“Reflections” is a new column featuring thoughts and commentary by former HEALTHCARE DESIGN Editor-in-Chief Richard L. Peck.

A statement that I heard often when I was Editor-in-Chief, to the point that it became a mantra, was, “We should try to get design input from the people affected most directly, the patient.” Tough to argue with a statement that is so democratic and common sense-why shouldn't healthcare designers' most direct “customers” have a say?

I have to say, though, a couple of experiences I've had recently have caused me to wonder. Both actually occurred on the long-term care side of things, where I camp out as editor of HEALTHCARE DESIGN's sister publication, Long-Term Living, and its annual DESIGN/Environments for Aging issue. The most recent attention-grabber was an awards ceremony held this March for one of our DESIGN citation winners, a new residence for retired nuns. The architects deserved the award for a truly beautiful facility-but maybe too beautiful: one of the Sisters commented in accepting the award that “this (the new structure) is really too much.” It turned out that she and others, many if not all of whom had accepted vows of poverty years ago, were having difficulty adjusting to such pleasant, comfortable surroundings. Some would argue that they should relax and accept God's blessings where they find them, with so much ugly stuff in the world. But I found their response perfectly understandable in the context of their vows and life experience. And I was thankful that it didn't prevail.

This was actually an echo of an experience I had with the same competition a year ago. In this case, the project involved the conversion of a cavernous old dining room in a facility-long known to its neighbors-into several smaller, more intimate, attractively well-appointed dining spaces. The architect involved told me that, in initial planning, the older residents pushed back-they liked their big dining room just as it was; they were used to it and just didn't see the need for the conversion. The architect noted that this was not, in his experience, an uncommon reaction among older residents of facilities being renovated. In this case, however, the ultimate selling point for the designers was that future, younger residents might appreciate the upgrade and be more likely to populate the facility and keep it alive.

In both these cases the “grass roots” had a message for the designers: don't change a thing, or at least don't expect us to be completely comfortable when you do. And herein lies the rub with public involvement in design: you may get responses as varied as people are varied-and you may not like what you hear.

This isn't necessarily a bad thing. It is something to prepare for, though, when it comes to involving your customers in the design process. HD

Healthcare Design 2009 May;9(5):96