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Healthcare
Positive Distractions
Engineering the Waiting Experience of
Pediatric Patients
Presenters
2009 NACHRI F iliti D i2009 NACHRI Facilities Design
Conference, Austin, TX
Debajyoti Pati, PhD, FIIA, HKS Arch...
The Ongoing Debate
In a time of rising health… In a time of rising health
costs, it doesn’t make a ton
of sense for facili...
Question
What role do hospital waiting areas play?
Learning Objectives
Understand the influence of positive
distractions on pediatric patients while
waiting
Understand the r...
Agenda
Waiting Experience
Positive DistractionsPositive Distractions
Study Objectives
Study Procedure
Children’s Data Anal...
Acknowledgments
Children’s Medical Center Dallas
American Art Resources
Mohawk
Catherine Mayer Fine Art
Henry Domke Fine A...
Acknowledgments
Co-Investigators
Dr Upali Nanda, American Art Resources
Laurie Waggener, WHR Architectsgg ,
Agenda
Waiting Experience
Positive DistractionsPositive Distractions
Study Objectives
Study Procedure
Children’s Data Anal...
Waiting Experience
The Cornell
University Studyy y
Location: Weill Cornell
Medical College, New York
Six clinical outpatie...
Agenda
Waiting Experience
Positive DistractionsPositive Distractions
Study Objectives
Study Procedure
Children’s Data Anal...
Positive Distractions
Outcomes during
procedures:p
Better pain control
Reduced anxiety, fatigue
and distress
Reduced patie...
Agenda
Waiting Experience
Positive DistractionsPositive Distractions
Study Objectives
Study Procedure
Children’s Data Anal...
Study Objective # 1
Can positive distractions produce positiveCan positive distractions produce positive
behavioral outcom...
Study Objective # 2
Do positive distractions in an environment actDo positive distractions in an environment act
as points...
Study Objective # 3
Are multisensory distractions more effective
than purely visual distractions?
Agenda
Waiting Experience
Positive DistractionsPositive Distractions
Study Objectives
Study Procedure
Children’s Data Anal...
Study Site # 1
Children’s Medical Center Dallas - Dental Clinic
Study Site # 2
Children’s Medical Center Dallas – Cardiac Clinic
Distraction Conditions
5 positive distraction conditions
Still nature photo slide show Naturep
Ambient Art
Ambient Art wit...
Subjects and Data Collection
Subjects:
Pediatric patients visiting the
Process:
10 min randomized distraction
clinic
>= 5 ...
Subject Attributes
Dental Clinic
Age = 10.95 (mean); 5 – 17 years
Cardiac Clinic
Age = 11.57 (mean); 5 – 17 yearsg ( ) y
E...
Outcome Measures
Attention
Positive distraction
Other art work
Toy
B kBook
Wall
Ceilingg
Floor
Door
Window
Furniture
Peopl...
Outcome Measures
Physical Behavior
Calm
Fidgety
Fine movement
Gross movement
Intense
Outcome Measures
Activity
Playing with toysy g y
Playing with non-toys
Non-play activity or other play
Outcome Measures
Location
In seat
Out of seat
On Lap
Outcome Measures
Social Behavior
Positive interaction
Negative interaction
Solitary behavior
Analytical Procedures
Paired sample t-tests for identifying significant
differences between distraction and no-distraction...
Agenda
Waiting Experience
Positive DistractionsPositive Distractions
Study Objectives
Study Procedure
Children’s Data Anal...
Distraction vs No-Distraction
What differences in attention, behavior andat d e e ces atte t o , be a o a d
activities wer...
Attention :: Dental Clinic
Attention
Type
Distraction No-
Distraction
Difference Significance
TV Monitor 27 73 2 16 25 57 ...
Attention :: Cardiac Clinic
Attention
Type
Distraction No-
Distraction
Difference Significance
TV Monitor 20 58 0 41 20 17...
