativity tools2.3.2
Creativity may be a part of the whole design process or concentrated to an idea generation phase. Tools helping us to gather data about the user or to evaluate concepts help us to come up with new ideas and to improve the concepts we have invented. Therefore, tools from the research phase, idea generation phase and evaluation phase are all listed as creativity tools in this thesis.
Research tools
Research tools help us gain a better understanding for the problem at hand and the future context of the product we are designing. User observations, interviews, focus groups (Stewart & Shamdasani, 1990) and cultural probes (Gaver et al, 1999) all give us a better understanding of the end-user, her needs, desires, limitations and wishes. Observing the end-user, and visiting their home environment may lead to ideas we would never have thought of in a desk-based research study.
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Studying the context (Stappers & Sanders, 2003) and systematically dissect the processes and services we provide may help us get ideas of new, better ways of working. Tools like Lean (Liker, 2003), Six Sigma (Harry & Schroeder, 1999), Persona (Cooper, 1999) and Scenario building (Bonnie & Nardi, 1992) helps us analyze the intrinsic parts of a process individually which may lead us to new thought patterns and solutions.
Patent searches and product benchmarking teach us how other companies have solved the problems we encounter. Disassembling competitors’ products will give us ideas for solutions to technical problems, and “disassembling” their design processes and studying their customer interaction will teach us about how we can improve our own ways of working.
Idea generation tools
This category of creativity tools includes the well-known Brainstorming tool (Osborn, 1963) that, by encouraging quantity and prohibiting critique of ideas help us get our held back ideas on to the table. Methods like Six thinking hats (De Bono, 1985), Scamper (Eberle, 1997) and TRIZ (Altshuller, Clarke, Shulyak & Lerner, 2005), helps us look at the problem in a new way by forcing connections or changing our mindset.
Evaluation tools
By systematically evaluating our design choices we can adapt the design to better fit the user, but also come up with new ideas to solutions of challenges at a component level. User testing tools such as Task Analysis (Annett & Duncan, 1967), Think aloud (Ericsson & Simon, 1993), Role-play and Scenario building (Bonnie et al, 1992) give us access to the user opinions about the product and thus tells us where to spend most effort in improving the design. Physical testing and computer simulations tells us what parts of our product that are most likely to fail, which enables us to focus our creative efforts on the problematic areas.
The creative workplace2.4 When a competent team is gathered, the design process is in place, and all members are well trained in the available tools we have a good starting point for innovation. The critical now is to make sure the physical environment does not hinder creativity.
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“An innovative environment should provide creative spaces where employees can meet to test new ideas with each other”
The physical work environment2.4.1
Tom Kelly from the American design firm IDEO has strong beliefs in what creates a good work experience, which he shares in the book The Art of Innovation Kelley et al, 2001). First of all, the creative workspace should not hinder innovation. The availability of wall-space insensitive to getting sketches taped on the wallpaper is a first step towards making full use of the office space in the innovation process. Furthermore they state that “when it comes to office space, the fewer rules the better”. Tom Kelley encourages movable modules, and allowing the employees to design their own workspace. The ongoing projects serve as the base for all space planning and a crucial goal is to “make it easy to hold quick spontaneous local meetings”. An innovative environment should provide creative spaces where employees can meet to test new ideas with each other (Norell Bergendahl, 2009).
It is important that the area assigned to innovation work has a relaxed atmosphere. There should be room for spontaneity and play, therefore facilities like high-end conference rooms are poorly suited as innovation workspace.
Resources to help innovation2.4.2
An important aspect of successful design projects is having the right resources available. Resources include physical resources such as office space, books and video equipment, as well as less tangible resources like time for idea generation and the right competence among the team members (Norell Bergendahl, 2009). Other examples of resources that may have a positive impact on the innovation process are prototype lab and materials or other possibilities to quickly test ideas by the means of prototypes, the adequate software tools, users willing to participate in tests of prototypes and products (Kelley et al, 2001). On a project infrastructure level funding and room for creative work is important, and in some parts of the process it is important to set the organization streamlining apart in favor for creativity to flourish (Dekker, Nyce & Hoffman, 2003).
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Method3. This chapter describes the methods used to gather empirical data, and gives an overview of the work process of the thesis itself. The literature study gathered data for the theoretical framework of the project, whereas the interview study and pilot project gathered empirical data specific for the setting at the Sister Kenny Research Center.
Project protocol3.1
Thesis work model3.1.1
The thesis project followed an iterative model where the different deliverables have continuously grown and evolved over time. Prototypes of the handbook and work model were made early on and elements has been added and removed as the needs and scope of the project became clearer. (Figure 7 to the right)
Throughout the project working visually has been a central aspect. For example, the work model continuously grew as part of a large post-it note flowchart on the wall. (Figure 8) The content of the chapters of the handbook was early on described briefly in a three ring binder, creating a document prototype. This way of working visually served as a communication aid with the different stakeholders of the project and provided a project overview.
Figure 8: Picture of the post-it note flowchart used to map out the design process for the Sister Kenny Research Center.
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PHASE 1Litearature studyInterview study
PHASE 2Handbook draft
Case study
PHASE 3Finalization ofthe Handbook
Outcome
Process
Tools
Resources
PHASE 1Litearature studyInterview study
Outcome
Process
Tools
Resources
PHASE 2Handbook draft
Case study
Outcome
Process
Tools
Resources
PHASE 3Finalization ofthe Handbook
Outcome
Process
Tools
Resources
Figure 7: An illustration of the design process of the thesis project showing how the project has evolved in an iterative way. Phase 1: Analysis of the literature in the field and a study of generic design
processes. Phase 2: Draft of a design process for the setting at the Sister Kenny Research Center, and a first draft of the Innovation Handbook.
Phase 3: Final specification of the process, tools, resources and outcome that are specific for the Sister Kenny Research Center. Final version of
the Innovation Handbook
Innovation Handbook: First draft
Innovation Handbook: Final version
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Furthermore the process has been user-centered and the needs of researchers at the Sister Kenny Research Center have been a central part throughout the project. The insights gained from spending time shadowing and interviewing clinicians formed the foundation of the requirements set up for the Innovation Handbook and the Design Process.
Project phases3.1.2
The following subchapters describe the three different phases of the project.
Phase one
The first phase of the project spanned from the arrival in US in September to the end of October, and focused on gathering information about the thesis topic, the Sister Kenny Rehabilitation Institute and the Sister Kenny Research Center. This was done through a literature research, an interview study and by observing the every day work of the clinicians. Meetings were attended and nurses, and physical therapist were “shadowed” for some hours. Attending seminars and workshops treating topics like creativity tools and the design of medical technology were also part of the research phase.
Phase two
Phase two started in November and ended in February. Drafts of the handbook and work model were developed and tested in a pilot project. Phase two also included workshops where tools and methods in the handbook were applied in different contexts, which provided opportunities to test its feasibility.
Phase three
Phase three started in the middle of December and ran to the end of the project, and treated the finalization of the handbook, work model and a report with strategic recommendations to the management at the Sister Kenny Research Center.
Literature study3.2 The literature study included research on design processes, group psychology, creative workplaces, creativity tools and interdisciplinary
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teams. About fifty articles, thesis reports, dissertations and nine books were reviewed for the project.
Interview study3.3
Semi structured3.3.1
A semi-structured interview method was chosen to be able to adapt the questions to the interviewee’s background and role in future development projects at the Sister Kenny Research Center. For the interviewees employed at Sister Kenny Rehabilitation Institute the interview protocol included questions about expectations of the Sister Kenny Research Center, attitudes towards research and technology, ideas of how to recruit clinicians to research projects, and issues concerning research projects and administration. For the interviewees not employed at the Sister Kenny Rehabilitation Institute, the interview protocol was individually designed, mainly focusing on innovation and designing in interdisciplinary teams.
The results of the interview study were of qualitative nature and were summarized in a report. The answers were divided into the following categories; Research experience at the Sister Kenny Rehabilitation Institute, Attitudes towards research, The future of the research center, and Practicalities.
Subjects3.3.2
The interviewees were mainly employees at the Sister Kenny Rehabilitation Institute, such as occupational therapists, physical therapists, nurses, physicians and administrative personnel. Interviewees not employed at the Sister Kenny Rehabilitation Institute were individuals with a background either in creativity and innovation theory or development of medical technology. All together thirteen individuals were interviewed.
Pilot project3.4 The pilot project was a project dealing with the development of a graphical user interface for a device with the purpose of assessing fall risk in patients. The purpose of the study was to assess the feasibility
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of the design process and some of the tools described in the handbook. The project ran over a period of five weeks and the Clinical Innovation Team consisted of an occupational therapist, a nurse, a physical therapist and an engineering student. The clinicians were recruited from the Sister Kenny Rehabilitation Institute and the engineering student was recruited from the Royal Institute of Technology (KTH) in Stockholm, Sweden, and had a background in mechatronics. All participants were selected as specifically suited to participate. The author of this thesis project acted as a facilitator to the process. The project comprised all steps in the design process from project initiation to working prototype. The time limit was determined by the time the engineering student spent at the Sister Kenny Research Center. The clinicians each spent in total six hours, whereas the engineering student worked full-time on the project. The pilot project also comprised a subjective qualitative evaluation of the participants view on the project. (Figure 9)
Week 1 Week 2 Week 3 Week 4 Week 5
Team BuildingProblem DefinitionProduct Requirements Document
Idea generationConcepts evaluationConcept selection
Testing and evaluationof final concept
Full Clinical Innovation Team
EngineeringStudent
Presentation offinal conceptReport
Implementation offeedback fromevaluation
Sublevel developmentProgrammingPrototyping concept
Forming concepts from idea
Research on topicReview of existing software
Figure 9: Illustration of the structure of the pilot project.
Evaluation criteria for design process3.5 One selection criteria has been central for the choice of design process structure in the handbook, as well as the creativity tools enclosed; the underlying design process and creativity tools had to be well known and commonly used. The design process and creativity tools chosen have thereafter been adapted to fit the circumstances at the Sister Kenny Research Center and the format of the handbook.
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Empiric results4. This chapter presents the results from the interview study and the pilot project. The results from these studies served as a base for the synthesis part of this study; creating the innovation strategy package.
Interview study4.1 The interview study included in total thirteen interviewees from different backgrounds, most of them employees at the Sister Kenny Rehabilitation Institute. The interview protocol can be found as an appendix. (Appendix A) The most important findings are presented below. The Sister Kenny Research Center should:
Offer a mix of large and small projects, alternatively large projects with smaller subprojects. Many novices to research want to start at a small scale.
Provide a well-functioning virtual meeting area and videoconference facilities to include people at other hospitals and enable collaborations with partners in other countries.
Provide a work model and a clear structure to follow when conducting research at the Sister Kenny Research Center. Guidelines have been missing prior to the existence of the Sister Kenny Research Center, which has possibly been keeping people from doing research.
Develop long term plans and strategies for research conducted at the Sister Kenny Research Center.
Provide clear paths in to research projects and encourage clinicians to join and come up with own suggestions for research. “Headhunt” project participants who do not dare to step up themselves.
Ensure that results from activities at the research center are quickly noticeable throughout the Sister Kenny Rehabilitation Institute to spread information about the Sister Kenny Research Center and spur interest for research, as well as creating a good attitude towards the Sister Kenny Research Center.
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Develop a database over patients interested in volunteering for clinical studies.
The outcome of the interview study was incorporated in the development of the Sister Kenny Research Center Design Process, the Innovation Handbook and the Recommendations report, all part of the outcome of the thesis.
