Systems Thinking Journey

Documenting our process and journey throughout the research project :)

[system-design-hospital]

Weekend: Sorting Data

We took the time to finally sort our data into a systems map with all the components, which took a lot of time as all the sticky notes kept falling down. We finally made a systems map and the task flows of the areas we studied. We also made an info dump board.

Systems Map with all the components

Info dump (still working on it)

[system-design-hospital]

Day 6: Dosa and STDs

The title will make sense, trust me. We went to the hospital again like the 5 days before but with two members down. This time to dive deeper into specific processes. There was a crowd gathered outside the entrance and randomly this dude set a bowl on fire! what?! We then realised this was a fire drill and all the support staff were present. The instructor set a bowl on fire and brought an extinguisher and doused it. It was fun to watch.

OK, play time over. We set out to work. Srika went to the ENT department, Sia went to gynac and Sid and Arpita went to the billing department.

Looking into the OPDs

Sia witnessed drama at the gynac department. The MS and the head of gynaecology were fighting. Sia left and went to the paediatric department. Srika looked at the ENT in great detail and noted down the process for start to finish.

Billing

Sid and Arpita went to billing and interviewed the receptionists. The receptionists explained the system of billing- how 3 slips are made- pink one for the patient, yellow for the department and white for their own records. They also complained about how much they hated the system.

Pharmacy

At the pharmacy, Sid and Arpita went in just to sit silently and observe. But a woman started chatting with them. She asked them about design, and they in turn asked them about the pharmacy. She wanted us to design uniform for them! The woman explained all the places where they have to enter data. Meanwhile, two other women were distributing medicines to the patients. It was fun to observe what they were doing.

Dosa

We were starving and decided to eat at Kessel Mall. Halfway in, we changed the plan and went to Brahma Sarovar for dosa. We reached the place and some of the members were trying out podi dosa for the first time. Then we left. Halfway in, (again) Sid realised he left his umbrella at the restaurant. WE WENT BACK TO RETRIEVE IT.

Role play

Finally, we reached the hospital and there wasn’t much time left so we quickly did the roleplay. Sid went through the entire process and ended up waiting to enter the panchkarma. He slept. Suddenly, his name was called and he rushed to enter. The experience was below par (according to him). He was called to a separate room and grilled about personal matters before just declaring its an STD despite multiple attempts to convince the doctor it was a skin issue he had since he was a child. What?! In the end, he got a prescription for anti biotics which weren’t available in the pharmacy and he was told to get it from an external pharmacy down the road. We then went back to campus.

Step 1- Registration of patient

Step 2- Initial examination by intern (she takes BP and asks questions about sleep, hunger, and bowel)

Step 3- Waiting for name to be called by attendant (It took an hour so Sid slept)

Step 4- More waiting in the queue to go to the doctor's room

Inside the room: MORE WAITING. Then you talk to a junior doctor who asks more specific questions about the ailment. Then you meet the main doctor, and even he examines. Then he told the attendant to take Sid to a separate room where he was asked more questions about history and general habits. Then, Sid was escorted into the main room and talked to the doctor. Sid was informed it was a viral infection. After, the doctor proceeded to ask questions about NID, Design and his home city. The doctor then prescribed a bunch of medication. Sid was informed by the attendant that this medicine won't be available in the in house pharmacy and told him to get it from an external medicine provider. (Contact details were provided.)

[system-design-hospital]

Day 5: "Mind, body and soul"

The e-rickshaw guy who told us he’ll come betrayed us and we unfortunately had to call Kishore bhaiya, an egotistical man-child who got offended we called someone else while returning to campus. Anyway, we decided to put this behind us and reached the hospital but we didn’t go to the regular ayurveda department.Our minds were blown when we found out AYUSH was actually an abbreviation and not a name. We had to visit the rest. We had to visit YUSH and that’s exactly what we did.

We asked Kishore bhaiya to drop us to further away from the main ayurvedic hosputal and we spotted Unani and Homeopathy departments. We walked towards it. There were two three small blocks. It was quite modest, especially in comparison to the huge ayurvedic complex. We were loitering outside when a person walked out and asked us what we wanted.

Exploring Homeopathy and Siddha

This guy was weird. He kept asking questions and had this weird pony tail. Then we realised everyone here had weird pony tails. His name’s Dr. Chakrapani and he was in charge of homeopathy and introduced us to his assistant who didn’t have a formal education but was very skilled. Suddenly, in between this lady barges in with a heavy tamil accent. (Why does this keep happening?) and the doctor introduced her as the Siddha expert. Srika and Sid went out to talk to her and the rest eventually ended up in her office.