Attention :: Key Inferences
Substantial diversion of attention to the TV monitor
during distraction conditions
Presence of...
Physical Behavior: Dental Clinic
Behavior
Type
Distraction No-
Distraction
Difference Significance
Type Distraction
Calm 6...
Physical Behavior :: Cardiac Clinic
Behavior
Type
Distraction No-
Distraction
Difference Significance
Type Distraction
Cal...
Distraction vs No-Distraction Inferrences
Dental Clinic Cardiac Clinic
Most children were observed to
be ‘calm’, ‘solitary...
Distraction Conditions Comparison
How is attention distributed between the
distraction conditions?
Distribution of Attention
Dental Clinic %
Attention
Cardiac Clinic %
Attention
Ambient Art with Sound 42.35 Ambient Art 37...
Distribution of Attention :: Key Inferences
Overall, multi-sensory (visual + auditory) stimuli attract
greater attention
S...
Interaction Effects?
Did bj t tt ib t ( th i itDid subject attribute (ethnicity,
developmental disability, illness type)
i...
Physical Behavior :: CALM
CALM
(Most to Least)
Dental Clinic Cardiac Clinic
Aquarium Ambient Art
Ambient Art with Sound Aq...
Physical Behavior :: FIDGETY
FIDGETY
(Least to Most)
Dental Clinic Cardiac Clinic
Ambient Art with Sound Aquarium
Still Ar...
Physical Behavior :: FINE MOVEMENT
FINE MOVEMENT
(Least to Most)
Dental Clinic Cardiac Clinic
Ambient Art with Sound Ambie...
Physical Behavior :: GROSS MOVEMENT
GROSS MOVEMENT
(Least to Most)
Dental Clinic Cardiac Clinic
Aquarium Ambient Art
Aquar...
Activity :: PLAY TOY
PLAY TOY
(Most to Least)
Dental Clinic Cardiac Clinic
Aquarium Aquarium with Sound
Ambient Art with S...
Activity :: PLAY NON-TOY
PLAY NON-TOY
(Most to Least)
Dental Clinic Cardiac Clinic
Aquarium with Sound Still Art
Ambient A...
Location :: OUT OF SEAT
OUT OF SEAT
(Least to Most)
Dental Clinic Cardiac Clinic
Aquarium Still Art
Still Art Ambient Art ...
Location :: IN SEAT
IN SEAT
(Most to Least)
Dental Clinic Cardiac Clinic
Aquarium Still Art
Still Art Ambient Art with Sou...
Social Behavior :: POSITIVE INTERACTION
POSITIVE
INTERACTION
(Most to Least)
Dental Clinic Cardiac Clinic
Aquarium with So...
Social Behavior :: SOLITARY BEHAVIOR
SOLITARY BEHAVIOR
(Least to Most)
Dental Clinic Cardiac Clinic
Aquarium with Sound St...
Key Behavioral Inferences
Population attribute (ethnicity, developmental
disability, illness type) may constitute ay, yp )...
Question
Is patient attribute (as defined by clinic) a
major predictor of behavior?
Method: 2 x 5 Factorial Designg
Still ...
Factorial Analysis: Attention
Attention WITHOUT Covariate
Clinic Distraction Interaction
WITH Covariate
Clinic Distraction...
Factorial Analysis: Behavior and Activity
Attention WITHOUT Covariate
Clinic Distraction Interaction
Calm
WITH Covariate
C...
Key Inferences
A number of behavior outcomes associated with patient attribute:
Culture and/or Neurological State and/or I...
Agenda
Waiting Experience
Positive DistractionsPositive Distractions
Study Objectives
Study Procedure
Children’s Data Anal...
Inferences
Presence of distraction conditions associated with change in
children’s attention, activities and behavior
P ’ ...
Question
Any explanations for the apparent importance
of waiting experience?
Items in Overall Visit and Experience
Felt cared
Child treated in timely mannerChild treated in timely manner
Felt welcome...