Pilot project4.2 The pilot project was a project dealing with the development of a graphical user interface in an interdisciplinary Clinical Innovation Team. The project comprised all steps in the design process from project initiation to working prototype, concentrated into a period of five weeks. The meetings with the Clinical Innovation Team were lead by a facilitator.
Project phases4.2.1
The following part describes the outlines of the project.
Project initiation phase
As a part of the team building and research process all members tested the device. After that a short introduction to the design process was given together with the time plan for each step. Lastly, the team defined the problem by using tools in the handbook.
Conceptual phase
The problem definition and delimitations were reviewed, and the group members shared reflections and ideas that sprung from the previous workshop. A vast number of ideas of solutions were generated.
The engineering student used the ideas as a foundation for concept generation. At the third meeting in a mixed group five concepts were presented and the clinicians gave their view of each concept from the view of an end-user. The input from the clinicians led to a combination of concepts to be selected as the winning solution.
System development phase
The engineering student developed a working prototype of the final
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“I want to communicate the results to the patient, in a way I think he can handle”
interface concept. The fourth and last time the group met this prototype was evaluated using tools described in the handbook. No evaluation was done with patients.
The impact of having an interdisciplinary team4.2.2
The result of the project was an interface that the clinicians on the Clinical Innovation Team considered easy to use. During the scope of the project the interdisciplinary nature of the team proved to have a significant impact on the result.
Comments like “if it takes more than five minutes I won’t do it”, and “there’s not much room for new devices. One screen is a must” helped defining the problem and delimitations of the project. In the idea generation phase input like “An instruction video is good. Especially for research purposes, since you tend to deviate from the protocol”, and “I want to communicate the results to the patient, in a way I think he can handle” influenced the end-result significantly.
The clinicians were part of the idea generation and concept generation in a more extensive way than if they would have solely been consulted for evaluation purposes. Ideas like “Show the results as a time, written in green text for ‘no fall risk’ and in red for ‘fall risk’”, and “If the study requires that I log every patient, don’t make it possible to skip registering patient data” are examples of input from clinicians that became part of the final solution.
In the evaluation phase the clinicians acted both end-users and team members by giving their opinion on the system, such as “It’s user friendly” and “I don’t care about the looks and graphics as long as it’s easy to use”, but also coming with suggestions for improvements such as “Pressing ‘start’ is better at most steps than if the system starts automatically”.
The team members’ evaluation4.2.3
The participants were asked to answer a few questions about the project (Appendix B) some time after the project was finalized. The questions addressed whether their thoughts about research and development projects had changed with their participation in the project, how they felt their knowledge and experience was utilized, how they experienced the shift
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“It is very important to have input from each of the different clinical areas, because we are not the same and we have different goals for our patients”
from clinical work to research and how they liked the design process. The participants were also encouraged to share their ideas about future development projects. Texts written within quotation marks are the
participants’ own words as written in the evaluation. Words within parenthesis are added to facilitate the understanding of the evaluations comments.
The evaluation gave an overall positive view of the project. Comments like, “I feel we all collaborated well. If an idea was thrown out on the table we were all able to add on to that idea to make the
final project. It was definitely a team effort”, indicates that the participants, irrespective of their background, felt like they were a part of the process.
Attitudes towards research
In the interview study several clinicians working at the Sister Kenny Rehabilitation Institute testified that they felt intimidated by research, something that participants in this project also felt. However, participating in this project made them feel more comfortable and open to participate in future projects. The participants found the project interesting and said that it was “interesting to (see) how it can be helpful in nurses’ practice” and that it was “nice to think about something different than (patient) treatment”.
Interdisciplinary setting
This project combined both two technical disciplines (design engineering and mechatronics) and three clinical disciplines (occupational therapy, physical therapy and nursing). This was seen as a good thing by the participants who stated that it is “very important to have input from each of the different clinical areas, because we are not the same and have different goals for our patients”. Several statements in the evaluation indicate that the group work went well. The collaboration contained little friction and the participants “took each others ideas without judging” and “no one wanted to overpower the other”. The participants felt their knowledge was utilized and taken into account.
The user’s perspective the clinicians brought to the table was appreciated as can be read from statements like “(it is) beneficial to be working with the future users of the product early in the development process”. The interdisciplinary setting does not come without friction though and
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it was said that “creating trust and understanding is one of the major challenges”.
Advice for future design projects
The participant in the pilot project also gave useful recommendation for future projects. More time to “bond and create trust within the team” and having an even stricter process to follow were mentioned. Time to be able to prepare for the project and to have a clear picture of what one’s own role in the project will be were other suggestions of improvement.
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Project outcome5. This chapter presents the synthesis part of the project and how the analysis of the current situation at the Sister Kenny Research Center together with the background information gained in the literature study was shaped into a comprehensive innovation strategy package.
Innovation strategy package5.1 The outcome of this thesis project is a comprehensive innovation strategy package with a set of tools to facilitate the innovation process at the Sister Kenny Research Center. The strategy package consists of three interlinked parts:
A design process adapted to the work environment at the Sister Kenny Research Center. The design process is visualized in the work model illustration (Appendix C).
An Innovation Handbook describing the design process to the Clinical Innovation Teams. The Innovation Handbook contains tools to use in each step in the design process.
A report with recommendations to the management at the Sister Kenny Research Center of how to best support design projects. This report also includes recommendations of how to best use the physical workspace at the Sister Kenny Research Center. (Appendix D)
These parts are further described below.
Design Process5.2 The design process developed for the Sister Kenny Research Center is built on a generic Stage-gate model, adapted to the conditions under which research work will be conducted. The design process consists of mainly three phases; Project foundation Phase, Conceptual Phase and Design Phase (Figure 10). The Design Phase is different for products, software, services and work methods. Each of these three phases consist of a number
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of steps, which in turn includes a set of creativity tools to facilitate the design work. More information about this can be found in the chapter 5.3 Innovation Handbook.
PROBLEM ANDGOAL DEFINITION
RESEARCHPHASE
TEAMBUILDING
PROJECTINITIATION STOP
STAGE-GATE
CONCEPTEVALUATION
CONCEPTGENERATION
IDEAGENERATION STOP
STAGE-GATE
PROJECTCLOSURE
PROTOTYPEBUILDING
TEST ANDEVALUATION
COMPLETESYSTEM DESIGN
SUB-LEVELSYSTEM DESIGN STOP
STAGE-GATE
EVALUATIONSMALL-SCALE
IMPLEMENTATIONDETAILED
DESCRIPTION STOPSTAGE-GATE
Project Foundation Phase
Conceptual Phase
Product and Software Design PhaseTrack one:
Service and Work Method Design PhaseTrack two:
Phase Iteration
Figure 10: The Design Process developed for Sister Kenny Research Center.
The design process is visualized in a graphic work model illustration. It shows how each step of the process is dependent on having the proper resources, people and support, and what outcome to expect in the different steps. The work model illustration also shows what pitfalls lie in each step and how the product and work process will suffer if the step is not executed properly.
The full work model illustration can be viewed in Appendix C and is presented as an illustration of the handbook chapters below.
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“With no more preparation than the time it takes to read the pages of a certain phase in the handbook, the Clinical Innovation Teams will be able to work creatively in design projects”
Innovation Handbook5.3 The Sister Kenny Research Center Innovation Handbook is a step-by-step guide to designing in interdisciplinary teams in a clinical setting. Over approximately eighty pages the outlines of the design process adapted to
the context at the Sister Kenny Research Center, is presented. The step-by-step structure enables the Clinical Innovation Teams to quickly get started with development of rehabilitation technology even without previous experience from innovation work. The clinical setting together with structured methods will lead to novel innovations with the ultimate goal of improving the lives of patients.
The goal of the handbook is that “With no more preparation than the time it takes to read the pages of a certain phase in the handbook, the Clinical Innovation Teams will be able to work creatively in design projects”.
The Innovation Handbook is not included in this report.
Step-by-step guide to innovation projects5.3.1
Each step of the design process covers two to four pages of the handbook, where the purpose and goal of the steps are described, together with a presentation of a number of tools that can help achieve those goals. Finally each chapter is concluded with a few questions of reflective nature. (Figure 11 to the right)
The handbook has two tracks covering on one hand the development of products and software and on the other hand the development of services and work methods. The two tracks follow the same structure up to concept choice, and are thereafter described separately. The handbook strives to give examples for all possible designs and the process is kept generic enough to suit a wide range of development projects.
Handbook chapters5.3.2
The following part of the report describes in short each chapter in the handbook, in the order they appear. The pages in the handbook that do not refer to the actual steps of the design process are explained in the chapter 5.3.3 Orange Pages.
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Introductionto project phasePhase goals
Symbol marking thatthis step ends in a stage-gate
Methods and creativity tools Reflective questions
Figure 11: A picture of the layout of the Innovation Handbook chapters.
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Introduction
The introduction explains the purpose of the handbook, recommendations of how to work with the chapters of the handbook. This chapter also defines a few terms that are central throughout the document, such as product, project owner, Clinical Innovation Team and project leader. Furthermore the introduction chapter shows an overview of the design process and it’s stage-gate nature.
Project initiation
This chapter suggests a few methods of how to analyze clinical procedures to find areas of improvement. This step may be omitted in projects where the problem is already loosely defined. This and the following three chapters are illustrated in Figure 12 to the right.
Building the team
The team building chapter gives an introduction to the group and gives a few examples of exercises that can be used to create a well-functioning team. The teams are encouraged to use the problem at hand in the team building process. This may help create a better understanding for the different disciplines in the team.
Defining the problem and goal
This chapter treats the process of defining the framework of the project, such as problem definition, goal definition, purpose and project delimitations. These documents serve as the project’s foundation for the latter stages of the process.
Research phase
This chapter explains a number of tools to conduct research, such as user observations, cultural probes, scenario techniques and context mapping. The research phase ends with a stage-gate where the team should present the framework of the project and a summary of the research phase to the stakeholders.
DESIGNPROCESS
RESULTS
INFRASTRUCTURE
PEOPLE
PROBLEM ANDGOAL DEFINITION
RESEARCHPHASE
TEAMBUILDING
PROJECTINITIATION STOP
STAGE-GATE
PROBLEMDEFINITION
REQUIREMENTSPECIFICATION
RISKANALYSIS
FUNDING LIBRARY/ACCESSTO JOURNALS
ACCESS TOSUBJECTS FOR
RESEARCH
CAMERA ANDAUDIO/VIDEORECORDER
INTELLECTUALPROPERTY
CONTRACTS
ACCESS TOPHYSICAL
WORK SPACE
PROJECTOWNER
CIT CIT CIT PROJECTOWNER
PROJECT LEADER OR
FACILITATOR
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DESIGNPROCESSDESIGN
RESULTS
INFRASTRUCTURE
PEOPLE
PROBLEM ANDGOAL DEFINITION
RESEARCHPHASE
TEAMBUILDING
PROJECTINITIATION STOP
STAGE-GATE
PROBLEMDEFINITION
REQUIREMENTSPECIFICATION
RISKANALYSIS
FUNDING LIBRARY/ACCESSTO JOURNALS
ACCESS TOSUBJECTS FOR
RESEARCH
CAMERA ANDAUDIO/VIDEORECORDER
INTELLECTUALPROPERTY
CONTRACTS
ACCESS TOPHYSICAL
WORK SPACE
PROJECTOWNER
CIT CIT CIT PROJECTOWNER
PROJECT LEADER OR
FACILITATOR
Figure 12: The work model illustration for phase 1; Project Foundation Phase
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Idea generation
The fuzzy process of idea generation is explained and the playfulness of this phase is underlined. A set of tools is provided, including brainstorming, six thinking hats and attributes listing. This and the two following chapters are illustrated in Figure 13 to the right
From ideas to concepts
This chapter explains the difference behind ideas and concepts and provides a step-by-step guide of how work to get from one to the other. It also stresses the importance of sketching and in other ways visualize concepts to better be able to communicate them to others.
