Guest Services: A New Approach
Providers have put a lot of time and effort into fine-tuning the patient experience and creating supportive workplaces for staff—and with good reason. But their sights are now resting on another population that’s coming into healthcare buildings: families and visitors.
One of the reasons is that moms, dads, siblings, spouses, and friends are being recognized as important players on patients’ care teams.
Christine Hester Devens, associate principal and interior project designer at AECOM (Minneapolis), attributes the shift in part to healthcare reform. “There’s a lot of talk about patient engagement, and family is a big part of that, especially when you’re dealing with the elderly, children, or even a spouse,” she says.
Family members are now considered a critical part of the healing process, getting more involved in the discharge process and supporting the patient as they transition back home and perform ongoing care. Their engagement can play an important role in reducing preventable readmissions, which could help save facilities from incurring financial penalties to hospitals, as part of the Affordable Care Act.
This new mindset is leading organizations to put more thought and planning muscle into creating appealing spaces that support these caregivers’ needs. While in the past, a waiting room per floor and chair at the patient bedside may have been seen as sufficient, today’s solutions include spacious family zones in the patient room, sibling lounges, outdoor respite spaces, and meditation rooms.
“It’s creating space that’s not just an afterthought,” says Devens. “It’s actually an important area on the unit or a convenient location elsewhere in the facility.”
A more thoughtful approach
One of the biggest drivers for this change is the transition to private patient rooms, with family and visitors more apt to remain in the care setting than retreat to waiting rooms or lounges. Recognizing the positive benefits of loved ones becoming more involved in patients’ treatment and recovery, owners are pursuing modifications to traditional layouts.
During the planning stages of the new Parkland Memorial Hospital in Dallas, which is set to open in 2015, Walter Jones, senior vice president of facilities planning and development at Parkland Health & Hospital System (Dallas), says a family and patient advisory committee requested the ability for families to reside in patient rooms. Since the facility was switching to private rooms in its new location, dedicated family zones were planned to accommodate the large families that the community hospital has historically seen.
The setting includes comfortable seating, a rollout sofa, workspace, and individual lighting controls, so visitors are able to do whatever they need during the duration of the stay, Jones says. Staff space is located on the opposite side of the room to allow both groups to function with as few obstructions as possible.
These new in-room zones are complemented by more traditional family lounges or respite spaces, from small niches in hallways to dedicated family day rooms at the end of corridors, where visitors can go when a patient is having a procedure, or simply to make a phone call or take a break.
“You have to have that variety,” Jones says. “Fatigue can set in as well, particularly on long stays, so you want to give the visitor the ability to change their scenery.”
Patti Meszaros, director of facility planning at Mercy Health and Catholic Health Partners (Cincinnati), agrees that this variety of spaces is a necessity. When Mercy Health built a new 645,000-square-foot replacement hospital on the west side of Cincinnati, the design team of AECOM (Los Angeles), Mic Johnson of Architecture Field Office (Minneapolis), and Champlin Architecture (Cincinnati), allocated space at the end of each patient wing for day rooms, complete with floor-to-ceiling windows, colorful seating, and tables.
“There are times when you need to leave the room from an emotional perspective or when something’s going on,” she says. ““It’s a great place for families and loved ones to find respite or take a moment.”
No longer tethered
Technology is another factor that’s driving changes in the design and location of family and visitor spaces by giving people the ability to move about a facility and still feel connected to a patient’s status.
Sheila Cahnman, vice president and healthcare market sector leader at AECOM (Chicago), says in the past, visitors may have felt that they had to sit by a volunteer desk or status board to await updates on a loved one’s surgery, for example. Now, however, those boards are located throughout facilities or smartphone-wielding nurses are sending text messages to provide important information right away. “The idea that [families and friends] can go wherever they want really opens up a lot of possibilities of where we put these spaces,” she says.
As such, designers say they’re seeing organizations add more retail options, including health- and wellness-related services, and higher-end food venues. “They’re incorporating these things that provide convenience to families,” Devens says. “So they’re not stuck sitting in a waiting area for a long period of time.”
Balancing the need for both social and less-social settings, meditation rooms and multifunctional spiritual spaces are growing in popularity, too. Many facilities are also recognizing the desire of parents, spouses, siblings, and friends to stay connected to work. So dedicated workspaces in family lounges or standalone media and research centers are becoming more common.
While benefiting families and visitors, these efforts also help patients. “If you’re in the hospital and your spouse is still able to keep up with their work yet be present for you, you're probably less stressed,” Devens says.
Planning and design considerations
Designers say Lean processes are helping many organizations in the planning stages to determine potential volumes in a facility at a given time—and thus their space needs. For a recent women’s center project, Devens says the team used an experience mapping process, a design tool that helps outline prototypical patient experiences, to help determine the location and size of sub-waiting spaces for patients and families. “We realized that some of them were not large enough or that they weren’t in the correct location for the path of travel,” she says.
Consultation spaces are another important family/visitor space for caregivers and the medical staff to discuss a patient’s medical status or discharge instructions outside the patient room and public corridors. Gary Vance, director of national healthcare at BSA LifeStructures (Indianapolis), says while he’s designed these spaces into corridors in surgery, imaging, and ED departments, it’s been difficult to get physicians and medical staff to use them. “I think they’re so rushed, they have no time,” he says.
In an ideal situ
ation for a surgery consult room, Vance says the design would include two entrance doors, one for doctors to enter from surgery and one for families to enter from the waiting area, eliminating the need for doctors to walk through public areas where they might get caught by other families with questions.
When it comes to design aesthetics, designers are focusing on many of the same hospitality attributes found in waiting rooms to create a setting that’s inviting and comfortable, including a variety of seating choices, standing-height workstations, artwork, and pops of color.
Lauren Bevers, director of interior design at BSA LifeStructures (St. Louis), says she likes to provide private zones within family lounges and waiting areas by incorporating movable screens that can flex based on need while also improving acoustics. She’s also seeing seating and tables with integrated charging stations. “We’ve got to provide them with the comforting environment that allows them to use the space how they need to,” she says.
That design intent extends to family-focused outdoor courtyards and gardens, too. During a project for the James Mandell Building at Boston Children’s Hospital, designers incorporated a “hanging garden” for the bone marrow transplant department located six floors above street level. The quiet oasis for patients and families features a series of outdoor seating areas that are adjacent to the main corridor and family lounge, becoming a visual extension of the inpatient unit. “Having outdoor spaces with plants, art, light, and color offers a patient distraction and privacy from their healthcare demands,” says Brian Carlic, director of landscape at Payette (Boston). “Being allowed to go outdoors is a restorative experience.”
Parkland’s new campus includes a 1-acre wellness park with shaded seating areas, benches, and walking paths. “There’s enough room to be as communal or as individual as you want to be in the garden because of the size and the layout,” Jones says.
Room for improvement
With the continued focus on HCAHPS scores and patient—and family—satisfaction, the need for and importance of family and visitor spaces will continue to evolve. The key, say owners and designers, is providing the types of things to make the family members’ stay more endurable without losing too much functionality in their day-to-day life.
AECOM’s Devens says she’d like to see more visual arts and opportunities for nature in lounges and respite areas to provide maximum stress relief. “It’s about making them more of a pleasant sensory experience,” she says.
Beyond its family zones, lounges, and outdoor settings, Parkland is building in retail space on the first floor of the parking garage for future services and conveniences that might appeal to family members. “They may be in the hospital for almost as long as the patient is,” Jones says. “They need to be able to have a change of scenery in order to stay refreshed.”
Anne DiNardo is senior editor of Healthcare Design. She can be reached at firstname.lastname@example.org.