Mediation Analysis
Perception
Wait
Area
regarding
Staff
Overall
Perception
regarding
Exam
Room
Experience
Overall
g g
Staff
The Ongoing Debate
… In a time of rising health
costs it doesn’t make a toncosts, it doesn t make a ton
of sense for facil...
Agenda
Waiting Experience
Positive DistractionsPositive Distractions
Study Objectives
Study Procedure
Children’s Data Anal...
Implications
Waiting experience
associated with keyCarefully engineer
waiting experience
associated with key
organizationa...
Implications
All positive distractions
are not the same
Culture and/or
neurological state and/or
li i t i t d ithclinic ty...
Implications
Attention on People:
Do not ignore
physical placement,
dj i iWhether distraction
conditions were switched
on ...
Q U E S T I O N S
Definitions of Terms: Attention
Attention Eye-fixation on any object/person will be recorded as
attention. Objects can inc...
Definition of Terms: Physical Behavior
Calm No visible major motor movement
Fidgety This will be coded whenever repetitive...
Definition of Terms: Activity and Location
Playing with toys Defined as playing with toys in the room (ifPlaying with toys...
Definition of Terms: Social Behavior
Positive interaction All vocalizations directed to
sibling/parent/objects excluding s...
NACHRI_2009_Positive Distraction Study
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NACHRI_2009_Positive Distraction Study

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NACHRI_2009_Positive Distraction Study

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NACHRI_2009_Positive Distraction Study

  1. 1. Healthcare Positive Distractions Engineering the Waiting Experience of Pediatric Patients
  2. 2. Presenters 2009 NACHRI F iliti D i2009 NACHRI Facilities Design Conference, Austin, TX Debajyoti Pati, PhD, FIIA, HKS Architects Jeff Stouffer, FAIA, HKS Architects
  3. 3. The Ongoing Debate In a time of rising health… In a time of rising health costs, it doesn’t make a ton of sense for facilities to be spending lavishly on perks. Jacob Goldstein, in Behind Hospitals’ Pretty Facades, Dingy Rooms for Patients, Wall Street Journal, August 20, 2008
  4. 4. Question What role do hospital waiting areas play?
  5. 5. Learning Objectives Understand the influence of positive distractions on pediatric patients while waiting Understand the role of positive distractions in the parents’ waiting experience Distinguish the difference between uni-g sensory and multi-sensory distractions
  6. 6. Agenda Waiting Experience Positive DistractionsPositive Distractions Study Objectives Study Procedure Children’s Data Analysisy Parent’s Data Analysis ImplicationsImplications
  7. 7. Acknowledgments Children’s Medical Center Dallas American Art Resources Mohawk Catherine Mayer Fine Art Henry Domke Fine Art
  8. 8. Acknowledgments Co-Investigators Dr Upali Nanda, American Art Resources Laurie Waggener, WHR Architectsgg ,
  9. 9. Agenda Waiting Experience Positive DistractionsPositive Distractions Study Objectives Study Procedure Children’s Data Analysisy Parent’s Data Analysis ImplicationsImplications
  10. 10. Waiting Experience The Cornell University Studyy y Location: Weill Cornell Medical College, New York Six clinical outpatient servicesSix clinical outpatient services Key findings: Physical environment attractiveness correlated with perceived care quality and anxietyanxiety Physical environment attractiveness correlated with perceived waiting timeperceived waiting time
  11. 11. Agenda Waiting Experience Positive DistractionsPositive Distractions Study Objectives Study Procedure Children’s Data Analysisy Parent’s Data Analysis ImplicationsImplications
  12. 12. Positive Distractions Outcomes during procedures:p Better pain control Reduced anxiety, fatigue and distress Reduced patient-controlled sedation doses Reduced pulse rate Greater relaxation Most studies on adult patients
  13. 13. Agenda Waiting Experience Positive DistractionsPositive Distractions Study Objectives Study Procedure Children’s Data Analysisy Parent’s Data Analysis ImplicationsImplications
  14. 14. Study Objective # 1 Can positive distractions produce positiveCan positive distractions produce positive behavioral outcomes in children (with and without neurological disorders)?without neurological disorders)?