Concept evaluation and selection
This phase leads up to the second stage-gate in the design process. The different steps of evaluating the concepts and converging towards a final selection are explained in this chapter. The importance of a good requirements specification and objective evaluation is emphasized.
After the concept evaluation and selection the chapters of the handbook differ depending on if the project treats development of, on one hand, products or software, and on the other hand service or work methods. The following four chapter summaries refer to the process of developing products or software, whereas the last two deal with service and work method design.
DESIGNPROCESS
RESULTS
INFRASTRUCTURE
PEOPLE
CONCEPTEVALUATION
CONCEPTGENERATION
IDEAGENERATION STOP
STAGE-GATE
OBJECTIVECONCEPT
SCREENING
POSSIBLE PATENTAPPLICATION
CHOICE OFFINAL CONCEPT
CHOICE OF2-5 CONCEPTS
LARGE NUMBEROF IDEAS
IDEATIME
PROTOTYPEMATERIALS
IDEATIME
STORAGE SPACEFOR PROTOTYPES
AND SKETCHES
CITPROJECT LEADER OR
FACILITATOR
CIT CIT PROJECTOWNER
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Figure 13: The work model illustration for phase 2; Conceptual Phase.
DESIGNPROCESSDESIGN
RESULTS
INFRASTRUCTURE
PEOPLE
CONCEPTEVALUATION
CONCEPTGENERATION
IDEAGENERATION STOP
STAGE-GATE
OBJECTIVECONCEPT
SCREENING
POSSIBLE PATENTAPPLICATION
CHOICE OFFINAL CONCEPT
CHOICE OF2-5 CONCEPTS
LARGE NUMBEROF IDEAS
IDEATIME
PROTOTYPEMATERIALS
IDEATIME
STORAGE SPACEFOR PROTOTYPES
AND SKETCHES
CITPROJECT LEADER OR
FACILITATOR
CIT CIT PROJECTOWNER
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Sub-level development
The chapter of sub-level development starts by explaining the iterative nature of the system development process. Design for manufacturability and modular design are briefly explained. This and the three following chapters, as well as the project closure chapter are illustrated in Figure 14.
Complete system design
This chapter explains how to go about when joining the part of the sub-level development phase into a functioning system. The ideas of industrial design and robust design are explained.
Prototype building
The prototype chapter recommends a pre-set procedure of how to plan the level of complexity for the prototype and explains the different types of models that can be built. The underlying reason for making several generations of prototypes is explained and the iterative nature of the design model is once more underlined. This chapter also contains a brief introduction to the Sister Kenny Research Center Design Lab and what is are available there.
Product testing
This last step of the system development phase for products and software leads up to the last stage-gate. If the team chooses to work with four stage-gates the team will start over with a second iteration at the sub-system development chapter.
The product testing chapter suggests methods like building analytical models, task analysis, role-play and interviews to test the product at hand.
DESIGNPROCESS
RESULTS
INFRASTRUCTURE
PEOPLE
PROTOTYPEBUILDING
TEST ANDEVALUATION
PROJECTCLOSURE
COMPLETESYSTEM DESIGN
SUB-LEVELSYSTEM DESIGN STOP
STAGE-GATE
FULL-SYSTEMPROTOTYPE
SUB-SYSTEMPROTOTYPES
SUMMARY OFEVALUATION
FUNCTIONPROTOTYPE
PROJECTDOCUMENTATION
FUTURE DESIGNRECOMMENDATIONS
CAD TOOL DESIGN LABACCESS
FUNDING OFPROTOTYPE
MATERIAL
SUBJECTS FORSTUDY
ENGINEER ENGINEER ENGINEER CIT PROJECTOWNER
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Figure 14: The work model illustration for phase 3; Product and Software Design Phase.
DESIGNPROCESSDESIGN
RESULTS
INFRASTRUCTURE
PEOPLE
PROTOTYPEBUILDING
TEST ANDEVALUATION
PROJECTCLOSURE
COMPLETESYSTEM DESIGN
SUB-LEVELSYSTEM DESIGN STOP
STAGE-GATE
FULL-SYSTEMPROTOTYPE
SUB-SYSTEMPROTOTYPES
SUMMARY OFEVALUATION
FUNCTIONPROTOTYPE
PROJECTDOCUMENTATION
FUTURE DESIGNRECOMMENDATIONS
CAD TOOL DESIGN LABACCESS
FUNDING OFPROTOTYPE
MATERIAL
SUBJECTS FORSTUDY
ENGINEER ENGINEER ENGINEER CIT PROJECTOWNER
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Detailed description
This is the first step of the system development phase of the track for service and work method design. It presents methods like storyboards and persona (Cooper, 1999) to facilitate the process of thoroughly mapping the different steps of a new service. This chapter, the following chapter, and the project closure chapter, are illustrated in Figure 15.
Implementation and evaluation
This last step of the system development phase for services and work methods leads up to the last stage-gate. This chapter guides the teams in the process of implementing the new service on a small-scale, and thereafter evaluates the results. Tools like role-play, task analysis (Annett et al, 1967), and interviews are briefly explained. A full-scale implementation plan should be presented at the last stage-gate meeting.
Project closure
The final step of the design process is common for both product and software design, as well as service and work method design. The project closure chapter provides tools to ensure future improvements and knowledge transfer.
The Clinical Innovation Teams are asked to document the process in both an external report aimed at the different stakeholder and an internal report ensuring that valuable experience is passed on to future Clinical Innovation Teams. Furthermore the project should be evaluated and the team members should provide each other feedback on their contribution to the project.
Orange pages5.3.3
Here and there in the Innovation Handbook the reader will find so-called Orange pages that do not represent a step in the design process like the other chapters do. The orange pages provide information on topics that are useful to know in some projects but not others, or address the process of documenting more in depth.
Product requirements document
The instructions of how to write a product requirements documents suggests that the different demands are divided into the two different groups “must requirements” and “should requirements”. Furthermore the
DESIGNPROCESS
RESULTS
INFRASTRUCTURE
PEOPLE
EVALUATION PROJECTCLOSURE
SMALL-SCALEIMPLEMENTATION
DETAILEDDESCRIPTION STOP
STAGE-GATE
FULL-SCALEIMPLEMENTATION
PLAN
SUMMARY OFEVALUATION
SUPPORT FORIMPLEMENTATION
VIDEO AND AUDIOEQUIPMENT
CIT CIT CIT PROJECTOWNER
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Figure 15: The work model illustration for phase 3; Service and Work Model Design Phase.
DESIGNPROCESSDESIGN
RESULTS
INFRASTRUCTURE
PEOPLE
EVALUATION PROJECTCLOSURE
SMALL-SCALEIMPLEMENTATION
DETAILEDDESCRIPTION STOP
STAGE-GATE
FULL-SCALEIMPLEMENTATION
PLAN
SUMMARY OFEVALUATION
SUPPORT FORIMPLEMENTATION
VIDEO AND AUDIOEQUIPMENT
CIT CIT CIT PROJECTOWNER
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teams are encouraged to choose a few key requirements that will serve as the center of attention for the idea generation phase.
Risk analysis
The instructions of how to make a risk analysis suggest a simple version where the risk factor is the product of the risk’s likelihood and severity. This chapter also includes suggestions of how to handle different levels of risk factors.
Visualization
The visualization chapter encourages the reader to use symbols, pictures, sketches and renditions as means of communication. It addresses the effect of visualization in user testing and how it can be used to sell a product idea to an external stakeholder.
Writing a scientific article
This chapter shows a common version of a scientific article layout, its intrinsic chapters, and examples of how to list references. The chapter is written for readers with little or no experience of writing scientific reports and articles.
Setting up a clinical trial
This chapter describes the basics of setting up a clinical trial and aims at clinicians who may be planning to set up their first study, and engineers who are new to the field of clinical trials. It provides an outline of the different steps of the process towards getting a clinical trial approved and introduces the reader to rules and regulations that apply.
Reference resource5.3.4
The handbook serves as an introduction to the language of design projects and some of the terms used in the clinical care that non-clinicians may be totally unfamiliar with. Throughout the handbook some words are found in italic, which means they can be found on www.wikipedia.org (wikipedia, webpage) with an introduction to the term and links to find out more.
Overview 5.3.5
The handbook is presented as an overview and comprehensive document giving an introduction to the field of development projects, but does not claim to provide depth. It encourages, however the team members to
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“The report addresses aspects of workplace design and ideas of how to ensure quality of care and maintain productivity when clinicians engage in research activities”
do further research themselves and gives advice of how to do so by for example suggesting related books to read. The handbook also makes use of the fact that the rehabilitation care can be found close by at the Sister Kenny Rehabilitation Institute.
Recommendations report5.4
Document for the management5.4.1
This ten pages report contains recommendations to the management on how to create a work environment where innovation can happen and where creative ideas are welcome, as well as how to engage clinicians in research projects. The report addresses aspects of workplace design, recommendations on how to deal with uncertainties that come when moving between clinical care and research and ideas of how to ensure quality of care and maintain productivity when clinicians engage in research activities. The full recommendations report is enclosed as Appendix D.
Physical workspace design5.4.2
As the premises of the research center was in the process of being built when this thesis project started, a review of the blueprints was done from an innovation perspective. A few spaces were designated for innovation work and the analysis showed that some alternations to those areas might be beneficial. In general can be said that the Sister Kenny Research Center premises consists of a rehabilitation lab, offices, a design lab, a conference room, a small library and work stations assigned to the Clinical Innovation Team members. The conference room was intended to serve as the main space for innovation projects.
To create more space for innovation work and a more informal area for the Clinical Innovation Teams to undertake their projects one of the areas with workstations for the Clinical Innovation Team members was redesigned. A number of computer workstations were eliminated in favor for tables and chairs, a whiteboard and a bulletin board (Figure 16, next page). In addition a whiteboard was added to the conference room.
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C
A B
D
Figure 16: Four pictures showing: A. The original blueprint for what later became the innovation area. B. The vision extracted in this thesis
project. C. Suggestion for revised blueprint and furnishing. D. The innovation area in use during a workshop.
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Discussion6. This chapter discusses the methods used in the master thesis as well as the results. An analysis of the risks of not complying to the recommendations given and what may happen when the innovation strategy package is used in its future context is presented. In this chapter I have chosen to refer to myself as the author of this chapter in first person.
Setup of master thesis6.1
Methods used6.1.1
The thesis study comprised a literature study, an interview study and a pilot project. The results from those studies served as the base for the synthesis part of the project where the innovation strategy package, including the design process and handbook, was created. Since this project focused on developing a new structure for innovation, extensive testing of the tool was left out of the scope of the project. Further testing, such as a longitudinal study of a project following the innovation structure, is likely the only way to control its feasibility.
Pilot project
The pilot project proved that the work model designed for the Sister Kenny Research Center could work well in an interdisciplinary team with a facilitator present. The evaluation with the team members showed that they thought the process kept them focused and that a step-by-step process is necessary in these kinds of projects, which suggests that the design project was effective. Although conducted over a short time span the pilot project included all steps of the design process, which should be seen as a strength in the testing.
