Emergent Social Interactions Between A Hospital Patient And A Service Robot A Research Through Design inquiry into the social dynamics of the interaction framework hospital patient, service robot, and caregiver Denisa Maria Bucuroiu

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Between A Hospital Patient And A Service Robot

A Research Through Design inquiry into the social dynamics of the interaction framework hospital

patient, service robot, and caregiver

Denisa Maria Bucuroiu

bucuroiudenisa@outlook.com

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Abstract

The following documents a research through design inquiry into how socialites of a hospital environment are disrupted or improved by implementing a service robot. The robot, support for excessive work, represents a new intermediary between a patient and a caregiver. Robotic work routines appear as better, more efficient, and more affordable. Apart from other ethical and inclusive considerations given to this dialogue, the social values hidden in traditional workflows are of equal importance.

This thesis attempts to generate constructive design research about emergent social norms and social dynamics caused by service robots’

implementation. The lessons learned are presented in a final research discussion. Further applied, the knowledge held common grounds with a rehabilitation robot developed by Blue Ocean Robotics.

Keywords: social interactions, human-robot interaction, service robots, patient care

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Acknowledgments

The knowledge gathered and employed in this thesis was possible only through a fantastic collaboration process. I will express my gratitude to my supervisor at Blue Ocean Robotics, who has been an excellent support for learning about robots for the past year. At the same time, to all other colleagues at Blue Ocean Robotics who actively participated in this thesis through expert interviews and monthly meetings. Even so, to my supervisor at Malmo University, David Cuartielles, who offered great support and knowledge for completing this thesis.

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1. Introduction

The global, societal interest in transitioning towards robotized systems across sectors is rapidly growing. Social, economic, and political determinants lead to increased requests to rapidly adjust to a changing society (World Health Organisation, 2021; Bodenhagenet al., 2019). With the technological progress as a considerable agent to facilitate these needs, many questions remain unanswered.

This paper aims to determine the social effects of robot implementation within the internal logistics of a hospital. The following research aims to identify social values and social interactions that emerge or diminish in this new context. This thesis is written in collaboration with Blue Ocean Robotics.

The theoretical framework represents the research journey in determining a holistic perspective on healthcare service robots. Seven robot makers who participated in this study appeared as research and technology experts (Manzini, 2015, p. 58). They are presented in detail in subchapter 4.2.1.

Thus, basing this knowledge on their field expertise offered an input easily validated through academia. One can say that they acted as books, presenting their experience from current and real-life scenarios.

The limitations of the paper lied in the process that needed to be covered.

The research cycle had to be completed by applying this knowledge to a different purpose robot, the Patient Transfer Rehabilitation Robot. Starting from a broad view on robotics in healthcare allowed linearity of thought for a design inquiry focused only on delivery service robots. Besides, design and technology decisions had to be made within the robot’s current capabilities.

Thus, ensuring a somehow relevance at the end of the study.

1.1 Motivation

As part of the company’s subsidiary, Patient Transfer Rehabilitation Robots, I undertook a research project concerning needed action points for the safe implementation of rehabilitation robots. The reflections during this phase prior to the thesis were primordial. I studied the complexities of deploying a robot into its hospital environment, highlighting aspects such as ethics, inclusivity, labor, and social disruptions. Thus, this led to the question of how hospital patients and caregivers were socially affected.

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1.2 Delimitations

The following thesis focuses specifically on the hospital environment.

Therefore, the final study will outline only social interactions under the conduit of a hospital patient or a caregiver.

1.3 Thesis Structure

The thesis presents the following chapters:

Chapter 2 offers below the surface knowledge on the novelty of robots, the motivation behind the current robotic implementation, and current values of patient-caregiver interaction

Chapter 3 reviews current service robot technologies as a starting point for the future design

Chapter 4 sets the methodological knowledge employed in this research and design

Chapter 5 describes the implementation process from design foundation to the final user study

Chapter 6 applies the knowledge generated in this research on a non-fictional robot

Chapter 7 aims to open up a discussion on insights generated through this thesis; also, it outlines a self-critique

Chapter 8 concludes the research findings and proposes a contribution

1.4 Ethical Considerations

Any ethical concerns were taken into account as advised by Malmö University’s Ethical Committee. At the beginning of the study, an application for ethical review was submitted. This was in regards to conducting research within an organization. Secondly, as the design space was still open, employing more advanced data studies on hospital patients was possible. The application was accepted, and it offered several guidelines. However, due to the final project not employing data validation prototypes, the remaining considerations regarded the use of personal data and confidentiality. The research was conducted within Blue Ocean Robotics in the same respects. Additionally, the research within the company was conducted under a non-disclosure agreement. Thus, constant considerations were made while outlining research insights. The ethical considerations given to the topic were numerous and will be presented along with the research.

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1.5 Research Questions

The main research question of this study was:

How might we generate constructive design research about the emergent social interactions between human patients, service robots, and human caregivers in the hospital environment?

The initial assumptions of this study were:

1. There are underlying social implications in the daily interaction of a patient and a caregiver;

2. The implementation of a robotic solution changes the traditional work synergy and thereof, these underlying social implications;

3. Knowledge about new social implications for all three agents of interaction can be generated through research through design;

2. Theory

2.1 A brief historical perspective on robotics

In the quest of creating a timeline of robotics development, this research went back to one particular visionary. Today contemplated by some as “the father of robotics” (Stone, 2005, p. 1-5), Joseph Frederick Engelberger was an American engineer and entrepreneur. He envisioned robots as a channel with a greater purpose: to release humans of that work that does not dignify them (Engelberger, 1980). Primarily, the recent emergence of the concept

“robot” (Čapek, 1947) and “robotics” (Asimov, 1942) in science fiction sustained his vision. Above all, a chance encounter with a recent invention entitled “Programmed Article Transfer” (Stone, 2005, p. 1-5) materialized it.

Together with its inventor, George Devol, Joseph Frederik Engelberger laid the foundation of the first robot prototype. In 1961, Unimate was the first industrial robot commercialized and heavily implemented in its sector. It showcased a robotic arm that could perform repetitive tasks. It was initially integrated into car production, automating metalworking and welding processes.

While significant actions towards automation started as early as 270 B.C.

(Stone, 2005, p. 1-2), the commercial success of Unimate brought to the world a materialization of what others envisioned possible. In between the 1960s and 1980s, a series of innovations opened the way to concretizing the benefits of robotics across sectors. Notable advancements in technologies

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such as machine vision, mobile base, multiple robot axes, and teleoperation (International Federation of Robotics, 2021) further paved the way towards a world with robots.

