The Pennsylvania State University The Graduate School

Department of Architectural Engineering

EXPERIENCE-BASED DESIGN REVIEW OF HEALTHCARE FACILITIES USING INTERACTIVE VIRTUAL PROTOTYPES 

A Dissertation in Architectural Engineering by

Sonali Kumar

Copyright 2013 Sonali Kumar

Submitted in Partial Fulfillment of the Requirements

for the Degree of

Doctor of Philosophy May 2013

++++

Editor’s note: Links to published chapters:

•  Introductory material and Chapter One: http://www.joelsolkoff.com/dr-sonali-kumars-thesis-on-virtual-reality-modeling/
•  Chapter Two: https://joelsolkoff.com/chapter-2-dr-kumars-thesis-on-virtual-reality-modeling/
•  Chapter Three: https://joelsolkoff.com/chapter-3-dr-kumars-thesis-on-virtual-reality-modeling/
• Chapter Four: https://joelsolkoff.com/chapter-4-dr-kumars-thesis-on-virtual-reality-modeling/
• Chapter Five: https://joelsolkoff.com/chapter-5-dr-kumars-thesis-on-virtual-reality-modeling/
• Chapter Six: https://joelsolkoff.com/dr-sonali-kumars-thesis-on-virtual-reality-modeling/

++++

The dissertation of Sonali Kumar was reviewed and approved* by the following:

John I. Messner

Professor of Architectural Engineering Dissertation Advisor and Co-Chair of Committee

Chimay J. Anumba

Professor and Department Head of Architectural Engineering Co-Chair of Committee

Madhu C. Reddy

Associate Professor of Information Sciences and Technology

S. Shyam Sundar

Distinguished Professor of Communications

Richard A. Behr

Charles and Elinor Matts Professor Emeritus of Architectural Engineering

*Signatures are on file in the Graduate School

++++

ABSTRACT

With rapid technological advances taking place in the architectural, engineering and construction fields, virtual prototyping is increasingly being used during the design review  process of specialized building types such as healthcare facilities. Current research in healthcare facility design strongly indicates that the physical environment greatly impacts end-users in issues of safety and overall health quality. This has led to emerging trends and design approaches such  as experience-based design and evidence-based design that encourage participation and collaboration with the end-users of healthcare facilities. Interactive virtual prototyping provides opportunities for embedding experience-based design concepts that enable end-users to truly experience design alternatives and concepts during design reviews. However, studies have also highlighted that developing interactive virtual prototypes is a time-consuming and labor intensive process.

This study proposes an experience-based virtual prototyping system (EVPS) that was developed, implemented and evaluated at the Hershey Children’s Hospital. The goal of the study was to simulate experience-based design concepts in virtual prototypes within the context of healthcare facilities. This goal was achieved through four objectives. First, requirements for experience-based design review were analyzed by documenting end-user activities in healthcare facilities. Second, a framework was developed to categorize end-user tasks into scenarios that could be simulated in interactive virtual prototypes of a healthcare facility. The third objective focused on developing a computer application called the Experience-Based Virtual Prototyping System (EVPS) to simulate scenarios that take place in healthcare facilities. Lastly, the developed EVPS application was implemented at the Hershey Children’s Hospital to evaluate the effectiveness of task-based scenarios for extracting end user feedback during design reviews.

A virtual prototyping procedure was developed to rapidly convert digital model content into interactive experience-based virtual prototypes for design review. Strategies for development included creation of a system architecture to identify interaction media, modeling content as well as features and functionality requirements. Design information workflows were investigated to efficiently transfer model content from building information modeling tools to an interactive real- time rendering platform. Procedures to incorporate interactivity were explored to enable simulation of task-based scenarios in virtual prototypes. Finally, a database of reusable interactive model content was developed and utilized for rapid production of experience-based virtual prototypes.

The experience-based virtual prototyping system was implemented and tested with nurse participants at the Hershey Children’s Hospital. Focus groups enabled the identification of end- user needs and functionality requirements for developing the EVPS. The EVPS application was developed and tailored to the needs of the end-users at the Children’s Hospital – these included transition planning, way finding and staff training before they moved into the new facility. End- users preferred the EVPS to traditional methods of design review, as they were better able to visualize the design and understand the layout of spaces. A user study was designed to compare the design feedback obtained from participants in two conditions comprising a simple walk through and a task-based scenario within the virtual prototype stimulus. The study revealed that adding task-based scenarios in interactive virtual prototypes increases the level of engagement in end users and enables them to provide detailed design feedback related to their daily healthcare activities.

