Experience + Empathy

Expressing empathy through design is always received with gratitude from both patients and their families.

When designers take to heart a patient’s emotional outlook and state of mind, patients encounter a more positive experience when undergoing treatments and procedures.

Providing the patient with a sense of control throughout the healthcare experience is the key to establishing a sense of trust between the patient and hospital staff. The design of hospitals interested in providing an empathetic approach must address multiple issues to assure a positive medical outcome. The issues to consider are ease of navigating the facility, private communications between patient and staff, visual privacy in exam areas and when patients are transported through the facility.

Navigation + Access

One of the initial ways of providing a sense of control comes in the form of the way the patient navigates the facility. A clear path of travel from the entrance to the site to their final destination should be defined by signage, points of interest, and human contact to ask for direction. Some facilities offer valet service and volunteers to assist wheelchair bound patients to their destination. The patient does not need to rely on family members to attend an appointment, thus offering a sense of independence to the patient. Pairing these efforts with additional scheduling options and appointment times as well as easy “Access to the location hospitals, clinics and physician offices… transportation… and special services” dramatically improves a patient’s access to care, and important part of building a patient-centered system as discussed in Picker’s Eight Principles of Patient Centered Care as explained by the nonprofit OneView.

Privacy + Patient Interaction

Privacy + Technology. Privacy is key factor of the patient experience.

Experienced design teams see an underlying parallel: privacy in the exchange of personal information is just as important as physical privacy within an exam room.

Privacy begins at the point of registration when personal information is conveyed. In order to gather the required information while still preserving confidentiality, front desk design is critical. Providing patients with an enclosed booth or consult room increases their comfort level.

At the same time, to avoid the verbal exchange of information where possible, healthcare providers can utilize alternate methods of data collection – electronic devices, for example. Providing patients with a tablet device to self-navigate and answer questions ensures privacy. In some healthcare systems, patients can check in with their own devices, even before they arrive at the facility.

Interaction + Connection. The way providers interact with patients is always important, but especially in situations where patients are undergoing multiple treatments for the same condition, such as dialysis or chemotherapy treatments.

For these patients, the continuity of seeing the same providers and support staff is an important part of their treatment, as they form relationships with the staff members they regularly see. If you want to learn more about the patient’s experience to gain a better understanding, then you can have a look at this. In many cases, according to OneView, “During focus groups, patients express feeling vulnerable and powerless in the face of illness… proper coordination of care can alleviate those feelings” (OneView, Eight Principles of Patient Centered Care). Care coordination helps minimize these concerns as much as possible by offering patients a consistent and reliable source of support.

Providers who can understand their patients’ emotions and the effects of the medications they are providing, develop a strong human connection, provide a sense of comfort and stability for patients. The way in which providers and staff speak to one another in front of the patient and family members can have an effect on the patient’s wellbeing, as noted in the white paper, “Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care” published on the website for the Institute for Healthcare Improvement.

This connection plays a powerful role in a patient’s overall experience. A critical aspect at this point is acoustics: if a patient is expressing how they felt before medication (calm vs. anxiety, or perhaps if they are having difficulty focusing), a physician needs to connect and really listen but the only way to do that is by having an acoustically quiet place: through the use of white noise or some way to block out activity outside the room.

A Patient’s Experience in the ER

The patient’s experience at the emergency room is dramatically less predictable than a typical office visit and necessitates specific design attention. In the emergency room, patients often arrive in distress, and with unpredictable patient volumes, a large ER waiting room greeting patients can feel terribly impersonal and intimidating.

The increase in the use of freestanding ERs demonstrates a comfort level for patients to approach a building in their neighborhood as opposed to a large hospital in a different part of town. This daily reminder of emergency care just down the street builds a feeling of trust and control.

In the ER, after patients go through triage, they see a doctor and await next course of treatment. High visibility design choices reassure patients that they are visible to staff and their needs are being addressed. Sliding glass doors with blinds are a strategy that provide flexibility: they can be open for patient supervision or closed for privacy allow patients to rest without feeling isolated. The comfort of knowing care providers are keeping an eye on them helps patients relax and remain composed amidst sometimes exceedingly frightening circumstances.

