Principal Perkins+Will USA.
In response to the anxiety many patients experience in a closed MRI—in some cases, requiring sedation before a procedure—the healthcare field developed open MRI technology and redesigned MRI suites to reduce patients’ stress. Yet few healthcare organisations have recognised the potential for common forms of technology—from harsh lighting and blaring pagers in public spaces to the myriad of cables, tubes, outlets and monitors in private patient rooms—to contribute to patients’ and families’ stress.
It is both desirable and practical to integrate technology with a humanistic, healing environment. Top healthcare leaders have made this a priority, examining the problem from a patient-focused perspective. They have found that cost-effective design solutions involve making thoughtful technology choices, reducing negative sensory impacts, and creating a positive focal point in the space.
Here is a look at challenges and cost-effective solutions in common public spaces, clinical exam / treatment rooms, and private patient rooms, with examples from healthcare organisations that have successfully implemented them.
Public spaces, including entrance lobbies and waiting areas, are the literal and figurative ‘front door’ to the facility. All too often, these spaces are designed with pleasing finishes and furniture, only to have the environment marred by haphazard deployment of common technology: harsh artificial lighting, a noisy overhead paging system, televisions, vending machines, visible cables, a clutter of signage, clusters of parked wheelchairs and equipment, and so forth.
Patients, families and visitors form first impressions in these spaces, which are lasting impressions of the facility and the organisation. Negative impressions are often expressed on satisfaction surveys as low scores for ‘overall impression,’
Unlike clinical areas, public spaces typically do not have a designated ‘user group’ and so they tend not to be a focus of programming and project budget. Instead, priorities are understandably on the clinical spaces themselves and integration of mission-critical clinical technology.
Location and staffing issues pose additional challenges. When these spaces are located in the building core or below grade, it is challenging to provide soothing natural lighting and create a positive focus of attention, such as a view of the outdoors. Yet there are practical alternatives, including simulated natural lighting, a bold design feature using natural materials, or artwork.
Selection of technology may be based solely on staffing efficiency; for example, in an effort to reduce the number of administrative staff in the reception / registration area of a clinical department, the institution may use a noisy overhead paging system to call patients for their appointment. They may overlook simple, efficient alternatives, such as loaning individual pagers to each patient or silent visual cues. ATM-style self-registration kiosks and bedside registration systems can also enhance staffing efficiency as well as the patient experience.
For example, leaders of St. Joseph’s Healthcare Hamilton, Ontario, Canada, overcame these challenges through effective design of a new diagnostic imaging department. Although it is located below grade, the design solution for the entry / waiting area creates an environment that appears to be illuminated by daylight through use of light boxes with indirect artificial lighting and natural materials. The use of glass and other reflective, translucent and transparent materials enhances illumination without resorting to direct overhead lighting. An accent wall of natural stone creates a positive focal point and is coordinated easily with the overall budget due to its relative minimal area.
The overall design of the space intuitively directs patients’ attention to their destination. Moreover, the registration area is clear to patients without requiring signage. A system displaying a number silently calls the next patient, avoiding the need for a paging system or staff calling out. At the same time, consolidation of six waiting rooms into one enabled cost-effective staffing with one reception person to greet patients as they arrive.
In this case, leaders adopted a number of best practices from the hospitality industry, which has elevated greeting, registering and directing guests to an art form--seamlessly incorporating lighting, communication and security technology into a humanistic environment.
Clinical spaces, such as peri- and post-procedure areas, exam and treatment rooms, create special challenges as they often involve highly technological medical procedures, with associated equipment and finishes designed for effective infection control. Yet, here too, there are cost-effective design solutions to reduce the anxiety and stress associated with the sensory impact of technology, create a positive focal point, and provide for an aesthetic alternative to stainless steel, plastic and tile surfaces.
Effective lighting is critically important for peri- and post-procedure, exam and treatment areas, yet effective lighting need not mean that the high-intensity lighting is also the ambient lighting -at least, not all the time. Instead, an energy-efficient lighting system can be designed with a range of lighting types and fixtures, including indirect ambient lighting and optional use of overhead fluorescent and / or task lighting.
Effective use of acoustic wall and ceiling treatments, as well as personal head phones at times reduces the auditory stress associated with procedures, including MRI. Designing an alcove or partition to screen emergency equipment, such as code carts, reduces the stress that can be associated with this visual cue, yet the equipment remains readily available to staff.