TABLE OF CONTENTS

LIST OF FIGURES…….………………………………………………………………..…viii LIST OF TABLES…….…………………………………………….…………………..……xi ACKNOWLEDGEMENTS…….………………………………………………………..….xii

Chapter 1 INTRODUCTION………………………………………………………………………………. 1

1.1  BACKGROUND………………………………………………………………………………….. 1

1.1.1  Experience-based Design……………………………………………………………….. 2

1.1.2  Virtual Prototypes for Healthcare Facilities……………………………………….. 3

1.1.3  Interaction with Virtual Prototypes…………………………………………………. 3

1.2  RESEARCH GAP…………………………………………………………………………………. 4

1.3  RESEARCH GOALS…………………………………………………………………………….. 6

1.3.1  Research Questions……………………………………………………………………… 7

1.3.2  Goals and Objectives……………………………………………………………………. 7

1.4  RESEARCH SCOPE……………………………………………………………………………… 8

1.5  RESEARCH METHODOLOGY………………………………………………………………. 9

1.5.1  Experience-based Virtual Prototyping System Concept……………………….. 9

1.5.2  System Design……………………………………………………………………………. 9

1.5.3  System Development……………………………………………………………………. 9

1.5.4  System Implementation………………………………………………………………… 10

1.5.5  System Assessment……………………………………………………………………… 10

1.6  THESIS STRUCTURE………………………………………………………………………….. 11

Chapter 2 ROLE OF VIRTUAL PROTOTYPING IN DESIGN REVIEW…………………….. 12

2.1  DESIGN REVIEW……………………………………………………………………………….. 13

2.1.1  Design Review Process…………………………………………………………………. 13

2.1.2  Design Communication and Visualization………………………………………… 15

2.1.3  Review of Design Visualization Media…………………………………………….. 16

2.1.4  End-Users in the Design Process…………………………………………………….. 20

2.2  EXPERIENCE-BASED DESIGN APPROACH TO HEALTHCARE

FACILITIES………………………………………………………………………………………. 23

2.2.1  Healthcare Design- Complexity, challenges and present state……………….. 23

2.2.3  Evidence-based Design Approach in Healthcare…………………………………. 25

2.2.4  Defining Experience-based Design………………………………………………….. 26

2.3  VIRTUAL PROTOTYPING FOR DESIGN REVIEW…………………………………… 27

2.3.1  Definition of Virtual Prototypes……………………………………………………… 28

2.3.2  Virtual Prototyping in AEC Domain……………………………………………….. 29

2.3.3  Virtual Prototyping for Healthcare Facilities……………………………………… 31

2.3.4  Advantages of Virtual Prototyping………………………………………………….. 33

2.4  EXPERIENCE-BASED VIRTUAL PROTOTYPES: NEEDS AND OPPORTUNITIES……………………………………………………………………………………………………. 35

2.4.1  Addressing the Research Gap…………………………………………………………. 36

2.4.2  Game Engines to develop Virtual Prototypes…………………………………….. 37

2.4.3  Simulating Experiences as Scenarios in Gaming Environments…………….. 38

2.4.4  Scenario-based Design Theories……………………………………………………… 38

2.5  SUMMARY………………………………………………………………………………………… 39

Chapter 3 RESEARCH METHODOLOGY……………………………………………………………. 40

3.1  RESEARCH APPROACH………………………………………………………………………. 41

3.1.1  Information Systems Research……………………………………………………….. 41

3.1.2  Systems Development………………………………………………………………….. 43

3.1.3  Adopted Research Approach………………………………………………………….. 44

3.2  RESEARCH STEPS………………………………………………………………………………. 48

3.3  RESEARCH METHODS AND TOOLS…………………………………………………….. 52

3.3.1  Systems Development………………………………………………………………….. 52

3.3.2  Case Study…………………………………………………………………………………. 53

3.3.3  Evaluation…………………………………………………………………………………. 56

3.4  SUMMARY………………………………………………………………………………………… 58

Chapter 4 FRAMEWORK FOR EXPERIENCE-BASED VIRTUAL PROTOTYPING…….. 59

4.1  METHOD TO DEVELOP EXPERIENCE-BASED VIRTUAL PROTOTYPES….. 60

4.2  REQUIREMENTS ANALYSIS……………………………………………………………….. 61

4.2.1  Identifying Stakeholders……………………………………………………………….. 61

4.2.2  Investigating and Documenting Scenarios………………………………………… 62

4.2.3  Framework of scenarios………………………………………………………………… 68

4.3  EVPS DESIGN PROCESS……………………………………………………………………… 70

4.3.1  System Architecture…………………………………………………………………….. 70

4.3.2  Story boarding the Graphical User Interface……………………………………… 74

4.3.3  Identifying Media for Interaction……………………………………………………. 76

4.3.4  Interactivity Environment Selection………………………………………………… 77

4.4  EVPS DEVELOPMENT PROCESS………………………………………………………….. 79

4.4.1  Design Information Workflows………………………………………………………. 80

4.4.2  Information exchange challenges……………………………………………………. 81

4.4.3  Real-time rendering challenges………………………………………………………. 82

4.4.4  Optimal information exchange workflow………………………………………….. 83

4.5  INCORPORATING INTERACTIVITY IN EVPS………………………………………… 84

4.5.1  Navigation…………………………………………………………………………………. 86

4.5.2  Interactive Objects……………………………………………………………………….. 88

4.5.3  User Interface Development…………………………………………………………… 91

4.5.4  Scenario Scripting……………………………………………………………………….. 94

4.6  PROCESS VALIDATION………………………………………………………………………. 96

4.6.1  Framework to rapidly develop reusable model content…………………………. 96

4.6.2  EVPS Development Strategy………………………………………………………….. 98

4.6.3  Experience-based Virtual Prototyping Procedure………………………………… 102