A Patient’s Experience in Surgery

Surgery prep. A close second to an ER visit, surgery is also a highly stressful experience for patients.

Following the patient’s perspective of a typical surgery experience-inpatient and outpatient-offers insights for providers.

So much is happening before, during, and after surgery, design can play a role in making the entire process smoothly unfold.

Patient privacy again enters into the equation during surgery prep, where pre-op patients all too often gowned for surgery with privacy consisting of nothing more than a curtain. Rooms with fixed walls allow patients to feel substantially more secure during this phase.

Surgery. Next, patients briefly meet the surgical team, discuss anesthesia, and are transported to the operating room, picked up from a gurney, and placed on the operating table – often a very cold surface.

It is essential for ORs to be kept cold to satisfy equipment needs, but provider can consider ways to create balance for patients. For example, the table itself can be heated, or heated blankets can be used to keep patients much more comfortable.

Post-surgery. Patients coming out of surgery often feel vulnerable, so it’s more important than ever to ensure their comfort and wellbeing.

After surgery, informing patients where they are headed gives them a sense of control over their situation. Personal recovery rooms – again, with fixed walls, rather than curtains – provide an appropriate level of privacy for patients as they re-orient themselves after an operation.

Most facilities do not allow family members past a certain zone, so patients can quickly feel isolated and unsure of their surroundings.

The presence of a familiar face-the nurse or surgeon-will help put the patient’s mind at ease. The use of decentralized nurse stations bring the nursing staff closer to the patient bay for direct observation

For outpatient procedures, the experience doesn’t end until they reach their vehicle, so the experience of departure becomes especially important. Patients who are in pain and/or wrapped in bandages may feel uncomfortable traveling through busy or even congested lobby areas.

Some hospitals provide a separate exit for post-surgical patients leaving the facility. Ideally, these spaces allow a family member to have immediate vehicular access to a covered walkway where patients can have a quiet departure, at a comfortable pace.

Patient experience continues even after the hospital stay ends. OneView states that “Patients express concern about their ability to care for themselves after discharge” and indicate that careful instruction significantly improve post-surgery or post-stay outcomes (OneView, Eight Principles of Patient Centered Care).

Consult Rooms + Family Experience

Care providers will deliver a diagnosis and discuss treatment plans in consult rooms. these spaces can be distressing places for patients and their families.

Simple features like providing a monitor where providers can pull up information or show films gives patients more information and empowerment in decision making.

Tools, such as a white board to draw what they are discussing the use of various types of technology/electronic devices, help deliver more information to patients, enabling doctors to further explain and clarify. Sound-proof walls keep sensitive information private and allow patients to freely express themselves.

Considering family members is also important.

Having family present is more than just a source of comfort to patients receiving a diagnosis. Family members are often the keepers of information and will also likely be the ones filling out the patient experience evaluation.

The family experience is almost as important as the patient experience in terms of what they have access to, how they are treated, and where they wait. Offering sound deadening booths to make calls can support this effort. According to OneView, “Providing accommodations for family and friends, involving family and close friends in decision making, and supporting family members as caregivers” makes a patient’s diagnosis easier to handle (OneView, Eight Principles of Patient Centered Care).

Everyone responds differently in these situations, so it is important to provide for a variety of patient and family needs. Options can include immediate access to an outdoor garden and/or a spiritual space like a chapel, as well as access to vending machines or cafeteria for a snack or meal while waiting

The final aspect of the process for patient satisfaction is how the appointment or procedure is concluded.

During a consult, the physician may suggest follow-up treatments. If these are not carefully tracked during the appointment, the onus will be on the patient to schedule. This is an added burden to patients who are already sick or injured, and possibly overwhelmed.

Providing patients with all the resources they need to schedule the suggested follow ups, or even having patient advocacy staff who will arrange those appointments, is a relatively small effort that makes a significant difference for patients.

Context + Perspective.

Healthcare designers aim to always be thinking from the point of view of the patient, staff, and families. This involves relating to an actual experience, not an abstract, this is tangible and real.

There are exercises designers and architects can do to build awareness of what it is like to move through facilities: being in a wheelchair for a day or wearing a blindfold and moving through building.