  15. 15. Study Objective # 2 Do positive distractions in an environment actDo positive distractions in an environment act as points of focus that can improve the overall waiting experience?overall waiting experience?
  16. 16. Study Objective # 3 Are multisensory distractions more effective than purely visual distractions?
  17. 17. Agenda Waiting Experience Positive DistractionsPositive Distractions Study Objectives Study Procedure Children’s Data Analysisy Parent’s Data Analysis ImplicationsImplications
  18. 18. Study Site # 1 Children’s Medical Center Dallas - Dental Clinic
  19. 19. Study Site # 2 Children’s Medical Center Dallas – Cardiac Clinic
  20. 20. Distraction Conditions 5 positive distraction conditions Still nature photo slide show Naturep Ambient Art Ambient Art with Sound Nature Slides Aquarium Aquarium with sound Ambient Art All nature themes No-Distraction condition as control Aquarium
  21. 21. Subjects and Data Collection Subjects: Pediatric patients visiting the Process: 10 min randomized distraction clinic >= 5 years old With and without 10 min no-distraction Trained observers O b hild With and without developmental/neurological problems One observer per child Parent questionnaire Data Collection Dental Clinic: 6 days in Sample size Children data: 81 (Dental) + 77 December 2008 Cardiac Clinic: 6 days in January 2009 (Cardiac) Parents: 51 (Dental) + 24 (Cardiac)
  22. 22. Subject Attributes Dental Clinic Age = 10.95 (mean); 5 – 17 years Cardiac Clinic Age = 11.57 (mean); 5 – 17 yearsg ( ) y Ethnicity White = 25.3% Bl k 13 9% g ( ) y Ethnicity White = 40.8% Bl k 22 4%Black = 13.9% Hispanic = 58.2% Asian = 2.5% Black = 22.4% Hispanic = 35.5% Asian = 1.3% Gender Male = 59.3% Female = 40 7% Gender Male = 53.9% Female = 46 1%Female = 40.7% Developmental/ Neurological deficiencies P t 47 8% Female = 46.1% Developmental/ Neurological deficiencies P t 12 5%Present = 47.8% Present = 12.5%
  23. 23. Outcome Measures Attention Positive distraction Other art work Toy B kBook Wall Ceilingg Floor Door Window Furniture PeoplePeople Themselves
  24. 24. Outcome Measures Physical Behavior Calm Fidgety Fine movement Gross movement Intense
  25. 25. Outcome Measures Activity Playing with toysy g y Playing with non-toys Non-play activity or other play
  26. 26. Outcome Measures Location In seat Out of seat On Lap
  27. 27. Outcome Measures Social Behavior Positive interaction Negative interaction Solitary behavior
  28. 28. Analytical Procedures Paired sample t-tests for identifying significant differences between distraction and no-distraction diticonditions Covariance models to compare the five distraction conditionsconditions Factorial Design to identify main effects C l ti A l i t l l ti hi b tCorrelation Analysis to explore relationships between children’s behavior and parent’s perception Mediation analysis to explore the true pattern ofMediation analysis to explore the true pattern of relationship between waiting experience and perceived care quality
  29. 29. Agenda Waiting Experience Positive DistractionsPositive Distractions Study Objectives Study Procedure Children’s Data Analysisy Parent’s Data Analysis ImplicationsImplications
  30. 30. Distraction vs No-Distraction What differences in attention, behavior andat d e e ces atte t o , be a o a d activities were observed during the presence of positive distraction conditions?