In 1984, Joseph Engelberger formed Transition Research Corporation, later known as HelpMate Robotics (Stone, 2005, p. 1-10), based in Danbury, Connecticut (Evans et al., 1989). After proving the capabilities of robots in an industrial setting, the engineer was now determined to find supporters for his vision of a hospital service robot:

“HelpMate is a robotic materials transport system designed for hospitals and nursing homes. It is an autonomous robot that uses vision, ultrasonic proximity, and infrared proximity to sense its environment for navigation along hallways and obstacle avoidance.

It can navigate throughout a hospital, carrying medical supplies, late meal trays, records and lab samples for delivery to nursing units or hospital departments.” (Evans et al., 1989, p.251)

Subsequent to Unimate’s success, HelpMate proved its capabilities at Danbury Hospital in 1988. Thus, the institution continued implementing more robots of its kind (Engelberger, 1989). Currently commercialized as Pyxis HelpMate SecurePack (SP) by Cardinal Health, the robot is declared to be:

“The first system of its kind to navigate autonomously through hospitals and other medical facilities, including independently calling and using elevators, without the use of external guidance systems.” (NASA Technology Transfer Program, 2003, para.4 ) Unimate and HelpMate proved robotic qualities such as high-precision, unexhausted repetition, and the ability to work in unfavorable conditions.

Writing the foreword to Engelberger’s first book, Isaac Asimov, the first conceptualist of robot purpose and behavior, beautifully reflects:

“Back in 1939, when I was still a teenager, I began to write a series of stories about robots which, for the first time, were pictured as having been deliberately engineered to do their job safely. They were not intended to be creaky Gothic menaces, nor outlets for the mawkish sentiment. They were simply well-designed machines. I did not at the time seriously believe that I would live to see robots in action [...]

But then, why shouldn’t they? Robots fulfill an important role in the industry. They do simple and repetitive jobs more steadily, more reliably, and more uncomplainingly than a human being should.

Does a robot displace a human being? Certainly, but he does so at a job that, simply because a robot can do it, is beneath one’s dignity.

[...] Robots will shoulder more and more of the drudgery of the world’s work so that human beings can have more and more time to

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take care of its creative and joyous aspects.” (Engelberger, 1980, foreword)

2.2 The novelty of robots across sectors

Sixty years later, we still find ourselves deliberating on robot novelty. As the next concern of this research, seven robot experts answered the question,

“What is your view on the novelty of robots?”.

The majoritarian view of the interviewees regarded the novelty of robots across sectors as currently diminished. A growth in exposure and personal encounters with robots has created an increase in familiarity and individual perception. Thus, the overall understanding was that we are currently learning what robots are and how we can interact with them (Personal Communication, March 2-11, 2021).

One of the seven robot experts, a researcher at the Responsible Ethical Learning With Robotics consortium and publisher of “Perspectives on Robotics” (Sorenson et al., 2019), told the story of her first encounter with a robot:

“My first direct experience was in an industrial setting. There was a mobile robot, and it approached me. My first instinct was to step out of its way because I thought that it won't stop. Even though it had been explained to me that it had sensors and it would slow down and stop, I couldn't see in it. So I moved out of its way. This was in collaboration with a pick-and-place type of robot. I was always thinking that it looks like it's about to drop the goods. So even though I knew and had seen demonstrations on video that it was capable of doing its job, I was still sort of nervous. But after less than five minutes in the room with the mobile robot moving around, I stopped. I started to completely tune it out. I wasn't aware of its movement around me. It just sort of continued doing its work. And I was fine.” (Personal Communication, March 11, 2021)

When further asked what factors in this story could have contributed to a lasting element of fear, the interviewee reflected on the situation from different perspectives. Firstly, erratic, unpredictable behavior from the robot side. Secondly, if the fear element was running more deeply, perhaps as one feeling surveilled, thirdly, remaining fearful for a longer time could be associated with specific mental health.

A different interviewee, a User Requirement Analyst at Blue Ocean Robotics, described her initial perception of robots as highly critical. As an anthropologist oriented towards humanity, it was challenging to make sense of the concept. Her realization that “robots are made for humans and by

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humans” (Personal Communication, March 9, 2021) took place only after a close study and work with robots.

Thus far, an important insight into novelty is that direct experience with a robot is essential. Firstly, it is necessary for laying the grounds for a realistic, personal comprehension. Secondly, to release the human from the novelty of this experience. Considering the latter, the novelty was argued to present different levels of experience. To begin with, “this novelty wears off quickly” (Personal Communication, March 11, 2021). To continue with, by accepting progressively robots in one’s life, an individual steps into new dimensions of their novelty. In this regard, another interviewee, a Human-Robot Interaction Expert at Blue Ocean Robotics, stated that we are already exposed to this technology in some ways: “There is probably a vacuum cleaning robot in every home by now!” (Personal Communication, March 2, 2021).

2.3 The novelty of robots in the healthcare sector

The discussion further shifted towards the novelty of robots in the healthcare sector. One of the interviewees noted: “the novelty takes place in the name of a robot” (Personal Communication, March 11, 2021). This environment is one of the main spaces where humans feel exposed to

“strange machines” (Personal Communication, March 11, 2021). The feeling of not being able to make sense of the equipment around oneself represents an ordinary situation (Löwgren & Reimer, 2013, p.90). Throughout history, hospital patients built trust in letting themselves free in the capabilities of unknown medical equipment. This trust, as argued by another interviewee, a Healthcare Product Specialist at Blue Ocean Robotics, is usually transferred from the caregiver to the patient.

Thus far, this knowledge outlined insights on the dynamics of implementing new equipment that is autonomous and not static, nor overviewed by a human. Machines coming to us represent the novelty of the hospital experience with robots. Secondly, the level of trust towards these new machines must start from the caregiver. Thus, this can ensure a trust transfer towards hospital patients.

2.4 Experiential novelty as a learning space

Across all personal communication, the interviewees attributed two main qualities to describe one’s attitude towards a robot: fear or fascination.

Firstly, a possible situation of an individual who argues a non-acceptance towards robots. However, one rapidly changes attitude once the human-robot interaction takes place. Not necessarily orderly, but what could grow from the first attitude is curiosity. This individual could come

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from the space of previously gained understanding or a space of initial fascination.

Thus far, this pointed out a meaningful insight. The description took place only through extremes of a certain behavioral spectrum, and the degree of novelty appeared as a critical factor in attributing one or the other.

Therefore, a causal relationship between an individual’s initial response and understanding of a robot must exist.

To understand the hidden lessons, an unpacking of the insight followed. To study the human inherent psychological qualities as part of a possible relationship with a robot, Khan. Jr et al. (2004) conducted the first attempt.

