VisionOn Case Study

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Vis-invis and VisionOn form two consecutive projects. Vis-invis engaged in research leading to the development of dynamic visualisation approaches of use in the prevention and control of healthcare associated infections (HAIs). A set of three concept prototype visualisations was produced and evaluated, and were seen as ready for further development and application. VisionOn takes this initial work forward through a knowledge exchange project by developing a tablet-based training tool for healthcare staff using digital visualisations of data on pathogens: how they behave in the ward context and how to prevent their spread. Co-design methods are used to develop and evaluate the visualisations, developed from quantitative data on pathogens, through inputs from key hospital staff stakeholder groups – from two NHS Scotland regions doctors, nurses and cleaning staff, with support from GAMA Healthcare Ltd.

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The Vis-invis and VisionOn projects address an important environmental and social health issue, namely.

Healthcare Associated Infections (HAIs) caused by pathogens such as MRSA, Norovirus, and Clostridium difficile which present a substantial global problem. In addition to the distress and potentially fatal consequences for patients who are infected, HAIs are costly – the cost to acute services in NHS Scotland was estimated in the 2007 national prevalence survey at £183 million. The 2014 World Health Organisation global surveillance report on antimicrobial resistance showed that “a post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century”. The prevention of the spread of HAIs in the first instance is therefore of crucial importance as the significant risk is that the pathogenic microorganisms, which cause these infections, can make designated healing places become harmful spaces.

Project Details

The aim of Vis-invis was to engage in research that would lead to the development of dynamic visualisation approaches of value in the prevention and control of HAIs. A phased approach was used which involved: initial workshops with small groups of NHS staff and patient focused public representatives; developing prototype visualisations based on emergent and existing data; further workshops evaluating a suite of concept prototype visualisation options; refinement of visualisations / scoping of potential applications; and a structured feedback / next steps national seminar with key stakeholders at the project’s end.

Vis-invis resulted in three concept prototype visualisations, centred on: 1) the idea of ‘place’ (i.e. the ward setting) and the spread of pathogens through touch; 2) the idea of ‘people’s perception of risk’, differentiating the highest risk areas of the ward for spread of infections; and 3) the idea of ‘pathogens in context’, exploring visualisations based on participant’s descriptions of the appearance and location of pathogens in the ward context. The following key deliverables and outcomes were achieved:

• A profile of ways of seeing pathogens in medical and surgical ward contexts. The data gathered during Workshop 1 achieved this. Workshop 2’s evaluation of the resultant prototype visualisations also illuminated staff perceptions in this regard.

• A profile of related clinical issues that may benefit from dynamic visualisation approaches. During the process of eliciting role, perceived risk, and conceptions of pathogens, and during evaluation of the prototypes, many clinical contexts and practice issues related to HAI were identified that could benefit from these applications.

• The development, evaluation and refinement of a suite of visualisation options. This was achieved in a way that involved research and knowledge exchange with a range of healthcare workers and some lay representatives. The resultant evaluated prototypes were seen as ready for further 42 43 development and application.

• A functioning knowledge exchange network for visualisations in healthcare. Throughout the project the team maintained professional engagement with a wide group of professionals (HAI Leads, healthcare professionals) and personal engagement with a smaller group of healthcare workers (nurses, healthcare assistants, estates, domestics).

• Further details can be found at

VisionOn extends the Vis-invis achievements by developing a tablet-based training tool for healthcare staff using digital visualisations, exploring three themes supported by original quantitative data from research studies involving the microbiologist on the research team: transmission of infection and hand hygiene; the effect of cleaning on pathogen growth; and pathogen location and survival properties. The 12-month project is designed to elicit the experience of doctors, and nursing and cleaning staff, through a co-design process using visualisations, mock-ups and prototyping.


Quantitative data from academic research studies on the microscopic pathogens responsible for HAIs are not commonly used in staff training information due to the difficulties in communicating the findings in a meaningful way which relates to practice. In VisionOn, by presenting the data in a format appropriate for end-users, in relation to the context in which they are to be used, the possibilities for their application in training are being investigated.

Currently available training materials for healthcare and cleaning staff largely focus on the procedural requirements of specific job roles, e.g., procedures to minimise the transmission of
infection, hand hygiene protocols, guidelines on the use of personal protective equipment, and maintenance of a clean environment and clean equipment. The ‘making visible’ of data about (normally invisible) pathogens, through the use of visuals, mock-ups and digital prototypes as prompts during the iterative co-design process, provides a new and complementary approach to generating training information for the important issue of HAIs.


VisionOn brings a participatory co-design approach, involving key stakeholders, to inform the development of innovative visual training materials communicating important data on pathogens in an accessible manner for use in staff training for the first time.

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Vis-Invis (2015). [online]. Last accessed 19th June 2015 at: