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Preparing for high patient volumes during healthcare crises

Helping hospitals to cope with the strain of increased patient volumes has been one of the challenges of the COVID-19 pandemic. Innovative solutions have been proposed to increase emergency surge capacity, including converted shipping container units designed by Fero. HHF conducted a usability evaluation and led co-design workshops of these mobile units to help ensure that, should they be needed, patient safety, quality of care, and infection control would not be compromised.


University Health Network and the Government of Ontario

In Collaboration With

Fero International


Usability Testing, Environment and Workflow Design, Co-Design Workshops


Throughout the COVID-19 pandemic, the Ontario healthcare system has faced challenges like never before. As hospitalizations increased at the start of the pandemic’s second wave, the provincial government and hospitals mobilized in response. Our team was involved in as many projects as possible to help ensure patient care would not be compromised in an emergency. One notable project was the evaluation of converted shipping containers, designed by Fero International, that have great potential to be quickly deployed as emergency Intensive Care Units and Operating Rooms in the event that patient volumes exceed hospital capacity. We were engaged by the province and University Health Network (UHN) to evaluate Fero’s exciting and promising design in order to inform their decision to acquire them for potential deployment. The findings from our study also provided recommendations to Fero for design improvements to promote patient safety and ease of use within these unconventional environments.

Diagram of Fero's prototype units

The individual containers can be sealed together to create a field hospital. Each patient room has the capacity to be changed from a negative pressure isolation room to a positive pressure room.


Developing the Test Plan

This study was a collaborative effort with healthcare workers and various departments at UHN as we all worked towards the common goal of ensuring these units could be ready for imminent deployment. With a tight timeline, we created simulation scenarios, recruited healthcare workers for the study, and coordinated with UHN Medical Engineering and Transportation Services to obtain medical devices and equipment (which needed to be shipped to the Fero headquarters in Hamilton, Ontario). All of this required careful planning to avoid putting added pressure on the healthcare system in an already challenging time. The urgency and short duration of the study meant that our test plan needed to be flexible, and we continued to refine it throughout our evaluation.

Panoramic Image of the inside of the mobile unit, showing a patient room and the nursing station
Usability Testing and co-design mitigation workshops

Our human factors specialists facilitated high-fidelity simulations in the prototype units, during which an ICU physician, nurses, and respiratory therapists completed individual and group scenarios. The scenarios were designed to test how easily normal ICU tasks could be carried out in this new environment, especially in the event of an emergency that would require rapid entry of medications, equipment, and healthcare teams to the unit.

The unique conditions of the study allowed for the participating healthcare workers to co-design the environment in tandem with our usability testing. We documented observed usability issues in our evaluation and recorded participant-reported issues and feedback, then led co-design mitigation workshops after each session to address the uncovered issues. During these workshops, participants generated and prototyped ideas to eliminate issues and better support their workflows. We then had the opportunity to test these ideas and continue to workshop them until we arrived at solutions.

Image of brainstorming on the whiteboard walls, showing how healthcare workers would make changes to the unit

The nursing station within the unit was adapted into an observation room for our human factors specialists. Mitigation brainstorming was done on the unit’s whiteboard walls.


Our feedback and recommendations were presented to the provincial government and UHN, which would influence their decision to procure the mobile units if needed. Fero was able to use our assessment to improve upon the design of their prototypes and they had already begun making design changes based on the identified issues shortly after the evaluation. Although UHN did not procure these pressurized medical mobile units during the worst waves of the pandemic, these units have great potential for future use. In fact, through this co-design and usability study, UHN and other hospitals now have a proven solution which can be quickly and safely deployed as various needs arise.

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