Q&A: Patient-Centered Design

A growing trend in the push for consumer-focused healthcare is a surge in patient-centered design of hospitals and medical centers. As a result, architectural and construction firms nationwide have seen an increase in RFP’s for projects.

 

JRA Architects of Lexington, Ky., has a diversified portfolio of hospital projects, including the Dr. Thomas Haas Surgical Center in Louisville and Hardin Memorial Hospital, a 300-bed facility in Elizabethtown, Ky.  HC+O News spoke with Steve Wiser, director of healthcare design at JRA Architects, discusses patient-centered design and emerging trends that improve the patient experience.  

 

 

A: There’s plenty of jargon out there as to what this concept means, but what it means to me is a design that focuses on the patient and how that patient is treated. From a Health Insurance Portability and Accountability Act standpoint, patient-oriented design refers largely to the patient’s privacy, including making sure each patient is not viewable from outside a treatment or exam room and ensuring private conversations cannot be heard outside the room.

 

A: Definitely. That’s why nowadays you’re going to have doors on treatment rooms. It used to be that you would have cubical curtains in a treatment space, but now it’s all walls and doors to limit noise and increase privacy.

 

 

A: A lot of it has to do with orientating a space. For instance, how the exam table is positioned within a space so that when a patient is positioned, the caregiver is oriented properly to use his or her preferred hand while having easy access to necessary equipment needed to conduct whatever clinical tests they are performing. Positioning of the exam table is important from both a privacy and caregiver standpoint.

 

The positioning of the sink is a critical component because a sink is one of the items in a room that can’t easily be moved. A more specific element of patient-centered design is orienting the sink to where it facilitates staff in washing their hands. It’s always a big debate in regard to exam room design, as to where to place the sink because you want to encourage the staff to constantly wash their hands.

 

So those two items – where the door goes and where the caregiver cleaning stations are positioned – are most important. Then the focus is largely on making sure equipment is placed properly, whether that equipment includes a clinical light, a diagnostic tool or the placement of cabinets.

 

Over the course of an exam room’s life, the room may stay the same for up to 25 years before it is renovated. The bricks and mortar of it, i.e. the doors and walls, may last a long time. However, the treatments conducted within that space might change a lot. The room may go from serving as an ultrasound lab to an orthopedic exam room to some other kind of treatment room. That exam room may change out several times over its course. You want to design each room so that it is flexible.

 

 

A: It’s kind of a balance of both. You have to understand that the staff is going to be using that space as well, and you want to make it efficient for them too. I start out with the patient and where he or she is positioned, but then I think about the staff and how those individuals will function within the space too.

 

 

A: That deals a lot with patient sensitivity, because no one likes going to stark, institutional-like spaces. Hospitals should encourage individuals to take care of their health and not be afraid of seeing a physician, so you want to make the environment as patient friendly as possible.

 

For example, at University of Kentucky’s Kentucky Neuroscience Institute, we did a project with [modular cabinet manufacturer] Midmark that that is a very patient-friendly, welcoming environment with warm colors and finishes.

 

KNI was a 15,000-square-foot renovation of a clinical space for outpatients that required us to demolish a section of a building and rebuild its interior. When complete, we had a very artistic, soothing space with a main hallway, which looked much like an art gallery with special lighting and nice artwork on the walls, all of which served as an entryway into the patient-treatment area. In the patient-treatment area were nice exam rooms and attractive finishes.

 

Each exam room was laid out so that when a patient came into the room, they were quickly oriented for the clinical procedure. We designed in a dual entryway for this particular project, creating both a patient and staff entry into the room.

 

There are varying schools of thought on having two entries like that, as it limits staff interaction with patients but hides much of the administrative stuff from the patient and visitors. You don’t have the patient exposed to all the hustle and bustle of what goes on behind the scenes.

 

 

A: Nowadays we are adding in a lot of digital items like television monitors, which are used as educational tools or to display patient information and status. A lot of clinical items are going wireless, allowing for all the different equipment to work without cords everywhere. Wireless tools have eliminated some of the cable management issues in an exam room, allowing a lot of equipment to be more mobile and flexible as to where it goes. Some items still need cables, however, but thankfully cable management flooring has become more readily available to help with this.

 

 

A: We’ve done a lot of focus groups with patients to design new areas. If a facility consents to it, what we do is we contact the patients and see if they want to be part of a focus group. We’ll either call them up or meet with them individually and go over what they liked and disliked during their stay, in regards to the facility design and layout.

 

We also take plenty of input from staff in designing a new facility. Staff has to work five days a week or more in the hospital and they’re really the end users. If they don’t like it, then the patients may not like the treatment either. For instance, I always try to make sure staff areas are naturally lit. Natural light is a comforting element for both patients and staff, so I always try to incorporate in natural light wherever possible. Oftentimes, if you design without staff input, then more then likely they are not going to like the ultimate result and that plays into the quality of patient care as well.