Bringing that personal knowledge of what it is to use a hospital is key to also understanding from the staff side that they have to feel efficiency has been planned in so that they can bring a positive attitude to the experience. At the same time, staff need awareness of post-traumatic stress/experiences and how it will affect a child or an adult the next time they have to visit, if not for themselves then for a friend.

Barbara Audet, RID, NCIDQ, CHID, Leed AP, is Coordinator / Interior Designer with Dekker/Perich/Sabatini. She can be reached at Barbaraa@dpsdesign.org.

Bill Sabatini, FAIA, FACHA, is Principal with Dekker/Perich/Sabatini. He can be reached at bills@dpsdesign.org.

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If anything ever proved that the old adage, “by failing to prepare, you are preparing to fail,” it is the monumental task of transitioning to a new health care facility. Anyone who has participated in this complex experience — not only hospital leaders and staff, but also patients and their families — values the unique opportunity presented by this transition phase.

For many health care facilities, including hospitals and ambulatory care centers, a move can be an opportunity to transform and improve operations to correlate with the new facility. Testing and careful vetting processes conducted during this transition bring clarity and improvement to care delivery. Lean principles maximize operational efficiency and provide performance metrics to enable continuous improvement.

Just as building and engineering commissioning verifies and documents the facility systems to ensure they are planned, designed, installed, tested and maintained to owner specifications, human commissioning ensures that people understand protocols and processes and are prepared for operations. Human commissioning is the development of operational processes, verification and documentation of workflows to ensure that the building performs and is used as intended. Preparing staff for change is at the core of transition planning to work efficiently and safely on day one in the new facility.

By working with health care decision makers, departmentally and cross-functionally, project team leadership aims to move staff from “current state” to “future state,” bring drawings to life by documenting all processes and flows for staff training, ensure the original intent of the project is carried through to operations and prepare for day one readiness. People are creatures of habit, and, given the opportunity, staff will take old habits to the new facility. Effective transition planning ensures that new processes take hold in the new facility.

Here are key considerations, tools and insights into transition planning for health care leaders.

Synergy & Improvement

The transition planning process involves understanding current state processes, identifying what is changing and creating future state process flows. This means developing leadership teams, identifying key operational goals, prioritizing operational initiatives, forming cross-functional transition teams and facilitating team efforts.

A focus by leadership on the patient and staff experience orients the transition team to think more broadly about multi-disciplinary collaboration — how staff delivers care and their processes — rather than the narrow, vertical silo perspective so common in health care today.

To prepare staff for day one of the move, it is critical to begin by charting components of process change at least nine to 12 months in advance. Key components include care model integration, flows within and among departments, medication, equipment and materials flow, new process flow maps, staff and public paths of travel, and department utilization and fill strategies.

In this process, cross-functional teams come together to improve the entire facility and its operations. A work plan can be used to manage participation among diverse teams. A work plan can make sure the process from facilitation to deliverable is scheduled, illustrating the time period for individual project phases. Detailed schedules and timelines are developed nine to 12 months prior to opening to ensure efficient, effective and on-time activation and occupancy. The work plan is extremely effective in lean planning where phases often overlap, and many people are working simultaneously to meet a shared launch date.

Perhaps the most significant aspect of transition planning is weaving together the many layers necessary to prepare staff to work in a new environment with new processes. During the transition-planning phase, disparate departments and people are brought together, often for the first time. They are tasked with hearing how departments can work to create ideal future state processes. The goal is to achieve a balance between individual departmental needs and overall concerns, such as patient safety, infection control and supply inventory. All processes are assessed; nothing is left behind.

One successful project was at Major Hospital in Shelbyville, Ind., which was completed in January 2017 by Cincinnati-based general contractor Messer Construction Co., and BSA LifeStructures, based in Indianapolis, which provided architecture, interior design and civil engineering.

“At Major Hospital, we saw an opportunity to turn our new building into more than just a physical setting. We asked, ‘Could we deliver improved care to our community using transition planning?’ In the end, we found our once silo-based departments became a connected system where communication and processes were improved,” said Linda Wessic, COO, CNO, Major Hospital.

