The Product Development Journey: How the HiBack Bedside Chair was Created

Anyone who has had family or friends in hospital can testify to uncomfortable ward seating. We were getting overwhelmed with feedback about issues with high back chairs on hospital wards – not only were they uncomfortable, unsightly and difficult to move around, but they were directly contributing to some of the larger problems hospitals were grappling with, like deconditioning, PJ Paralysis, and delayed discharges.

In fact, the issues with unsuitable bedside chairs in hospital wards is an age-old problem, with the current range of high back chairs and bedside chairs proving woefully inadequate in so many different areas – patient comfort, staff operating the chairs, transfers, postural problems, and size.

The time for radical change and an overhaul of bedside seating provision was way overdue. With us being so close to this issue working with hospitals on a daily basis, and the problem so apparent, we felt we had to step in and provide a solution.

Jump straight to…

• • • • Why We Began: Market Feedback Received
      • The Goal
      • The Design Process
      • Product Testing and Trials
      • Summary

Why We Began: Market Feedback Received

We began our development journey because we noticed the wide-spread dissatisfaction with existing bedside seating in hospitals.  So, the initial step in our journey was to collate and summarise the vast amount of feedback we had received from the hospital wards, and use this to inform the design brief.

We now have a patent pending on our unique design, the result of 2 years of research and development! Our journey from concept to completion started with the feedback that began the innovation process.

From speaking to a wide range of different healthcare teams, clinicians, staff and patients, this was the feedback we were getting loud and clear:

Tissue Viability Nurses

Tissue Viability teams are concerned with the skin integrity of patients, a critical factor with the eye-watering cost of pressure injuries in hospitals and the harm they pose to patients’ health. Pressure ulcers result in longer hospital stays, increasing length of stay by an average of 5-8 days. In 2015, cost per pressure ulcer varied between £1214 and £14108, depending on the severity.

Preventing pressure sores is critical to stop patient deconditioning and the exponential effect this has on discharge times and cost per patient day.

Feedback Received:

• Tissue Viability Nurses had concerns with the materials being used in bedside chairs, and hard surfaces which were putting patients with low skin integrity at risk of pressure sores.  With high usage, the vinyl fabric used to upholster bedside chairs degrades over time, resulting in cracks and creases which chafe against the patient’s skin:
• “The pressure from the rough cushion surfaces in contact with the skin while sitting out in the chair.” (UHCW Trust) – The lack of inbuilt pressure relief with hard fabrics and dense foam was leading to staff improvising by adding pressure cushions and pillows. Not only being dangerous with cushions slipping on the hard vinyl and causing falls, this was complicating pressure problems.
• “Nurses and therapists are improvising with extra pressure cushions which does not entirely change the comfort status of the patient while sitting out.” (UHCW Trust) – The resulting change in seat dimensions from adding cushions can in fact worsen sitting posture and exacerbate pressure issues even further, particularly as around 19% of body weight goes through the patient’s feet, and if the seat is too high then more pressure goes through the patient’s thighs and sacrum.
• Hard wooden armrests with no shaping or cushioning were causing pressure problems with patient’s arms – “The armrest is also reported to be uncomfortable by some of the patients and increases pressure on the contact skin area.” (UHCW Trust)
• At Whiston Hospital (Mersey and West Lancs Teaching Hospitals), patients were getting sores on their elbows from the hard wooden armrests.

Hospital OTs (Therapy, Dementia)

Occupational Therapists work on the wards to help patients mobilise and readapt to daily activities. A lot of rehabilitation revolves around using the chair to transfer onto and remobilise. OTs were struggling to use the chairs effectively as they weren’t supporting the patient’s posture properly.

Feedback Received:

• “They are not height adjustable and therefore patients struggle with transfer from the chair when the height is too low, and when the height is too high, their legs dangle off the floor.” (UHCW Trust) – The discomfort of the bedside chairs is deterring many patients from getting out of bed and into a chair, directly contributing to ‘pyjama paralysis’ which is a national issue in NHS hospitals.
• “Therapists are having to substitute with a recliner chair to re-train sitting endurance for patients, as many decline to sit out on the high back chair reporting that it is uncomfortable.” (UHCW Trust) – OTs are looking for chairs that support posture better, which improves digestion and overall wellbeing, and prevents patients slumping to one side or forwards.
• Seat dimensions and armrest heights cause issues if they cannot be adjusted to suit each individual patient. When armrests do have height adjustment, faulty mechanisms have been known to collapse, trapping patients’ arms and putting them at risk of injury.
• “We also order extra chair raisers, in most situations, we don’t have enough of them to cover the high-back chairs on the ward. We source footstools to support when legs are dangling off the floor.” (UHCW Trust)