  31. 31. Attention :: Dental Clinic Attention Type Distraction No- Distraction Difference Significance TV Monitor 27 73 2 16 25 57 0 000TV Monitor 27.73 2.16 25.57 0.000 Other Artwork 0.36 0.42 -0.06 0.886 Toy 4.24 8.22 -3.98 0.007 Book 1.97 2.17 -0.2 0.829 Wall 7.1 7.57 -0.47 0.818 Ceiling 2.91 2.52 0.39 0.723 Floor 2.66 3.83 -1.17 0.373 Door 3.65 3.5 0.15 0.910 Window 3 52 5 7 2 18 0 179Window 3.52 5.7 -2.18 0.179 Furniture 3.19 5.16 -1.97 0.245 People 36.12 51.64 -15.52 0.000 Themselves 6.53 7.10 -0.57 0.792
  32. 32. Attention :: Cardiac Clinic Attention Type Distraction No- Distraction Difference Significance TV Monitor 20 58 0 41 20 17 0 000TV Monitor 20.58 0.41 20.17 0.000 Other Artwork 1.52 1.24 0.28 0.825 Toy 19.13 13.16 5.97 0.081 Book 8.09 15.47 -7.83 0.017 Wall 1.95 3.0 -1.05 0.333 Ceiling 0.52 0.37 0.15 0.737 Floor 3.42 3.04 0.38 0.726 Door 0.75 1.02 -0.27 0.737 Window 4 03 5 11 1 08 0 369Window 4.03 5.11 -1.08 0.369 Furniture 0.97 1.21 -0.24 0.730 People 32.27 44.36 -12.09 0.008 Themselves 6.75 11.6 -4.85 0.028
  33. 33. Attention :: Key Inferences Substantial diversion of attention to the TV monitor during distraction conditions Presence of distraction conditions diverted attention from two or more of the following to the TV monitor: people, book, toy, themselves Positive Distraction do help focus attention “People” drew most attention even in the presence of distraction conditionsdistraction conditions
  34. 34. Physical Behavior: Dental Clinic Behavior Type Distraction No- Distraction Difference Significance Type Distraction Calm 64.92 58.3 6.62 0.080 Fidgety 20.99 19.41 1.58 0.570 Fine 10 79 15 36 4 57 0 051Fine Movement 10.79 15.36 -4.57 0.051 Gross Movement 2.63 5.18 -2.55 0.079 Intense Movement 0.67 1.75 -1.08 0.153
  35. 35. Physical Behavior :: Cardiac Clinic Behavior Type Distraction No- Distraction Difference Significance Type Distraction Calm 68.88 59.92 8.96 0.029 Fidgety 11.50 13.08 -1.58 0.473 Fine Movement 18 33 23 32 4 99 0 183Fine Movement 18.33 23.32 -4.99 0.183 Gross Movement 1.28 3.49 -2.21 0.049 Intense 0 00 0 19 -0 19 0 176Intense Movement 0.00 0.19 0.19 0.176
  36. 36. Distraction vs No-Distraction Inferrences Dental Clinic Cardiac Clinic Most children were observed to be ‘calm’, ‘solitary behavior’, ‘in seat’, ‘not playing’, and ‘watching Most children were observed to be ‘calm’, ‘solitary behavior’, ‘in seat’, ‘not playing’, and ‘watching other people’. Distraction condition results in: other people’. Distraction condition results in:Distraction condition results in: More attention on TV Monitor More calm; less fine and t Distraction condition results in: More attention on TV Monitor More calm; less gross tgross movement movement
  37. 37. Distraction Conditions Comparison How is attention distributed between the distraction conditions?