4.7  SUMMARY………………………………………………………………………………………… 104

Chapter 5 CASE STUDY- HERSHEY CHILDREN’S HOSPITAL………………………………. 105

5.1  CASE STUDY DESCRIPTION………………………………………………………………… 106

5.2  CASE STUDY APPROACH……………………………………………………………………. 108

5.3  FOCUS GROUPS…………………………………………………………………………………. 110

5.3.1  First Focus Group – December 9, 2011……………………………………………… 110

5.3.2  Data Collection……………………………………………………………………………. 111

5.3.3  Participants………………………………………………………………………………… 115

5.3.4  Second Focus Group – January 30, 2012……………………………………………. 116

5.3.5  Potential Use of EVPS at Hershey Children’s Hospital………………………….. 116

5.4  SCENARIO ANALYSIS………………………………………………………………………… 117

5.4.1  Scenarios based on End-Users…………………………………………………………. 118

5.4.2  Scenario Categories………………………………………………………………………. 121

5.4.3  Scenarios based on Spaces……………………………………………………………… 122

5.4.4  Validation of Scenarios…………………………………………………………………. 125

5.4  EVPS DEVELOPMENT STRATEGY……………………………………………………….. 126

5.4.1  Model content…………………………………………………………………………….. 127

5.4.2  Level of realism…………………………………………………………………………… 127

5.4.3  User Interface……………………………………………………………………………… 127

5.4.4  Interactive Objects……………………………………………………………………….. 129

5.4.5  Challenges in Development……………………………………………………………. 130

5.5  PHARMACY DESIGN REVIEW……………………………………………………………… 132

5.5.1  Design Review Meetings……………………………………………………………….. 135

5.5.2  Findings…………………………………………………………………………………….. 137

5.6  LESSONS LEARNED……………………………………………………………………………. 138

5.7  SUMMARY………………………………………………………………………………………… 140

Chapter 6 EVALUATION OF EVPS…………………………………………………………………….. 141

6.1  EVALUATION STUDY DESIGN…………………………………………………………….. 143

6.1.1  Metrics for Effective Design Review………………………………………………… 144

6.1.2  Stimulus Design………………………………………………………………………….. 144

6.1.3  Scenario Development………………………………………………………………….. 147

6.1.4  Addition of Design Inaccuracies……………………………………………………… 149

6.2  DATA COLLECTION PROCEDURE……………………………………………………….. 150

6.2.1  Pre-test questions………………………………………………………………………… 152

6.2.2  Think aloud protocol…………………………………………………………………….. 153

6.2.3  Post-test questions……………………………………………………………………….. 153

6.2.4  Participants………………………………………………………………………………… 155

6.3  QUALITATIVE DATA ANALYSIS…………………………………………………………. 157

6.3.1  Analysis Process………………………………………………………………………….. 158

6.3.2  Coding into themes and categories…………………………………………………… 158

6.4  RESULTS AND FINDINGS……………………………………………………………………. 162

6.4.1  Post-test results…………………………………………………………………………… 162

6.4.2  Amount of feedback……………………………………………………………………… 165

6.4.3  Categories of feedback…………………………………………………………………… 167

6.4.4  Additional Scenarios…………………………………………………………………….. 173

6.5  DISCUSSION………………………………………………………………………………………. 174

6.5.1  Quality of feedback………………………………………………………………………. 175

vii

6.5.2  Level of engagement…………………………………………………………………….. 175

6.5.3  Recommendations……………………………………………………………………….. 176

6.6  CHALLENGES……………………………………………………………………………………. 176

6.7  LESSONS LEARNED……………………………………………………………………………. 177

6.8  SUMMARY………………………………………………………………………………………… 179

Chapter 7 CONCLUSIONS………………………………………………………………………………… 180

7.1  RESEARCH FINDINGS………………………………………………………………………… 180

7.2  RESEARCH CONTRIBUTIONS……………………………………………………………… 181

7.2.1  Closing the Research Gap………………………………………………………………. 182

7.2.2  Theoretical Implications………………………………………………………………… 183

7.2.3  Methodological Implications………………………………………………………….. 183

7.2.4  Practical Implications……………………………………………………………………. 184

7.3  LIMITATIONS…………………………………………………………………………………….. 185

7.4  FUTURE RESEARCH…………………………………………………………………………… 186

7.4.1  Measuring level of effort in developing EVPS…………………………………….. 187

7.4.2  Incorporating interactive attributes in BIM elements……………………………. 187

7.4.3  Developing and evaluating more detailed scenarios……………………………… 188

7.4.4  Developing and evaluating more interactivity features………………………….. 188

7.4.5  Investigating methods to extract end user scenarios…………………………….. 189

7.4.6  Improving designer’s understanding of end user experience……………………. 189

7.5  CONCLUDING REMARKS……………………………………………………………………. 190

REFERENCES………………………………………………………………………………………….. 192

Appendix A Experience-Based Virtual Facility Prototyping Plan Template……………… 198

Appendix B Focus Group Questions……………………………………………………………… 200

Appendix C IRB Form……………………………………………………………………………….. 202

Appendix D Protocol Script for Evaluation Study…………………………………………….. 204

Appendix E Questionnaire………………………………………………………………………….. 206

Appendix F Coding Guide…………………………………………………………………………… 213

Appendix G Results of t-tests………………………………………………………………………. 215

LIST OF FIGURES

Figure 1-1. Concept of the Experience-based Virtual Prototyping System (EVPS)…………. 6