The team in the pilot project was interdisciplinary consisting of a nurse, and occupational therapist, a physical therapist and an engineering student. It would have been desirable to include patients who would also be end-users of the interface developed in the project. It is unclear what impact that would have had on the result and on the analysis of the design process. The pilot project only tested the development of a graphical user interface and does not test the development of a for example a product or a service. The respondents to the evaluation may have been biased by the fact that
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the person who would read the evaluations was part of the design team and the inventor of the design process under evaluation.
From a facilitator’s point of view the project went smoothly and the clinicians mastered the transmission from clinical care to interface design with no problem. The engineering student managed well in integrating the clinicians’ input in the final product. This project also shows that a the time plan for the design process is flexible and that a team can go from problem definition to working prototype in a short time span given the right resources.
Interview study
The interview study included a wide range of people who may be affected by the work at the Sister Kenny Research Center. It has, however shortcoming in the number of people with vast experience from design projects in interdisciplinary teams. The thesis project could most likely have benefited from more interviews of a benchmarking nature.
The process6.1.2
Design process used in the thesis project
A structured but flexible approach has been used as a process for this thesis project. Many uncertainties influenced the project and its structure. For a long time the availability of a project for a pilot project was uncertain, and one of the planned projects were cancelled. The research center premises were not finalized until a few months into the project. Possibilities to address research topics in workshops and discussions have been captured on short notice throughout the project. The goal has always been to gather as much as possible of the clinical view of research and different ways for clinicians to engage in research. The flexible approach has been necessary to be able to include those elements.
The process have been of an iterative nature where the initial structure of the project outcome was set early on, and then built upon and improved through feedback and implementation loops (Figure 10). This has ensured opportunities to comment on the result and few surprises for the external stakeholders of the project (mainly the director of research). The drawback of such a design process is that the first design was set at a time where the topic was only initially explored. It is possible that the project outcome would have looked different if the design process had started later on.
53
“Most tools are well-known creativity tools, but some are newer or from unspecified sources”
Although, with the pilot project starting only a couple of months in to the project, the structure was forced to be set early on.
Even though clinicians have been the main source of information and experience in this project it is likely that their knowledge could have been used even further to improve the quality of the project outcome.
Selection process for creativity tools
The structure followed when choosing creativity tools was somewhat subjective. A number of criteria have been used in the process, but furthermore I have served as a tester of the feasibility of the tools. Mainly subjective factors have determined whether a creativity tool is easy enough to understand from the short introduction in the handbook. That way of evaluating the creativity tools was the initial plan, and more objective evaluations can only be done after the innovation model has been in use in its intended future setting. Most tools are well-known creativity tools, but some are newer or from unspecified sources. Examples are the UTPS Scenario technique (Janhager, 2005), and the “Smart little people” who is said to spring from the TRIZ (Altschuller et al, 2005) and the creativity tool Dream factory, which comes from industry practice. Common for all these tools are that they have been tried out by me, as a design engineer student and determined to be useful and suitable for people new to innovation work. It may be argued that the creativity tools should have been better and more objectively tested. Tools mentioned in the first edition of the Innovation Handbook may be excluded after further testing and new tools may be included.
Some creativity tools were excluded due to their complexity, even though they can serve as a powerful booster to creativity when used properly. Examples of such tools are TRIZ (Altshuller et al, 2005) and versions of TRIZ such as SIT (Goldenberg et al, 2003) and SCAMPER (Eberle, 1997). These tools are considered to require training to be mastered in a useful way, or require extensive facilitation. When the first version of the handbook was written it was not clear whether such facilitation would be available.
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“So what happens if the Clinical Innovation Teams or the Sister Kenny Research Center management do not follow the recommendations given?”
The strategy package in context6.2 The Innovation Handbook and the Design Process described in it, merely suggests one of many ways of working in design projects. In cases where experienced researchers or designers work in development projects other processes may be applied with great success. It is, however, suggested that in teams comprising members who are new to research, the work model
described in the Innovation Handbook should be followed. I believe that having a work model that is explicitly explained and shared with all group members will create teams where the members can work more equally – a crucial aspect in interdisciplinary teams.
So what happens if the Clinical Innovation Teams or the Sister Kenny Research Center management do not follow the recommendations given? It is likely that the success of projects will depend more on luck and a few influential members, rather than a team effort. Failure rates are likely to go up due to insufficient mapping of the user needs and user contexts, which is a common mistake in designing. It is also important that the teams spend enough time on creating a team feeling and trust among each other (West, 2002), a step that is often overlooked. Failure to comply with that may hinder the innovation process due to fear of sharing ideas with the team.
Use of the clinical setting6.2.1
The Sister Kenny Research Center and its proximity to the Sister Kenny Rehabilitation Institute provides many interesting opportunities to the involvement of patients in innovation work and the analysis of the clinical care as a starting point for research. This has been integrated in the innovation strategy package for the Sister Kenny Research Center, but may have been so even more.
The use of the Sister Kenny Research Center unique setting was limited by the fact that the research center is totally new and that routines for including patients in studies are no yet fully implemented. The Sister Kenny Research Center has to work on a long-term strategy to build such a structure. Regulations regarding the Clinical Innovation Teams’ possibilities to use patients, patient data, testing and surveys for research purposes were left out of the scope of this thesis project.
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“Simply involving users in the design process will not guarantee success”
Interdisciplinary designing6.3 It should be mentioned that simply involving users in the design process will not guarantee success (Dekker et al, 2003). Involving users will rather impose more challenges to the design team, but may also generate better end-results if integrated successfully.
It is argued that interdisciplinary design teams should be used in human-centered designing (ISO 13407:1999), and the innovation strategy package presented in this thesis project is built with the interdisciplinary Clinical Innovation Teams as one of its major foundation elements.
It is my belief that clinicians, patients and other stakeholders should be involved as designers, rather than advisors. As advisors they would rely on the engineers to address the correct questions to be able to share valuable knowledge. By including them as designers they can constantly address and reflect on issues related to their situation and experience, which will lead to insights for the whole team about the user and the user context. The Sister Kenny Research Center Innovation Handbook provides tools and guidelines for users in the Clinical Innovation Teams, whether clinicians, patients of other stakeholders, to be able to make that shift towards designing. By including an experienced designer as a facilitator that crossover can be made even easier.
Even though clinicians are often, from practical reasons, grouped as one in this report and in the Innovation Handbook, it is important to keep in mind that they are not a homogenous group. As stated in the pilot project evaluation, different clinicians have different goals for the patients and bring different experiences to the table. It is recommended that the clinicians included in each project be recruited from the right disciplines. The same warning is raised against viewing patients as a homogenous group.
Design process 6.4
Choice of design process6.4.1
The stage-gate process used as a model for the design process developed for the Sister Kenny Research Center has several benefits that are useful
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“The model is straightforward and easy to follow for an organization that is putting a design process in place, as in the case with the Sister Kenny Research Center”
for the work structure at the research center. Among others, a Stage-gate process ensures certain transparency and enables a project to be monitored and controlled by various stakeholders (Phillips, Neailey & Broughton, 1999). Some projects at the Sister Kenny Research Center may include a great number of stakeholders, and stakeholders with interest in different
parts of the process that are not able to spend much time following the rest of the project. Providing a number of stage-gate meetings where those stakeholders can join was seen as a strength. Stage-gate processes have also shown to improve teamwork and success rates in new product launches, as well as help detecting failure earlier (Cooper et al, 2001).
Drawbacks mentioned with stage-gate processes are that it is sequential and that innovation projects need to be of a more iterative nature. Since the conditions and requirements forming the base of a development project may change, strictly closing one phase may be unsuitable to the complex kind of problem solving that designing is. I believe that the strictness of a stage-gate process is beneficial for a project encompassing members new to designing. The model is also straightforward and easy to follow for an organization that is putting a design process in place, as in the case with the Sister Kenny Research Center. The rigid structure will provide guidance, and decisions of project phase iterations can be taken in consent with the different stakeholders. The design process created for the Sister Kenny Research Center also includes elements of iterations, which are further discussed below.
Iterative nature6.4.2
The stage-gate process designed for the Sister Kenny Research Center has a few iterative elements that ensure useful feedback loops to be included in the design work. For instance, the living documents encourage a team to revisit the decisions made earlier and to incorporate the lessons learned. Furthermore the process encourages the building of prototypes throughout the project. This way of working enhances the chance of gaining insights about the design that can be integrated in the final product. Ultimately the projects at the Sister Kenny Research Center will often make up only one of many design cycles. After one Clinical Innovation Team has designed
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“All design projects will benefit from having a facilitator with experience from design projects available”
a new product, another team is likely to redesign the product or test it by setting up a clinical trial.
Design process robustness6.4.3
The design process provides a structured way of working, but can also be used as a flexible starting point or inspiration for other ways of working. The determining factor of whether the design process will have its intended effect is whether it is being accepted and followed by the Clinical Innovation Teams. There are no control elements in the process that ensures that it is followed properly, and there is a risk that inferior compliance to the structure will make the process ineffective. It is of utmost importance that the management of the Sister Kenny Research Center supports the design process and that its use is actively encouraged.
Innovation Handbook6.5 The Innovation Handbook is intended to serve as an aid to innovation projects and to help explore creative solutions. The idea is that the Innovation Handbook will, as an independent tool, be enough to guide someone new to research and development projects through the process of designing new products. Whether this requirement is met is not tested in this project, but it is my belief that the Innovation Handbook is comprehensible enough to provide that guidance, but that all design projects will benefit from having a facilitator with experience from design projects available.
The handbook contains so-called “Wiki Words”, which are terms used in the handbook that can also be found on Wikipedia (www.wikipedia.org). It should be mentioned that Wikipedia may not be a reliable source of reference, but it is an excellent tool to quickly gain an overview of a subject and to find further reading material.
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Physical workspace6.6 The physical workspace at the Sister Kenny Research Center was built during the scope of this thesis project and minor alternations were done to the original plan in order to create a space better suited to innovation work (Figure 16). The Sister Kenny Research Center facilities were finalized in November 2008 and have since been used frequently. The alternated space has served as setting for a number of brainstorm sessions, interdisciplinary workshops, informal presentations and social gatherings. The conference room that was initially intended for those kinds of gatherings has been actively used for meetings, even those not directly related to research work. For that reason it is reasonable to conclude that the conference room would not have been available sufficiently for informal gatherings and an additional space was necessary. The office space is, in its new design, better suited to serve as innovation facilities than the original design with computer workstations would have been.
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Conclusion7. The goal of this project was to develop a comprehensive innovation strategy package for the Sister Kenny Research Center that provides guidance to the Clinical Innovation Teams working in development projects. By providing a design process, the tools to use in the every day work and guidelines of how to create a good working environment, this thesis project gives a good foundation for innovative and successful projects to be conducted at the Sister Kenny Research Center.
The Design Process developed gives structure to the innovation work and provides a common terminology that facilitates communication within the team and with other stakeholders.
The Innovation Handbook provides guidance for people who are new to research in how to engage in the Sister Kenny Research Center activities. It helps interdisciplinary teams to cooperate and use its strengths, while providing a common language and ground to build on when designing. It provides tools that will help the Clinical Innovation Teams to come up with creative, more innovative solutions to the problems at hand.
The Recommendations Report helps the Sister Kenny Research Center provide the resources necessary for successful innovation projects to be conducted.
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Recommendations8. This section describes the actions recommended to undertake as part of implementing the outcome of this thesis project.
Implementation of results8.1 For this thesis project to have full effect it is important that the recommendations are implemented and supported from the management. It is recommended that all innovation projects conducted at the Sister Kenny Research Center that involves individuals new to research should use the Innovation Handbook and the design process developed.