  38. 38. Distribution of Attention Dental Clinic % Attention Cardiac Clinic % Attention Ambient Art with Sound 42.35 Ambient Art 37.18 Aquarium 28.87 Ambient Art with Sound 23.67 Still Art 28.00 Aquarium with Sound 23.00 A i ith S d 23 49 A i 14 53Aquarium with Sound 23.49 Aquarium 14.53 Ambient Art 4.66 Still Art 9.11 Both Clinics %Distribution by Clinic Both Clinics % Attention Ambient Art with Sound 66.02 Distribution by Clinic Aquarium with Sound 46.48 Aquarium 43.40 Ambient Art 41.84 Still Art 37.11Combined Mean Distribution
  39. 39. Distribution of Attention :: Key Inferences Overall, multi-sensory (visual + auditory) stimuli attract greater attention Still nature slide show demonstrate least preference HOWEVERHOWEVER Substantial differences between the two clinics A pattern observable for cardiac population Ambient art conditions, Aquarium conditions, Still, q , Nature No meaningful pattern identifiable for dental population
  40. 40. Interaction Effects? Did bj t tt ib t ( th i itDid subject attribute (ethnicity, developmental disability, illness type) interact with attention and behavior?interact with attention and behavior?
  41. 41. Physical Behavior :: CALM CALM (Most to Least) Dental Clinic Cardiac Clinic Aquarium Ambient Art Ambient Art with Sound Aquarium with Sound Still Art Ambient Art with Sound Aquarium with Sound Still ArtAquarium with Sound Still Art Ambient Art Aquarium Pole ReversalPole Reversal
  42. 42. Physical Behavior :: FIDGETY FIDGETY (Least to Most) Dental Clinic Cardiac Clinic Ambient Art with Sound Aquarium Still Art Aquarium with Sound Aquarium Ambient Art Aquarium with Sound Ambient Art with SoundAquarium with Sound Ambient Art with Sound Ambient Art Still Art Block ShiftBlock Shift
  43. 43. Physical Behavior :: FINE MOVEMENT FINE MOVEMENT (Least to Most) Dental Clinic Cardiac Clinic Ambient Art with Sound Ambient Art Aquarium Still Art Aquarium with Sound Ambient Art with Sound Still Art Aquarium with SoundStill Art Aquarium with Sound Ambient Art Aquarium Pole ReversalPole Reversal
  44. 44. Physical Behavior :: GROSS MOVEMENT GROSS MOVEMENT (Least to Most) Dental Clinic Cardiac Clinic Aquarium Ambient Art Aquarium with Sound Still Art Ambient Art with Sound Ambient Art with Sound Still Art Aquarium with SoundStill Art Aquarium with Sound Ambient Art Aquarium Total ReversalTotal Reversal
  45. 45. Activity :: PLAY TOY PLAY TOY (Most to Least) Dental Clinic Cardiac Clinic Aquarium Aquarium with Sound Ambient Art with Sound Aquarium Still Art Still Art Aquarium with Sound Ambient Art with SoundAquarium with Sound Ambient Art with Sound Ambient Art Ambient Art Partial ReversalPartial Reversal
  46. 46. Activity :: PLAY NON-TOY PLAY NON-TOY (Most to Least) Dental Clinic Cardiac Clinic Aquarium with Sound Still Art Ambient Art Ambient Art with Sound Still Art Aquarium Ambient Art with Sound Aquarium with SoundAmbient Art with Sound Aquarium with Sound Aquarium Ambient Art Block ShiftBlock Shift
  47. 47. Location :: OUT OF SEAT OUT OF SEAT (Least to Most) Dental Clinic Cardiac Clinic Aquarium Still Art Still Art Ambient Art with Sound Aquarium with Sound Aquarium Ambient Art Aquarium with SoundAmbient Art Aquarium with Sound Ambient Art with Sound Ambient Art Partial ReversalPartial Reversal
  48. 48. Location :: IN SEAT IN SEAT (Most to Least) Dental Clinic Cardiac Clinic Aquarium Still Art Still Art Ambient Art with Sound Ambient Art with Sound Aquarium with Sound Ambient Art Ambient ArtAmbient Art Ambient Art Aquarium with Sound Aquarium Pole ReversalPole Reversal
