The Changing Needs of Caregivers, Patients, and Families in Healthcare Design
Metropolis Think Tank visits WHR Architects and healthcare experts to discuss the process of designing healthy environments for patients, their families, and clinicians alike.
Susan S. Szenasy in discussion with the panelists at WHR Architects as part of the Metropolis Think Tank program
Images provided by WHR Architects
Throughout 2015 Metropolis’s publisher and editor in chief Susan S. Szenasy visited leading architecture and design firms across the country as part of the Metropolis Think Tank series of discussions on key issues surrounding human-centered design. On August 27, she talked with the principals of WHR Architects, the Houston-based healthcare practice group of EYP Inc., as well as the clinical and operational healthcare experts they invited to participate in the discourse. They focused on the changes in healthcare and the process of designing healthy environments, for patients, their families, and clinicians alike. What follows is an edited transcript of the conversation.
PODS VS CENTRAL STATIONS
MAGGIE DUPLANTIS, RN, Director, Clinical Planning and Design, Houston Methodist (MD): We spend a lot of time meeting with the end users who will occupy a space, digging deep into what it takes to take care of the patient–the needs of the patient really drive the design. From the nurses’ perspective, their work area needs to connect with their patients. Recently we created pods that contain supplies and meds. That’s a change. In most hospitals, to this day, the nurses walk a racetrack, because they work out of central nurses’ stations, one central med room, and one supply room. So the nurses tend to hoard and put stuff in their pockets knowing that they have to carry some essential items across these spaces. Our goal is to design a way for them to be able to be near each patient, rather than traveling around.
DAVID WATKINS, FAIA, Founding Principal of WHR, the healthcare practice of EYP (DW): We spend a lot of time thinking about designing better methodologies, not just to provide for the patients, but for the staff as well. Healthcare centers are extremely staff-intensive. They’re twenty-four hours a day. The lights never go off in a hospital. The lack of vitamin D and healthy food, and time to get away and rest, make for an unhealthy workplace. So we spend a lot of time thinking about ways to take care of the people who work there—after all, it’s the nurses and clinicians who make the hospital work—as well as the patients and the family that accompanies them.
SSS: What are some of the approaches to reducing stress in these environments?
LAURIE WAGGENER, IIDA. RRT, AAHID, EDAC, Research and Evidence Based Design Director, WHR Architects (LW): This ties back to efficiency. If you can create a successful spatial organization and think critically about some things that aren’t working for the nurses, you’ll automatically reduce their stress. In addition to providing them with access to natural light, preliminary research indicates that if you can have a source of light in the nurse station there is more laughter and less consumption of caffeine. Healthcare delivery is very time sensitive. Response time of delivery of care is an important metric for our clients. Responsive workplace design needs to reflect these client goals. Maggie did a deep dive in a recent project where she looked at the process of medication delivery. The nurse typically has to go to five destinations before getting to the bedside. That’s ridiculous. We tried to get it down to maybe two points of destination, by virtue of thinking of process and configuration of the healthcare workplace.
At Ocean Medical Center’s Emergency Department pediatric wing, large light wells bring natural down through the corridor to the benefit of staff and patients. Touch down points provide prompt, private team collaboration areas strategically designed within the typical emergency department work station. There is access to natural light and specific reflectance values of surface materials which address staff visual comfort, mood and alertness levels for a high performance healthcare workplace.
© Jeffrey Totaro
FINDING THE BEST, MOST APPROPRIATE TECHNOLOGY
SSS: Technology plays an enormous role in record keeping, in the patient-doctor and patient-nurse relationship. But what I see is a kind of mistaken idea of how technology works.
MD: The nurse needs to have the information to take care of the patient in the most expedited manner. What does that look like? Is it a handheld device? But is that really the best solution? We’re getting older and hand held devices have small screens. And who has time to scroll through a screen? We want a lot of information at a glance. So the devices are getting bigger and not smaller. We have to be very careful with the way we design technology. We want our nurses and doctors to collaborate and discuss the care plan in a supportive environment and they are often surrounded by distractions and screens in situations where they need to make decisions very promptly.
It’s a balancing act and you need to think about it critically. When you are developing what you think is an improvement, you need to also consider the aftermath of that improvement.
Mark Vaughan, AIA, ACHA, Senior Medical Planner and Leader of WHR’s Dallas Office: The staff’s work is so important. To do their best work requires them to be healthy, empowered, and be very efficient. To accomplish this is vitally important for us as designers. In some of our projects we’ve given the staff lots of opportunities to take breaks, to get away from work, and collect their thoughts. At a Heart Hospital in North Carolina, for instance, they have a great dietary program, with award winning chefs cooking for the staff as well as patients. There’s an herb garden, and everyone can choose from what’s prepared. There is a cafe that provides food on demand for everyone in the hospital community.