The management at the Sister Kenny Research Center should support the Clinical Innovation Teams with all means possible, following the advice in the Recommendations report. The Sister Kenny Research Center should actively recruit clinicians from a range of disciplines who are interested in research.
It is important that the management at the Sister Kenny Research Center encourages the Clinical Innovation Teams to spend the adequate time in the team building phase, the problem definition phase and idea generation phase. These steps of a process are often overlooked.
Lastly it is crucial that the management at the Sister Kenny Research Center and the experienced researchers are familiar with the innovation strategy package developed for the Sister Kenny Research Center so that they are leveled with the Clinical Innovation Teams when participating in projects.
Future projects8.2 The following projects are recommended to undertake as steps on the path of creating an innovative research center.
Evaluate the Innovation Handbook as an independent tool to aid innovation
Create an infrastructure for patient testing and clinical trials,
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including a patient database.
Work on changing attitudes towards research, and to make sure all Sister Kenny Rehabilitation Institute clinicians know about the work conducted at the Sister Kenny Research Center.
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References9. Adamsson, N. (2007), Interdisciplinary integration in complex product development – Managerial implications of embedding software in manufactured goods, Department of Machine Design, KTH.
Allina Hospitals and Clinics, website on the Internet, 15 March, 2009, http://www.allina.com
Altshuller, G., Clarke, D. W., Shulyak, L., Lerner, L. (2005), 40 Principles: TRIZ keys to innovation, Worcester: Technical Innovation Center, Inc.
Amabile, T. (1993), What does a theory of creativity require?, Psychological Inquiry, Vol. 4, No. 2, pp. 179-237.
Annett, J and Duncan, K (1967) Task analysis and training in design, Occupational, Psychology Vol 41 pp 211e221.
Badke-Schaub, P. (2007). Creativity and innovation in industrial design: wishful thinking?, Journal of Design Research, Vol. 5, No. 3, pp. 353-367.
Bonnie A. Nardi (1992) The use of scenarios in design, ACM SIGCHI Bulletin, v.24 n.4, p.13-14, Oct. 1992.
Browning, T. R. (1998). Integrative mechanisms for multiteam integration: findings from five case studies. Systems Engineering, 1(2), 95-112.
Cohen, D., Lindvall, M., & Costa, P. (2004). An introduction to agile methods. In Advances in Computers (pp. 1-66). New York: Elsevier Science.
Cooper, A. (1999), The inmates are running the asylum, Indianapolis: Sams.
Cooper, R. G. and Kleinschmidt, E. J. (2001) Stage-gate process for new product success, Innovation Management, Denmark. Source: http://www.stage-gate.dk/articles
de Bono, E. (1985), Six thinking hats, New York: Little, Brown and Company.
63
Dekker, S.W.A, Nyce, J.M. and Hoffman, R.R. (2003) From contextual inquiry to designable futures: What do we need to get there? IEEE Intelligent Systems. 18(2). 74-77.
Dougherty, D. (1992). Interpretive barriers to successful product innovation in large firms. Organization Science, 3(2), 179-202.
Dym, C. L, Agogino, A. M., Eris, O., Frey, D. D. and Leifer, L. J. (2005), Engineering design thinking, teaching and learning, Journal of Engineering Education, January 20005.
Eberle, B. (1997), Scamper: Creative Games and Activities for Imagination Development, New York: Prufrock Press.
Eftring, H., (1999), The Useworthiness of robots for people with physical disabilities, Doctorial dissertation, Lund University, Department of Design Sciences.
Ekvall, G. (1996), Organizational climate for creativity and innovation, European journal of work and organizational psychology, 1996, 5(1), 105-123
Ericsson, K. and Simon, H. (1993). Protocol Analysis: Verbal Reports as Data (2nd ed. ed.). Boston: MIT Press
Fast Company Magazine, website on the Internet, 15 March 15, 2009, http://www.fastcompany.com/magazine/89/creativity.html
FDA, US Food and Drug Administration, website on the Internet, 15 March, 2009, http://www.fda.gov/opacom/morechoices/mission.html
Gaver, B., Dunne, T., & Pacenti, E. (1999) Cultural Probes. ACM Interactions, January, February, pp. 21-29.
Goldenberg, J., Horowitz, R. and Levav, A. (2003), Finding your innovation sweet spot, Harward Business Review, March 2003.
Harry, M. J. and Schroeder, R. (1999). Six Sigma: The Breakthrough Management Strategy Revolutionizing the World’s Top Corporations. New York, NY: Doubleday.
HIPAA, Health Insurance Portability and Accountability Act, website on the Internet, 15 March, 2009, http://www.hhs.gov/ocr/privacy/index.html.
64
IRB, Institutional Review Board, website on the Internet, 15 March, 2009, http://www.fda.gov/oc/ohrt/irbs/faqs.html.
ISO 13407: 1999. Human-centered design processes for interactive systems.
Jacobsson, I., Booch, G. and Rumbaugh, J. (1999), The unified software development process, Boston: Addison Wesley Longman, Inc.
Jalote-Parmar, A. and Badke-Schaub, P. (2008) Workflow integration matrix: a framework to support the development of surgical information systems, Design Studies, 29, pp 338-368
Janhager, J. (2005), User considerations in early stages of product development – Theories and methods, Department of Machine Design, KTH.
Kelley, T. and Littman, J. (2005) The ten faces of innovation: IDEO’s strategies for defeating the devil’s advocate and driving creativity throughout your organization. New York, NY: Doubleday
Kelley, T., Littman, J., Peters, T. (2001), Art of innovation: Lessons in creativity from IDEO, America’s leading design firm, New York, NY: Doubleday.
Liker, J. (2003), The Toyota Way: 14 Management Principles from the World’s Greatest Manufacturer, First edition, McGraw-Hill.
Lund, K. (2009), The Sister Kenny Research Center Innovation Handbook, unpublished material.
Martin, R. (2007), Design and business: Why can’t we be friends? Journal of Business Strategy, Vol 28, no. 4, pp. 6-12.
McKenna, E. C (2000). Business psychology and organizational behavior: a student’s handbook. 3. ed. Hove: Psychology Press.
Norell Bergendahl, M. (2009). Kapitel 1. Så skapar du det innovativa företaget. In Olsson, A. (Ed.), Innovationsförmåga, (18-39). Malmö: Holmbergs i Malmö AB.
Olsson, A. (Ed.). (2009). Innovationsförmåga. Malmö: Holmbergs i Malmö AB.
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Osborn, A. F. (1963) Applied Imagination: Principles and procedures of creative problem solving (third revised edition). New York, NY: Charles Scribner’s Sons.
Phillips, R., Neailey, K., Broughton, T. (1999) A comparative study of six stage-gate approaches to product development, Integrated Manufacturing Systems, 10 (5), 289-297.
PIEp, Product Innovation Engineering Program, website on the Internet, 15 March, 2009, http://www.piep.se.
Royce, W. W. (1970). Managing the development of large software systems, Conference proceedings, IEEE Wescon, August 1970, pp. 1-9. Published by TRW.
Sanders, E. B.-N. (2002), From user-centered to participatory design approaches, Design and the Social Sciences. J.Frascara (Ed.), Taylor & Francis Books Limited, 2002.
Sanders, E. B.-N. and Stappers, P. J. (2008), Co-creation and the new landscapes of design, CoDesign, Vol. 4, No. 1, March 2008, pp. 5-18.
Sawyer, D. 1997, Do it by design. An introduction to human factors in medical devices, US department of Health and Human Services, Public Health Service, Food and Drug Administration, Centre for Device and Radiological Health, USA.
Schutz, W. C. (1958). FIRO: A three-dimensional theory of interpersonal behavior, New York: Holt, Rinehart & Winston.
Stappers, P. J. and Sanders, E. B.-N. (2003), Third International Conference on Design & Emotion, Loughborough, Taylor & Francis.
Stauffer, D. (2004) Thinking clockwise: A field guide for the innovative leader, Minneapolis, MN: MinneApplePress.
Stewart, D W and Shamdasani, P N (1990) Focus groups: theory and practice, London: Sage Publications.
Takeuchi, H. and Nonaka, I. (1986), The New New Product Development Game, Harvard Business Review 86116:137-146.
Ulrich, K. T., Eppinger, S. D. (2008) Product Design and Development, New York: McGraw-Hill.
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Ulwick, A. (2005) What customers want: Using outcome-driven innovation to create breakthrough products and services, New York: McGraw-Hill.
VDI-Richtlinie 2221 (1993) Methodik zum Entwickeln und Konstruieren technischer Systeme und Produkte. VDI-Verlag, Dûsseldorf
West, M.A. (2002). Sparkling Fountains or Stagnant Ponds: An Integrative Model of Creativity and Innovation Implementation in Work Groups. Applied Psychology: An International Review, 51(3), 355-424.
Wikipedia, website on the Internet, 15 March, 2009, http://www.wikipedia.org.
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Appendix A: Interview protocolThis is the outline of the interview protocol for the interview study. The interviews were all conducted orally.
Have you ever conducted research or participated in research projects?
Can you tell me about the project?
How was that project funded?
What problems did you encounter?
What would you have done differently?
What are your expectations on the Sister Kenny Research Center?
What do you think are the greatest responsibilities that the Sister Kenny Research Center has?
What do you think is the attitude towards research among the clinicians?
What groups of clinicians should we try to engage in research?
How can we best reach out to those groups?
Do you have any general ideas of how we can encourage clinicians to engage in research?
What do you think is the attitude towards technology among the clinicians?
What do you think will be the major challenges that the research center will encounter?
Do you have any general advice for the Sister Kenny Research Center?
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Appendix B: Evaluation of pilot projectThese questions were sent to the participants of the pilot project as part of the project evaluation.
These questions were sent to the participants of the pilot project about two months after the project was completed.
How did your thoughts about research projects and the Sister 1. Kenny Research Center change with your participation in the StepWiz project?
How did you feel that your knowledge and experience was 2. utilized in the StepWiz project?
What would you say you added to the project?3.
How did you experience changing from clinical work into all 4. of a sudden working on a project developing rehabilitation technology?
During the project the team followed a strict step-by-step process. 5. How did you experience that?
What would you suggest for future projects including clinicians 6. and engineers working together on the same team?
For the engineering student question 4 was exchanged for the following question:
4. How did you experience working with clinicians on a technology development project?
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Appendix C: Work model illustration
70
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mea
n th
at
the
proj
ect h
as n
othi
ng
to a
im a
t and
not
hing
to
eval
uate
the
conc
epts
and
id
ea a
gain
st. T
he p
rodu
ct
requ
irem
ents
doc
umen
t is
str
ongl
y pa
ired
with
th
ose
docu
men
ts a
nd
the
resu
lts fr
om th
is s
tep
serv
e as
a fo
unda
tion
for
all c
onse
cutiv
e st
eps
in
the
desi
gn p
roce
ss.
TE
AM
BU
ILD
ING
As
the
new
Clin
ical
In
nova
tion
Team
is
asse
mbl
ed a
nd th
e te
am
mem
bers
spe
nd ti
me
and
ener
gy g
ettin
g to
kno
w
each
oth
er th
e pr
ojec
t ef
fi cie
ncy
may
suf
fer.
It is
ther
efor
e im
port
ant
that
the
team
get
s en
ough
tim
e to
pro
perly
gai
n a
team
feel
ing
quic
kly,
as
wel
l as
suffi
cien
t gui
danc
e in
the
early
sta
ges
of th
e de
sign
pro
ject
. Thi
s ph
ase
calls
for
a st
rong
team
le
ader
who
can
gui
de th
e pr
ojec
t wor
k fo
rwar
d.