The authors defined a robot as an inanimate point of interaction. Even so, the conclusion presented the possibility of a transfer of social perception over a robotic pet. The transfer was materialized through traditional patterns, easily recognizable by humans.

Building upon this and other fundamental work, Catharina Smedegaard (2019) outlines a meaningful approach for discussing one’s perception of a robot. Most importantly, the author discusses it in connection with the degree of novelty. In this way, the researcher notes:

“The phenomenon of novelty effects is only eclectically and peripherally addressed within most research [...] it is usually framed as a source of noise in need of reduction.” (p.411)

As an intense dialogue within the field of Human-Robot Interaction, she highlighted this perspective as “potentially problematic” (p.412).

Considering that the novelty in question is the actual reason for conducting research, the motivation behind dismissing novelty remained ungrounded.

Experiential novelty represents “the original feature of experience” ( p.414).

Regarded as “a lack of pre-established meaning” (p.412), one’s reaction generated at this point represents the accurate expression of this exact lack of meaning.

Barto et al. (2013) note that the mental process of looking for meaning entails the examination as a search into any past observations for already created meanings. Thus, novelty can represent “a negotiation of familiarity”

(Smedegaard, 2019, p.413) between the examiner and the object of examination. Thus, Catharina Smedegaard (2019) notes novelty as having gradient features. When something presents complete familiarity, novelty is inexistent. And vice versa. As Berlyne (1950) pointed out, anything considered completely novel must contain some familiarity. A familiar clue will translate into an invitation to enter the experience. In this way, an object utterly devoid of any familiarity will translate as devoid of an experience possibility.

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Regarding the experiential novelty as “symptoms of learning,” rather than

“temporary noise” (Smedegaard, 2019, p. 412) or the way towards inclining the user’s engagement into the respective experience (Shin et al., 2018), might create insights into the needs of the human who is in the process of learning. Thus, perhaps a reflection over the space of experiential novelty, a conversation on how one understands the situation from one’s point of departure, might appear a more empathetic approach towards the human in question.

2.5 Deﬁning a robot

This research has presented a brief history of robotics development and a short deliberation of their novelty. To close this first level of understanding, a third question spanned throughout all personal communication with seven robot experts. The question “What is a robot?” (Personal Communication, March 2-11, 2021) was meant to gather a generally agreed opinion of its definition. Across different academic sources, the definition is often noted as controversial and relies on specific perspectives (Spectrum &

Guizzo, 2020). Thus, the definition of a robot outlined in this chapter sets the foundation of the future design work.

Foremost, all interviewees attributed the word “machine.” To follow, all answers employed different terms that belong to the quality of one’s autonomy: “intelligent,” “by itself,” “makes a choice,” “semi-autonomous,”

“fully autonomous” (Personal Communication, March 2-11, 2021). Thus, the definition of a robot emerged as “an autonomous machine.”

On a much specific note, one interviewee stated a meaningful perspective that defines the robot “as a hybrid between humans and machines”

(Personal Communication, March 9, 2021). Therefore, with the robot regarded as a human creation, it must hold qualities of its human counterpart. Regarded from an experiential novelty perspective, the robot then receives these humane qualities to appear itself as an intelligent being.

These two elements, the human and the robot, appear as integrated and not separate parts of our world. Thus, the emergent relationship remains conditional and never absolute. The definition of a robot develops only in its co-existence with a human.

2.6 The validity of research

This thesis puts forth three initial assumptions of research, outlined in subchapter 1.5. Presented to all seven robot experts, this concluded their individual support for the research perspective. In regards to the research specifics, the Human-Robot Interaction Expert noted the focus as “novel”

and “insignificantly covered by current academia” (Personal

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Communication, March 2, 2021). The thesis’ view that proposes a possible change in the social tendencies of hospital patients was generally agreed to be caused by a new implementation of service robots. It will create new social norms, social behaviors, and dynamics that require research and empathizing (Personal Communication, March 2-11, 2021). Lastly, from a business point of view, the study of the effects of robot implementation was argued to represent great support to current and future robot makers. In this regard, the interviewee, a Chief Executive Officer of Patient-Transfer-Rehabilitation Robots at Blue Ocean Robotics, stated:

“We will need to go through this process for the next ten years before we can fully eliminate the inability of working with robots” (Personal Communication, March 8, 2021).

Publications on the validation of the implementation of robots as the main consequence for the research of human-robot interaction in the healthcare sector remain numerous in academia (Zardiashvili et al., 2020; Christoforou et al. 2020; Tan et al., 2020; Sorenson et al., 2019; Cresswell et al., 2018;

Jenkins & Draper, 2015). The academic discourse on the social consequences (Gunes et al., 2020) and ethical concerns (Bartneck et al., 2021,p. 73-76; Sorenson et al., 2019, p. 65-89) is vast and tackles numerous research angles. The discourse is either focused on the human, his new experience, reaction, and behavior in short or long-term interaction, or on the caregiver, his new practice, and labor implications. Even more, it discusses how to transfer qualities found in both parties to a robot intermediate to ensure collaboration and coexistence. Thus far, rarely this discourse contains a holistic dialogue about a service robot as a new mediator between the socialities of a hospital patient and a caregiver. Even less on the newly created social structure during the provision of food, medicine, and cleaning.

2.7 The socio-economic-political context

The United Nations proclaimed the period between 2021 and 2030 as the

“Decade of Healthy Aging” (World Health Organisation, 2021, para. 1). It led to international actions that regard ageism as “an insidious scourge on society” (World Health Organisation, 2021, para. 2). Officially regarded as a

“social determinant of health” (World Health Organisation, 2021, p. 56) and as “an economic burden because of its health consequences” (World Health Organisation, 2021, p. 55), the World Health Organisation noted:

“Ageism increases risky health behaviors, negatively affects physical and mental health, accelerates cognitive decline, slows recovery from disability.” (World Health Organisation, 2021, p. 56)

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Due to this social determinant, demographic and economic effects require advancements in providing healthcare. According to Bodenhagen et al.

(2019), the welfare system will undergo significant changes in the next twenty years. An inclining aging population and a declining mortality rate in adults and infants foresee an overwhelming number of patient hospitalizations (p. 2).

Even more, a critical shortage in caregiving staff will accentuate these challenges (Bodenhagenet al., 2019). A significant number of unfilled vacancies leave an insufficient workforce to care for the ill. Motivated as an economic effect and rarely sustained politically, a series of initiatives are in place to retain the caregiving workforce. (Chew, 2017)

As an active member in the field, the Healthcare Product Specialist at Blue Ocean Robotics noted that a common situation is that caregivers feel unable to conduct their work proficiently. Limitations in time and resources are the causes of not being able to provide specialized care. Failure in providing treatment often causes them to move between different departments in the search for professional achievement. If this is not achieved, this often leads to work resignments. On a bigger scale, this is one of the main drives for staff shortage and inexperienced caregivers. This will result in an unsatisfactory system, with loss of knowledge and lack of experience.