Hospital Physios (Rehab, Therapy)

Physios in hospitals are working to get patients up and mobilised after their hospital treatment.  Early mobilisation has been shown to massively assist patient recovery times and prevent deconditioning. Having the right sitting posture, angle, lumbar and head support all contributes to reconditioning the patient and helps get their muscle strength and mobility back.

Feedback Received:

• With seat bases that are too flat, patients were adopting uncomfortable postures such as sacral sitting and even sliding out of the chair onto the floor.

Typical hospital bedside seating

Falls Teams

Falls teams in hospitals have expressed concern about the falls risk for frail patients using current high backs. Inpatient falls are the most frequently reported safety incident, with more than 250,000 falls in hospitals each year.

Feedback Received:

• The optimum degree of seat rake is needed so that the patient is upright but doesn’t have to strain to stop themselves falling forward out of the chair. We discovered that existing chairs were not sturdy enough and could move during transfers, heightening the risk of falling.

Moving & Handling Teams

Moving & handling staff are primarily concerned with the ergonomics of staff and patients, particularly when it comes to standing assists and side transfers.

Feedback Received:

• The fixed wooden armrests prevent lateral transfers from the bed to the chair, and fixed seat heights can make transfers an issue if the seat is too low or too high.
• “We use the support of two or more to transfer the patient from the chair in which situation assistance of one staff member could have sufficed.” (UHCW Trust)
• Manchester University Hospital Trust Moving & Handling Team reported multiple counts of armrests coming loose and legs destabilising, rendering the chairs unsafe to use.

Infection Control Teams

All patient seating has to meet rigorous infection control standards, by using materials that prevent the ingress of water and bacteria.

Feedback Received:

• High back chairs can be notoriously difficult to clean with hidden seams and recesses between the seat and backrest. Many wooden frames have gashes, and with the lacquer surface removed, bacteria can easily gather and grow, and bodily fluids are soaked into the frames. The pin adjustment mechanism on the legs can harbour dirt and fluids.
• Ease of cleaning is important for infection control teams, and the way fluid drains from the chair seat so it doesn’t ingress into the chair base is also significant.
• “The layers of the cushions rip off, increasing infection risk” (UHCW Trust)

EBME

The Electrical, Biomedical and Clinical Engineering (EBME) teams in hospitals are these to ensure all equipment meets certain quality standards.

Feedback Received:

• Being able to easily recycle and replace parts is an important factor, as are low maintenance costs and durability.
• Patient safety is another important factor, which is compromised if bedside chairs are unstable and easily tip over. When leg heights are adjusted, this can cause safety issues as the chair can slide forward on wheels when tipped backwards to adjust the legs. The pins in the height adjustment mechanism have been known to break, causing the chair to collapse.
• “The Wheels are not suitable for moving around on the ward. Some of which require a special moving trolley to take from point A to B.” (UHCW Trust)

Low height bedside chair with drop-down armrests

The Patients Themselves

Complaints from hospital patients about their bedside chair experience abound, you don’t have to go far to find someone who has had an experience similar to those described below. Here’s just a snapshot of patient stories!

Feedback Received:

• “My father was in hospital for over a week whilst waiting for a pacemaker to be fitted. As he was able bodied, he sat beside the bed rather than staying in bed all day. However he was so uncomfortable as the chair was the wrong size and his feet couldn’t reach the floor properly, and both the seat and backrest were very hard. He couldn’t cope with sitting out all day so had to get back into bed at times, even though he wanted to stay sat up and working on his laptop!”
• “At 6ft 4, I found the chairs in the hospital too low to the ground. I found myself slumping in the chair just to make myself comfortable.”
• “Not just bedside chairs, the hospital I attended during tonsillectomy recovery had a treatment room full of old-style chairs, sitting in one of these for hours was not comfortable!”

Hospital Visitors

Even people visiting family and friends in hospital have experienced discomfort during their stay!

Feedback Received:

• “Last month I sat on a hospital bedside chair for several hours while my husband was away for surgery. It was so uncomfortable! I had to use my coat rolled up for a back cushion.”