PR
OJE
CT
INIT
IAT
ION
This
pha
se re
fers
to a
ll ac
tiviti
es p
rior
to h
avin
g a
full
Clin
ical
Inno
vatio
n Te
am. T
he id
entifi
cat
ion
of a
pro
ject
, pro
blem
ar
ea o
r ca
se to
stu
dy,
as w
ell a
s ga
ther
ing
any
nece
ssar
y fu
ndin
g fo
r th
e pr
ojec
t. Fu
rthe
rmor
e th
e re
crui
tmen
t of t
eam
m
embe
rs ta
ke p
lace
du
ring
this
ste
p.
If yo
u ar
e a
clin
icia
n w
ith
an id
ea fo
r a
proj
ect
plea
se c
onta
ct th
e S
iste
r K
enny
Res
earc
h C
ente
r to
see
how
you
can
wor
k to
geth
er to
gat
her
fund
ing
and
to re
crui
t a te
am.
72
DES
IGN
PRO
CES
SD
ESIG
N
RES
ULT
S
INFR
AST
RU
CTU
RE
PEO
PLE
CO
NC
EPT
EVA
LUA
TIO
NC
ON
CEP
TG
ENER
ATI
ON
IDEA
GEN
ERA
TIO
NST
OP
STA
GE-
GAT
E
OBJ
ECTI
VEC
ON
CEP
TSC
REE
NIN
G
POSS
IBLE
PAT
ENT
APPL
ICAT
ION
CH
OIC
E O
FFI
NAL
CO
NC
EPT
CH
OIC
E O
F2-
5 C
ON
CEP
TSLA
RG
E N
UM
BER
OF
IDEA
S
IDEA
TIM
E
PRO
TOTY
PEM
ATER
IALS
IDEA
TIM
E
STO
RAG
E SP
ACE
FOR
PR
OTO
TYPE
SAN
D S
KETC
HES
CIT
PRO
JEC
T LE
ADER
OR
FAC
ILIT
ATO
R
CIT
CIT
PRO
JEC
TO
WN
ER
CO
NC
EPTU
AL P
HAS
E
73
DES
IGN
PRO
CES
S
RES
ULT
S
INFR
AST
RU
CTU
RE
PEO
PLE
CO
NC
EPT
EVA
LUA
TIO
NC
ON
CEP
TG
ENER
ATI
ON
IDEA
GEN
ERA
TIO
NST
OP
STA
GE-
GAT
E
OBJ
ECTI
VEC
ON
CEP
TSC
REE
NIN
G
POSS
IBLE
PAT
ENT
APPL
ICAT
ION
CH
OIC
E O
FFI
NAL
CO
NC
EPT
CH
OIC
E O
F2-
5 C
ON
CEP
TSLA
RG
E N
UM
BER
OF
IDEA
S
IDEA
TIM
E
PRO
TOTY
PEM
ATER
IALS
IDEA
TIM
E
STO
RAG
E SP
ACE
FOR
PR
OTO
TYPE
SAN
D S
KETC
HES
CIT
PRO
JEC
T LE
ADER
OR
FAC
ILIT
ATO
R
CIT
CIT
PRO
JEC
TO
WN
ER
STA
GE
-GA
TE
IIIt
is ti
me
to m
eet w
ith
the
Clin
ical
Inno
vatio
n Te
am, p
roje
ct o
wne
r, pr
ofes
sors
, tut
ors
and
othe
r st
akeh
olde
rs.
The
com
plet
e gr
oup
shou
ld to
geth
er c
ome
to a
con
clus
ion
to w
hat
conc
ept w
ill be
ele
cted
for
furt
her
deve
lopm
ent.
For
the
stud
ents
it is
re
com
men
ded
to s
how
bo
th c
once
pts
that
fully
fu
lfi ll
the
requ
irem
ents
sp
ecifi
ed a
s w
ell a
s a
few
con
cept
s th
at a
re
very
inno
vativ
e an
d m
aybe
une
xpec
ted.
If th
e pr
ojec
t inv
olve
s st
uden
ts
ther
e m
ay h
ave
to b
e ex
tern
al re
quire
men
ts
that
hav
e to
be
take
n in
to c
onsi
dera
tion,
su
ch a
s de
man
ds fo
r w
orki
ng p
roto
type
s or
th
e in
clus
ion
of a
cer
tain
te
chno
logy
.
CO
NC
EP
T
EV
AL
UA
TIO
NIn
this
ste
p it
is im
port
ant
to s
tres
s an
obj
ectiv
e ev
alua
tion
usin
g th
e pr
oduc
t req
uire
men
ts
docu
men
t. Th
is is
the
step
whe
re it
will
show
if
the
prod
uct r
equi
rem
ents
do
cum
ent i
s w
ell-w
ritte
n.
CO
NC
EP
T
GE
NE
RA
TIO
NIf
the
idea
gen
erat
ion
phas
e w
as th
e tim
e fo
r bo
ld id
eas,
this
is th
e tim
e fo
r br
ingi
ng th
ose
idea
s in
to th
e pe
rspe
ctiv
e of
re
ality
, whi
lst s
till k
eepi
ng
the
inno
vativ
enes
s hi
gh.
The
Clin
ical
Inno
vatio
n Te
ams
may
nee
d ex
tern
al
expe
rtis
e in
tech
nica
l ar
eas
to h
elp
expl
ore
wha
t id
eas
are
feas
ible
.
In th
is s
tep
it is
impo
rtan
t to
kee
p an
ope
n m
ind
to
nove
l sol
utio
ns. T
here
is a
ris
k th
at in
nova
tive
idea
s th
at s
olve
the
prob
lem
in
a be
tter
way
are
reje
cted
in
favo
r of
mor
e si
mpl
e id
eas
that
fi t p
eopl
e’s
initi
al p
ictu
re o
f a s
olut
ion
bett
er.
IDE
A G
EN
ER
AT
ION
Any
body
can
com
e up
w
ith n
ew id
eas.
Tha
t is
also
why
it is
so
hard
to
com
e up
with
thos
e un
ique
idea
s th
at n
obod
y el
se th
ough
t abo
ut. T
he
team
nee
ds s
omeo
ne
to p
ush
them
into
the
unex
plor
ed in
this
pha
se,
to e
ncou
rage
them
to
seek
furt
her
whe
n it
feel
s lik
e al
l the
pos
sibl
e id
eas
have
bee
n ex
plor
ed. A
fa
cilit
ator
hire
d by
the
Sis
ter
Ken
ny R
esea
rch
Cen
ter
wou
ld b
e th
e be
st,
but i
f tha
t is
not a
vaila
ble
mak
e su
re s
omeb
ody
in
the
grou
p ta
kes
the
lead
in
this
pha
se. S
ucce
ssfu
l id
ea g
ener
atio
n do
es
not h
ave
muc
h ro
om fo
r do
ubt o
f who
is e
ntitl
ed
to s
peak
or
who
se
inst
ruct
ions
to w
ait f
or.
A fa
ilure
to p
rope
rly
supp
ort t
he C
linic
al
Inno
vatio
n Te
ams
in
this
pha
se w
ill m
ost
likel
y re
sult
in p
oor
inno
vativ
enes
s an
d pr
edic
tabl
e so
lutio
ns.
74
DES
IGN
PRO
CES
SD
ESIG
N
RES
ULT
S
INFR
AST
RU
CTU
RE
PEO
PLE
PRO
TOTY
PEB
UIL
DIN
GTE
ST A
ND
EVA
LUA
TIO
N
PRO
JEC
TC
LOSU
RE
CO
MPL
ETE
SYST
EM D
ESIG
NSU
B-L
EVEL
SYST
EM D
ESIG
NST
OP
STA
GE-
GAT
E
FULL
-SYS
TEM
PRO
TOTY
PESU
B-SY
STEM
PRO
TOTY
PES
SUM
MAR
Y O
FEV
ALU
ATIO
NFU
NC
TIO
NPR
OTO
TYPE
PRO
JEC
TD
OC
UM
ENTA
TIO
N
FUTU
RE
DES
IGN
REC
OM
MEN
DAT
ION
S
CAD
TO
OL
DES
IGN
LAB
ACC
ESS
FUN
DIN
G O
FPR
OTO
TYPE
MAT
ERIA
L
SUBJ
ECTS
FO
RST
UD
Y
ENG
INEE
REN
GIN
EER
ENG
INEE
RC
ITPR
OJE
CT
OW
NER
TRAC
K O
NE:
PRO
DU
CT
AND
SO
FTW
ARE
DES
IGN
PH
ASE
75
DES
IGN
PRO
CES
S
RES
ULT
S
INFR
AST
RU
CTU
RE
PEO
PLE
PRO
TOTY
PEB
UIL
DIN
GTE
ST A
ND
EVA
LUA
TIO
N
PRO
JEC
TC
LOSU
RE
CO
MPL
ETE
SYST
EM D
ESIG
NSU
B-L
EVEL
SYST
EM D
ESIG
NST
OP
STA
GE-
GAT
E
FULL
-SYS
TEM
PRO
TOTY
PESU
B-SY
STEM
PRO
TOTY
PES
SUM
MAR
Y O
FEV
ALU
ATIO
NFU
NC
TIO
NPR
OTO
TYPE
PRO
JEC
TD
OC
UM
ENTA
TIO
N
FUTU
RE
DES
IGN
REC
OM
MEN
DAT
ION
S
CAD
TO
OL
DES
IGN
LAB
ACC
ESS
FUN
DIN
G O
FPR
OTO
TYPE
MAT
ERIA
L
SUBJ
ECTS
FO
RST
UD
Y
ENG
INEE
REN
GIN
EER
ENG
INEE
RC
ITPR
OJE
CT
OW
NER
TE
ST
AN
D
EV
AL
UA
TIO
NFo
r us
er te
stin
g, h
avin
g su
bjec
ts a
vaila
ble
is th
e m
ost i
mpo
rtan
t, an
d at
the
sam
e tim
e th
e m
ost d
iffi c
ult t
o at
tain
. E
ncou
rage
the
Clin
ical
In
nova
tion
Team
s to
pl
an e
arly
for
a pa
tient
st
udy,
by
recr
uitin
g su
bjec
ts, a
pply
ing
to g
et it
ap
prov
ed b
y th
e IR
B, e
tc.
If re
crui
ting
subj
ects
fail
ther
e ar
e st
ill m
any
way
s to
test
pro
duct
s, s
uch
as s
imul
atio
ns, o
r te
stin
g w
ith c
linic
ians
or
othe
r pe
ople
that
may
not
fi t t
he
user
gro
up b
ut th
at c
an
test
oth
er a
spec
ts o
f the
de
sign
. You
sho
uld
striv
e to
at l
east
pre
sent
som
e ki
nd o
f use
r-te
st re
sults
at
your
fi na
l pre
sent
atio
n.
STA
GE
-GA
TE
III A
ND
IV Th
e st
age-
gate
mee
ting
num
ber
thre
e is
an
inte
rmed
iate
mee
ting
to c
heck
the
cour
se
of th
e pr
ojec
t and
is
reco
mm
ende
d to
be
held
af
ter
the
fi rst
iter
atio
n of
th
e de
velo
pmen
t pha
se.
Sta
ge-g
ate
num
ber
four
is
the
last
pre
sent
atio
n,
and
is th
e m
eetin
g w
here
th
e fi n
al re
sults
will
be
pres
ente
d. In
a s
mal
ler
proj
ect s
tage
-gat
e th
ree
can
be o
mitt
ed.
