Innovation blog: IV fluids for Land Cruisers - Getting started

Our teams work in conflict zones, epidemics, and places where no other health care is available. This means thinking differently to solve problems that simply don't exist in conventional medical settings. In the second instalment of their blog, nurse Josie and logistician Anup write about getting stuck in to a design problem that could save valuable time in an emergency...

The team discuss ideas

When transferring patients, moving medical supplies and transporting building materials, MSF uses Land Cruisers - 4x4 cars which can cope with a wide variety of road surfaces (or no road surface at all!). But as we explained in our last post, these cars weren't built to be used as ambulances, and one of the big issues is that there is nowhere to hang the bags of IV fluids that we need to keep our patients stable until we can get them to the medical care they need.

After years of coming up with quick fixes and temporary solutions, for the next three weeks we (Josie, an MSF nurse, and Anup, an MSF logistician) will be working with Fearsome, a product design agency, to try to develop a lasting solution that could improve care in MSF projects around the world. 

Product design stages, put simply:

Stage 1: Information gathering

Stage 2: Visualisation and analysis

Stage 3: Prototyping and testing 

Stage1: Information gathering

So currently, we are at stage 1. This involves gathering as much information around how those five minutes of making an IV fluid holder came about, the actual process of making it and then everything that happens after. This again is quite hard to do, consistently going over everything about those five minutes for five days can at times be pretty draining.

This stage actually started before we arrived in Glasgow, with Nils starting to ask questions about MSF and the IV fluid holders as soon as we knew the project was going ahead. From these questions and answers he created a timeline for the IV fluid holder from procurement to its end of life and everything it will go through in between.

Photo of white board with timeline for the product, from procurement through to disposal once it has reached the end of its life

Timeline for an IV fluid holder in a Land Cruiser. Photo: Fearsome / MSF

This discussion then led to a trip to Brussels where we could get our hands on a Land Cruiser and some IV fluids and really show Nils what it involved. We took several pictures of the Land Cruisers and played out patient referral scenarios that Nils then created story boards from. 

The storyboard consists of nine photos, each depicting a different stage of getting a baby into the car and hooked up to IV fluids

Paediatric referral storyboard. Photo: Fearsome / MSF.

Storyboard showing all the stages involved in getting an adult into the car and hooked up to IV fluids.

Adult referral. Photo: Fearsome / MSF

From these and further discussions, will build a collection of scenarios in which the product would be used. At this point, Fearsome explained how it was important not to be visualising a solution, but to gather as much information as possible to understand what the product would have to go through!

We also then did a few test-runs with hooks available, placing them in different positions and using different styles to see how the fluids moved while the Land Cruiser was driven around. Several videos were made so we could show the rest of the team.

While in Brussels we also created a plan for the three weeks in Glasgow, generating a to-do list that needed to be completed before the official start date. 

The project plan is written out by hand in a notebook

Project plan. Photo: Fearsome / MSF

We then headed up to Glasgow in January to start these three weeks.

Our first meeting was to present Fearsome with a typical day in the life of an MSF nurse and technical logistician, and to provide a background to the Land Cruisers, their uses and patient referrals. After this the aim for the rest of the week was to gather as much information as possible!

 Although we’d thought we knew it all, as we’d lived it, breathed it and put up with it for years, we suddenly learnt so much more

We reached out to our MSF friends in the field who provided us with a wealth of knowledge. Although we’d thought we knew it all as we’d lived it, breathed it and put up with it for years, we suddenly learnt so much more. We also gained valuable contacts in both the English and Scottish Ambulance services and even spoke to advisors working for Toyota to develop Land Cruiser Ambulances for NGOs.

All the information we gathered was priceless, however, when you spend your morning sending out e-mails and the afternoon waiting for replies it can be quite a long day. Plus, with such a short time-frame, a day’s wait seemed to make a big difference into whether we were actually getting somewhere and it didn’t always feel like we were using Fearsome to their full potential. This is definitely a part of the process that could have been done before we reached Glasgow.

This information led to the creation of personas of each person involved in the use of an IV fluid holder and what they might say about the current situation. 

A picture of a medic, surrounded by speech bubbles with things they might say about the situation

Persona of a medic in the Land Cruiser with a patient on IV fluids. Photo: Fearsome / MSF

This was fun. You might recognise some of the names as we used actual people we knew from the field. Obviously, we didn’t quote them, so this is not what they have actually said, well, not all of it anyway.

We then create workflows. Discussing in detail, every step of the process when an IV fluid holder is needed for an emergency or pre-planned patient transfer. 

Whiteboard showing emergency referral workflow, written out in different coloured marker pens
Photo of a whiteboard withe the workflow written out in different coloured marker pens

Whiteboard showing less ad hoc referral workflow, written out in different coloured marker pens

Three workflows, showing an emergency, planned and slightly less ad hoc scenarios. Photo: Fearsome / MSF

It was here that things got a little difficult. Anup might mention something a log would do and I might say that not all logs would do that, then I would say what a nurse would do and he would say not all of them.

Having to go over every single detail and every scenario that could occur in that detail was really tough and we both got a little frustrated, as we both knew what we would do, but having to think of what every nurse and every log would do meant we got a bit defensive with Anup representing all the technical logisticians and myself representing all the nurses.

Having to go over every single detail and every scenario that could occur was really tough

The tension that might occur in the field was reoccurring in the office. Luckily, we got to the end of the scenario and moved on.

With all our information gathered, Nils called a ‘crit’ (critique), inviting the rest of the Fearsome team to come over to our workspace and be presented with the problem, the personas and the workflows.

At each stage the team asked questions, really wanting to know exactly how the current situation with the IV fluid holders in the Land Cruisers worked and what the IV holder designed would need to do. Having this crit generated more questions and provided us with different viewpoints and ideas. 

The team gather for the 'crit'

A captivating crit. Photo: Fearsome / MSF

From here we changed the negative comments in our personas to positive ones to outline what the ultimate IV fluid holder would achieve and this would be the criteria we would then run every idea we had against. 

Picture of a medical persona, surrounded by speech bubbles suggesting all the previous issues have been addressed

Positive persona of a medic who had an IV holder in the Land Cruiser when transferring a patient.  Photo: Fearsome / MSF

Bring on the idea generating!!

Want to find out what happened next? Click here to read the next instalment of the blog.

Want to know the background? Read the team's first post here.