Figure 2-1. Approach to conducting the Literature Review………………………………………. 12

Figure 2-2. Design Review during the Facility Life Cycle………………………………………… 14

Figure 2-3. Design Communication between participants………………………………………… 15

Figure 2-4. Spectrum of AEC representation tools………………………………………………….. 17

Figure 2-5. Design Reviews as a BIM Use (Source: CIC Research Group 2010)…………….. 20

Figure 2-6. Co-productive relationship between designers and users in EBD. (Source:

NHS 2008)……………………………………………………………………………………………….. 26

Figure 2-7.  Patient room display in a virtual reality CAVE system. (Source: Dunston et

al. 2007)………………………………………………………………………………………………….. 32

Figure 2-8. Patient interview within an immersive virtual environment. (Source:

Whalström et al 2009)………………………………………………………………………………… 33

Figure 2-9. Cost Influence Curve. (Source: Paulson 1976)……………………………………….. 35

Figure 3-1.   IS Research Framework (Source: Hevner et al. 2004)……………………………… 42

Figure 3-2.  Research approach (Source: Nunamaker et al. 1991)……………………………….. 43

Figure 3-3.  Research process……………………………………………………………………………… 46

Figure 3-4.  Systems development methodology (Source: Nunamaker et al 1991)…………. 53

Figure 4-1. Experience-based virtual prototyping procedure……………………………………… 60

Figure 4-2. Stakeholders in the healthcare design process: Designers and End-Users……… 62

Figure 4-3. Design Review of the Kaiser Pharmacy Virtual Mockup in the ICon Lab…….. 64

Figure 4-4. Virtual Mockup of a Medical Office Pharmacy……………………………………….. 64

Figure 4-5. Example of eliciting and documenting scenarios…………………………………….. 66

Figure 4-6. Framework for incorporating Scenarios in virtual prototypes…………………….. 69

Figure 4-7.  System Architecture of Experience-based Virtual Prototyping System……….. 71

Figure 4-8. Concept design for the Graphical User Interface (GUI) of the EVPS application……………………………………………………………………………………………….. 74

Figure 4-9. Snapshots within the Unity game engine interface showing different steps for design review using scenarios for a healthcare facility model………………………………………………………………………………………………………….. 75

Figure 4-10. Screenshot of the Unity game engine application………………………………….. 78

Figure 4-11. Interoperable file formats to transfer geometry content between tools……….. 80

Figure 4-12. Typical workflow adopted for transfer of model content to develop EVPS….. 83

Figure 4-13. Interactivity in virtual prototypes………………………………………………………. 85

Figure 4-14.  Character controller depicting a nurse downloaded from

www.mixamo.com.……………………………………………………………………………………. 88

Figure 4-15.  Door Prefab with the door trigger collider…………………………………………… 91

Figure 4-16.  Start Menu with interactive buttons to load levels and change options……… 92

Figure 4-17. “Heads-up displays” and mini-maps to aid in way finding and spatial

awareness………………………………………………………………………………………………… 93

Figure 4-18. Scenario Menu and Scripting approach……………………………………………….. 94

Figure 4-19. Reusable model content package – avatar of an elderly person on a mobility device…………………………………………………………………………………………………………… 98

Figure 4-20. Conceptual representation of level of effort (LOE)………………………………… 99

Figure 4-21.  Experience-based Virtual Prototyping procedure…………………………………… 103

Figure 5-1. Rendering of the new Hershey Children’s Hospital (Source: Payette

Architects)……………………………………………………………………………………………….. 106

Figure 5-2. Children’s Hospital under construction…………………………………………………. 107

Figure 5-3. Timeline for Hershey Children’s Hospital case study……………………………….. 109

Figure 5-4. Data Collection during Focus Group 1………………………………………………….. 112

Figure 5-5. Color-code post-it notes with end-user scenarios…………………………………….. 112

Figure 5-6. Scenarios generated from 1st focus group meeting………………………………….. 113

Figure 5-7. Spaces identified on the fourth floor for draft EVPS development………………. 114

Figure 5-8. Users identified for scenarios during second focus group meeting………………. 119

Figure 5-9. Mapping scenarios based on category and users………………………………………. 121

Figure 5-10. Spaces identified for EVPS development……………………………………………… 123

Figure 5-11. Spaces identified for development in Second Floor and Ground Floor…………… 126

Figure 5-12. Second Floor schematic plan used in the menu for EVPS…………………………. 128

Figure 5-13. Space trigger objects and mini-map camera in the second floor EVPS……………. 129

Figure 5-14. Existing pharmacy (left) moving into the new pharmacy (right)………………….. 133

Figure 5-15. Pharmacy floor plan and snapshot of pharmacy EVPS……………………………… 133

Figure 5-16. Snapshot of pharmacy EVPS……………………………………………………………… 134

Figure 5-17. Design Review meeting using the Pharmacy model………………………………… 135

Figure 5-18. Transition Planning and design review meeting using EVPS and floor plans……………………… 136