She talked for an hour about Siddha and everything associated with it. Her intentions to spread Siddha through camps and how she could’ve started her own practice and made a lot of money but she decided to travel to the other end of the country to propagate the teachings of Siddha. She complained about the management and how they slow her down and accuse her of overspending. She went in great detail about being strong and independent and kept repeating the phrase, ‘Mind, body and soul.’ Mid conversation, this guy enters with needles lodged in his arm and told us he tried acupuncture for fun. What!?

RIP

We were extremely exhausted by the end of it and sat outside and lamented the fact that we missed the chicken in the mess. Arpita floated the idea that we could order food but later we decided to go in person ourselves. An unfortunate turn of events, and Ayushi’s blood pressure dropped. The tamil doctor suggested to eat pickle and asked the assistant to check her pressure. Us being as shameless as we are, started recording the whole thing in the name of roleplay. She eventually got better and we went to get food and left back to college as we were exhausted.

We also saw medicine stock coming to the hospital which happens only once in 6 months. The medicines were from IMPCL and the logistics company was Balaji Logistics.

Back to campus

We got to the lecture hall and started populating the boards. We got sticky notes and started writing down components and put them on the board. We then categorised them into categories, but the stupid sticky notes kept falling. Here's an image of Srika being depressed because of it. Overall the day was cursed and we wanted to take a day off to figure out what to do next.

[system-design-hospital]

Day 4: More data, less sanity

We returned to the hospital again today, one member down with illness stayed back. Quite the irony. We had a plan of action today however, two of us will observe the people wandering around the premises while the rest will stay in the medical superintendent’s office. Since we split up, the accounts will be separate for each pair.

Sid & Srika at the lobby

In the lobby, we noticed everyone looked well off, with smartphones and good clothing. The pharmacy was crowded, with no covers for medicines; one patient struggled with six bottles, dropping one.

Powders were transferred to ziplock bags by hand, and pharmacists, overwhelmed by questions, often directed patients to interns. Many patients seemed lost after receiving their slips at reception, wandering until asking for directions, unlike repeat visitors. We saw a scared kid at a weighing machine, and outside the OPD, patients waited on benches as doctors called names.

An elderly woman, needing help with her forms, told me she preferred 'desi medicine' for her knee pain and was searching for someone in a white coat. We overheard two women with Tamil accents at the pharmacy, and learned one had recently moved here because of her husband’s job.

No wheelchair facilities were evident, as an old man struggled in with his son’s help. Upstairs at the Panchkarma OPD, we saw a person taking blood pressure before sending patients inside.

Sia at the registration booth

Sia sat down with the guys at the registration booth and observed what was happening. Patients list their name, age, and gender along with ailment and the lady at the counter gives them a slip with the number of the appropriate department. Sia immediately noticed patients looked clueless right after getting the slip. They wander around aimlessly until they ask someone in the know. Repeat visitors know the place well and walk around with purpose.

Ayushi & Vaishnavi at the Medical Superintendent’s office

Ayushi and Vaishnavi decided to sit inside the medical superintendent’s office. (Totally not because of the air conditioning.) We entered and they offered us chai and water and we got to work immediately. His name was Dr. Rajendra Singh and he had a PhD. in Ayurveda along with a MD in Shalya. He talked about what he does which is basically authorise decisions and is responsible for the overall running of the hospital block.

People kept meeting him often and everyone were afraid of him. He had this aura of authority. People lowered their tone around him. A person entered trying to sell medicine. He listed down the properties in great detail and tried his best to convince him to place an order. He even gave him cosmetics for his wife! He had a clerk who sat next to him. He had his own office too. We then asked the medicine guy questions too. He then explained how the government decides prices for meds and this keeps varying throughout the year and the cost is assessed plus also how they have reputed The entire space was divided into with a partition through the middle. One half was for the MS and other half was for his assistant.

[system-design-hospital]

Day 3: Exploring areas nearby

We went to the hospital, this time with the intention of exploring the college campus and other buildings in the hospital complex like the State Drug Testing Lab, Govt. Ayurvedic office etc. We wanted to find how these places are connected to the hospital and how they work.

We also went to the hospital to observe people, but it was very empty compared to the previous day. The MS told us people come on different days to see a doctor of their choice, as two doctors sit in one OPD, alternating everyday.

Roaming in the college campus

We went to talk to the Principal of the college, Dr Devendra Khurana. However, he did not give us permission to talk to the administration department. That left us with no choice, so we decided to explore the college itself. We saw the offices of department heads, saw the micro-anatomy lab and seminar hall of the college.