DW: Then there’s the issue of distraction. What came out of another study that we were a part of is the awareness that the nurses behind the counter deal with four, five, six things all at once—maybe seven or eight—and when that happens somebody can get hurt. Somebody gets the wrong medication; somebody doesn’t get responded to. Yet the culture in those workstations is that everyone looks out for each other, so we need to ask, is it better to have a centralized station or a decentralized one? Once you decentralize it you lose that support network. Those are profound operational and design decisions that have to be thought about very carefully.
MD: We need to have a modified approach, a hybrid. As long as I’ve taken care of patients I’ve seen that nurses do not like to be decentralized away from communication. We need to collaborate. We need to talk to each other. Today we design charting spaces in the hallways outside the rooms, and we have a much smaller collaboration space from a nursing station perspective, so we can still gather and discuss our patients.
SSS: How does the process of developing this look?
DW: What I’ve seen more recently is the creation of mock-ups, pulling them all the way back to the beginning of the project. We do very loose full-scale, rapid prototyping that’s built around process. So we’re following the work of the clinician, looking at precisely what steps need to be required to fill mediation. The same thing has been done when we work on a nursing unit—a fullscale mock-up. We were using 4 by 8 sheets of cardboard, and you could just move things around on the fly. We followed the work, looking at what was actually required of the ideal quality care, and how could we do that in the least number of steps so that nurses could spend the maximum time with the patient instead of running around trying to find stuff.
SSS: What is the current philosophy, knowing how people in hospitals are often under medication, or experiencing conditions beyond their control, to displaying art in healthcare spaces?
LOUISE CARTER NICOLSON, RID, AAHID, IIDA, EDAC, Principal, Skyline Services (LCN): I don’t think we have enough research to claim there is a definitive solution. Therefore, just like design, you have to go to each client and say, “Ok, these are some options that we can look at.” But what we try to do is think holistically about the environment—what is being done architecturally, what is the light like, what is going on in this whole space and how can we, from an art perspective, provide something that will support the healing process, that will support the staff, that will support the family. It’s a whole different mindset. It’s not thinking about a catalogue of images and just hanging them on the wall randomly. The right thing to do is to be able to have a library, options, so you can change what’s there. We’ve talked about programs where a lot of patients know they’re going to come in for surgery and they can preselect what they’d like to have in their space.
You shouldn’t be looking at art as just a piece to hang on the wall. We think about art as part of the healing environment.
SSS: What change has the Affordable Care Act brought? How are healthcare facilities dealing with the increased numbers of patients?
DW: One way is to get more out of the infrastructure, either by reducing length of stay or putting less burden on the actual hospital itself by moving some treatment capabilities outside to a tertiary care setting, and more to the outpatient setting in the communities.
SSS: How are you looking at your materials to eliminate known carcinogens?
Roseann Pisklak, IIDA, AAHID, LEED AP, Interior Design Studio Leader, WHR Architects (RP): That’s continuing to evolve because our furnishings really have to be durable and have moisture barriers and so we’re continuing to watch that, but we’re also looking at new technologies that are less hazardous and toxic to the environment.
We’re looking at wood, and bringing in that natural environment indoors—letting patients have access to natural daylight.
DW: The most profound change in healthcare is that there shouldn’t be any trade secrets. You have to share information. It’s a quid pro quo kind of process. We’re seeing that happen. That wasn’t true 25 years ago. I think the notion of improving the overall quality of practice and also the quality of output of what the design industry does has definitely happened, and that’s a profound change.
The Metropolis Think Tank series is presented in partnership with our sponsors, Bretford, DuPont Solid Surfaces, and Sunbrella.
WHR Architects, Houston: Roseann Pisklak, IIDA, AAHID, LEED AP, Interior Design Studio Leader; Laurie Waggener, RRT, IIDA, AAHID, EDAC, Research and Evidence Based Design Director; Mark Vaughan, AIA, ACHA, Senior Medical Planner and Leader of WHR’s Dallas Office; David Watkins, FAIA, Founding Principal of WHR, the healthcare practice of EYP.
Maggie Duplantis, MHA, RN, Director, Clinical Planning and Design | Houston Methodist; Louise Carter Nicolson, RID, AAHID, IIDA, EDAC, Principal, Skyline Services. Susan S. Szenasy, Metropolis.