NORSK DESIGNRÅD
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When the patient is a child
The Hospital Book is primarly for children aged form 8 to 12 years old. Photo: Rikshospitalet HF / Thea Tønnessen
Rikshospitalet University Hospital is helping sick children and their parents to relate to, and process, their experiences at hospital. They have developed the Hospital Book which uses text and visual elements to inspire children in hospital to speak about, feel and record their own experiences.
A multidisciplinary resource group at the hospital has helped give the book’s content a sound medical basis, in a way that children and their parents can understand. The book, which is interactive, allows children, their parents and hospital staff to shape its content so that is meaningful and works on several levels.
“The Hospital Book can be used regardless of the diagnosis the child has received. It is primarily intended for children between the ages of eight and twelve who have been admitted to hospital for three days or more. The book is given to the child by health care professionals when the child is admitted to hospital,” explains Kristine Hetland Clark, who is project manager for the Hospital Book and information consultant at Rikshospitalet University Hospital, which each year treats more than 30,000 children.
A good aid
The Hospital Book project was originally initiated by writer Taran Bjørnstad and graphic designer Tone Bergan. The end product is the result of in-depth interviews with 19 children and their parents, and close cooperation with Kristine Clark and a resource group at Rikshospitalet University Hospital consisting of psychiatrists, surgeons, various other specialists, pre-school teachers and representatives from the pain-relief team. All content has been tested by the group on an ongoing basis and discussed down to the smallest detail.
“One important principle in treating children is to see the healthy child as well,” says Kristine Clark. “The Hospital Book becomes a familiar object in an unfamiliar situation and can help give the child a sense of sorely missed control,” she explains. “It is the child’s voice and needs that are expressed in the book, not the needs of health care professionals to provide information.
Not easy finding funding
Since the book was an initiative from outside, it was necessary to finance developments with the aid of external funding. First and foremost, it was important to present the book to the hospital staff and management and to hear their reactions. The feedback received was entirely positive.
”The task of financing the project was incredibly heavy going and took a long time,” explains graphic designer Tone Bergan. “It was essential important that the idea was firmly rooted in the management and the health care professionals. We applied for funding from a number of bodies, including the Norwegian authorities, the Health South-East Trust and rehabilitation authorities. Once the rehabilitation authorities had granted us funding, the ball began rolling, and the project rapidly became fully financed,” she says.
Close cooperation yielded good results
The ongoing process, including development of content, structure and form, went very quickly. “In spite of regular meetings and discussions with the resource group, and at times very different approaches to the same issues, we enjoyed a form of highly effective and close cooperation. The objections we occasionally encountered proved to be fruitful. We were met with trust by the professional environment all the time and were humble in the face of their expertise without giving up our convictions,” Tone explains.
Follows the entire process
The Hospital Book is divided into seven chapters and deals with the entire process involved in a stay in hospital. It is a combination of log book, medical guidebook, activity book and literary reader. The seven chapters are:
- 1. Me + My life: This is me
- 2. Me + My body: Focus on the medical process
- 3. Me + My thoughts: Opening up to feelings
- 4. Me + My time: Focus on creativity and activity
- 5. Me + My opinions! Praise and criticism and new experiences
- 6. Me + My memories: A medal before going home
- 7. Aaron + Elvis: A book within a book (the literary part)
A specially adapted situation
The Hospital Book needs to be able to fill a need there and then, and for this reason it has no page numbering. The book’s spiral binding and elastic strap to keep it closed indicates that it is a private volume, and also makes it easier to add extra loose pages.
The book is illustrated with soft, balanced colours. This is important, among other things because a child undergoing treatment will perhaps not tolerate bright colours. The book’s guide consists of a small, illustrated figure bearing a red cross.
“All decisions concerning the form and structure of the book taken into account the needs and wishes of the children, as these were revealed in in-depth interviews,” Tone explains.
The book is used as follows
During the child’s time in hospital, he or she can note down his experiences in the Hospital Book, on pages that are adapted for the various feelings and events. The book is the child’s own little arena for him or her to master – a haven for praise, criticism, sighs, joy and frustration.
“The book can help children to express their feelings and it paves the way for dialogue between the child, its parents and health care professionals. It gives everyone involved a common point of departure and reinforces their participation in the treatment process. In this way one also achieves a more effective and better quality hospital stay,” says Kristine Hetland Clark, who maintains that such a large project requires the right professionals and good alliances internally. The comprehensive analysis carried out in advance, through interviews with potential users, was also crucial to the final result.
Easy to cooperate?
When asked how she found it working closely with the initiative-takers and designers, with their special focus on their wishes for the book, she says that collaboration was exceptionally good.
Doesn’t every such process encounter conflict and difficult periods?
Kristine Hetland Clark smiles and points out that the only thing that was found to be difficult in this process was the funding. Tone Bergan agrees.
The road ahead?
The Hospital Book was awarded the Norwegian Design Council’s Award for Design Excellence in 2009. At the recommendation of the Ministry of Health and Social Affairs, funding was granted to distribute the book throughout the country. The task of implementing the book in workplaces continues – and therein lies the next challenge.
“We have held regional seminars and provided training, and everybody has said that the Hospital Book is important. The challenge is to get it to receive greater priority, among other things among busy hospital managers,” says Kristine, who is keenly involved in this matter, and is looking forward to a good systematic evaluation of the project this autumn. The evaluation involves three major hospitals, and is based on interviews with children, parents, health care professionals and focus groups.
They are so certain, however, that the book has a future that they already have plans to produce similar books for the brothers and sisters of children in hospital and/or the children of parents who are undergoing hospital treatment. The experiences gleaned from the preparation of the Hospital Book indicate that the same approach should be used for any new projects. And there is such a great need for books of this kind that they are not certain whether they will even wait for the Hospital Book to be assessed before they start…
