Mobility Speedometer

Overview

Our team was tasked with improving the mobility of patients during inpatient hospital stays. Lack of patient movement can lead to worse health outcomes and increased discharges to skilled nursing facilities instead of home. The ultimate design, called the Mobility Speedometer, was low cost, simple to produce, and intuitive to understand by providers, staff, patients and their families. The tool is a laminated, wall-mounted poster that aligns with the Johns Hopkins Highest Level of Mobility (JH-HLM) measurement framework. To use, a nurse indicates a patient’s daily mobility goal with the arrow and marks the patient’s discharge mobility goal by dry erase marker. Mobilization episodes are then documented throughout the day in an Epic flowsheet.

Pilot Results: 

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Discovery

We held one-on-one interviews with providers and staff at Salem Hospital to understand the challenges of mobilizing patients in the inpatient medicine and surgery units. This lay the foundation for co-design workshops. While mobilizing patients was understood as important, there were barriers—like the fear that a patient could fall—that often kept providers and staff from mobilizing patients more. 
Role: interview providers; feedback synthesis; workshop planning & design 

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Co-Design Workshops

We held two workshop sessions with a select group of Salem hospital providers and staff to further brainstorm the challenges & possible solutions to mobilizing patients. Participants collectively agreed that there was a need for more communication between role groups, patients, and their families and were interested in a color-coded physical tool to support this. Communication was seen as critical for building confidence about patient safety and capabilities, for sharing responsibility across the whole care team, and for giving patients and their families more agency during their stay.

︎Co-design workshops: We engaged participants with worksheets that pushed their initial ideas, allowing them to consider more fully their stakeholders, environment, and constraints.

Prototyping

Our team was then charged with producing a prototyped tool that could address this need. After sketching sessions and with feedback from our team’s partners, we believed simple visual metaphors would be both attractive and simple for patients to understand. We pursued this simple odometer which could visualize a patient’s mobility progression from ‘bed level’ to walking down the hall. The four levels simplifies the Johns Hopkins Highest Level of Mobility (JH-HLM) 8-point scale, making it simpler for patients and their families who may be unfamiliar with the clinical framework. JH-HLM was the standard practice for mobilizing patients at Salem Hospital and was gaining traction as the standard across Mass General Brigham hospitals. 
Role: visual design; prototyping; planning workshop & designing workshop materials, leading user feedback sessions 

Product Requirements:

• Due to limited budget and time, the tool would need to be produced in-house for the pilot study (75 patient beds).
• Due to patient room constraints, the tool would need to be able to be sanitized easily and fit a compact space.
• To fit into existing workflows, the tool needed to build off the JH-HLM scale which was already a standard metric by nursing. 
• Due to system constraints, the tool could not require Epic changes, but would need to be additive to existing workflows. Documentation of JH-HLM existed in nursing flowsheets, but required initial wrenching in manually. 

︎Early prototypes from concept to more refine  

︎Stakeholder feedback: Ahead of the pilot, we held virtual and in-person informal feedback collection sessions with nurses. This process aided with initial buy-in as nurses prepared to adjust their daily workflows to incorporate the Speedometer tool. 

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Testing 

The Mobility Speedometer was piloted for three months in 75 inpatient beds at Salem Hospital in 2023. 

Pilot Results:

 

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Iterations & Additional Testing

From Salem Hospital, the Speedometer was expanded to select units at Brigham & Women’s Hospital. In preparation for this roll-out, I revised the Speedometer based on feedback from providers at Salem Hospital, requirements from newly instituted MGB brand guidelines, and MGB leaders specializing in accessibility and inclusion.
Role: prototyping; visual design; leading user feedback sessions 

Prototype Revisions:

• Due to duplicative documentation of mobilizations on both the Speedometer and within the Epic flow sheet, all daily documentation requirements were removed. Patient initials and discharge goal are to be filled in during the nurse or physical therapist’s initial mobility assessment.
• In scaling across multiple hospitals, we worked with a manufacturer to produce. Instead of velcro and a paper fastener, the arrow is now affixed by a grommet. 
• Colors of four phases were adjusted for greater contrast and the iconography was shifted from white to black for greater contrast for patients.
• A headline was added in both English and Spanish to capture the attention of patients. 

Version Adaptations:

In addition to Speedometer revisions, the tool was adapted to better serve more patients and room environment constraints. Across the MGB system, patient rooms vary in size, format, etc. and we needed to accomodate these spaces to be able to systemetize the Speedometer. 

︎The wheelchair version was developed with support by physical therapists at Spaulding Rehabilitation Network and MGB leaders in accessibility, equity, and inclusion. Mobility activities have been altered to serve patients who use wheelchairs in their daily life. To fit into existing workflows, this version could be easily swapped out with the ambulatory Speedometer version installed in patient rooms. 

︎Dry erase magnet version: Due to space constraints in Mass General Hospital inpatient rooms, I designed a version that is smaller and a dry erase magnet that can attach to existing white boards. It is currently in place in all applicable inpatient beds at MGH. 

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Scaling & Expansion

Because of the success of the pilot at Salem Hospital in 2023, MGB leadership became interested in scaling the Speedometer thanks to its ease of use, flexibility across hospital workflows and culture, and alignment with goals to decrease length of stay (LOS). Versions of the Speedometer are now used in over 900 inpatient beds total at Salem Hospital, Brigham & Women’s Hospital, Mass General Hospital, and are being rolled out across the rest of the Mass General Brigham system through 2026.

As part of this scaling, this tool has expanded into a mobility package which allows individual units to customize how they integrate mobility interventions into their daily workflows. In addition to internal scaling, a digital physical therapy company is currently exploring integration. See the package components below. 
Role: graphic design & art direction of marketing materials; prototyping 

Supplementary Mobility Package Components:

Mass General Brigham Springboard Studio 

Boston, MA

Spring 2022–present

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For more info:
︎MGB Springboard Studio Case Study