Figure 5-19. Snapshot of IV Preparation and Clean Room with high shelves……………………. 137

Figure 6-1. Development of evaluation study stimuli in Unity game engine……………………. 145

Figure 6-4. Data collection and video recording setup………………………………………………. 151

Figure 6-5. Age range of participants……………………………………………………………………. 156

Figure 6-6. Plot showing time taken by participants in both conditions to explore stimuli…….. 157

Figure 6-7.  Coding of video into categories of design review feedback using Nvivo

software…………………………………………………………………………………………………… 160

Figure 6-8. Coding of video into categories of design review feedback…………………………. 162

Figure 6-9. Results for location of dialysis machine…………………………………………………. 163

Figure 6-10. Results for location of glove boxes and sanitizers…………………………………… 164

Figure 6-11. Familiarity with virtual prototypes……………………………………………………… 165

Figure 6-12. Ease of movement around the facility decreasing by age group……………………. 165

Figure 6-13.  Description of the dialysis scenario during design feedback and  recommendations…………………………………………………………………………………… 169

LIST OF TABLES

Table 2-1. List of studies that used Virtual Prototyping for Design Review………………….. 30

Table 3-1. Research method adopted for each research task………………………………………. 51

Table 4-1. Scenario categories based on Level of Detail (LoD) required………………………. 67

Table 4-2. Scenario Tracking script with its variables and functions…………………………… 95

Table 4-3. Matrix of example specifications mapped based on level of effort………………… 101

Table 5-1. Hershey Children’s Hospital facts…………………………………………………………. 107

Table 5-2. List of questions asked during focus group 1…………………………………………… 111

Table 5-3. Participants of focus groups in December 2011 and January 2012……………….. 115

Table 5-4. List of potential healthcare facility end-users who could use the EVPS………… 118

Table 5-5. End-users mentioned in scenarios collected during 2nd focus group meeting….. 120

Table 5-6. Type and number of doors in the second floor of the hospital…………………….. 131

Table 6-1.Development process for task-based scenario-patient dialysis………………………. 148

Table 6-2.List of design inaccuracies added in stimuli……………………………………………… 150

Table 6-3.Time taken by participants to explore the stimuli……………………………………… 156

Table 6-5. Amount of participant feedback in Condition A and B……………………………… 166

Table 6-6. Design change recommendations and issues raised based on condition…………. 167

Table 6-7. Feedback related to issue of patient emergency………………………………………… 168

Table 6-8. Feedback related to work processes for dialysis scenario…………………………….. 170

Table 6-9. Feedback related to issue of infection control………………………………………….. 171

Table 6-10. Feedback related to issue of patient privacy…………………………………………… 171

Table 6-11. Feedback related to equipment supplies and storage………………………………… 172

Table 6-12. Additional scenarios proposed by participants………………………………………… 174

ACKNOWLEDGEMENTS

My journey thus far could not have been possible without the help of countless people who inspired and supported me. First, my deepest and most heartfelt thanks to my advisor and mentor, Dr. John Messner, for instilling in me a passion for innovation and the desire to always strive for the best through the utmost discipline and work ethic. I could never imagine that the quest we embarked on together would be as exciting, fun and rewarding as the virtual prototypes and gaming engines that were part of this research. I’m extremely grateful to have had such an understanding, compassionate and driven advisor.

I would like to thank Dr. Chimay Anumba, who always believed in me and supported me even when I was unsure of where the path would lead. More importantly, I learned from him the importance of always being humble yet confident in life. I thank Prof. Richard Behr for paying attention to the details and always encouraging me to do the best I could. I feel fortunate that he chose to support this research endeavor through the Smart Spaces Center.

I am grateful to Dr. Madhu Reddy, who enabled me to see my research through a healthcare perspective and helped me ask the right questions about my research. He taught me to take my work less seriously and yet be able to challenge the ideas and beliefs I held so close.

Lastly, I cannot thank Dr. Shyam Sundar enough for teaching me about the rigor of research methodology and inspiring me to pursue my goals through dedication and a sense of joy. I feel truly privileged to have professors who are highly esteemed in their respective fields on my committee.

I am very thankful to all my friends at Penn State who have been a constant support to me at all times– Dragana, Tabitha, Rob, Craig, Steve, Ralph, Bimal, Bryan, Atefeh, Andrea, Yifan and Ying.  I feel blessed to have such wonderful friends and would have been completely lost without you. Thanks to all the students of the Virtual Prototyping class who helped with my research, especially Chris Wiacek and Matt Hedrick for coming up with the idea of using interactive virtual prototypes in healthcare. I also extend my thanks to Michele Smith, the Nurse Manager at the Hershey Children’s Hospital for her enthusiasm towards this project and being a great help in recruiting nurse participants for the user studies.

Through the course of my research, I made an invaluable and lifelong friend in Joel Solkoff, who helped me in more ways than he will ever know. I have thoroughly enjoyed our deep and wholehearted conversations about the future of healthcare, potential of virtual prototypes and life in general. [Bold face supplied by the publisher.]