From the start of the project Wessic explained that the hospital’s goals were clearly defined from a patient perspective through a process that engaged all parties.

“Hospital operations and our model of care were translated into real-life practice,” said Wessic.

The task of compiling, organizing and interpreting the transition and move can seem almost herculean in its complexity and scale. Process maps and graphical paths of travel present critical information for easy reference by the staff. Staff must understand their individual roles in the larger effort. Too much information and too many new processes introduced at once can be overwhelming. Prioritizing the scale of the transition and move — as well as trialing and testing some of the new processes in the current facility — can alleviate this.

Approximately three months prior to the move, the work of transition planning and its deliverables are transferred to education teams to begin training for all staff. How and when new processes are integrated can significantly optimize a harmonious transition and how well changes will be effectively adopted over time. In the period following a move, transition teams should remain integrated for at least six months to ensure that teams can finely tune processes as a collective body.

Terry Thurston, RN, BSN, MBA, is the healthcare operations planner with BSA LifeStructures. She can be reached at tthurston@bsalifestructures.com or 317.819.7878. Part II of this two-part series will be available in coming weeks.

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In his first few weeks in office, President Trump has very quickly put into action many of the promises he made on the campaign trail. This has many hospitals wondering what their future looks like, if major changes to the health care system are in fact underway. From a design and construction perspective, this may not have too much of an impact on any plans for growth (either pending or in progress) that hospitals may already have; one of the promises in the President’s inauguration speech was to improve the country’s infrastructure, including its hospitals. Following the Affordable Care Act (ACA) measure to tie Medicare funding to patient satisfaction, hospitals had already started investing in making improvements to the patient experience through new construction, hospital expansions, upgraded equipment, improved technology, and more. Even if the measure that prompted these moves changes due to the new administration, it seems as though the emphasis on making them likely will not.

But with the ACA in jeopardy, the industry is facing regulatory uncertainty. The question that remains, then, is how a hospital’s infrastructure will support potential changes to health care policies and processes. Should we modify plans, or put them on hold, until we know more about what’s to come?

The answer is no — as long as you’ve got the right technology in place. The current unpredictability underscores the critical need for hospitals to develop more flexible, agile infrastructures that can support any kind of change. Sure, the political climate is unlike any we’ve seen in quite a while. But that doesn’t change the fact that parties in power change in our country on a regular basis — whether it’s four years or eight, whether the change is minor or more extreme. Rather than dealing in hypotheticals and trying to determine where recent political changes will take the health care industry, hospitals must invest in sustainable technology that will be able to handle any changes down the line. Regardless of who’s in office, the health care industry needs to remain focused on technological innovation.

More specifically, hospitals caught in this political tug-of-war should be looking at technology solutions that will help them easily and rapidly deploy sweeping changes to processes and protocols, without any extra cost or time delay. The challenge of being able to do this seamlessly has been brought to light for many hospitals recently, as they begin to see that the multi-billion dollar investment made in Electronic Health Records (EHRs) in the last few years has been somewhat lacking in terms of ROI. “Easy” and “rapid” aren’t words anyone would use to describe EHRs, employed not only for their intended purpose but also for analytics and reporting to help meet CMS requirements and improve care. Unfortunately, EHRs weren’t designed with the future of regulations or ease of innovation in mind.

With EHRs, the cost to adapt is just too high. Typically, when a change is made to the EHR, hospitals have to pay for it; not only financially, as an added customization from the EHR vendor or a third-party consultant, but also in time spent — up to several months to see a change implemented. For example, there are some hospitals in the U.S. that just recently got Ebola alerts activated in their EHR systems — well after the time of need. It will now take another nine months for those alerts to be deactivated.

On the local level, the state of Illinois recently mandated new protocols regarding sepsis diagnosis and treatment. That’s a change that hospitals around the state may not have planned for in advance, yet the right infrastructure would allow them to respond to it quickly — without waiting months or even years to see the new protocols deployed.

So what can hospitals put in place to ensure they can support whatever change may come its way? Health care is an industry in which change is inevitable, whether due to a new administration, a global disease epidemic, state legislature, or even patient demand. Because of that, EHR systems alone are not the solution; think of them more as an electronic filing cabinet, or an operating system upon which other technologies can be built.