  49. 49. Social Behavior :: POSITIVE INTERACTION POSITIVE INTERACTION (Most to Least) Dental Clinic Cardiac Clinic Aquarium with Sound Still Art ( ost to east) Ambient Art with Sound Ambient Art Aquarium Aquarium with Sound Ambient Art Ambient Art with SoundAmbient Art Ambient Art with Sound Still Art Aquarium Pole ReversalPole Reversal
  50. 50. Social Behavior :: SOLITARY BEHAVIOR SOLITARY BEHAVIOR (Least to Most) Dental Clinic Cardiac Clinic Aquarium with Sound Still Art Ambient Art with Sound Ambient Art Aquarium Aquarium with Sound Ambient Art Ambient Art with SoundAmbient Art Ambient Art with Sound Still Art Aquarium Block ShiftBlock Shift
  51. 51. Key Behavioral Inferences Population attribute (ethnicity, developmental disability, illness type) may constitute ay, yp ) y factor determining physical and social behavior Most frequent top and bottom conditions: Dental Clinic Cardiac Clinic Most frequently at the top Aquarium Ambient Art + Still Art Most frequently at the bottom Ambient Art Aquarium
  52. 52. Question Is patient attribute (as defined by clinic) a major predictor of behavior? Method: 2 x 5 Factorial Designg Still Art Ambient Art Ambient Art + Aquarium Aquarium + Sound Sound Dental Cardiac
  53. 53. Factorial Analysis: Attention Attention WITHOUT Covariate Clinic Distraction Interaction WITH Covariate Clinic Distraction Interaction TV Monitor Yes Other Art Toy Yes Yes Yes Book Yes Wall Yes Yes Ceiling Yes Yes Yes Ceiling Yes Floor Door Yes Yes Window Furniture Yes People Yes Themselves
  54. 54. Factorial Analysis: Behavior and Activity Attention WITHOUT Covariate Clinic Distraction Interaction Calm WITH Covariate Clinic Distraction Interaction Calm Fidgety Yes Fine Movement Yes Gross Movement Yes Yes Yes Gross Movement Yes Intense Play Toy Yes Play Non-ToyPlay Non Toy None/Other Play Yes Yes Out of Seat In Seat On Lap Yes Positive Int Yes Negative Int Yes Yes YesNegative Int Solitary Yes Yes Yes
  55. 55. Key Inferences A number of behavior outcomes associated with patient attribute: Culture and/or Neurological State and/or Illness Type Difference reduces when controlled for no-distraction condition data Multi-sensory distractions more effective in Dental Clinic Behavior Dental Clinic Cardiac Clinic Calm Ambient Art (S); Aquarium Ambient Art Fidgety Ambient Art (S) Aquariumg y ( ) q Fine Movement Ambient Art (S) Ambient Art Gross Movement Aquarium Ambient Art Intense Movement Aquarium (S) Aquariumq ( ) q Positive Interaction Aquarium (S) Still Art Negative Interaction Aquarium Still Art Solitary Behavior Aquarium (S) Still ArtSolitary Behavior Aquarium (S) Still Art
  56. 56. Agenda Waiting Experience Positive DistractionsPositive Distractions Study Objectives Study Procedure Children’s Data Analysisy Parent’s Data Analysis ImplicationsImplications
  57. 57. Inferences Presence of distraction conditions associated with change in children’s attention, activities and behavior P ’ i i i i d i h hild ’ iParents’ waiting experience associated with children’s attention, activities and behavior Elements of parents’ waiting experience associated with their perceived waiting time Parent’s waiting experience (including perceived waiting time) associated with their:associated with their: Exam room experience Perception regarding staff Overall visit Overall experience
  58. 58. Question Any explanations for the apparent importance of waiting experience?
