Bedside Manner

May 17, 2005
Healthcare environments focus on patients, caregivers, and guests

From picking the right chair to using specialized keyboards, workplace productivity and ergonomic equipment is a hot topic. Improved productivity and ergonomic design is crucial in every work environment. This is especially true in healthcare environments where staff member errors can lead to catastrophes, and increased productivity refers to quicker recuperation times for patients.

In the past, healthcare design tended to focus on the needs of medical professionals. Today, healthcare facilities and design professionals are beginning to reconsider the total healthcare environment to improve the overall experience for patients, healthcare providers, and guests. “We are adopting a patient-centered design approach, so we try to look at everything from the patient’s perspective,” says Evan Musheno, planner, facilities management, Ohio State University Medical Center, Columbus, OH.

With approximately 3.5 million square feet of healthcare facilities, the Ohio State University Medical Center is a complex of multiple hospitals and off-site clinics. Last fall, the Richard M. Ross Heart Hospital at the Ohio State University Medical Center had 90 patient rooms redesigned. This 5-story, 225,000-square-foot hospital, with its cardiovascular wellness focus, provides services from routine diagnostic treatment to robot-assisted surgical procedures and heart transplants.

Before Ross Hospital’s design phase, the medical center interviewed a wide range of medical personnel and facilities professionals to better understand hospital design. The center’s customer service department also continually tracks the satisfaction levels of its patients and guests. Next, the hospital built a full-sized mock-up of the new patient room and allowed hospital staff members to review the design and work out the kinks before the construction process began. Continual patient and staff input was an integral part of the modernization.

Ross Hospital’s new patient rooms are roughly 50-percent larger than previous patient rooms. Guided by universal design principles, all of the new rooms are private and identical in layout. “This uniform layout made it easier for all of the medical personnel,” says Musheno. The rooms also feature private bathrooms and pull-out beds for guests. These amenities greatly improved patients’ and visitors’ levels of satisfaction. “It is a huge difference from where we had the patients in the past,” says Musheno.

Every patient room also features natural light, as well as a black-out and a privacy shade for window treatments. For additional privacy, each room has a large folding aluminum door and a cubicle curtain. One idea that sprang from the patient-centered universal design employed was that functions, tests, and procedures would come directly to each patient room as much as possible.

The hospital also looked to bold colors and artwork to create a healing environment. Instead of plain white walls, Ross Hospital has been visually warmed with rich brown and yellow tones. The hospital planners worked with two art consultants to create an artwork mission statement that centered on healing. With the art consultants, the facilities and design team chose original art pieces, limited edition prints, and reproductions to make the hospital space cohesive and beautiful. “We tried to make our rooms conducive to the patients’ needs to generate more satisfaction,” says Musheno.

Musheno predicts that testing and medical equipment will get smaller, and the portability of certain procedures will improve, allowing patients to stay in the comfort of their hospital rooms. “I believe this will be better for patient recovery,” says Musheno. Musheno also sees more amenities coming into hospitals, such as DVD players, computer access, and high-end ergonomic seating typically seen in offices. These amenities address the needs of both patients and visitors, reducing stress and aiding a patient’s healing process.

“I believe that healthcare design should focus on all three principal users: the caregiver, the patient, and the guest. They are all using the space; they all have different uses for the space; and the products need to function for all of the users,” says Lee Falck, co-president, Brandrud, Auburn, WA. Healthcare furniture manufacturer Brandrud engaged in extensive research, including direct observation and interviews, to discover design principles that would make patient rooms work better.

According to Falck, each piece of patient room furniture should have multiple uses for at least two different user groups, such as a nightstand that offers tabletop space for caregivers to take notes and shelves for patients to store mementos. Mobility in furniture is another design trend in patient rooms.

Seating and cabinets on casters allow guests and patients to customize their spaces, easily creating a sense of privacy, control, and personalization. To achieve a home-like feeling, patient rooms need areas where patients can organize their gifts, cards, and personal items.

“Social support is critical to helping patients heal,” says Falck, noting that this interaction comes from visiting family members and friends who provide emotional support to the patient and encourage the patient to comply with medical professionals. To foster social support, Falck believes patient room design should accommodate visitors with appropriate solutions, such as personal item storage areas, worksurfaces, and sleeping space. Adds Falck, “If your guests are accommodated for, you’re going to feel more supported; and those are all of things that will make a space feel like home.”

The Workspace Futures Exploration group at Steelcase, Grand Rapids, MI, has been researching healthcare facilities - especially in-patient hospital floors - for the past 2 years. Rooted in cultural anthropology, this group practices human-centered design based on anthropological methodology process principles.

In addition to standard market research, the group engages in extensive secondary research to understand the root causes of medical errors and how physical space could help reduce them. In conjunction with the Academy of Neuroscience for Architecture, San Diego, the Workspace Futures Exploration group conducts ongoing workshops to establish hypotheses on the design of physical space and ways to measure the results. The group also collaborates with the Center for Health Design, headquartered in Concord, CA, to share their research with other professional organizations. “Generally, when you think of ergonomics you think of physical ergonomics, but what we are thinking of here is mental or cognitive ergonomics,” explains Joyce Bromberg, director at Steelcase’s Workspace Futures Exploration group.

Cognitive ergonomics refers to physical environments that help knowledge workers perform better. “It really is all about the connection of learning, memory, and physical space,” says Bromberg. Basically, people tend to remember items based on an object’s location in relation to other items.

The Workspace Futures Exploration group, for example, studied how hospitals store and retrieve medical supplies and offered tips to reduce clutter and misfiling of supplies. “Hospitals are full of stress, they’re full of clutter, and they’re full of anticipatory anxiety,” says Bromberg. Research has shown that stress in the healthcare environment can lead to employee errors and impede the healing process for patients. Effective ergonomic design in healthcare facilities supports healthcare providers and gives a sense of control to patients and guests.

One of the most stressful times in hospitals is when doctors are giving a diagnosis and explaining future treatment. Whiteboards allow doctors to give explanations to patients and family members easily, and then the doctors’ explanations can be printed out for patients’ families. This method reduces stress for medical professionals, patients, and visitors. Waiting room seating is also being designed with higher backs to allow guests to rearrange seating and create some privacy.

The design of healthcare facilities is changing rapidly. Some hospitals have already brought in small refrigerators to hold snacks to support visiting family members. Bromberg envisions patient rooms with flatscreen displays and wireless keyboards and mice so that patients and guests can do research on the Internet or check their e-mail. “Like hotels, we are seeing hospitals forming partnerships with entertainment providers to offer on-demand movies,” says Bromberg. In the future, patients could call up their own schedule of procedures as well as descriptions of these procedures. This advance knowledge reduces patient anxiety.

“It is very exciting to envision a hospital room that is all about reducing stress,” notes Bromberg. This where healthcare design and productivity connect: design that encourages healing by focusing on comfort and control.

Regina Raiford Babcock ([email protected]) is senior editor at Buildings magazine.

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