To be ready for change, it’s time for the health care industry to course-correct on EHR investments, and build infrastructure instead on technologies that are nimble and don’t require major added costs to rollout system changes based on government regulation.

The good news? Technology is already a key element of hospitals’ design and construction plans. A 2015 study by Premier found that the biggest investment for hospital expenditures is on health information technology, according to 72.2 percent of respondents.
Hospitals looking to expand or break ground have the opportunity to make smart investments in flexible technology that will adapt to any regulatory changes that might come about in the next year, and continue to meet the changing tide of patient demand. Instead of trying to determine where political change will take the medical community and when, these hospitals need to prepare by investing in flexible technology systems that can handle changes down the line seamlessly.

Bryan Haardt is the CEO of Decisio Health, based in Houston.

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“We are excited to be able to begin this next phase as it means that we are getting that much closer to this project becoming a reality,” said Scott H. Perra, president/CEO of MVHS in a statement. “Both companies have extensive local and international experience, with projects in New York and around the United States as well as in many cities abroad. The companies are committed to working with our local businesses whenever possible to complete the project.”
NBBJ and Turner have extensive experience working together and have completed more than $2.6 billion in projects, many which have focused on health care.

Planning for the hospital, which will be located in downtown Utica, began back in 2014. The new hospital was originally set to be an 830,000-square-foot facility at a cost of $573 million. However, the new cost projection is $480 million for a 750,000-square-foot facility.

“Planning a project of this magnitude occurs in several stages over the course of years,” said Perra, in a statement. “In late 2014, we developed estimates based upon preliminary design concepts. We continue to perform studies and evaluations to further refine the project as we advance through the phases of the development process.”
In addition, the original concept included 430 inpatient beds, while now the revised plan calls for 400 beds.

The project will also include a 24-bed in-patient “shell” that could be finished and used at a later time, if needed, according to an article by local news outlet WBIX. That decision alone saves more than 15,000 square feet of new construction and adds to the overall savings, according to WBIX.

MVHS will be involving the community throughout the design and construction process since it will impact those in surrounding areas. A completion date has not yet been set but project team members and MVHS will update the public as plans progress.

For more information about on project, visit MVHS’ website.

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From cleanliness and accessibility to heavy wear, hospitals face a unique set of challenges. Flooring is no exception. It’s a crucial part of creating a quality care setting. Below, are various factors to consider when choosing flooring for a health care facility and also steps on how to incorporate evidence-based design into a hospital flooring plan.

When discussing evidence-based design in hospital flooring, it’s a smart bet to lean heavily on the guidelines provided by The Center for Health Design (CHD), which, in 2012, published a peer-reviewed guide to implementing evidence-based design (EBD) in the selection of health care flooring. The guide draws on EBD and original research, detailing industry best practices for flooring. This approach sees real results that help promote the well-being of those who walk through a health care facility’s doors. Here are some key considerations for weighing your health care flooring options.

Pay Attention to Flooring

The entrance of a hospital, its corridors and clinical areas serve different purposes and will face different pressures. Entrances, for instance, are the first areas patients, families and visitors see in a hospital. They also experience some of the heaviest foot traffic. A health care facility will want a welcoming floor that promotes the specific design vision and makes a strong first impression for its patrons. Corridors also see heavy use, including foot traffic and heavy rolling loads, such as equipment carts, stretchers, med carts and wheelchairs. Clinical areas are at the highest risk of accumulating pathogens and other harmful germs.

Minimizing Fall Risk

Choosing the right flooring can minimize the risk of patients sustaining falls, so hospital flooring should be slip-resistant, impermeable and easily cleaned. That’s all easy enough, but other EBD standards such as recommendations for finishes are not as obvious. The finishing on hospital flooring should have a low reflectance value as to prevent glare, and joints and seams should be few and far between in order to prevent tripping.

