Family in Focus
One of the key things that one realizes in training is that we very often treat whole family units. When you are treating persons who have elements of frailty, their loved ones become all the more critical to their care and to plans that help move patients toward better health. Thus supporting families/loved ones to feel at place in the clinical environments helps develop better plans that have more chance of successful implementation with our patients,” according to Dr. Anthony J. Perry, MD, clinical transformation officer at Rush University Medical Center in Chicago.
The Institute for Patient- and Family-Centered Care, a nonprofit organization founded in 1992, defines patient- and family-centered care as “an approach to the planning, delivery, and evaluation of healthcare that is grounded in mutually beneficial partnerships among healthcare providers, patients, and families. Patient- and family-centered practitioners recognize the vital role that families play in ensuring the health and wellbeing of infants, children, adolescents, and family members of all ages” (Source: The Institute for Patient- and Family-Centered Care).
The core concepts of this model of care are as follows:
Respect and dignity. Healthcare practitioners listen to and honor patient and family perspectives and choices. Patient and family knowledge, values, beliefs, and cultural backgrounds are incorporated into the planning and delivery of care.
Information sharing. Healthcare practitioners communicate and share complete and unbiased information with patients and families in ways that are affirming and useful. Patients and families receive timely, complete, and accurate information in order to effectively participate in care and decision-making.
Participation. Patients and families are encouraged and supported in participating in care and decision-making at the level they choose.
Collaboration. Patients and families are also included on an institution-wide basis. Healthcare leaders collaborate with patients and families in policy and program development, implementation, and evaluation; in healthcare facility design; and in professional education, as well as in the delivery of care. (Source: The Institute for Patient- and Family-Centered Care)
Using the Rush University Medical Center new hospital building—slated for completion in early 2012—as a case study, we can examine how the basic tenets of patient- and family-centered care can be incorporated into the design of hospital buildings. As designers, it is critical for us to recognize the vital role that the family can play as part of the care delivery team to help aid in the patient’s healing process. The family’s involvement in the patient’s care can ultimately help to shape the floor plan of the unit as well as the design of the patient room.
Patient unit and room design with family in mind
The Rush University Medical Center’s new hospital building is a 14-story, 806,000-square-foot building that incorporates a five-story curvilinear bed tower on top of a clinically focused building base, which houses surgical, diagnostic, and therapeutic services. The iconic butterfly shape of the bed tower is truly the result of an “inside-out” approach to design, in which the interior functions and delivery of patient care helped influence the shape of the building.
According to Perry, “We have created patient care units with natural work flows for the staff that keep them in close proximity to the patients. We feel this is key to helping patients and families feel connected to their staff and safe in our environment. In doing this, we also have worked to maintain local and functional spaces near the patient rooms where staff can interact with each other to maintain mentoring relationships amongst staff that are also critical to their ongoing development and job satisfaction.”
The 304 acute and critical care patient rooms in the bed tower are private, acuity-adaptable, standardized, and same-handed to help reduce staff error and increase patient safety. According to Lou Bunker-Hellmich, “The repetitive actions performed in standardized patient rooms are thought to reduce cognitive burden on staff and, consequently, reduce errors (from both latent conditions and active failures), especially in life-threatening or emergency situations” (Bunker-Hellmich, 2010). Also, the rooms are planned as neighborhoods to encourage efficient interaction between the medical staff and visiting family members. Each floor houses two identical units that are subsequently broken down into two neighborhoods (Figure 2).
Three of the core concepts described by The Institute for Patient- and Family-Centered Care—information sharing, participation, and collaboration—can be seen in the floor plan of the new hospital building with the design of the resource centers, consult rooms, and nurses' stations.
Families are able to access medical information and research at resource computers provided within the family lounge located on each floor. The family lounges are designed to be comfortable waiting spaces featuring community art walls and exterior views—providing families with a place of respite as they wait for their loved ones. The main Resource Center is located on the main public thoroughfare and is available to all patients and family members. (Figure 2).