Lastly, I would like to thank my parents and family – without their support, encouragement, prayers and all the positive thoughts they sent my way, I could not have accomplished any of my goals. Thanks a lot for always understanding me, believing in me and assuring me that there is light at the end of the tunnel. No words can express my gratitude to Vijay for constantly motivating me and enabling me to be persistent through the best and worst times. I’m glad you made all those trips to visit me during the first two years of our marriage and offered your support, insight and advice whenever I sought it. Thanks for always being there for me, I could not have done this without you.

I dedicate this dissertation to my grandparents whose presence I will always miss. Thanks for giving me the most precious memories – I will cherish them all my life!

Chapter 1 INTRODUCTION

The Architectural, Engineering, and Construction (AEC) Industry is currently undergoing a rapid transformation from a primarily 2D design and review process to the implementation of more robust 3D Building Information Modeling (BIM) applications. One element of this transformation which is critical to delivering high quality, innovative design solutions is the ability for designers and other project stakeholders to truly experience design alternatives and concepts throughout the design process. Virtual facility prototyping is one of the approaches that provide opportunities for teams to develop innovative solution concepts throughout the design review process as well as propose changes relatively early in the building delivery process. This ability to design creatively in interdisciplinary teams and visualize the complex and specific tasks performed in increasingly specialized facilities such as healthcare can prove to be critical skills required for future design professionals.

1.1 BACKGROUND

Healthcare facilities are some of the most difficult building types to design due to the increasing complexity of their building systems as well as the need to address requirements of the many stakeholders. A seminal report on healthcare environments (Ulrich et al. 2004) suggests strong links between the physical environment to the patients and staff in areas of reducing staff stress and fatigue as well as increasing effectiveness in delivering care, improving patient safety, reducing stress, improving health outcomes, and finally improving overall healthcare quality.

This has led to the emerging phenomenon of including the end-users, such as patients and staff, in the design process to deliver better healthcare facilities. Therefore, this thesis explores experience-based design; a term used in the healthcare facility design context to involve end- users and examines the benefit of using virtual facility prototyping by the healthcare industry for interactive experience-based design review.

 1.1.1  Experience-based Design

Experience-based design is a user-focused design process with the goal of making user experience accessible to the designers, to allow them to conceive of designing experiences rather than designing services (Bate and Robert 2007). There is widely published research that addresses the subject of end-user influence upon design from different perspectives. Some refer to that perspective as experience-based design (Bate and Robert 2006), evidence-based design (Hamilton and Watkins 2009, Stankos 2007), participatory design (Nutter 1995, Luck 2003), user-centered design (Norman 1988) and other frequently appearing terms with similar intent. Since users evaluate the built environment differently from designers (Zimmerman and Martin 2001), participatory design approaches attempt to bridge a gap in understanding between users and designers.

The Institute for Innovation and Improvement at UK’s National Health Services (NHS) is leveraging Experience-based design to focus on re-designing and improving healthcare services and facilities, based on patient and staff feedback (NHS Institute for Innovation and Improvement 2010). Similarly, the Center for Health Design is using the Evidence-based Design (EBD) approach to help healthcare and design professionals improve the quality of healthcare through the built environment (Center for Health Design 2010). Although there is a substantial amount of literature that cites “evidence-based design in healthcare facilities”, there is a lack of guidance for designers on quality criteria to improve the design of healthcare facilities (Dunston et al. 2007).

1.1.2  Virtual Prototypes for Healthcare Facilities 

A virtual prototype is defined as a digital model (mock-up) of a structure or product used for testing and evaluating form, design fit, performance and manufacturability as well as for study and training (Wang 2002). Virtual prototypes can be extremely useful in understanding the tasks performed by healthcare practitioners by incorporating their knowledge of how things work in their settings into the virtual environment. For large complex projects such as hospitals and healthcare facilities, virtual prototypes can be used to tailor environments to user needs (J. Whyte 2002). In the AEC context, digitally rendered three-dimensional models have been used to review design aspects of physical spaces such as courtrooms (Maldovan et al. 2006), mechanical rooms, patient rooms (Dunston et al. 2007), nuclear power plants, industrial plants and stadiums. Virtual prototypes can provide a degree of functionality as they can allow further degrees of interactivity including multiple viewpoints, the ability to zoom in and out, and the ability to selectively view components. It has also been noted that virtual prototyping and 3D modeling is a means of  rapidly developing designs (Gopinath 2004, Schaaf and Thompson 1997). There is immense opportunity in developing tools that not only create virtual prototypes of healthcare facilities but also allow interaction with the end-users. Healthcare facilities can benefit significantly through  the application of virtual prototyping in the design process as it enables evaluation of a range of essential criteria.