Then we saw students leaving a lecture room, so we followed them to see where they were headed. We joined the crowd, and it turned out they were all heading outside for lunch. We talked to three first year students, asked what they do in the college. They said they only visit the hospital if needed and mostly study in the college. They also suggested us to talk to third and fourth year students.

Observing and talking to interns

We came back to the hospital disappointed as we couldn’t get much info from the college. We decided to talk to the students working in the hospital, to see what we could learn about the college and the hospital. She told us that the hospital and the college are two separate entities under the SKAU University.

We talked to Dr Ekta, who was interning in the hospital. She was a BAMS student. She explained all the subjects that they study in the college- Rachna Sharir, Kriya Sharir, Ayurveda Siddhanth, Dravyagun, Rasa Shastra, Stri Roga and Prastuti, Balrog, Panchkarma, Kayachikitsa and Shalya Tantra. They also study Sanksrit language in their first year. She also talked about her college and the struggles faced by students, the complications that arose with the introduction of a new exam after internship.

She also explained that her work as an intern to is to assist the doctor, who is also their teacher. She talks to the patients before the doctor, notes down patient history and takes their vitals on the slip given at reception.

Drug Testing Lab and DO office

We entered the Drug Testing Lab first, where a nice lady at the reception explained what the role of this place was. The DTL is an independent body responsible for testing out the drug samples sent by the government. The samples come from the District Ayurvedic Officer (DO).

Then we went to the DO office to inquire more info. We were informed there that the place is responsible for research and development of Ayurvedic medicines. She also mentioned the Herbal farm near the campus which they use for development as well. They supply powder form medicines all over the state, and they are working to develop more different kinds of medicines.

The MD students from the college come to these places for their research work, as well as to test drugs. Apart from this, there is no direct connection to the hospital.

Failed attempt at role play

We sent a member to role play as a patient and see how the process for visiting a doctor is. He said he has a headache and got a slip at the reception. The receptionist told him to go to room 50, but it was closed. The doctor had left at 3.50 PM, before the OPD timings, that day. The receptionist had also left.

The place was starting to get emptier and emptier every minute. We saw many interns chatting, many people saying bye and leaving. They were locking all the OPDs and turning all the lights off. Most of the people left, were in front of the MS office, who had some work left or were about to leave.

After OPD Hours

Since most of the people were gone, we went to the first floor to talk to inpatients. There were a few people resting on the beds in the panchkarma ward. We talked to a middle aged woman from Yamuna Nagar, who had been admitted the previous day for panchkarma therapy.

She told us that she gets her medicine at the beginning of the day, then she’s left alone all day. All patients are left on their own after getting their daily medicine/therapy. The woman was bored in the hospital and had fun talking to us.

Pharmacy

The pharmacy was open after hours, till 8 PM. We talked to the in-charge their and understood the system of it. They order around 150 medicines (as listed in the Govt. Drug list) one month prior. The main supplier is Indian Medicines Pharmaceutical Corporation Limited (IMPCL).

The medicines come to Storage, from where they go to the Dispensary and are registered in the Expenditure register. When any medicine is finished, the demand goes back to Storage. Doctors are given the list of medicines, from which they prescribe medicine to the patients.

All medicines in the pharmacy are free of cost. Medicine comes in the form of powder, tablet, paste and liquid. They are all categorized and then alphabetically arranged. Sometimes patients are given medicines, and to ask any doubts they are sent to the interns, who explains it to them.

We got many insights, almost all the information and context about the system at the superficial level. We decided to come back the next working day to get to know more about the people involved in the system. tiring day lol.

[system-design-hospital]

Day 2: Visiting a hospital

After a lot of infighting and straight up civil war drama rivalling the Mahabharata, our new group rose like a phoenix out of the ashes and we changed our space to Sri Krishna AYUSH. Ayurvedic Hospital. We visited the facility. It was the only medical college in Kurukshetra.

Context of the place

Shri Krishna AYUSH University, established by the Haryana Government under Act No. 25 of 2017, began its operations in the academic year 2018-19. Headquartered in Sector 8, Kurukshetra, Haryana, it is the first university of its kind in the world to offer all AYUSH courses. This university plays a pivotal role in the affiliation and regulation of Ayurveda courses across government and private colleges in Haryana.

Tour of the Hospital

We walked in through the emergency block and tried to soak everything in and get a feel for the place and later found out about the main entrance. There, we spoke to the medical superintendant, Dr. Rajender Singh who introduced us to Dr. Priya, an intern who is doing PG. She gave us a tour of the place, meticulously explaining everything in great detail.

Dr. Priya started with the OPDs and explained what the purpose of each ward was. She guided us through the entire hospital starting with the lobby where patients are instructed to get a slip with their name, age and sex.

