When designing a healthcare facility, there are many conflicting interests driving the project’s outcome. Administrators are most concerned typically by the upfront project costs while operations executives are concerned with streamlined processes to establish predictable ongoing cost savings. Healthcare providers (physicians and nurses) are most interested in having functional workspaces that meet their needs of job-specific tasks along with patient safety issues.
When meeting with design professionals, these three key constituencies all are active members of the project team, assuring their voices and concerns are heard and incorporated in the final design. Often times, unfortunately, one voice – the most important – is not included: that of the patient. Because of this, many healthcare facilities succeed from an operational standpoint, but fail to address patient and community needs for a healing environment.
By definition, according to the American Institute of Patient-Centered Design, “Patient-centered design supports the practice of patient-centered care by creating environmental conditions that facilitate healing.” Empowering the patient, respecting patient privacy, providing accessible accommodations and spaces that facilitate healing, and searching for opportunities to meet patient needs are all valuable tenets for the creation of a truly healing environment.
A few healthcare designers identify themselves as “patient-experience specialists.” How they’ve earned this distinction varies widely. For this author, it came from personal experience. I originally enjoyed a fast-paced career in public relations for the high-tech industry. A cancer diagnosis brought a life change. From my experiences came the never-ending question, “What more can be done to improve the patient experience and promote healing?”
From a healthcare interior designer’s perspective, I believed the design team could deliver better, more creative spaces that promoted healing. These spaces and places could meet patient needs more effectively while also meeting the needs of administrative, operational and healthcare staff. I have “been the patient in that bed.” My work is not based upon empirical research, but experiential knowledge, which lead to greater understanding of patient experiences from the time they walk in the facility’s door (check-in) to when they leave the healthcare facility (discharge).
A valuable example of my patient-centered approach took place for a client who was opening endoscopic procedure facilities in the southwestern United States. During the initial design planning stage, my physician ordered me to have a colonoscopy – what a great opportunity to gain insight on the patient experience for this highly unpopular but necessary procedure. The procedure was performed at the out-patient surgical center of my client’s competitor. From check-in to discharge, I recorded the event, noting various design elements. I took note of everything, from the artwork and furnishings, to my experiences in pre-op, post-op, and the procedure room. What I gleaned was invaluable for my client and aided in the design process to assure we had facilities that not only met state and federal requirements, but most importantly, responded to patient needs for privacy and comfort. The experience of being a patient influenced the facility design along with the selection of finish materials, furniture and artwork. A standard institutional design suddenly became more patient- and family-friendly, and gave my client a unique competitive advantage, based on my insights.
Julie Cooper, MS, EDAC, a Seattle, Washington-based healthcare interior design principal, uses empirical research as a patient-experience specialist. Cooper uses observational studies of clients’ facilities, credible research, demographic data, focus group feedback and experience mapping to gain insight into how patients really use healthcare spaces and how to improve the patient experience.
According to Cooper, “patient satisfaction with medical environments is now mission-critical for US-based healthcare administrators. Research shows that most patients and their families judge the quality of clinical care received based on their perceptions of mostly non-clinical care environments. These perceptions determine where patients choose to go for services and whether they return. Patient-centered design, convenient access to services and the therapeutic hospitality the patient encounters not only improve patient care but have far-reaching marketing and financial impacts on the healthcare organization.”
Cooper has a special interest in evidence-based design. All of her projects include relevant research and knowledge applied to guide the design process. In a recent project, she was tasked with developing a family-friendly waiting environment for a new hospital. She studied how patients, families and visitors actually used public waiting spaces, including furnishings and visitor amenities. Her process analyzed demographics, un-met needs and user input, including patient and staff trials of furnishings, fabrics and finishes. The best design solution was a mix of different types of individual upholstered seating placed in familial groupings. This included some seating with high backs to provide a sense of privacy, and helped address the patient needs of different ages, sizes, body shapes and cultures.
Some hospitals and medical centers have embraced the idea of making the patient needs first priority during the design process. The Cleveland Clinic (located in Cleveland, Ohio) has gone so far as to create the Office of Patient Experience where patient-experience specialists serve as part as the design and construction team.
According to Brian J. Smith, Director, Strategic Project Development at the Cleveland Clinic, “Patient experience is a cornerstone of everything we do, including our construction projects. We have conducted a great deal of research in the healthcare industry and found that we are incorporating all of the recommendations in terms of enhancing patient experience. For example, we develop open green landscaped areas wherever possible to provide a calming, natural environment as patients and visitors are entering and leaving the hospital.”
As healthcare design professionals, we have an obligation to our clients to meet the program and budget requirements for their design project. Taking on the role of “patient advocate” is not a mutually exclusive task. To some extent, we all can be a “patient-experience specialist.” To ask the question, “What can we be doing better for the patient?” costs nothing, yet brings a powerful voice to the project team and ultimately yields greater positive outcomes for the completed project.
About the Author:
Anne Marie Philbrook is an NCIDQ-certified and EDAC-accredited healthcare interior designer. She is principal and lead designer of Philbrook Healthcare Design, based in the United States. Her patient-centered focus and extensive design experience advances the development of healing spaces, leading to positive patient and staff outcomes.