Texture & Noise Absorption

Texture affects many aspects of the flooring’s performance, ranging from noise absorbance to reducing injuries related to falling. Preventing falls is important, but they will inevitably happen, and floors that have energy-absorbent properties will minimize injuries of staff or patients who fall. This can also be achieved through underlays that will increase cushioning. Underlays and finishes can also be used for noise absorbance, reducing noise from rolling carts or heavy foot traffic.

Reducing Staff Fatigue

Nurses, doctors and other health care facility personnel work long shifts. And, for much of those shifts, they’re on their feet. Cushioned flooring or mats can reduce staff fatigue, saving their feet and their sanity. However, CHD recommends that cushioning be combined with roller mobility, so that equipment can still be transferred easily.

Minimizing Risk of Infections

Health care associated infections (HAIs) are a health care facility’s nightmare. EBD can guide hospitals in choosing flooring that best mitigates the risk of HAI, while improving the overall patient experience. CHD has a host of recommendations to this end. It recommends against using carpet, especially in burn units and operating rooms, where the risk for airborne pathogens is high.

Going Green

LEED guidelines shouldn’t be ignored when choosing a flooring solution that works for you. In addition to allowing your facility to be in accordance with USGBC standards, choosing the right floor coverings will also improve the indoor air quality of your facility. The LEED for Healthcare guide offers guidance on how to best accomplish this.

Aaron Hartung is the marketing manager at Spectra Contract Flooring, the largest commercial flooring contractor in the U.S. He can be reached at 303-778-8665.

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A feasibility study is designed to uncover the strengths and weaknesses of any project. Not only does this evaluate a project’s potential for success, it helps document every aspect of planning, engineering and construction while revealing the full scope of the project. To complete a feasibility study in full, precise documentation during each phase of the project is critical. In Part I of this article, the benefits of communication and accessibility were discussed, now specifics of the study are explored a bit more thoroughly.

By documenting each step in the process, projects are revamped and redesigned and will often go through several iterations of approvals or short delays. When a project is finally relaunched, it’s important for the team to have access to the feasibility study and the defined scope so they can address budget plans and timelines surrounding project construction. This approach can be particularly important for large-scale projects such as health care facilities.

Developed Components

Accurate information captured from the right sources contributes to key components of a study, including the following:

Floor-plan layouts: As with every other aspect of the assessment, floor plans must reflect the current state of the building. To verify the plan, visit the site and walk through it. Identify key systems and needed modifications or improvements. It is important to include a demo plan with the new work plan so that a facilities group can account for the cost of the demo. Also, make sure that the equipment plan is taken into consideration because it can lead to a lot of demand on the existing infrastructure, especially from an electrical standpoint.

Engineering narratives: To develop a realistic narrative, seek the technical, detailed input unique to the perspective of the maintenance staff. Recently, the project team serving the University of Alabama at Birmingham Hospital met with the maintenance group to walk through a space slated for renovation. The team learned vitally important details that they could not have derived from inspecting drawings, such as minor repairs and renovations that were completed by the maintenance staff but not documented.

Construction estimates: Construction estimates should reflect good historical data that is both regional and, when possible, client-specific. Experienced planners have the latest historical data and a working knowledge of its meaning and application. A project team conducting a feasibility study may have client-specific data, or the information might come from the facilities group. A real risk of an inaccurate estimate arises when material costs escalate between the time of the feasibility study and the time that the project is put out for bid. A feasibility study should explicitly clarify that its projections are based on prices known as of a specified date.

Dynamic Starting Points

So, why might a well-documented feasibility study not exist? At the initial starting point of the project there is no purchase order to associate with the cost of the study, meaning the funds to the study are not available. Usually funding is not available until a board of directors has approved a project. Although feasibility studies are not that expensive and can be done quickly, the funding must be allocated for them.

Experienced project teams see and understand this dynamic and have strategies to help facilities groups begin this important pre-planning step toward clarity and confidence that comes from knowing what a project entails and how it can be done within a reasonably precise time frame and within a well-researched and fully documented cost estimate.

By gathering key stakeholders and achieving consensus on the scope of a project, a facilities group begins to empower decision makers toward a very successful project.

Scott Heywood, AIA, LEED AP, is director at the Ghafari Birmingham, Ala., office, and can be reached at sheywood@ghafari.com or 205-203-4611.

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