(Personal communication, March 2, 2021)

Along the same lines, the healthcare sector is currently facing pressures from political organizations that require innovation and increased serviceability at a reduced cost (Bodenhagen et al., 2019). Under social, economic, and political pressure, the healthcare sector is motivated to explore new strategies and project implementations.

2.8 Workload transfer from a caregiver to a service robot

The already proven robotic capabilities motivate the healthcare sector to consider their deployment to solve the challenges mentioned above. This chapter presents the fundamentals for designing three robot concepts as substitutes for a caregiver providing food, medicine, and cleaning.

Subchapter 2.8.1 concludes that caregiver involvement in indirect care. This appears double compared to the time spent in direct interaction with patients. Direct and indirect care are defined within this subchapter.

Thus, this chapter also defines the service robot as a support for the excessive workload found in internal logistics. The future design inquiry will employ the dynamic of a robot as work support and of a caregiver as liberated from heavy labor. This liberation, expected to materialize in more

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time for care work, will be further researched in terms of a new purpose. A possible change was identified in subchapter 7.3.

Subchapter 2.8.2 concludes the work routines that a respective service robot should follow.

Subchapter 2.8.3 concludes the needs that a respective service robot should solve.

2.8.1 The internal logistics of a hospital

Thus far, the caregiver has been described as part of a declining work sector.

Limitations of time and involvement in heavy labor tasks create work dissatisfaction. To strengthen this insight further, a quantification of time spent on tasks sustaining the internal logistics follows.

In a typical Scandinavian hospital, nurses spent 29.8% of their daily time on direct care and 53.6% on indirect care (Granlund et al., 2013). The rest belong to administrative and personal time, aspects out of the research scope. To explain, direct care includes activities conducted face to face with a patient, such as examinations and treatments. Indirect care includes activities that do not present interaction with the patient as essential. These can represent the preparation of medication and food (Granlund et al., 2013).

For feasibility reasons, the quantifications that follow include only activities targeting the support of food, medication, and cleaning. The majority of direct care counted for 23.1% of total daily time. Patient hygiene with 12.5%, patient nutrition with 3.9%, medical treatment with 3.9%, and support information and teaching with 2.8% (Granlund et al., 2013).

Indirect care counts for 43.4% of the total daily time. Report of information with 8.7%, food handling with 7.7%, own transportation with 6.6%, handling of medication with 5.6%, care documentation with 5.4%, paper and computer work with 3.2%, cleaning with 2.7%, rounds with 2.2% and medicine preparation with 1.3% (Granlund et. al., 2013).

2.8.2 Food logistics

2.8.2.1 Work routine

According to research in the field, the work routine necessary for ensuring food delivery to a patient entitled:

“The transportation department picks up the food carriages from the hospital kitchen and transports them to the wards three times a day for breakfast, lunch, and dinner. The nursing staff brings the food carriages into the patient ward. The trays are then served to each

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hospital patient. After the meals are consumed, the nursing staff brings the carriages back to the elevator hallway.” (Granlund et al., 2013, p. 8)

2.8.2.2 Present challenges

The biggest challenge in supporting food logistics lies in the overwhelming number of tasks required to complete this cycle. Registration, ordering, and serving of food are time-consuming and involve complex workflows. Due to this fact, meals can be served cold, incorrect, or delayed. (HealthCat, 2020)

2.8.3 Medicine logistics

The prescription of medications takes place through a nurse-doctor collaboration. The storage and handling of medicine stock and distribution take place through the internal hospital system. Nurses are primarily involved in the administration of medications across settings. Nurses can also be involved in both the dispensing and preparation of medications.

(HealthCat, 2020) 2.8.3.2 Present challenges

Along the same lines with food logistics, medicine logistics include the same complex cycle. Registration, ordering, distribution, and administration are time-consuming and involve complex workflows. Due to this fact, caregivers are faced with heavy labor to facilitate the administration of medicines to each hospital patient. (HealthCat, 2020)

2.8.4 Hand hygiene logistics

Caregivers are required to conduct hand hygiene for themselves and to supervise hand hygiene for each hospital patient. The focus increases on the transfer from one patient to another and dealing with infectious disease treatment. On the patient side, the caregivers are required to provide extra attention to hospital patients who cannot wash their hands on their own or who present forgetfulness and carelessness in their personal hygiene.

(HealthCat, 2020) 2.8.4.2 Present challenges

Hand-hygiene facilitation takes place on a much smaller scale in terms of completion cycle, compared to food and medicine logistics. However, due to lack of time for the caregivers on this logistic, severe effects can occur.

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Bacterial spread from hands and other surfaces represents a threat to the spread of diseases and infections in the hospital sector. Poor hand hygiene increases bacterial spread and can thereby prolong or exacerbate the health of hospital patients. The staff focuses on their own, but to a lesser extent on patients' hand hygiene. (HealthCat, 2020)

2.9 Deﬁning emotional care and the social norm

Given the above-mentioned considerations, service robots enter the design space of this project to release the caregiver of significant workload. Thus, the only natural inquiry that laid further was “Which are the unseen values, not related to task completion, usually transferred by a caregiver to a patient?”.

From a psychological point of view, human beings aim for “the engaged life, which involves, among other aspects, intimate relations or friendships”

(Graaf, 2016, p.590). Social moments are “brief events that occur during an interaction between two or more agents that have the potential to impact social dynamics” (Durantin et al., 2017, p.179). Thus, social abilities represent means of responding through different modalities for a dynamic of interaction (Durantin et al., 2017). These modalities often include gaze, conversation, sensitivity, the ability to act within social norms and interpret social meanings (Durantin et al., 2017).

As “interpersonal interaction is inherent to nursing care” (Birkelund et al., 2012, p.608) and an ideal situation employs the caregiver as an agent of

“therapeutic relationship” (Fortuno et al., 2017, p.84), the patient should experience the following qualities, elements of a healthy human-to-human relationship: compassion, empathy, dedication, and commitment (Gunther and Alligood, 2002). Thus, an understanding of the hospital social norm helped define the possible socialities of a patient and a caregiver. With all daily interactions as part of the framework of hospital care provision, care implies:

“The process of protecting someone or something and providing what that person or thing needs.” (Cambridge English Dictionary, n.d.)

Along these lines, assuming the caregiver achieved the more procedural aspects of the support in a safe environment, the other possible interaction with patients should be of emotional nature.