Aesthetically pleasing alternatives to stainless steel, plastic and tile, such as scrubbable simulated-wood floor coverings and casework, are compatible with infection control procedures.
Finally, creating positive focal points on the wall facing the bed and on the ceiling in the exam / treatment room give patients a positive feature to explore during stressful procedures.
For example, leaders at St. Joseph’s implemented these room designs, lighting and finishing solutions in the peri- and post-procedure room and exam/treatment rooms of their diagnostic imaging department.
Notably, they supported design features that create positive focal points-a simulated window view of the outdoors on the wall facing the beds and simulated ‘sky domes’ in the ceiling above each bed and above the treatment table. Working with vendors and contractors on the selection and detailing of materials effectively managed the associated costs. Moreover, close construction supervision ensured that these solutions were properly implemented.
Although the diagnostic imaging department is built into a hill, one end is exposed to grade where the MRI procedure room features an exterior window. This required shielding from passersby on the outside. So designers created a planted green space between the sidewalk and the MRI room’s window, which creates a buffer zone while allowing natural light and views from within the room.
Technology and a healing inpatient environment typically make strange bedfellows. The first challenge is location of the patient’s bathroom -- inboard or outboard? Often, nursing staff express the need to see the patient at all times, so they advocate for the unobstructed views provided by an outboard bathroom and, sometimes, a window on the corridor wall. But here is an example where technology can and does meet this clinical need: often, the information nursing staff are looking for is already on their monitors, without the need to see the patient at all times.
Locating the bathroom inboard is an evidence-based design solution that maximises the family zone of the room adjacent to the bed, facilitates family participation in patient care, and increases positive outcomes. Accommodating family members and this consideration of the “ergonomics of hand-holding” also has an operational value; for example, family members can serve food to the patient, help the patient go to the bathroom, and take on some of the ‘hunt and gather’ functions of the staff for requested items, freeing staff for skilled care.
Seamlessly integrating the technology that surrounds the patient is often a challenge as it must be readily accessible for staff. Take the headwall, for example, which contains a myriad of outlets, cables and tubes--altogether, creating a negative environmental character for patients and family members. Some of the common solutions to disguising the headwall are well-intentioned but ineffective. Solid panels that can be slid over fixtures to try to disguise or hide this technology are often moved out of the way by nursing staff on a permanent basis. Wood paneling or special framing and edging around the headwall is not only expensive, but also tends to draw the focus toward the headwall rather than away from it.
Instead, it is more effective to create a positive alternative focal point, for example, a large window with a sill that is low enough to afford a good view from the bed, or a large flat-screen TV or a well scaled piece of art on an otherwise uncluttered footwall.
A solution to further reducing the clutter of wall-mounted glove dispensers, sharps disposal containers, and so forth, is to build the headwall about a foot from the wall, placing dispensers on shelves behind it.
Careful attention must be given to integrating room lighting, patient monitoring and communication systems, furniture, cabinetry and finishes in this environment.
In one case, for the Critical Care rooms at Saints Memorial Medical Center in Lowell, Massachusetts, USA, the designers and healthcare planning team worked so hard to integrate technology into a healing inpatient environment, that when the public health inspector suggested putting a glove box on the footwall, a nurse objected: “No, that’s the art wall.”
This brings up an important point: leaders and staff are becoming advocates for the seamless integration of technology with a humanistic environment.
Patient-centered care is top priority; innovation follows
When healthcare leaders and staff have a vision for patient-centered care as their top priority—including the patients’ experience of the environment—the programming of the project can become the starting point of a partnership among the healthcare leadership team, senior- and staff-level representatives of user groups, and designers to fulfill the vision.
In the process, the partners can fully explore design, technology and operational alternatives, analyse costs, and determine their relative values to the vision.
Often, as in the examples of the healthcare organisations above, innovation follows.
Considering the human factor— integrating technology with a healing environment—improves the patient experience, with potentially far-reaching impacts on patient satisfaction and outcomes as well as operational efficiencies.
Dennis Kaiser offers over 30 years in the design of healthcare environments. He is a frequent author and speaker on topics of facility innovation, operations, design and project delivery for the Healthcare Industry. His solutions explore the edges of healthcare operations and building design based on his conviction that the industry, and therefore its facilities, makes drastic change.