May 15, 2009 History has fortunately overlooked the designer of the humble and seemingly universal hospital gown. Just as well, really, because he/she was no doubt well meaning and probably not due the universal curses that they have been subject to. Regardless, after more than a century, it's one of those semi-dysfunctional inventions that has endured because the chronically underfunded health systems of the world have always had more urgent technologies on their agenda than replacing the hated and embarassing garb. If you're like most people, you've probably spent waaaay too much time with your nether regions protruding from one of those dreadful hospital gowns. Now the University of Cincinnati is employing its design research capabilities to design better gown options which will soon be on display and may even reach market.
The University of Cincinnati houses internationally and nationally ranked programs in design, business and engineering and the faculty and students from these cutting-edge programs recently took on a project to design better hospital gowns in partnership with Hill-Rom Company, Inc., of Batesville, Ind., a maker of hospital beds and medical equipment.
The project is the result of an unusual, ongoing business-university model headquartered at UC called the Live Well Collaborative. The model works quite simply. International firms who are part of the Live Well consortium work with UC students and faculty in conducting research and developing ideas, making use of internationally ranked expertise on campus in the fields of design, engineering, business, medicine, anthropology and more.
It’s an innovation incubator, and the hospital gown project coming out of that incubator will be displayed publicly for the first time in UC’s sell-out June 12 fashion show.
Beyond that, Hill-Rom is now investigating the sales potential, manufacturability and marketing needs, as well as partnership possibilities, to perhaps pursue a new type of gown as a product. Such an offering would be at least a year away, according to Mike Grippo, vice president for business development and strategy with Hill-Rom.
“This would not be a project we would do entirely in-house. We would need partners because, for instance, we don’t work with textiles. So, who would our partners be? These are the kinds of questions we are looking at right now,” he explained.
This gown project drew on the resources of design, business, nursing and biomedical engineering faculty and students, including Margaret Voelker-Ferrier, UC professor of fashion design, Craig Vogel, UC associate dean, research and innovation and Ann Welsh, UC professor of management.
In addition, 30 students broke into three teams in order to conduct both research and design, looking at the gowns from the point of view of not only patients but also care givers and business professionals.
Challenges for the student teams
Elizabeth Kern, 23, a UC industrial design senior from Wyoming, Ohio, became a key leader of one of those teams, participating in the project because she wanted to make an impact “designing for people who are not always thought of.”
For Emma Sartini, 23, an industrial design senior from West Chester, Ohio, the project represented valuable experience related to the medical field. She explained, “Thanks to UC’s co-op program, I’ve gained working experience with Philips Respironics in Pittsburgh and with Ethicon Endo-Surgery here in Cincinnati. However, because of the confidentiality of the projects I worked on with those companies, I cannot put them on my resume. The hospital gown project for Hill-Rom is something I can put on my resume.”
She added that the project was unique, challenging and fun, but the best part was the response from Hill-Rom executives. “We made our final presentation, and they loved it,” said Sartini.
The final products were the result of in-depth research. For instance, the students met with a panel of nurses and with a designer who had recently been a hospital patient. These efforts resulted in valuable insights related to the life cycles of the gowns, needs of caregivers when working with gowns and patients’ preferences.
For instance, Dale Murray, associate professor of industrial design, met with the students after a lengthy, three-month hospital stay. “The issues with hospital gowns are innumerable,” he explained. “Fit is a big issue. They wrap uncomfortably around the bedridden patient, even wrapping around the neck. The ties become knotted or easily untied. A patient is alternately too hot or too cold. From the patient’s point of view, the common hospital gown today does not work.”
Needs and challenges identified by the students include
- Need to avoid pressure ulcers, skin lesions developed by patients due to wrinkles in or rubbing of material when patients are in a prone position for extended periods.
Need to accommodate braces and other medical items worn by patients.
Need for easy cleaning of gowns since they are laundered daily.
Need for ease in putting on and securing gowns with accessible closures. These closures must be able to withstand frequent washings and also accommodate medical devices.
Need for pockets, coverage and warmth.
Need to accommodate variations in body temperature.
The results: a rewarding array of options
According to Ann Welsh of UC’s College of Business, the initial UC research demonstrated that “when it comes to the hospital gowns in use today, one size fits none.”
And so, the solution eventually offered by the UC students is a “Progressive Recovery Collection.” These are options for multiple gowns that can, importantly, all be created from one pattern – a practice that would cut down on waste and inefficiency.
The options are:
- One gown for seriously ill bed ridden patients.
Another gown for the somewhat mobile patient.
A third gown for the fully ambulatory.
These final product ideas were the outcome of a demanding process that began with, literally, hundreds of ideas, according to Steve Engstrom, executive director of research and strategic innovation at Hill-Rom, who was one of the company executives who worked closely with the UC students.