With this broad cross-section of feedback from multiple hospital disciplinary teams, independent healthcare advisors and crucially the patients themselves, the healthcare market was crying out for change in this area, and it was clear that a radical overhaul of the antiquated high seat chair was needed.

The Goal

We put together a cross-functional team of product designers, seating specialists, healthcare experts, and moving & handling advisors, headed by our in-house R&D department. They were tasked with creating a sustainable, durable hospital bedside chair that put patient and carer wellbeing at the heart of its design, and could be produced at scale.

A key part of their brief was a commitment to minimise waste, and use lean production to minimise the carbon footprint of the chair, which would contribute to our net-zero ambitions.

This vision, born out of the market’s frustration with heavy, uncomfortable high seat chairs, marked the start of our product development journey. This was a learning experience in itself, experimenting with many different materials and engineering techniques until 18 prototypes and 2 years later, we turned our vision into a reality!

The Design Process

The design process was originally intended to take 2 months, but actually took 2 years until the final prototype was produced! This was an iterative process, experimenting and testing with all sorts of different materials and mechanics until we found the best solution.

We tested each prototype in real-life hospital environments to get direct feedback, and carried out in-house testing to simulate maximum loading and strain scenarios.

Our team of skilled design engineers brought together the years of experience and knowledge from our panel of clinical experts to inform the design process and produce a unique and specialised seating solution.

Here’s how we tackled the problems we were confronted with, using a problem-solving approach to develop original solutions from first principles.

HiBack Bedside Chair

All-in-One Height Adjustment

With height adjustment being the main feature of the chair, it was crucial this element was correct. We were clear from the outset that we had to have the ability to adjust the height of the whole chair in one action rather than from individual legs – this turned out to be the most challenging part of the design!

We tried a number of solutions, including gas-assisted lifts, ratchet assemblies, locating pins and many others. The only outcome we were fully satisfied with was a column lifter, which is already well known and proven within the medical device sector. The added challenge was to keep costs down and reduce maintenance requirements we didn’t want a powered mechanism, so we had to get inventive and create a manual version!

Enclosed in the base of the chair, the column lifter is a strong, simple mechanism used for higher weight limits, operated by a turn handle in the base of the chair. Effortless to operate, this is a fool-proof mechanism that lifts the whole upper seat section away from the base plate, and can be set to any degree within the 16-21” range.  The action is enclosed for patient safety and to keep free from contaminants.

Height adjustment mechanism

Rounded Edges for Safety

The continuous frame, enclosed sides and rounded edges minimise entrapment risk. The rounded edges and radial corners of the frame removes hard edges that the patient can knock or scrape themselves on, preventing the risk of tissue damage.

Stable Base Plate

The base plate stabilises the chair by providing a large contact surface with the floor. This provides a lower centre of gravity which stabilises the chair, keeping it firm and sturdy when used by heavier patients or if someone leans against the chair.

Soft Comfort Upholstery

The problem with hard, uncomfortable vinyl that cracks and tears was eliminated by using a soft, stretchy PU fabric, the same material as is used on pressure care mattresses. This breathable upholstery keeps the skin cool and wicks away moisture, important for patients who struggle to regulate body temperature. The 4-way stretch provides enhanced pressure relief, keeping patients comfortable for longer periods of time.

This fabric is also anti-microbial and anti-fungal.

Comfort upholstery

Ergonomic Seat System

The degree of seat rake and backrest angle is designed for maximum comfort and postural stability. We carried out a detailed study with tens of different types of chairs, measuring the angles and user comfort ratings, and checking posture, and the result was a clear winner.

The problem posed by patients falling forwards on bedside chairs that are too upright has now been resolved by this ergonomically designed seating system.

For wards where a more upright position is required for easier standing and remobilising, such as elderly wards, the base and backrest cushion can interchanged for a more upright version.

People who struggle with standing up out of a chair will find the HiBack makes things considerably easier. The front of the chair below the seat is recessed backwards so patients can tuck their feet back to give them more standing strength in their lower legs. The chair also works brilliantly with the Sara Stedy and other standing aids, allowing them to get right up against the front of the chair, within easy reach of the patient.

We wanted to provide a shaped seat with head support on each side, but wouldn’t restrict the patient’s view with the traditional wing back you see on most high back chairs. To do this, we built internal soft head supports into the top of the backrest on each side, and added an adjustable lumbar section at the bottom.