They get assigned to specific departments based on your ailment represented by a number of the slip. Later, she walked us through all the outpatient departments on the ground floor and the accompanying waiting areas. A general sense of uncleanness was observed with the washrooms and water coolers.

The following departments and wards were seen-

GROUND FLOOR 1. Reception 2. Dispensery 3. Medical Superintendent office 4. Emergency Ward 5. OT Block 6. Swasthy raksha (yoga room) 7. Stri rog OPD (gynaecology) 8. Shalya tantra OPD (stomach) 9. Shalakya OPD (eyes) 10. Shalakya OPD sub unit (nose and throat) 11. Balrog OPD (paediatrics) 12. Kriya karg OPD (child treatment) 13. Kriya OPD (physiology) 14. Kayachikitsa OPD (general medicine) 15. Dravyagun (drug testing) 16. Rasa shastra 17. Agni karma 18. Rakt Moksh

FIRST FLOOR 1. Medical record room 2. Narcotics treatment room 3. Kayachikitsa female ward 4. Deputy MS office 5. Matron office 7. Clinical Lab 8. Nurse Staff duty room 9. Panchkarma reception 10. Panchkarma OPD

Panchkarma

We then proceeded to go one floor upwards where the inpatient wards were located. Separate wards existed for male and female. The wards were mostly not occupied with a lot of empty beds. However, there was a long line which extended far beyond the waiting area outside the Panchkarma OPD. There were two people stationed on a bench managing the people and clearing any doubts they had.

Dr. Priya explained what Panchkarma was. It means to detox. It is an Ayurvedic treatment that helps cleanse and heal the body. It involves five main methods:

Vamana (Therapeutic Vomiting): Removes toxins from the stomach.

Virechana (Purgation): Cleanses the intestines using herbal laxatives.

Basti (Enema Therapy): Uses medicated oils or herbal decoctions to cleanse the colon.

Nasya (Nasal Administration): Clears the head and sinuses by applying herbal oils through the nose.

Raktamokshana (Bloodletting): Purifies the blood, traditionally done by controlled blood removal.

Clinical Lab

Later, we proceeded towards the pathology lab. There was a general lack of organisation. Urine samples were placed on the table out in the open. We were introduced to advanced machinery like the centrifuge. Syringes and other meds were stored in the refrigerator.

OT Block

Then we went to the Operation Theatre Block. This part, the Major OT was still under construction with exposed concrete walls, but the minor OT was functional with surgeries being conducted. Dr. Priya showed us the various instruments. There was a labor room which was not occupied.

Agnikarma

Finally, we were in the agnikarma department where Dr. Priya introduced us to various instruments to treat joint pain without the need for painkillers. The shalaka was one such tool. The pointed end is heated and then briefly touched to the skin to treat various ailments like joint pain, musculoskeletal issues, and certain skin conditions. Aloe vera and turmeric were common treatment methods. Bowls were placed for cupping therapy. To our astonishment, Dr. Priya picked up a container from the shelves and showed us leeches inside. The saliva of leeches contain anticoagulants. While feeding on the blood, these substances are released into the bloodstream thereby helping in improving blood flow and reducing symptoms of varicose veins.

Exploring more

After the tour was over, we decided to split up and observe different areas all over the hospital. We made a list of all the equipments, items, and other stuff kept inside every ward. Then we started observing the people around us.

Since we had enough information about the structure of the hospital, and we were tired and hungry, we decided to leave and come back tomorrow to uncover more. bye.

[system-design-hospital]

Day 1: Exploring different systems

First day of our project, our group discussed various areas of interest like hospital, bus stand, hotel, police line etc. It was decided to check out clusters of settlement in Kurukshetra- legal settlements like govt quarters and apartments, as well as illegal settlements like the ones in Umri and Ladwa.

Huda Office

We went to Haryana Urban Development Authority (HUDA) office in Sector 4 to inquire about different kinds of settlements in the region- Govt quarters and apartments. The information was given by Mr Anuj. From there we headed to Umri Village to check out rural illegal settlements.

Umri Village

This settlement connected with the Indra road in Umri had around 8000 houses. The houses were all clustered together based on the caste. There were sections or mohallas of Punjabi community living together. Similarly there were sections of Jatt, Harijan, Vyapari community etc. The area had a govt school, a mandir, many kirana stores, barber shops, parlours and stationery shops etc. The clusters were not consistent and unorganized. Moreover, the land was disputed for many people. Most of the houses had been constructed on the land illegally, but they had gotten it legalised in the past year. Only a few lands were disputed in court.

[system-design-hospital]

Introduction

Hello, we are final year students from the National Institute of Design, Haryana. We're documenting our system design project here.

hehe.