  59. 59. Items in Overall Visit and Experience Felt cared Child treated in timely mannerChild treated in timely manner Felt welcome Less anxiety feeling Recommend this clinic to others Quality of care child received Quality of service parent’s receivedQuality of service parent s received Quality of interaction with staff Quality of interaction with doctor
  60. 60. Mediation Analysis Perception Wait Area regarding Staff Overall Perception regarding Exam Room Experience Overall g g Staff
  61. 61. The Ongoing Debate … In a time of rising health costs it doesn’t make a toncosts, it doesn t make a ton of sense for facilities to be spending lavishly on perks.p g y p Jacob Goldstein, in Behind Hospitals’ Pretty F d Di R f P ti t W llFacades, Dingy Rooms for Patients, Wall Street Journal, August 20, 2008
  62. 62. Agenda Waiting Experience Positive DistractionsPositive Distractions Study Objectives Study Procedure Children’s Data Analysisy Parent’s Data Analysis ImplicationsImplications
  63. 63. Implications Waiting experience associated with keyCarefully engineer waiting experience associated with key organizational objectivesobjectives
  64. 64. Implications All positive distractions are not the same Culture and/or neurological state and/or li i t i t d ithclinic type associated with behavioral outcomes Positive distractions are attention grabbers Locate distraction conditions carefully Positive distractions associated with calm behavior Take advantage of behavioral influence of positive distractionbehavior positive distraction
  65. 65. Implications Attention on People: Do not ignore physical placement, dj i iWhether distraction conditions were switched on or not, most attention was fixated on other adjacencies, view corridors, and activities aroundwas fixated on other people activities around hospital waiting areas
  66. 66. Q U E S T I O N S
  67. 67. Definitions of Terms: Attention Attention Eye-fixation on any object/person will be recorded as attention. Objects can include art work, toys, furniture, etc. Positive distraction The flat screen TV in the waiting room on which artwork/music will be displayed Other artwork Any other artwork in the waiting area: painting, sculpture, … at any location in the waiting lounge Toy Any piece of toy/game in the waiting area or brought in by the subjectin by the subject Book Book or books in the waiting lounge or brought in by the subject Wall Blank portions of any of the wall in the waiting room Ceiling Ceiling of the waiting room Floor Floor of the waiting room Door Any of the doors of the waiting room Window Any window – external or internal – in the waiting room, including the reception desk/windowg p Furniture Any unoccupied furniture in the waiting lounge – without any person or thing on the furniture P l A i h i iPeople Any person in the waiting room Themselves Any portion of the patient’s own body
  68. 68. Definition of Terms: Physical Behavior Calm No visible major motor movement Fidgety This will be coded whenever repetitive, restless motor movements is observed which appeared to be primarily purposeless (e.g., taping a pencil, kicking one's foot)p g pe c , c g o e s oo ) Fine Movement Defined as fine motor movement involving very low intensity purposeful movements of body parts. Gross Movement Defined as gross motor movement involving taking one or more steps or, if sitting, moving the buttocks from one spot to another Intense Defined as engaging in inappropriate or excessively vigorous physical activities (e.g., throwing toys, running about, yelling or singing loudly)
  69. 69. Definition of Terms: Activity and Location Playing with toys Defined as playing with toys in the room (ifPlaying with toys Defined as playing with toys in the room (if available) Playing with non toys Defined as playing with non toy objects in the room (e.g., doorknob, table) Non-play activity/ Other Play Defined as neither playing with a toy or non- toy item (e.g., standing and gazing at the door; reading; eating; drinking) OR Other play activities (not involving toys or non-toys) Out of seat This will be coded if a child left the seat entirely at the time of observation In-seat This will be coded if a child is in his/her seat at the time of observation Parent’s lap This will be coded if a child is sitting on the lap of another accompanying adult.
  70. 70. Definition of Terms: Social Behavior Positive interaction All vocalizations directed to sibling/parent/objects excluding screams, shouts, cries, and whines; all cooperative responses involved with sharing an object; andespo ses vo ved w s g objec ; d hugs and holding hands Negative interaction Screams, shouts, or other utterances that indicate rejecting and oppositional behavior; hit, pinch, kick, and “nonplaying” push or pull; grabbing objects from sibling/parent; and destroying possessions of sibling/parent Solitary behavior All solitary activity (excluding parallel play conducted between two children within two feet of one another)

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