PR
OJE
CT
CL
OS
UR
EIt
is e
asy
to lo
ose
mot
ivat
ion
tow
ards
th
e en
d of
a p
roje
ct,
espe
cial
ly a
fter
succ
essf
ully
pre
sent
ing
the
fi nal
resu
lts. T
he
hand
book
spe
cifi e
s a
num
ber
of th
ings
to b
e ca
rrie
d ou
t, su
ch a
s a
feed
back
ses
sion
, as
wel
l as
cer
tain
doc
umen
ts
to fi
le in
a fo
lder
for
know
ledg
e tr
ansf
er. I
t is
the
resp
onsi
bilit
y of
the
proj
ect l
eade
r to
mak
e su
re a
ll th
ose
task
s ar
e ca
rrie
d ou
t.
PR
OT
OT
YP
E
BU
ILD
ING
Mat
eria
l and
mac
hine
s ar
e cr
ucia
l in
this
ste
p.
Res
ourc
es h
ave
to
be a
vaila
ble
or e
asily
at
tain
able
, els
e th
e pr
otot
ype
qual
ity w
ill m
ost
likel
y su
ffer.
Ano
ther
ris
k is
that
whi
le th
e C
linic
al
Inno
vatio
n Te
am is
wai
ting
for
mat
eria
l or
mac
hine
s th
e w
hole
pro
ject
is p
ut
on h
old,
mea
ning
val
uabl
e tim
e is
lost
.
CO
MP
LE
TE
SY
ST
EM
D
ES
IGN
If th
e co
st o
f the
pro
toty
pe
is o
f big
impo
rtan
ce,
now
is th
e tim
e to
kee
p an
eye
ope
n fo
r po
ssib
le
adju
stm
ents
that
cou
ld
brin
g th
e pr
ice
dow
n.
SU
B-L
EV
EL
D
EV
EL
OP
ME
NT
This
is a
pha
se w
here
th
e te
am m
embe
rs w
ith
tech
nica
l bac
kgro
und
will
step
in a
nd d
o th
e lio
n pa
rt o
f the
wor
k. If
ther
e ar
e cl
inic
ians
who
are
in
tere
sted
in e
ngag
ing
in th
is s
tep
it sh
ould
be
enco
urag
ed, a
s th
ey c
an
in m
any
case
s ad
d bo
th
idea
s fo
r te
chno
logy
and
cl
inic
al e
xper
ienc
e.
76
DES
IGN
PRO
CES
SD
ESIG
N
RES
ULT
S
INFR
AST
RU
CTU
RE
PEO
PLE
EVA
LUA
TIO
NPR
OJE
CT
CLO
SUR
ESM
ALL
-SC
ALE
IMPL
EMEN
TATI
ON
DET
AIL
EDD
ESC
RIP
TIO
NST
OP
STA
GE-
GAT
E
FULL
-SC
ALE
IMPL
EMEN
TATI
ON
PLAN
SUM
MAR
Y O
FEV
ALU
ATIO
N
SUPP
OR
T FO
RIM
PLEM
ENTA
TIO
N
VID
EO A
ND
AU
DIO
EQU
IPM
ENT
CIT
CIT
CIT
PRO
JEC
TO
WN
ER
TRAC
K TW
O:
SERV
ICE
AND
WO
RK
MET
HO
D D
ESIG
N P
HAS
E
77
DES
IGN
PRO
CES
S
RES
ULT
S
INFR
AST
RU
CTU
RE
PEO
PLE
EVA
LUA
TIO
NPR
OJE
CT
CLO
SUR
ESM
ALL
-SC
ALE
IMPL
EMEN
TATI
ON
DET
AIL
EDD
ESC
RIP
TIO
NST
OP
STA
GE-
GAT
E
FULL
-SC
ALE
IMPL
EMEN
TATI
ON
PLAN
SUM
MAR
Y O
FEV
ALU
ATIO
N
SUPP
OR
T FO
RIM
PLEM
ENTA
TIO
N
VID
EO A
ND
AU
DIO
EQU
IPM
ENT
CIT
CIT
CIT
PRO
JEC
TO
WN
ER
STA
GE
-GA
TE
III &
IVTh
e th
ird s
tage
-gat
e m
eetin
g is
an
inte
rmed
iate
m
eetin
g to
che
ck th
e co
urse
of t
he p
roje
ct
and
shou
ld b
e he
ld a
fter
the
fi rst
iter
atio
n of
the
deve
lopm
ent p
hase
. Th
is s
tage
-gat
e ca
n be
om
itted
in s
mal
ler
proj
ects
.
Sta
ge-g
ate
num
ber
four
is
the
last
pre
sent
atio
n w
here
fi na
l res
ults
will
be
pres
ente
d.
PR
OJE
CT
CL
OS
UR
EIt
is e
asy
to lo
se
mot
ivat
ion
tow
ards
th
e en
d of
a p
roje
ct,
espe
cial
ly a
fter
succ
essf
ully
pre
sent
ing
the
fi nal
resu
lts. T
he
hand
book
spe
cifi e
s a
num
ber
of th
ings
to b
e ca
rrie
d ou
t, su
ch a
s a
feed
back
ses
sion
, as
wel
l as
cer
tain
doc
umen
ts
to fi
le in
a fo
lder
for
know
ledg
e tr
ansf
er.
It is
the
proj
ect l
eade
r’s
resp
onsi
bilit
y to
mak
e su
re th
e C
linic
al
Inno
vatio
n Te
am fo
llow
s th
roug
h w
ith a
ll th
ese
task
s.
EV
AL
UA
TIO
NFo
r us
er te
stin
g, h
avin
g su
bjec
ts a
vaila
ble
is th
e m
ost i
mpo
rtan
t, an
d th
e m
ost d
iffi c
ult t
hing
. E
ncou
rage
the
Clin
ical
In
nova
tion
Team
s to
pl
an e
arly
for
a pa
tient
st
udy,
by
recr
uitin
g su
bjec
ts, a
pply
ing
to g
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78
Appendix D: Recommendations report
Recommendations for an Innovative Work Environment at the Sister Kenny
Research Center
Part of the Master Thesis project of Katarina LundRoyal Institute of Technology
February 2009
This report contains recommendations on an operational level to enhance the innovativeness in the development projects at the Sister Kenny Research Center. The suggestions made here are strongly related to the content of the Sister Kenny Research Center Innovation Handbook and a link between the two can be found in the Work Model Visualization. The report contains recommendations in the fields of administration, recruitment of members to the Clinical Innovation Teams, the physical workspace, resources and how to form a creative work climate as well as recommendations linked to the work structure of the development projects at the Sister Kenny Research Center.
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IntroductionThis report is part of the Master Thesis project with the title “Development of a Work Model for Innovation in a Clinical Environment at the Sister Kenny Research Center”. The recommendations in this report is part of a comprehensive plan for the innovativeness at the Sister Kenny Research Center, and should be viewed together with the Sister Kenny Research Center Innovation Handbook and the Work Model Visualization.
The recommendations chapter of this report is divided into five different fields of recommendations ranging from the physical work environment to how to how to create a mentality that foster innovative initiatives. If nothing else is mentioned the recommendations in this report are made assuming the project is of the structure of a master thesis project where a student working full-time form a team together with clinicians working part-time during a period of approximately six months. The recommendations however serve as a guidance for many other settings as well, and are in most cases independent from the project team structure.
This report was written for a research center still under development, just a few months after its opening and may have to be revised as the Sister Kenny Research Center mature over time.
Below a few words used repeatedly in this report are explained (in alphabetical order):
Clinical Champion. This is a clinician with special interest in a certain field who acts as the guardian and most likely project leader of a development project in that field.
Clinical Innovation Team. A Clinical Innovation Team is a team of clinicians, engineering students, patients and possibly other members working to develop technology around a clinical problem or basic research in the field of rehabilitation.
Project owner. This is the external stakeholder with interest in the project, which participates in the decision-making and monitors the progress of the project. Possible project owners are the director of research at the Sister Kenny Research Center, a representative from a company with interest in the project, or a teacher or professor at the home university of a student. The project owner normally has financial interest and responsibility in the project.
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Project leader. This is the “Clinical champion” or student that has an outspoken role as the project leader of the project.
Work Model Visualization. This is the flowchart linking the Sister Kenny Research Center Handbook with the recommendations in this report. It is provided as a separate document.
RecommendationsThe subchapters of this section of the report present recommendations in a variety of fields, all of them important to achieve a creative workplace where innovative development projects can happen.
Administrative1.
The clinicians in the Clinical Innovation Teams will in most cases only work part-time with research, and maintain a certain part of their time in the patient practice. It is considered a major part of the quality of care for patients to be able to meet the same therapist consistently. To enable this, therapists should if possible spend time on research projects the same weekdays from week to week. To facilitate the scheduling of therapists for the inpatient and outpatient care it is preferred that research activities are scheduled at least half-days and preferably full days at the time. It is the most beneficial for a development project if the team spends as much time as possible together and preferably longer sessions at the time. The schedules for the therapists are set approximately three weeks in advance, and notice of research activities for individual therapists should be given early enough to be included in the scheduling process to avoid additional work with changes.
For shorter research related activities the lunch hour can be used, but it’s important to keep in mind that scheduling seminars and meetings between noon and 1pm indirectly excludes all nurses who are busy helping the patients with their lunch at this hour. The nurses do not have a comparable hour that is suitable for research activities and they also have a more irregular work schedule with several different shifts to cover. Considering that the nurses has been said both to be crucial to the research projects and particularly hard to get involved in research, it is highly recommended that project related research activities are scheduled full days.
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The importance of maintaining productivity is an issue raised frequently when addressing the matter of scheduling and floating hours. The research center can actually be used to increase productivity and it is recommended that research projects contain some level of flexibility so that unproductive time causes by for example canceled appointments with patients can be used to conduct research work. Research projects will in many cases include engineering student in the Clinical Innovation Teams. Working in the interdisciplinary Clinical Innovation Teams will put extra stress on the planning and use of time that a normal student project would not require. It is important that the concept of productivity is explained to student and other external Clinical Innovation Team members who are not familiar with the ways of working at the Sister Kenny Rehabilitation Institute.
Recruiting clinicians to research projects2.
Some clinicians at the Sister Kenny Rehabilitation Institute have previous experience from research projects, but it is the aim of Sister Kenny Research Center to include also those with no background in research but with an interest to learn more.
Tools to include research novices
The following tools are useful in the process of expanding the recruitment base for research activities:
Headhunting . Ask specific clinicians, especially members of the research faculty, to join specific research projects that fit their area of interest.
Data gathering . Encourage clinicians to volunteer to collect data for research studies. That way they have a set protocol to follow but will still gain insight in how research studies are conducted which might serve as a stepping-stone for further participation. Smaller workshops are also good opportunities to involve clinicians that are new to research.
Share experience . Encourage the clinicians with research experience and employees at the Sister Kenny Research Center to share their story and tell how they first felt about research. It is also important to kill the myth of research as something that’s “nothing
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for me” and to tell what is actually being done at the research center. There is a conception about research that frightens people to join, especially among the nurses and older therapists who have had little or no element of research studies in their education.
Written guidance . The Sister Kenny Research Center Innovation Handbook is part of the work model of the Clinical Innovation Teams. The handbook serves as a guiding structure that has been missing in earlier research projects. The interviewees and other clinicians at the Sister Kenny Rehabilitation Institute have suggested that guidelines and a sort of introduction to research and development projects may help people engage in research for the first time. It might also enhance the quality of the research projects as many things has been solved (and learned) “on the go” in earlier projects.
