Design with Patients in Mind
Not quite 20 years ago, I sat alone in a hospital bed, wide awake in the middle of the night. The nurse had just left the room in tears. Moments prior, she had quietly entered to administer medication. I woke up as she inserted a needle into my IV line with medication prescribed for the other patient in the room. Out of habit, I asked her what medication she was giving me.
When she told me, the expression on my face alerted her that this was an error before the words could come from my mouth. She stopped the IV line, disconnected it and let the fluid that was headed for my veins spill onto the floor. I didn’t quite realize how serious this was until she cried, “Oh Lord, I could have killed this girl!” and left the room.
There I sat alone on my side of the curtain, afraid to call the nurse, too shaken to call my parents, wanting to cry, but holding back so as not to wake the patient sharing the room with me.
At the time, I was an undergraduate architecture student at Georgia Tech, not realizing that my personal healthcare journey would influence my career as much as my education. If I had been in a private patient room, this mistake probably would have never occurred. The nurse would have been less likely to confuse my medication with that of another patient, if I were the only patient in the room; and my family would have remained with me throughout my stay, a practice that often prevents medical error.
Even in the event that the error had occurred, in a private room, I would have had family support to address the problem on my behalf and to comfort me during this traumatic experience. If this environment had been designed for me, the patient, perhaps I would not have left the hospital against medical advice, and I could have avoided the subsequent setback in my condition.
Today, I carry that—and many other patient experiences—with me in every decision that I make as president of Institute for Patient-Centered Design, Inc.
The Institute is a nonprofit organization established to bring the concerns of patients to the design table. Our mission is to contribute to the quality of healthcare delivery through patient-centered design advocacy, education, and research. Institute for Patient-Centered Design was born out of the realization that even the most beautiful facilities that satisfy all code requirements can create numerous obstacles when designed with a lack of attention to patients’ needs.
As our first order of business, we began speaking with patients to assess current concerns and with clinicians to document best practices for care. Gleaned from interviews, literature reviews, and comments submitted by patients, we have developed strategies for supporting patients by design.
Our multidisciplinary team of patients, clinicians, and designers work closely with design professionals, students, vendors, and stakeholders to present innovative solutions. The Institute has created the first-ever Internet forum in which designers subscribe to read letters from patients addressing their concerns about facility design.
Many designers are compelled to respond, offering suggestions and participating in dialogue with patients on improving healthcare environments. As facilitators of this unique exchange of ideas, we encourage designers to step inside the shoes of the patient and to wear these shoes throughout the entire creative process.
The Institute has identified 10 principles that align with patient-centered care goals for design application. They are:
1. Respect privacy;
2. Facilitate communication, collaboration; and trust;
3. Accommodate patient and family participation;
4. Empower patients;
5. Promote safety and security;
6. Provide accessible accommodations;
7. Create comfortable environments;
8. Support healing;
9. Support staff’s goals; and
10. Identify design opportunities that respond to unmet needs.
Patient-centered design includes careful attention to the needs of end users, understanding the procedures that patients undergo and best practices for delivering quality care. It aligns closely with the practice of patient-centered care, creating an environment that supports the goals of patients, their families, and caregivers for achieving desired health outcomes.
Patient-centered design is not the use of random theories based on assumptions, but rather the development of creative solutions that address concerns expressed by real patients whose lives depend on the care they receive in the facilities we create.
Examples of patient-centered design are seen when spaces have been sized appropriately to accommodate not only patients, but their families and caregivers teaming at the bedside. Patient-centered design is attentive to the placement of a computer charting station that allows a caregiver to share the computer monitor with the patient as a tool for discussing the plan of care, rather than a barrier that requires the caregiver to turn away from the patient while charting.
Considering the needs of a diverse population, patient-centered design incorporates appropriate features, such as color contrast, to enable patients and family members with vision loss to navigate spaces safely and comfortably. It accommodates the bond between newborns and their families for the first time, with provisions for sound, lighting, temperature, and privacy to meet the individual needs of the most fragile neonates.
Patient-centered design empowers caregivers to build trust with patients by eliminating obstacles to delivering care and creating a supportive environment for all.
We often hear that architecture is the “backdrop of life.” I believe that evidence-based design proves that it is not only a backdrop, but an integral component of life, with the capacity to impede or empower. Responsibility to the patient does not rest solely in the hands of clinicians, but it also lies with professionals who are tasked to create solutions to accommodate the best care.
This process should not only include research that connects design decisions to credible evidence; there should also be a patient-centric philosophy adopted by healthcare design stakeholders valuing real involvement of patients and families, as well as clinical and support staff. The Institute is fortunate to have emerged in an age in which organizations, like The Center for Health Design, have paved the way for an evidence-based business case for transforming healthcare design, recognizing the impact of patient-centered design on health outcomes.
The Institute is proud to be an Association Partner of the HEALTHCARE DESIGN Conference. In 2011, we presented a session on patient empowerment. Based on the tremendous interest expressed, we have planned a very special workshop for 2012. In partnership with Vendome Group LLC and in collaboration with The Center for Health Design, Institute for Patient-Centered Design will introduce “The Patient Experience Simulation Lab” during the 2012 HEALTHCARE DESIGN Conference.
This program was created to enable healthcare design stakeholders to assume the role of patients and family members in the environment of care. Utilizing feedback provided by our patient contributors, we have developed a program to simulate many obstacles inadvertently created by design.
In preparation for this event, we are launching a design competition in search of “The Patient-Empowered Room.” We invite you to participate by submitting your ideas! The winning design will be used to inspire our patient room model, which
will be unveiled November 3, 2012, at the HEALTHCARE DESIGN Conference in Phoenix.
For more information, please visit PatientCenteredDesign.org/hcd12.
Tammy S. Thompson, RA, NCARB is President, Institute for Patient-Centered Design, Inc. She can be reached at firstname.lastname@example.org.