The following chapter concludes the comprehension of emotional care by human beings. The identified notion was then further researched under a hospital patient conduit. Finally, the data outlines a quantification of actions that belong to this social norm. In the research that follows, the

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inquiry took place only in the framework of human-to-human interaction, with no robotic intermediate.

2.9.1 The importance of emotional care in a hospital environment

To outline the scope mentioned above, a quantitative research engaged fifty human respondents in order to gather data about the importance and meaning of emotional care. In order for this data to comply with the hospital environment, the participation was filtered by one requirement.

Altogether, forty-six participants met the needed condition: to have been patients in a hospital, at least once in their lifetime, no matter their medical issue or length of stay. Natively, participants originated from a wide variety of areas: Central America, North America, Asia, Eastern Europe, Northern Europe, Northern-Western Europe, and Central Europe. Age-wise, participants ranged from the age of 20 to the age of 58. The most significant number of participants were between the ages of 20s to 30s. Gender-wise, survey participants were evenly distributed. Twenty-one respondents were females, and twenty-five respondents were males.

Firstly, 80% of the respondents noted emotional care as part of their own hospital experience. When rating the importance of emotional care, 54.3%

of the respondents agreed it was of very high importance. The rest of 34.8%

agreed only to high importance, 6.5% to moderate importance, and 4.3% to slight importance. Thus, the majority perceived emotional support as an essential quality when receiving hospital care.

2.9.2 Care as a human attitude

When rating care from a human perspective, most respondents rated safety as one of the most important feelings. Secondly, the feeling of being listened to, the feeling of being understood, and the feeling of comfort were equally rated. Lastly, the feelings of being accepted and the feeling of love seemed to also play a significant role.

2.9.3 Care as a hospital patient

Firstly, it is essential to note that the feelings inherent to care as a human attitude also complied to care as a hospital patient. Thus, a hospital patient felt cared for by feeling safe, feeling listened to, feeling understood, feeling comfortable, and feeling accepted. However, an important insight is that the feeling of love did not play a role on the spectrum of hospital care but rather belonged specifically to human care.

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2.9.4 The social norm

Further, the respondents answered how the caregivers should best express their emotional care, specifically in the framework of providing food, medicine, and cleaning.

The most crucial expression of care lies in the caregiver being a source of help. This means acting as a guide to any daily help the patients might need around the hospital. On the same level of importance, the caregiver should actively validate the patients’ individuality through awareness of their name, their medical issue, and who they are outside of the hospital. Following this, the caregiver should express an empathic attitude through presence and speech. The hospital patients believe it is vital for them to be asked about their day and mood and address them with caring expressions. Lastly, physical closeness did not represent an essential factor. Thus, analyzed together with the lowly rated feeling of love, this does not belong to the social norm in question.

2.9.5 Care as a practice

Based on qualitative research in the form of semi-structured interviews, the inquiry gathered further knowledge on how caregivers regard the above-mentioned social norm. Care as a practice was discussed with two healthcare representatives.

A reflection over a possible generalization of emotional tendencies of patients presented the feeling of distress and helplessness. These grow in intensity according to the severity of one’s illness.

Furthermore, one of the interviewees, a Healthcare Product Specialist, noted:

“If you as a caregiver can not motivate the patient, you can actually risk affecting the patient in an emotional way. They will trust themselves less and believe less in their rehabilitation. This is happening because they did not get this feeling of success.”

(Personal Communication, May 2, 2021)

Thus far, the primordial focus of a caregiver towards a patient is to make one feel safe, motivated, and confident. Further, both interviewees agreed that being a source of help, validating the patient’s individuality, and speaking emphatically presented checkpoints on a caregiver’s list. However, both interviewees noted that, in their view, the validation of individuality is the most important:

“People get exhausted if they have to explain themselves all the time about their identity and situation. And this can make the patient feel not understood.” (Personal Communication, May 2, 2021)

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2.9.6 A common view on care

Consulting hospital patients and caregivers outlined a great alignment in views. Thus, emotional care is an inherent quality of one’s care work and a primordial expectation of a hospital patient. The social norm for engaging in patient-caregiver interaction appeared as remaining in the framework of ensuring safety and help. Engaged caregivers seemed to care about instilling motivation and confidence primordially. Lastly, the social norm entitles caregivers to offer daily support, engage in social moments to validate individuality, and be present and speak empathically. With the caregiver dedicated to this social norm, the emotional expectations of the hospital patients are, thereof, reached.

2.10 A sensitized robot presence

All knowledge so far called for a rethinking of the situation through reflection and empathizing. Human beings in the situation of becoming hospital patients find themselves in the process of learning to interact with robots in the everyday. Caregivers are in the process of transferring work to a robotic counterpart. Thus, it places them in the situation of learning how to adapt as human beings and how to adjust as professionals.

Building on prior fundamental RtD work, this thesis employed the theory of

“sensitizing participation” and “materializing relationships” (Reddy, 2020, p. 241). Thus, a sensitized robot presence entailed “a shift from the narrow user experience” to “a much deeper engagement” (p. 241). The robot must regard “relations, agencies, subjectivities, and subsequently, frictions and conflicting perspectives” (p. 241). Additionally, the situation needed to address “non-existent relations” through “staging dynamic encounters between people” (p. 241) and robots. As opposed to the scope of materializing interactions only to meet a final end goal, the situation entailed “bringing up emergent relations” (p. 241) by caring about how they meet and experience things in the everyday.

These conditions can allow for “a re-familiarization” (p. 239) of robot technology. Thus, the human in the process of learning must not be the only one adjusting to a situation. The robot should also be re-familiarized in interacting with humans. In this way, a robot’s presence can adjust to the wider world that it is embedded in.

2.11 Summary

The chapter of theory generated based on expert and academic knowledge, presented important aspects for the design to follow. Firstly, it decided on experiential novelty as a learning space during the final user inquiry.

Secondly, it defined caregivers' work routines, thus the service robot’s new

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work routines. Along the same lines, it generated a new interaction dynamic of caregiver and service robots as intermediaries. Lastly, it uncovered the topic of emotional care and defined the social norm of patient-caregiver interaction. Through a sensitization of the service robot’s presence, the implementation will transfer these human social qualities to a service robot interface. For feasibility reasons, both technical knowledge and design concerns for realizing the future design will be addressed throughout the implementation chapter.

Following, an analysis of service robot technologies will be presented.

3. A selection of service robot technologies

Following up on subchapter 2.5, expert input from the field of robotics outlined the robot as an autonomous machine. Subchapter 2.8 motivated for service work transfer from a caregiver to a robot. Thus, the autonomous machine entails a further term, that of “service.” According to the International Federation of Robotics (2020), the application of service robots is widely spread across sectors. The International Organization for Standardization (2012) defines a service robot as “that which performs useful tasks for humans or equipment excluding industrial automation applications” (para. 2.10).