The Clinical Innovation Teams should be no bigger than seven members in total and preferably include members from all areas that can contribute to the project, such as physicians, therapists, patients and students, as well as other members with valuable experience.
Long-distance collaborating
To keep the interest up and to make clinicians from other Sister Kenny Rehabilitation Institutes around Minnesota feel part of the research faculty the following is suggested:
Form online groups based on interest, for instance stroke, pediatrics, cognitive rehabilitation, etc. The groups could meet, share literature on the subject and cooperate with each other to initiate research projects. These groups could also serve as a valuable resource when projects in specific areas are set up or when visitors or companies want participants for workshops or studies.
Videoconferencing will be an important element to keep in touch with people at other locations than Abbott Northwestern Hospital, and may enable teams of clinicians form different hospitals to work together. It is important that the videoconference equipment is made available, that it’s easy to use and that corresponding equipment is available at the other hospitals as well.
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Creative workplace3.
The right workspace can enhance the performance of a development team, and even more, the opposite can happen if the right facilities are not provided. A creative work area should contain the following:
Visualization space on the walls. Bulletin boars, whiteboards and room to post sketches and other documents related to the development projects.
A big table where there is room for the whole development team or participants of a workshop to use the table comfortably.
Preferably a sofa or something else indicating this is also a space dedicated to more informal discussions.
Redrawing the blueprints
It is recommended that the area with the computer workplaces in the offi ce area is altered to meet these recommendations of a creative workplace (Figure 1). It is estimated that the remaining nine computer workstations assigned to Clinical Innovation Teams distributed over the three work areas will meet the demands satisfactorily.
Figure 2. Left: the original plan for one of the Clinical Innovation Team areas of the Sister Kenny Research Center. Right: The proposed changes that will
make the work area more innovation friendly.
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The new proposal shows a room with three computer workstations instead of six and where the gained space is used as an area for informal meetings. A sofa, a big table, a coffee table as well as chairs and stools fill the room, creating a workplace suitable both for small presentations, informal gatherings and workshops. The stools can be stacked on top of each other and stored away when smaller groups use the space. The table should preferably be insensitive to scratching or accidentally being drawn upon. It is important to mediate that this is a space where the unexpected is allowed and where meeting discipline and other office rules don’t always apply. Note: These suggestions were implemented during the scope of the thesis project.
The wall in the bottom of the sketch is covered with a whiteboard and a bulletin board encouraging “on the wall communication” and providing a space to quickly show ideas to the whole team. It is also recommended that each project is assigned space on a permanent or movable bulletin board where they can put documents that are central to the project. Communicating with the help of the walls, will facilitate the switch from patient care to development project for the clinicians, creating a change of mindset as soon as they enter the Sister Kenny Research Center.
Creative work environment and resources4.
Making the work environment creative is no easy task. The practical changes need to be paired with the right attitude from the management level, which in turn needs to be mediated in the right way. In general it can be concluded that what is written in policy documents means little compared to what the management actually say and do.
Innovation triggers
Some elements can be identified as more important than others to create a work environment that fosters innovative development projects:
Acceptance of failure. The success rate is strongly linked to the failure rate. The Clinical Innovation Teams have to be allowed to try and experiment, and subsequently also be allowed to fail. It is important to encourage the experimental way of working especially early on in the design process whereas the latter stages of a development project should contain less risk taking. Avoid
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stifling good initiatives by overanalyzing, stalling or involving too much people, which can make the process bureaucratic. Start quick and start small.
Trust under responsibility. It’s important to create an environment where everybody dares to speak up and dares to present his or her ideas. New ideas should be received with a positive mindset and exploring new ideas further should be encouraged. In addition the management needs to provide a structure and a framework that the people of the development teams can rely upon. The teams need to be challenged to solve specific problems without having to worry about structural issues, and they need to be given enough time to be able to do so in an innovative way.
Resources . Providing the right resources is a crucial aspect of enabling innovative work. Resources include physical resources such as the right work environment, prototype material and a properly equipped design lab, as well as less tangible resources such as time and experience. The design lab needs to have the right machinery, and the most common material to work with should be available throughout the projects. The necessary equipment ranges from post-it notes and colored markers to machines for the design lab. The quality and innovative level of design can be tremendously decreased by a lack of resources.
Leadership . It is recommended that each project will have a project owner that is external to the project group. It may be the director of research, a mentor from a student’s home university or a person from a company involved in, or initiating the project. There may exist a kind of indoctrination among the students that the “right” answer comes from the teachers, and it is likely that this behavior is still strong at a master thesis level. The project owner must stress that decisions need to be made and that the Clinical Innovation Teams are expected to make those decisions independently based on the knowledge gathered in the project. Furthermore the management of the Sister Kenny Research Center should provide an overall strategy for research over the coming years.
In addition to these suggestions it is important to create a work environment that is welcoming and less formal than a normal office environment. This includes making sure the teams working at the Sister Kenny Research
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Center do not feel they are disturbing or interrupting the work of others. Achieving this can be as simple as telling new teams that workshops and loud activities are encouraged and that the space in the Sister Kenny Research Center is assigned to everything that can help innovative products being born.
Hiring an innovation booster
An additional human resource is planned to be available within short at the Sister Kenny Research Center, and that is the engineer in charge of the design lab. It is recommended that the person to be hired possesses the following skills:
Theoretical and practical technical knowledge . The basic requirement is that this person can serve as a resource close to the Clinical Innovation Teams projects, helping out in matters of technical problem solving and prototype building.
Coaching skills. To keep a productive level and a steady work pace even in the beginning of the development projects the Clinical Innovation Teams will need coaching. Before a team is fully formed and the team members have gotten to know each other it is hard to focus fully on the development work. It is recommended that the engineer works as a coach to either the whole team, or the engineering student or a “clinical champion” appointed project leader.
Industrial designer. The development projects at the Sister Kenny Research Center will almost exclusively deal with user-close designing where user needs and their capabilities and limitations will need in-depth analysis. Someone with a background in industrial designing or Human Factors Engineering is most likely to successfully combine those skills with the technical knowledge required. An industrial designer will be able to coach the Clinical Innovation Teams in visual communication that will be important when selling an idea to an interested company, or when gathering funding to make products mature for the market.
The current researchers at the Sister Kenny Research Center has an innovation-friendly mindset and has impressive track records in the field
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of innovations. There is however no formal training in innovation and creativity tools. Since the innovativeness has been explicitly expressed as a key factor at the Sister Kenny Research Center it is highly recommended that the future engineer working in the design lab possesses such skills.
Providing the right resources
Here follows a list of resources that should be provided for the teams to be able to conduct a successful and innovative development project:
Audio-recording equipment, video-recording equipment and digital camera. Make sure the video camera has enough capacity for its purpose and that the transfer from camera to editing equipment is easily done. Software for video and audio edition, such as a more advanced version of QuickTime should be installed on at least one computer. As the Sister Kenny Research Center has the possibilities to use computers and software that is not of Allina standard it is recommended that a Mac computer is considered. The iMovie application for Mac computers is easy to learn and enables rather advanced video editing to be done with little learning time. Apple also has other interesting applications suitable for media editing, and to create interesting presentations and booklets.
Software for illustrations, flowcharts and picture editing . Microsoft Visio is considered the leading software to create advanced flowcharts a purchase should be considered. The Adobe Creative Suite is the business standard for layout (InDesign), advanced picture editing (Photoshop) and vector-based illustrations (Illustrator). The Adobe CS package also contains software for flash programming. It is recommended that these programs are available on at least one of the Sister Kenny Research Center computers, and since they are used as a unit all programs should be available on the same computer.
Patient database for testing. One of the Sister Kenny Research Centers biggest assets is having the patient care so close by. There is however some obstacles to overcome before the benefits of that can be fully utilized. HIPAA and other regulations protecting patient safety and privacy, along with FDA regulations limit the way patients can be included in research. The Sister Kenny Research
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Center should analyze what needs to be done to be able to conduct patient studies and include patients on the Clinical Innovation Teams without having to go through the bureaucracy of regulations each time. Building a patient database with patients who have agreed to join in clinical trials or other studies for research purposes has been mentioned as a possible path to take.
Design lab equipment. The Sister Kenny Research Center Design lab should be equipped with all machines necessary to build prototypes for the most common types of development projects that will be conducted at the Sister Kenny Research Center. The research center should also initiate a collaboration with an external partner that can help with more advanced prototype building.
Intellectual property. The possibility of getting acknowledged in patents, or even to get financial rewards from developed products that make it to the market may serve as an incentive to join in research projects. The process of developing a structure for Intellectual Property at the Sister Kenny Research Center is still undergoing.
Innovative development projects – the management side5.
The Sister Kenny Research Center Innovation Handbook is provided as a tool for the Clinical Innovation Teams to work around, to facilitate the process of following a development project structure even without any previous experience from such projects. There is however some support required from the management of the Sister Kenny Research Center to best enable the handbook to have full effect.
The role of the project owner
First of all it’s important to know that the Innovation Handbook follows a so-called Stage-gate structure, where the development process contains a number of checkpoints where the project owner and the Clinical Innovation Team should meet to make important decisions. These Stage-Gates are added to ensure that choices are made before continuing to the next step in the process and to provide a chance for the project owner to get insight in the work and to participate in the decision-making process. Coordinate these meetings with the project leader or the Clinical Innovation Team.
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It will be useful for the Clinical Innovation Teams to get regular feedback from the project owner or an external stakeholder. Scheduled feedback meetings, together with the Stage-Gate checkpoints will provide useful incentive for the Clinical Innovation Teams to work goal oriented and to follow a specific timeframe. Posting strict deadlines and asking for documentation and presentations are actually positive stress-factors in a project, and it is encouraged to do so regularly.
Whoever will be involved in a development project or take part in the outcome of a development project should read the handbook and reflect upon the process. Some projects may better be carried out with a different approach and the Clinical Innovation Team together with the project owner should then agree on an alternative model.
Recruiting the right students
The project setting at the Sister Kenny Research Center is challenging and interdisciplinary team formations as well as cultural differences might put extra stress on the team members. It is recommended to carefully consider the recruitment of each team member, both students and clinicians. In the case of recruitment of a master thesis students from KTH or University of Minnesota thesis proposals should be announces to all students and an application process should be carried out. Besides the appropriate technical background the students should have a sufficient level of English, be prepared to take on some project leader responsibility and have shown that they can carry out projects independently. References from at least a teacher at the home university, as well as the student’s CV should be required and the project owner or other people involved in the project should thereafter choose the most competent student. KTH has also stressed the importance of a structured application process and it is in the interest of all stakeholders to make sure the students who come to the Sister Kenny Research Center are able to carry out their task in a satisfactory way.
Work model visualization
The final pages of the Innovation Handbook that is part of this thesis project, shows the design process developed for the Sister Kenny Research Center together with the resources needed and the expected outcome of
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each step. That design process illustration may serve as a link between the recommendations in this report and the design process that the Clinical Innovation Teams will follow.
Concluding remarksCreating an innovative work environment and teams with the capability to think outside the box demand a wide range of commitments and resources from the staff at the Sister Kenny Research Center. It is important that the whole aspect of innovativeness is overseen so that effects of good initiatives in one field are not canceled by attending poorly to other aspects. In the same manner it is important that the recruitment of clinicians and the cost of their time is not a waste of resources due to having the wrong student or lack of motivation from other team members. The students on these teams can have a huge impact on the results of the development project, both good and bad, and that should not be taken lightly.
Maintaining and shaping a creative work environment is an ongoing process and will demand continuous engagement from all staff involved. The goals and core values of the Sister Kenny Research Center need to be communicated over and over again.
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