Two larger consult rooms are provided per unit, each of which can be used for private conversations between healthcare providers and family members. “Recently, the patient-centered-care movement has encouraged greater patient involvement and a more egalitarian encounter with the clinician, promoting two-way communication and greater access to information” (Almquist et al, 2009). The consult rooms (located across from staff conference rooms) and adjacent corridor bench seating can also be utilized as an area of respite for family members when needed (Figure 2).
Decentralized, open nurses’ stations are provided to allow families to easily access staff and can help accommodate open dialogue between the caregiver and the family, as members of the patient care team. In addition, staff has better views of patient rooms and will spend less time walking to reach their patients (Figure 2).
The patient room
The new hospital building’s patient rooms are designed with three separate zones for the staff, patient, and family (Figure 2). The family zone features loose furniture as well as built-in casework at the footwall, providing guests with a designated seating area within the patient room. “Accommodating family members inside patient rooms is a relatively new development, which, in many hospitals, has replaced the outdated policy of restricted visiting hours for family members” (Pati et al., 2009).
The furniture includes a patient recliner with ottoman and a compact sleeper loveseat sofa, which pulls out to the sides to create a flat sleeping surface for one person to stay with the patient overnight. The footwall casework houses a storage cubby and shelves for displaying flowers and cards, and—in acute care rooms only—a bench with two drawers mounted underneath to allow additional seating for guests. The family also has ample room to store personal belongings either within the compartment hidden in the base of the sofa or at the footwall drawers.
Amenities within the family zone include a 42" flat-screen TV, complete with multiple channels and a
ccess to a variety of movies, with future possibilities of Internet access, medical topic information, and daily food selections available in each room. In addition, there are several extra electrical outlets in the room to allow for families to charge cell phones, laptops, and other personal devices.
Each of the acute and critical care patient rooms have large windows, providing patients and families alike with access to views of the Chicago skyline and ample daylight. The double window shades have two different opacity options (blackout and sheer), allowing visitors and patients to have individual control over their environment.
In addition to natural light in the patient room, there are multiple levels of electrical lighting. Wall sconces are located at the footwall above the storage cubby and at the headwall behind the patient recliner to create soft ambient lighting; nightlights are located in both the toilet room and the patient room; and a multiple-function overbed fixture for the patient features several softer lighting settings for when an exam is not taking place. Many of the lights in the room are also on dedicated switches, allowing patients and families to choose the lighting levels that will make them comfortable during their stay.
As the Rush University Medical Center new hospital building opens next year and we continue to develop patient rooms in the future, families will continue to play a critical role in the design of the patient unit. “Anecdotal evidence suggests that the presence of family provides the social support necessary to create a less stressful environment and improve patient safety” (Pati et al., 2009). HCD
Hannah Jefferies, MFA, NCIDQ, LEED AP ID+C, EDAC, is a Registered Interior Designer at Perkins+Will in Chicago. She can be reached at email@example.com. Jennifer Merchant, NCIDQ, LEED AP ID+C, EDAC, is an Associate at Perkins+Will in Chicago. She can be reached at firstname.lastname@example.org.
Almquist, Julka R., Caroline Kelly, Joyce Bromberg, Sandra C. Bryant, Teresa J. H. Christianson, and Victor M. Montori (2009). Consultation Room Design and the Clinical Encounter: The Space and Interaction Randomized Trial. Health Environments Research and Design Journal. Posted online 11/1/2009.
Bunker-Hellmich, Lou, (2010). Patient Focus: Developments in Inpatient Unit Design. Health Facilities Management, March 2010, 26-29.
Pati, Debajyoti, Thomas E. Harvey, Jr., Evelyn Reyers, Jennie Evans, Laurie Waggener, Marjorie Serrano, Rachel Saucier and Tina Nagle (2009). A Multidimensional Framework for Assessing Patient Room Configurations. Health Environments Research and Design Journal. Posted online 2/1/2009.