The following robot selection was made upon an analysis of varied service robot technologies directed towards food, medicine, and hand hygiene.

3.1 Bella Bot

An intelligent delivery robot designed by Pudu Robotics, the Bella Bot (figure 1) is designed to cater to many food delivery situations. The robot features “an innovative bionic design language, cute modeling, AI voice, and multi-modal interaction” (Pudu Robotics, 2021, para. 1).

In terms of safety, the robot’s autonomous motion employs omnidirectional obstacle avoidance. Equipped with 3D sensors, Bella Bot can sense obstacles at any angle and move away safely. In terms of modalities, the robot showcases both voice and touch inputs. An interesting feature was designed to enhance human-robot interaction. “Touch for feedback” (Pudu Robotics, 2021, para. 10) allows the human to pet the robot once the task is completed. The robot answers back through smart expressions.

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Figure 1. Bella Bot designed by Pudu Robotics - an autonomous food delivery robot (Retrieved April 2021 fromhttps://www.pudurobotics.com/product/detail/bellabot)

3.2 Pillo Health

An intelligent medicine dispenser assistant designed by Black+Decker, Pillo (figure 2) is intended to be a home companion for personalized healthcare.

The user can ensure its medication management through refill reminders, personal alerts, and caregiver permissions. Additionally, it supports dialogue about the weather, time, and general knowledge. Pillo showcases a personality “with a charming disposition, a true “someone” in the home.”

(Pillo Health, 2021, para. 2)

Figure 2. Pillo designed by Black+Decker - a smart home companion for medicine (Retrieved April 2021, from

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https://www.fiercehealthcare.com/tech/new-robot-offers-home-monitoring-and-medicati on-dispensing)

3.3 Hospi

Designed by Panasonic, Hospi (figure 3) allows for autonomous delivery of medicines and food. By utilizing a hospital’s map data, the robot can safely navigate the environment, including the usage of elevators. The robot showcases obstacle avoidance functionality. In interaction with a human being in proximity, the robot can turn its head and greet the passerby.

Figure 3. Hospi designed by Panasonic - an autonomous medicine delivery robot (Retrieved April 2021, fromhttps://www.asianscientist.com/2015/07/tech/cgh-panasonic-hospi/)

3.4 Rimephas

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Figure 4. Rimephas designed by Abena - a robot interface to teach hand hygiene (Retrieved April 2021, fromhttps://www.abena.dk/b%C3%A6redygtighed/rimephas)

Rimephas (figure 4) is a hand-hygiene robot interface developed by Abena in collaboration with the University of Southern Denmark and Sønderjylland Hospital. The robot is meant to support the promotion and the teaching of caring for one’s hand hygiene. Important to mention, this project started as a quick response to the pandemic situation.

4. Methodologies

4.1 Research Through Design

In an attempt to open the borders to what one perceived as exploration through creativity, Christopher Frayling outlined different possibilities for research into, for, or through art and design. He conceives art and design as

“concerned with the new” and research as “going over old territory”

(Frayling, 1993, p. 1). The writer defined “development work” as the one which can take a product and “customize it to do something no one has considered before and to communicate the results” (p. 5).

Building upon this fundamental definition, Zimmerman et al. define this product as one that “transforms the world from a current state to a preferred state” (2007, p.1). Zimmerman et al. come to define research through design as a practice employing design research as a process to address “the increasing complexity of systems” (p. 3) and design thinking as the application of this process. Design thinking, in this context, appears as

“an investigation to gain multiple perspectives over the problem” (p. 2) and unfolds through empathizing, ideating, iterating, and testing (IDEO, 2021, para. 5). This model was outlined for the Interaction Design field as a practice to integrate “the true with the how knowledge” (Zimmerman et al., 2007, p.5). The outcome of this practice puts forth “a concrete problem framing, an articulation of its preferred state” (p. 5), and a series of artifacts as documentation of this process. Firstly, the field of Interaction Design benefits from an articulation of existent and emergent technologies and their unforeseen effects. Lastly, it benefits from a holistic research contribution that balances conflicting perspectives (p. 6).

Thus, in this thesis, research through design was employed as a means of inquiry into a broader consideration of the human experience (Zimmerman

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et al., 2008, p.3). Not focused on usability but on the transition of computing technologies in a social context (p.3), this thesis uses research, design, and reflection as tools for inquiry. Thus, after exploring the contextualities of the thesis’ problem, a codification of this understanding into three design artifacts helped outline the final contribution to the field’s body of theory. The final design artifacts presented an “intentional outcome” for accessing “a preferred state” (Zimmerman et al., 2008, p. 5).

The construction of the final theory emerged from describing the relationship between “groups and phenomena” (p. 7). In this context, the social interactions — the phenomena — between hospital patients and service robots — the groups. This description identified wanted and unwanted effects. These appear as a reflection of the future ethical considerations of our problem (Zimmerman et al., 2010, p.310). Therefore, the final findings of this thesis could fall into the category of “theory for design” (p. 313).

4.2 Qualitative and Quantitative Research

4.2.1 Semi-structured interviews

The semi-structured interviews presented three common stages: the briefing, the setting, and the debriefing (Kvale, 2007). Further, five thematic categories of questions (Kvale, 2007) were created and assigned to an interviewee based on their expertise. All questions were direct and aimed at

“producing knowledge” (Kvale, 2007, p. 8). All interviewees received the questions prior to the interview.

Seven experts from the field of robotics participated in the semi-structured interviews: a Human-Robot Interaction Expert and Project Manager, a Technology Manager, a Healthcare Product Specialist, a Product Roadmap Coordinator, a User Requirements Analyst, and a Chief Executive Officer, and a researcher for “Perspectives on Robots” (Sorenson et al., 2019). The main governor of the conversation was human-robot interaction across sectors and focused on healthcare. However, at times, I — the interviewer — decided to take the path that felt relevant at the moment and that helped unfold knowledge about robotics as a much bigger story. Thus, the course of each interview flew naturally, turning back to the matter in question only when the topic was clearly out of scope. On the other hand, this stage spanned over two weeks. To be mentioned here, no scrutiny of the data was done throughout this stage. All of the interviews were conducted in more or less the same mindset and at the same knowledge level. Naturally, my comprehension developed slightly over their unfolding. At the same time, I noticed that my ability to interview was improving gradually. The competence was in regards to my ability to choose the right things to follow up on and the order of questions. As a result, I gathered a total of eight

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hours of audio recording. Each participant engaged in conversations for more or less sixty minutes.