1.1.3  Interaction with Virtual Prototypes 

Virtual prototypes are distinguished by their “capacity to portray 3-D spatial information in a variety of modalities, and their potential to immerse the user in the virtual world” (Nelson and Bolia 2002). Previous research has shown that immersive virtual environments are increasingly being used to review virtual mock-ups, which are a cost effective alternative to physical mock-ups (Leicht and Messner 2009). Markham (1998) identified three factors contributing to visualization in a virtual environment as immersion, interaction, and engagement. Interactive virtual prototypes facilitate an immersive understanding of a virtual model, especially for ergonomic and aesthetic design, as well as customer participation in design and evaluation (Wang 2002). Virtual prototypes also enable participants to navigate through the model space and evaluate the design based on various criteria through numerous vantage points within the model. User involvement can take a variety of forms, from appraisal of an expert modeled and animated 3-D virtual model with ensuing discussion to active design using a virtual prototyping design tool. Moreover, designs can be worked on over a long period of time and discussed among a larger group than is possible in traditional design situations (Davies 2004).

1.2  RESEARCH GAP

Communication of design information is of vital importance in the facility design process as each building project involves the collaboration of several disciplines and project stakeholders. Traditionally, communication of design information took the form of 2D drawings. According to Anumba et al. (1997), this often led to inadequate capture, analysis and prioritization of client requirements, lack of communication of design intent and rationale as well as poor integration, co-ordination and collaboration between the functional disciplines involved in the project.

Virtual prototypes are being increasingly used during design review since they can be especially useful for communicating design intent of specialized building types such as healthcare facilities. Virtual prototyping provides opportunities for a team of project stakeholders to truly experience design alternatives and concepts in the early stages of the design process. While helping in design review, virtual prototyping also allows multiple participants to navigate through the model space and evaluate the design based on various criteria through numerous vantage points within the model. Virtual prototypes offer an opportunity for various stakeholders representing the client healthcare organization to have an interactive experience with hospital units ranging from a patient’s room to an operating room to an entire hospital at a fraction of the cost of physical mock-ups (Dunston et al. 2007).  Prior studies that used virtual prototypes in design reviews of courtrooms (Majumdar et al. 2006, Maldovan and Messner 2006), operating rooms, and patient rooms (Dunston et al. 2007), indicated the benefits of using them over physical mock-ups. Virtual prototypes supported exploration and decision-making in the design process and offered an effective means of communication between diverse stakeholders of the project (Leicht and Messner 2009). Moreover, these studies also highlighted the opportunity to enhance end-user engagement in instances where team members leverage and communicate their tacit knowledge, enabling collaborative interdisciplinary participation over the early stages of the design development process.

While virtual prototypes are useful for design visualization, allowing the review participants to walk through the design of a facility to examine the space, textures and lighting, they are typically implemented in a static manner. Most virtual prototypes do not allow the user  to interact directly with the elements and objects within the virtual model. Moreover,  visualization in virtual prototypes is a challenge due to the lack of human characters (or avatars) and animations that depict how the facility is used or the tasks performed within the facility. At present, the prototyping process typically lacks a systematic structure or method to allow for task- based scenarios to take place for the review participant. Although a Building Information Model (BIM) of the facility contains geometric and attribute data that is transferred in the virtual prototype, there is no information on the behavior of the components within the facility. For instance, doors modeled in a facility do not swing open in a virtual prototype, despite containing intelligent attribute information such as location of its hinges. As a result, while reviewing, participants either walk through doors or they are simply not displayed in the prototype. This is because animation is still cumbersome to incorporate while developing the prototypes, which can lead to an unrealistic representation of the facilities. Due to these challenges, most current virtual prototypes do not enable people to truly experience the design.

The gaps in the current research on virtual prototyping for design review indicate a need to make the virtual prototyping process more efficient for developers, while also engaging healthcare end users in the design review process. Therefore, an opportunity exists to conceptualize and develop interactive virtual prototypes for the design review process that can enable participants to interactively perform certain task-based scenarios within the virtual prototype. Figure 1-1 shows a concept proposed in this study that combines theories of experience-based design with interactive virtual prototyping to form the Experience-based Virtual Prototyping System (EVPS).

Figure 1-1. Concept of the Experience-based Virtual Prototyping System (EVPS).

1.3  RESEARCH GOALS

In previous studies that were performed with static virtual 3D stereoscopic virtual prototypes in an immersive display (Maldovan et al. 2006, Leicht et al. 2010), it was observed that the reviewers, and in particular the end-user reviewers, of the models would frequently be found discussing the tasks that they would perform in a space. Yet, they were only able to navigate around the model and envision the task performance in their mind. Through their own visualization of the task, they could provide valuable feedback to the design team. Moreover, according to Dunston et al. (2010), owners, architects and construction managers generally have a need for rapid resolution of design alternatives, which places a significant time pressure in producing virtual mockups. Therefore, the aim of this research is to investigate methods to  rapidly develop interactive virtual prototyping systems for design review, which allows the user  to explicitly perform typical daily tasks just as they would in a physical setting. This would allow the user to improve their design review feedback and expose ineffective architectural layouts as well as allow the design professionals to review design through the role of end-users by engaging in scenarios of tasks performed in healthcare facilities.

1.3.1  Research Questions 

1. How can virtual prototypes which are used for design review of healthcare facilities incorporate end-user experience?
2. What procedures can enable rapid development of experience-based virtual prototypes of healthcare facilities for design review?
3. How can the use of experience-based virtual prototypes impact the design review process of healthcare facilities?

