Rethinking Patient Care Facility Design

May 28, 2019

Healthcare Innovation: At a time when many consumers have more choices in terms of healthcare facilities than ever, how can architects and designers begin to rethink facility design for patients and families with choices?

Jane Both: Much of the input from consumers into the design of a healthcare facility has come from Patient Advisory Panels. These groups usually have a vested interest in the organization, which is why they are on the panels. For several of our recent healthcare projects, we have engaged patients, family and staff using digital tools. In the past, we used a combination of videos and on-line surveys, but the problem was with the questions that were asked and the way responses had to be scripted. New digital visual tools allow us to ask open-ended questions that lead to a more informed discussion. The digital tools also facilitate responses from children and teenagers, as well as from persons whose first language isn’t English or French. Recently, we worked with a large group of patients at a major children’s hospital as part of a redevelopment. One of the tools was to have children and teenagers design their ideal patient bedrooms. Multiple children moved the family sleep sofa immediately adjacent to the patient bed. The digital tool encouraged respondents to explain why. The answer: “When I wake up at night, I need to be able to touch my Mom (or my Dad) so that I’m not scared.” We rethought the room design to movable sleep sofas that patients could relocate beside the bed or place near the window.

How can architects and interior designers use evidence from a variety of fields, including engineering, to rethink the built environment in patient care delivery?

Industrial Engineers are leveraging technology to help hospitals analyze the usage of clinical space over a period of time. This can be a huge benefit in the programming and design of Ambulatory Care Clinics. We find that, in the morning, many of the ambulatory clinics we tour are busy, seating is in short supply and patients are lined up in the corridors. Patients are frustrated—and so are healthcare staff. Go into the same clinic at 3:30 pm—and it’s empty. Using discrete-event simulation modeling, (the same computer models that are used for gate assignments at airports), developed by Industrial Engineers, the usage patterns for clinics can be analyzed and hospitals can gain a better understanding of the needs of their patients and clinicians throughout the day, as well as how they change over an extended period of time. These are dynamic operational environments that require solutions affording the ability to change and update room assignment data on a real-time basis. They should also provide robust and efficient disruption management, while maintaining safety, security, and cost efficiency.

How can the built environment be made to be a nurturing one for everyone navigating it—patients, families, and staff?

Wayfinding systems traditionally rely solely on words. This is a challenge for the elderly, the blind, those whose first language is not English or French and for young children, as well as for patients and visitors who are under stress due to a medical event in their lives. A logical floor plan with a clear separation of public spaces from back-of-house spaces makes passive wayfinding easier as it reduces the number of spaces to which patients have access. Clarity in organization of spaces and a consistent hierarchy of spaces provides users with consistent clues across the facility. Introducing views to the exterior and access to daylight provides patients and families with non-stressful wayfinding cues that not only help them find their way, but also offer respite from the healthcare environment. A shift from reliance on signage to a layered approach which provides multiple cues—color, icons, graphics, and lastly signage—on walls, floors and ceilings immerses patients and visitors in the environment, and provides many opportunities to choose to use the visual cue-type that is most comfortable for the viewer.

With so much care delivery shifting from the inpatient setting to the outpatient setting, how can architects and designers rethink the built environment in the ambulatory context?

Ambulatory environments need more space for families in recognition that patients rarely attend by themselves. Clinic appointments are often extended, as tests or procedures ordered by the healthcare practitioners often result in the patient and family member(s) spending many hours in the hospital. Our population is aging so, in addition to bringing a family member or caregiver, patients use accessibility devices that occupy space in waiting areas and exam rooms. One of the most important aspects, however, is connection. Providing space to plug in during long wait times, or connect to other family members who are not present, is more than a ‘nice-to-have’. It reduces the number of extra people—and reduces the number of complaints to staff about wait times. It also provides opportunities for pediatric patients to catch up on schoolwork so that they don’t fall behind—and it allows them to stay connected with their peers which for teens with chronic illnesses, helps them feel more like themselves. 

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