4.2.2 Digital Survey

The first digital survey gathered data from hospital patients. “What do you think of when we say care in a hospital?” contained six quantitative questions which outlined the insights presented in subchapters 2.9.1 to 2.9.4.

Two additional digital surveys collected qualitative and quantitative data, during concept testing and low-fidelity testing. These contained both qualitative and quantitative questions and allowed participation of any human being—thus ensuring universal feedback. This is presented in subchapters 5.4.2 and 5.6.

4.2.3 Secondary research

This thesis grounded the data gathered through qualitative and quantitative research in secondary research. Varied academic sources provided further in-depth knowledge about context, history, or relevant theories (IDEO, 2021, para.1).

A need for secondary research as a source of knowledge resulted from the impossibility of accessing the hospital environment as a space of own fieldwork. Subchapter 2.8 represented a step in ensuring a holistic perspective of the situation. The typical caregiver activities were needed to motivate the possibility of a robotic substitute. While not primordial, the knowledge offered a view grounded in reality. Thus, ensuring further the responsible design approach. To facilitate this source of secondary research, Blue Ocean Robotics allowed access to a research project (HealthCat, 2020) conducted in several Danish hospitals. Some of its findings and accompanying literature outlined the knowledge presented in this respective subchapter.

4.3 Responsible design practice

Tharp & Tharp (2013) categorized design practices into four main approaches, the commercial, the responsible, the experimental, and the discursive. Jesse M. Tatum (2004) reflected on design as a space entitled to put forth the question of “Why not change the world?” (p.66). However, the researcher emphasized the argument that the world in question does not belong to its designers. The designer should:

“develop and carefully examine both their own sense of desirable directions and their commitments to processes for arriving at social

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and political definitions of desirable directions and objectives for society.” (p. 76)

Thus, responsible design practice takes the approach of “socially responsible design” (Tharp & Tharp, 2013, p.406) driven by a more human-oriented notion of service.

4.4 Co-design

4.4.1 Co-design practice

“The people you are designing for can tell you plenty, and they can show you more” (IDEO, 2021, para. 1). Co-design or cooperative design practice creates similar values as participatory design practice. They are usually slightly differentiated as both focus on “giving a voice” (Bodker et al., 2000, p. 1) to end-users in the design process. A strong value that co-design practice entails is that of participation. As a “fundamental process” (Bodker et al., 2000, p. 7) in many other spaces such as democracy, or learning, this participation allowed for changing the question of design. A shift from “how do we design” to “how do we allow users to design” (p. 7) opened the way to more ethical and inclusive design products.

4.4.2 The human proximity model as a co-design tool

The Responsible Ethical Learning in Robotics proposes a roadmap for closing the gap between users and designers of robots. The motivation is to take a look at the disruptions created by robotics advancement (Sorenson et al., 2019, p.13). The research acknowledges the need for closer contact with the general public and societal concerns. The goal of the project is to align the vision of robot makers with empirically-based knowledge of human needs through a new proximity-based human-machine ethics. By giving voice to those affected by robots, the model intends to close the gap between robot makers and all affected stakeholders (p.14). One of the contributors explained that the human-proximity model was created from the need of creating human readiness levels in relation to a parallel to technological readiness levels. Applied in a student project, the model should be used as a conceptual tool. This tool helps to push the boundaries of the design space, by opening up to different voices in the design process (Personal Communication, March 11, 2021).

4.5 Enacting conversation through design prototypes

To further explore the border between design and research, apart from materializing an intended outcome of the desired change, the final design prototypes enacted inquiries and reflections (Brandt et al., 2013). A prototype as an enacting tool emerged from the practice of participatory

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design. Inspired from improvisational theatre, where the outcome of the play relies on participant input, this dynamic found its place in participatory design sessions. It entails “trying things out in a setting that resembles that where activities take place” (Brandt et al., 2013, p. 164). Making the situation “explicit” (Brandt et al., 2013, p. 168) and “as close as possible to the real environment” (Brandt et al., 2013, p. 168) allowed participants to enter a reflective mindset. Lightly perceived by all participants as

“conversation starters” (IDEO, 2021, para. 1), the final design prototypes created a comfortable space for insightful discussions on each situation.

Along the same lines, tackling a significant societal issue which includes large-scale environments and products, enacting a situation through design prototypes allowed users to “try out new roles, relationships, and practices that follow with a new design” (Brandt et al., 2013, p. 169).

5. Implementation

The following chapter describes the design process employed in this thesis.

The design space remained open to as many ethical and inclusive considerations as it allowed, through responsible design practice.

Implemented through three stages, concept, low-fidelity, and high-fidelity, the final prototypes were subject to input from different stakeholders.

Firstly, from robot makers as experts that showed the way (Manzini, 2015, p. 58). Secondly, from any human beings as “affected or distantly affected stakeholders” by the future design (Sorenson et al., 2019, p. 17). Lastly, from the end-users who directly use and interact with the robots (p. 17).

Designing between the borders of a research inquiry and making a design prototype kept the process of design thinking (IDEO, 2021, para. 5; figure 5). Empathizing with the design space and both end-users, the patients, and the caregivers, set the design foundation. Empathizing with existent robot technologies allowed for a concretization of robot design possibilities. The design stages to follow opened for brief co-creation sessions. Insights and integrated feedback generated the design of a research prototype. The RtD tool showcased a digital video introduction and a social intelligent robot interface. Employed in the final study, they outlined emergent social interactions in the hospital environment (figure 6).

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Figure 5. The Double Diamond design process

Figure 6. Detailed design process

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5.1 The design foundation

The design foundation considered the social norm generated in subchapter 2.9.4. Hospital patients perceived the caregiver as a source of daily help.

Most importantly, they expected the caregiver to speak and act empathically. From the caregiver’s perspective, the validation of patient individuality was primordial. Additionally, they believed that instilling motivation and confidence in a patient is essential. The new dynamic outlined in chapter 2.8, placed the robot as work support and the caregiver as released of excessive workload.

The following design based its intended outcome (Zimmerman et al., 2008, p. 5) on the concept of a robot as a source of help and as an interaction agent that speaks empathically and instills motivation. Through creating a preferred state (Zimmerman et al., 2008, p. 5) where both functionality and emotional care are transferred from a caregiver to a service robot, the design ensured a re-familiarization (Reddy, 2020, p. 239) of the robot with its context. The design focused on the patient’s perception and interaction with the service robot.

Along the same line, the design to follow had to remain grounded in the existing technologies presented in chapter 3. At the same time, the planning of the inquiry had to keep in mind its final application on a rehabilitation robot.

The final users of the RtD tool had to be regarded in terms of their own novelty towards robots. Thus, ensuring everybody with their respective level of knowledge was able to remain engaged (Smedegaard, 2019, p. 414).