“The students don’t have preconceptions, and so they bring fresh ideas. They come up with a wide volume of ideas and creative solutions that we can then break down and say, ‘What can we do with this in a comprehensive, holistic way?’ They’re very aware that we don’t want to solve one problem or create a solution for one thing that might have five unintended consequences,” explained Engstrom.
He added that Hill-Rom has shown the student work to a company advisory board of national nursing executives. “They were extremely excited about the project and saw that it has great value,” said Engstrom.
Gown for the seriously ill bedridden patient
The most important thing for a bedridden patient is to prevent pressure ulcers, according to Brooke Brandewie, a student who graduated from the product-development track of UC’s fashion design program in June 2008 and who is now working at the Live Well Collaborative as a design research associate.
“We created a gown that will allow the mattress to be the mattress. The gown is open backed for high-risk, immobile patients so the areas on the body (most susceptible to pressure ulcers) can be healed from the mattress technology, without fabric bunching in between,” Brandewie explained.
In addition, this gown (and the others created by the students) provides easy access at the shoulder – via slits and closures in the design – so that caregivers may operate IV units or other drug-delivery tools.
The students recommend that this gown – and the related versions – be made from naturally anti-microbial materials like bamboo or crabyon (a material actually made from crab shells).
UC’s Margaret Voelker-Ferrier said, “Such materials cut down on bacteria. This helps ensure the health of a patient and also cuts down on any body odors.”
The gown that serves as a “reward” for the improving patient
There’s nothing as comfortable as a bath robe, or your own clothes that you wear at home. And that’s the inspiration behind a gown created by the UC students for the semi-mobile patient. It mimics “comfort clothes.”
Said Brandewie, “As the patient improves in condition, they will ‘graduate’ to the next gown appropriate for their condition and mobility. It not only represents the patient’s progressive physical improvement, it provides a psychological boost as well,” said Brandewie.
Like all the UC-created gowns, it closes not via standard ties currently in use with hospital gowns but via a closure like a bathrobe belt. It’s secure, comfortable, can fit to almost any size and is also more flattering to the human figure.
The gown has a full back and a kangaroo pocket in the front, recognizing that the patient will lie in bed, sit in a chair, stand and walk. Portions of the gown are made of special material to wick away moisture and sweat.
And in recognition of the reality that patients sitting or resting will be colder than those on the move, this gown comes with accessories: A scarf with a pocket, arm warmers, leg warmers and shawl, all made of bamboo jersey to integrate both extreme softness and anti-bacterial characteristics.
Explained Brandewie, “We created the accessories to serve both caregivers and care recipients. The pockets in items are necessary because patients really don’t have a space that’s always within reach for the small items they use and want, like a phone, chapstick and iPod. In hospitals, we found that nurses and patients were improvising with mini purses tied to the side of the bed for extra storage and were cutting up old socks for arm warmers. And a patient with a shawl doesn’t have to call for a blanket and wait for it to be delivered.”
The fully mobile patient could wear crop pants with a gown top. For comfort and care, these crop pants feature a stretch-jersey waist that is comfortable (and expands and contracts to fit a variety of sizes). Each leg of the calf pants has snaps along the outside seam in order to accommodate braces or swelling. The shorter length of the calf pants also ensure that patients won’t trip over the hem.
A Business Case for producing the new gown designs
With designs in place, Hill-Rom is currently examining the creation of the new gowns for the market, looking at manufacturing, marketing and demand. That research will take about a year.
According to UC’s Welsh, the students taking on this project had to conduct in-depth business research before even starting the design process. This research was used to guide the entire project and its outcome.
“What we found,” she explained, “is that there are millions of hospital gowns in use daily since patients often go through as many as five gowns per day. The current gown is produced for about $3 and lasts for about 40 uses (before it starts degrading due to torn ties, permanent stains, etc.) So, there’s tremendous demand for hospital gowns and room in the market for alternate offerings.”
This business research then guided the design process, with the students ultimately designing the “Progressive Recovery Collection” to be designed from “smart” textiles. The idea would be to offer more expensive gown options at a higher price point. It’s a market position that is currently unfilled.
Welsh summarized, “There are a number of advantages to the UC designs created for Hill-Rom. It’s a product collection designed to fit a varied population, to be aesthetically pleasing and to incorporate therapeutic qualities.”
In addition, the UC students looked at preliminary ways to make the gowns available to target markets willing to pay something extra for the comfort and dignity of the improved designs. For instance, the items might be available online for pre-order in advance of a planned hospital stay.
Said Brandewie, “Items could be available online. Another idea is to have accessories in the gift shop of the hospital, for any patient or visiting loved ones to purchase. We thought that the patient could bring the separates home with them to keep and use in physical therapy.”
Words: M.B. Reilly, University of Cincinnati
Pics: Lisa Ventre, University of Cincinnati