There are several ways to learn, and one of those ways is the hard way. Recently Diana Spellman, a well-known interior designer and president of Spellman Brady & Company, completed a two-year journey as a patient herself, battling breast cancer. Enduring six surgeries, many months of chemotherapy, and radiation, she truly experienced what patients need in their healthcare environments. It's not just stylish furniture and fine art, but how existing environments contribute to the excellent healthcare delivered within them. In a wide-ranging and frank discussion with HEALTHCARE DESIGN Editor Richard L. Peck, Spellman described her hard-won “education” and how it will shape her future projects.

Richard L. Peck: What was the basic patient experience you just went through?

Diana Spellman: Well, to be blunt, there was nothing basic about my patient experience. It was a roller coaster of emotions, shock, fear, anger, and panic that transforms itself into trepidation, anxiety, and sadness, and all the while I was trying to present a strong front for my family, friends, and business. There were many times that I felt as if my entire being was exploding into a million fragments, especially after I found out that I carried the BRCA-1 gene that strongly predisposed me to ovarian/uterine cancer as well.

Anyone who knows me well understands that I am a strong but intuitive soul, one who always has a plan A, B, C, and D. I am highly productive and a survivor by nature. The most difficult part of this experience was the initial unfolding diagnosis. Many times I thought to myself, “I am strong and still feel these intense vulnerable feelings, so what does one feel who isn't as strong?”

Currently, my prognosis is very good. Truth be told, this was not just my diagnosis, it was our family's diagnosis and beyond. Like ripples of waves, it touched many people and situations in my life. Although it has taken a tremendous amount of energy to go through, one way to look at it is that this experience was a gift, because so many good things came out of it-but with a price tag of physical and emotional pain.

The mention of “patient experience” now absolutely resonates with me. And an important fact to remember: any patient who travels through a significant illness or injury carries it with them for a very long period of time. It almost seems as if there is an element of PTSD [post-traumatic stress disorder], as if the memories of the experience continue to ripple to the surface.

Peck: Did you experience any good environments along the way?

Spellman: Not really. But how does one define good environments? These spaces, at times, are subliminal and hard to put your finger on-but oh-so-negative when wrong. The single-dimension physical environment was often polluted with other offenses that overshadowed the experience. My patient care was excellent throughout the journey. I had outstanding physicians, but nearly every environment I experienced could have been greatly improved. I'll give you an example: During my initial needle biopsy, the overhead music was playing, as it happened, the theme song from Romeo and Juliet. I heard this and said to myself, “It's malignant.”

Another example of an environment that contributed in a negative way to my patient experience occurred while sitting half-naked in a hospital gown, being prepped for surgery, in a corridor construction zone. Let's think about the psychological and physiological impact that environment has on patients. In this temporary construction setting, upon being placed in a radiology room to insert some guide wire into my chest, the technician said, “Oops, I don't have the correct supplies; be right back, don't go away.” I thought, “Kind of difficult with wires threaded through my chest to not black out, let alone go away.”

Chemotherapy infusion spaces: While initially I was anxious and fearful, the team of physicians and nurses were comforting and gentle, both emotionally and physically, although many times the message or procedure was painful. The infusion area had dated physical surroundings that did not measure up to the excellence in care. For instance the floors, walls, and ceiling were devoid of any interest-flat, gray-tonal, tenant-grade carpet, light blue walls with silk wreaths for decoration, and recessed fluorescent lighting in the ceiling.

It was a shame that the area did not accentuate the beautiful view of trees and sky, but as with many developers' spec-built MOBs, the window walls did not take full advantage of the natural light. The windows were laden with heavy bronze-metal horizontal blinds and were situated higher off the floor, so a patient undergoing chemotherapy would have to stand up to see the views of nature. The infusion recliners were placed in a line facing each other and away from the windows. The line-up allowed for maximizing space constraints, but contributed to a sense of being boxed inside, hooked up in an artificial environment.

Interestingly enough, the hospital administration and physicians were contemplating a major move at that time, and with much joy, our team is now working with them to help create the nurturing environment they desire for their patients.