5.2 Ideation sessions

Translating the findings so far into a design concept initiated several ideation sessions. Three sessions generated ideas through brainstorming and sketching (IDEO, 2021) in physical and digital mediums. Three initial concepts are presented further.

A physical robot embodiment

The robot prototype displayed a physical embodiment of autonomy and social intelligence. Mechanics-wise, the robot base could perform some motion. The robot head could support touch-to-voice interaction. However, these physical materializations required considerate prototyping and programming techniques. The idea appeared risky as the final embodiment and mechanics could hinder a proper enactment of the research situation.

Another issue regards robot scale. The size of an actual robot could play a significant role in the dynamics of social moments.

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A tool kit for discussing social interactions

The kit aimed for one to sit down for a conversation over emergent social interactions. Similarly, as one has a conversation over tea, the kit would engage the participant in a discussion. A series of tools could isolate different interactive aspects of a robot: specific form, motion, voice, or gaze.

For instance, one of the tools could react to particular discourse. Another could perform the continuous motion, enacting the situation of autonomous presence. This idea appeared much closer to the intended outcome.

However, significant specifics of the hospital would be lost. Therefore, it seemed to conclude isolated reactions rather than a reaction towards the entire preferred state.

A digital embodiment and physical interaction with a robot interface

This idea emerged from the scope of generating a complete enacting of the situation. Firstly, allowing the participant to visualize the hospital space.

Secondly, 3D modeling would enable the participant to perceive the robots.

The digital medium could allow for appropriations of scale and aesthetics.

As direct experience was essential, the idea isolated the interaction within a physical component. Thus, each physical part could bring to life, through voice, the profiles of the robot.

5.3 Design concept

The design concept was built departing from the digital embodiment and physical interaction presented in the previous section. Thus, the final design presented a contextual, digital environment that prototyped robot task autonomy. The following subchapter introduces these three robot concepts.

Each robot targeted its specific work routine and the present challenge.

These elements, designed digitally, acted as enactors of a roboticized hospital environment. The study of interaction and its effects on hospital patients was focused on the design of a social intelligent interface. The interface design presented in this chapter entailed significant iterations. The final outcome can be found in chapter 5.8.

5.3.1 Designing familiarity

The generated robot concepts followed the principle of employing familiar clues as an invitation to interaction (Berlyne, 1950). The design of familiarity focused on the robot head showcasing eyes and mouth to resemble the means for communication. The simplified design through the employment of lines moving upwards and downwards meant to indicate a minimally invasive capability (Gunes et al., 2020, p. 9). Otherwise, each element of the robot’s embodiment employed simple forms. For instance,

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food compartments kept the traditionality of drawers. Additionally, the hand hygiene support employed the design of traditional sensor dispensers.

5.3.2 Three robot concepts

Figure 7. Design concept, Gloria - an autonomous food delivery robot

Gloria (figure 7) represents an autonomous robot that navigates between the hospital kitchen and patient wards. The primary functionality is to ensure breakfast, lunch, and dinner delivery efficiently. Secondarily, the service robot covers patients’ daily food intake and specialized nutrition.

The in-built trays structure allows for the weighing of served and picked-up food. Mechanics-wise, the service robot drives autonomously through an omnidirectional mobile base. Obstacle avoidance, night-driving lights, and efficient slowing-down are robot features that ensure safety.

Medi (figure 8) represents an autonomous robot that navigates between the hospital pharmacy and the patient wards. The primary functionality is to ensure medicine delivery and dispensing efficiently. The service robot does not present other functionalities. This design decision was taken regarding the trust involved in transferring this type of work to a robot.

Mechanics-wise, the service robot functions safely in the same manner as Gloria.

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Figure 8. Design concept, Medi - an autonomous medicine delivery robot

Figure 9. Design concept, Elio - an autonomous hand-hygiene robot

Elio (figure 9) represents an autonomous robot that navigates between the nurse and the patient wards. The primary functionality is to remind and support hand hygiene. The service robot does not present other functionalities. Mechanics-wise, the service robot drives autonomously

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through an omnidirectional beam structure. Elio employs the same safety features as Gloria and Medi. Interaction-wise, each robot showcases a robot interface. The interface employs touch input and voice output as interaction modalities.

5.3.3 The robot interface

Initially conceptualized as a robot console, this concept was iterated and altered. The original robot console idea (figure 10) presented a console base as a space of emotional reflection. These reflections were intended as notes about one’s interaction affects (Frank et al., 2020). In the form of a self-standing element, the robot interface was placed on the console to start the interaction. It presented several options of interaction. Primarily, the options displayed functions such as start meal, finish meal, or daily food intake information. Secondarily, the option of requesting a caregiver was presented throughout all interfaces.

Figure 10. Design concept, the robot interface - initial concept, robot console

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5.3.4 Designing touch-to-voice interaction

Designing interaction voice output allowed considerations for aspects such as physical form-voice appropriation and voice-induced personality. Aylett et al. (2019) note “social qualities and personality are inherited from voice, and these can influence our perceptions of technology and our experiences in interacting with them” (Aylett et al., 2019, p. 1).

5.4 Design concept testing

The next phase in the process aimed to ensure alignment with future users and robot makers. Thus, the evaluation of the concept consisted of two phases: testing with robot makers and testing with human participants. The motivation behind disregarding the “hospital patient” filter ensured that the testing reached other possible affected stakeholders.

During this phase, an essential input was to validate the resemblance between the three robot concepts and current robot technologies. Secondly, to understand the level of comfort in using the robot interface. Thirdly, it was open to other additional inputs on the overall design concept.

Testing with robot makers gathered input from five experts. Under the permit to conduct research, the same ethical considerations as in the semi-structured interviews stage applied. No personal information, except the title of the profession, will be shared in the final data. The testing session gathered feedback from a Healthcare Product Specialist, a Human-Robot Interaction Expert, a Chief Executive Officer, a UX/UI Robot Interface Designer, and a Technology Manager.

Testing with human beings gathered input from seven participants. The age range was found between the 20s to 30s and natively from European and Asian areas. The session employed visual material, quantitative and qualitative questions. Altogether, the participants offered input on twenty-three questions.

5.4.1 Testing with robot makers

Each robot concept appeared grounded correctly into existing technologies.

The industry’s current challenge is to “understand where a robot begins, and another one ends” (Personal Communication, April 15, 2021). Thus, a deliberation on the decision of dedicated versus multipurpose robots followed. Gloria, Medi, and Elio were analyzed in terms of primary and secondary purposes. With each robot presenting a different dynamic for building up trust relationships with the hospital patient, the separation done in this thesis appeared grounded. Thus, an extension of each robot through additional functionalities that do not affect the overall interaction