Welded Polypropylene Frame

The material we finally selected for the frame of the chair was a polymer called Polypropylene Copolymer (PPC). The properties of this material met all the requirements we needed after going through a long selection process, which started with:

• Composite timber boards such as MDF, HDF and HPL – although easy to engineer and cut to shape, the board would absorb fluid and bacteria if the laminate was broken, unsuitable for infection control
• Metal could be antimicrobial but was too cold and too hard, reducing patient comfort
• Trespa – used for laboratory worktops, this was highly bacteria and chemical resistant, but very heavy and expensive, so uneconomical

We finally settled on PPC, as it was lightweight, easy and economical to machine, and had the anti-microbial properties needed for the hospital environment. The material is highly resistant to knocks and scrapes, but even if the surface is penetrated, it is antimicrobial all the way through.

Being a polymer, the frame can be ‘plastic-welded’ in manufacturing, melting and joining both frame surfaces as a continuous piece. This has ensured maximum strength, as our chair is effectively made out of one piece of PPC!

Removeable Armrests

The padded armrests can be swapped over to bring them closer to the patient’s body, supporting the elbows and reducing the tendency for some patients to lean to either side.

Removeable armrests

Removeable and Interchangeable Upholstery

The backrest section is secured with a push-pin mechanism, which works a bit like fastening a button, and has been strength tested under maximum loading scenarios.

The seat cushion doesn’t need to be fixed down! This is because the strip of HIF fabric at the front of the seat base holds the cushion in place under high levels of pressure, due to the extremely high coefficient (friction) properties of the fabric.

This allows the backrest and seat cushion to be swapped out for cleaning, or the upholstery covers can be unzipped and removed for cleaning if preferred. Damaged cushions can easily be replaced, as all parts are interchangeable.

Fluid Drainage System

The cutouts and frame build have been designed for any fluid to run off the chair, rather than sit on the chair or seep into the base section.

This design prevents ingress of bacteria into the fabric or seat base, making the cleaning process much easier when washing the chair down with water and detergents.

The chair frame is constructed entirely from polymer, with no other wood or porous materials present. With all internal mechanisms sealed, this allows the chair to be deep cleaned in decontamination units, with PPC being able to withstand high temperature ranges.

Portering Wheels and Handle

The cutout handle on the back allows the chair to be wheeled along in a natural walking position, without leaning over the chair or causing strain.

The double castor design, with one on each side of the frame, prevents any rocking or wobbling as the chair is wheeled, making portering more efficient.

Rear view of HiBack showing portering handle, wheels and hygiene cut-out

The table below summarises the design features of the chair and the pain points they resolve.

Product Testing and Trials

The product development process was iterative, working and testing 18 different prototypes as we tested all the variables, over the course of the 2-year timeline.

For example, seven different frame materials were situation-tested in high usage environments before selecting the one that performed best.

Six different methods of height adjustment technologies were tested before settling with the robust internal seat mechanism that is used in highly complex medical equipment.

Some of the prototypes along the way!

Each material used was rigorously tested to ensure it conformed to infection and safety standards, and met the ultimate test of “prioritising the safety and wellbeing of both patient and carer”. This included load testing for durability, ingress testing to ensure water-resistance, and fire certification to achieve BS 7176:2007+A1:2011 certification.

To test the prototypes in real-life scenarios and flag up any operating issues, we conducted trials with numerous NHS trusts, including East Sussex, Manchester, Bradford, Wirral, St Georges, Barnsley, and Whiston. The direct feedback we gained from the TVNs and moving and handling teams working on the wards was invaluable, informing and shaping the finished design of the chair.

Summary

The end result of this 2-year R&D project was a radical, design-led bedside chair that solved the ergonomic problems so often cited by users, providing a next-generation chair that opens up new frontiers in the area of acute hospital seating. We have a patent pending, no. 2500863.2, putting on record our product development journey.

As summarised by our R&D director Graham Oliver, “Through our discussions with ward managers, moving & handling experts and Tissue Viability Nurses, the writing was on the wall with the current bedside chair offering. The discomfort and pressure issues were causing patient deconditioning and having a direct impact on discharge times. We cannot thank the experts enough who have guided us in our product development journey, scrutinising our designs from every angle to create this amazing bedside chair specially for acute care.”