Peck: What will you bring to new projects, as a designer, that you didn't bring before?

Spellman: As I spent much time receiving treatments, it was quite rewarding to sit back and really observe other patients. The mind/body experience was so powerful for me. Each time I had chemo, I visualized clean white bleach coursing through my body, mopping up each and every bad cell. I started to actually feel a euphoric response to the treatments-so empowering and positive, almost the way you feel when you are the star student. What created that feeling? I was so convinced my wellness would return that I could affect my health with these thoughts. I witnessed other cancer patients arrive for their first treatment, some so incredibly down and out, already giving in to the disease and its power.

My desire is to create a holistic approach to the environment, not just for the patient, but also for the caregivers and family members. As planners and designers, we know that the use of materials, furnishings, and artwork can take the space only so far. One of our company initiatives is to find other partners to work with us on multisensory environmental factors, such as climate control, auditory wellness, aromatherapy, and light and music therapy. You might think, why would the auditory environment be so important? But again, I have actually sat in a pleasant, visually appealing waiting room, only to have my pain and anxiety threshold increase significantly because of a printer behind the receptionist that sounded like a machine gun, clicking and chattering loudly. To locate that type of medical statement printer in a quiet zone is intrusive and a process problem. The same philosophy comes into play with the presence of TVs in every lobby and waiting room.

White noise and sound masking are key elements to the auditory recipe, but quite frankly so much of the recipe's success goes back to quality ingredients such as correct work flow processes and correct bed utilization-an initiative that must start at the top of the organization. So a key element for creating the right environment is the right management.

Peck: Why have you assigned such a central role to the CEO?

Spellman: I'll answer that with another example: When I developed a postsurgery infection in my reconstruction expanders, I was admitted to the hospital to be placed on IV antibiotics for an extended period. Because of mismatched bed availability, they ended up admitting me to a room in a urology unit-the “chamber,” I called it. It was a private room out of the 1950s, with a large white board and the hospital's “mission statement” displayed in a cheap frame, shared shower rooms, which I obviously couldn't use, and lots of old mosaic tiles going back decades.

I believe that a team must have the blessing and buy-in from the highest corporate level to create the most balanced sensory experience. The most rewarding and successful design work we've completed, with outstanding fiscal results, has been with CEOs willing to push the sensory envelope. Interestingly, many, but not all, have been female administrators. My speculation based on this experience is they are willing to take calculated chances with changes in operational processes that the total environment must follow. A CEO of any gender must have the passion to communicate the facility's environmental needs to the Board of Directors for approval. Vision, passion, and communication from the top are key ingredients.

Peck: So your goal is to sell CEOs on the comforting multisensory approach?

Spellman: Yes, based on our research of their patient base demographic and the natural surroundings, we want to extract from the facility's CEO and core planning team what they want the facility to feel like, to get them to move beyond the goal of providing excellent healthcare toward creating an environment that supports it with equal excellence.

Yes, our goal is to work closely with the C-suite teams. The CEO, CFO, COO, and CNOs are the individuals who drive the decisions regarding the healthcare delivery model, the use of financial resources, and balancing the fine line of beauty, function, and finances. The holistic design effort must be integrated with both the owner's vision and the architect's vision. We put tremendous effort into communication, with visual design and mood boards to kick-off a relationship with the owners [see figures].

True, no matter what we do, there are some patients we will never reach-they come in for chemotherapy and they're already defeated because they're used to seeing themselves as victims in life. Others come in ready to fight. But even for those who feel weakest and most at a loss, you can bring in features that will surround and support the elements in them that are weakened. HD

Diana Spellman has spent a 28-year career working to create beautiful and health-supporting environments for patients in hospitals and clinics (see “The HeART of Healing,” HEALTHCARE DESIGN March 2007, p. 67 and “Interior Design: Patient-Friendly Meets Budget-Friendly,” HEALTHCARE DESIGN November 2005, p. 42). For further information, contact Spellman Brady & Company at 314.862.0070 or dspellman@spellmanbrady.com, or visit http://www.SpellmanBrady.com.

Healthcare Design 2009 November;9(11):78-82