1.3.2  Goals and Objectives 

The primary goal of this research is to define, develop and assess the impact of a virtual prototyping framework for the rapid creation of scenario-based design reviews of healthcare facilities. The main purpose of the framework is to develop an efficient approach to creating virtual prototypes that allows interactive design review within the healthcare facility design context for end-users. The following objectives are being pursued to achieve the primary goal:

1. Develop a virtual prototyping procedure to represent end-user experience of healthcare activities in interactive virtual prototypes;
2. Design a framework for structuring end-user activities into scenarios that can be simulated in an interactive virtual prototyping system;
3. Develop an interactive computing platform entitled the Experience-based Virtual Prototyping System (EVPS) for implementation in healthcare facility design reviews; and
4. Assess the developed EVPS to evaluate the effectiveness of interactive virtual prototyping for enhancing the experience-based design review process of healthcare facilities.

1.4  RESEARCH SCOPE 

The research focuses on the design, development and implementation of the experience- based virtual prototyping system concept in a healthcare setting to study its impact on extracting design feedback from end-users. The design and development of the EVPS concept employed in this study was guided by literature review of prior studies, theories of virtual prototyping, real- time rendering and game engine development. The developed prototyping process was tested using various healthcare related projects that are outside the scope of this dissertation. However, implementation of the finalized experience-based virtual prototyping procedure was carried out through a case study in the healthcare facility setting- “Hershey Children’s Hospital”, which is discussed in more detail in Chapter 5.

To evaluate the developed virtual prototyping system, both qualitative and quantitative approaches were adopted to assess the impact of the EVPS on the design review process.

Although, the design review process involves many stakeholders including the project team and clients, the assessment of EVPS was geared towards end-users of healthcare facilities, specifically providers of healthcare such as nurses.

1.5  RESEARCH METHODOLOGY 

The research methodology adopted for this study is discussed in detail in Chapter 3.

Briefly, the following steps were undertaken to meet the objectives of this research:

1.5.1  Experience-based Virtual Prototyping System Concept

The first step was to review literature on virtual prototyping, design review and theories related to experience-based design in the healthcare context to conceptualize the EVPS concept. A pilot study was conducted to illustrate the potential of applying the EVPS concept during design review of healthcare facilities.

1.5.2  System Design 

This phase began with the design and development of a framework for structuring healthcare activities into scenarios that can be effectively simulated in interactive virtual prototypes. A data structure of task-based scenarios was developed to characterize the attributes and behaviors of elements required for simulation of scenarios. Next, an overall system architecture was created to define the components, databases and libraries required for developing the EVPS. Finally, interactive interface were designed to integrate features and functionality requirements that allow end-users to interact with the EVPS.

1.5.3  System Development

System development started with identification of an appropriate real-time rendering engine for EVPS development and investigating various design information workflows to transfer facility model content from BIM authoring tools to the EVPS. Next, strategies and methods to incorporate interactivity were investigated so that the EVPS would enable the end-users to perform specific task-based scenarios through use of interactive objects and scenario scripting. Consequently, a database of reusable interactive model content was generated to enable rapid development of the EVPS. The proposed virtual prototyping procedure was continuously reviewed by assessing capabilities and limitations of the developed EVPS through healthcare related projects and case studies.

1.5.4  System Implementation 

This phase included identification of suitable facility within the healthcare context that would benefit from employing the EVPS during design reviews. Next purpose of using the EVPS in design reviews was determined and several specific scenarios of activities to ascertain features and functionality requirements for inclusion in the EVPS were documented. Finally the EVPS was developed for end-users to review the facility design interactively while engaging in task- based scenarios within the virtual facility prototype.

1.5.5  System Assessment 

The final phase of system assessment was carried out through an observational study to assess the EVPS implementation during design review sessions with end-users of the healthcare facility. A user study was conducted using the EVPS with healthcare end-users, to evaluate the effect of task-based scenarios in obtaining design feedback.

1.6 THESIS STRUCTURE 

The current chapter introduced the research gap, research questions and objectives as  well as the scope of research and methodology. Chapter 2 reviews literature to determine the role of virtual prototyping in the design review process and explores possibilities of combining experience-based theories in interactive virtual prototyping to develop more effective design review tool for end-users. Chapter 3 introduces the systems development methodology used for conducting this research and gives an overview of research steps and methods employed. Chapter 4 describes the framework for experience-based virtual prototyping. Chapter 4 explains in detail the EVPS system design process, strategies for rapid development and incorporation of interactivity in virtual prototypes. Chapter 5 introduces the Hershey Children’s Hospital case study that is used for implementation of the EVPS. This chapter describes focus group discussions used for requirements analysis and an observational field study with the pharmacy staff that uses the EVPS during design review. Chapter 6 describes a user study to evaluate the effect of task-based scenarios embedded in the EVPS on end-user feedback during design reviews. The study protocol, analysis and findings are discussed. Finally, Chapter 7 presents the conclusions, contributions of the study, as well as limitations and directions for future research.

++++

Link to Chapter 2. https://joelsolkoff.com/chapter-2-dr-kumars-thesis-on-virtual-reality-modeling/

Copyright 2013 by Sonali Kumar. All rights reserved. Thesis published on this site by the express permission of Sonali Kumar.