Imagining a Better Hospital Room
In November 2006, the design firm Perkins+Will introduced an innovative model in the design of hospital rooms for child patients who experience extended hospital stays. The design infuses these long-duration medical spaces with an intensely user-focused design that transforms the hospital experience for some of the most vulnerable patients in the healthcare system.
The Perkins+Will vision of a more inviting, family-functional, and livable hospital room for children and their families can be found in two new showcase suites in Minneapolis. The suites were developed during a two-year period in collaboration with the nonprofit, Minneapolis-based Adopt A Room organization, the University of Minnesota Children's Hospital Fairview, and the Kraus-Anderson Construction Co.
The prototype rooms opened for use by patients in November 2006 at Fairview. The project brought together healthcare providers, Perkins+Will designers, and consumers with the highest level of motivation. The goal was to dynamically extend the boundaries of healthcare design for those children who must spend weeks—or months—in a single hospital room.
This design emerged from a transformative perspective on the needs and interests of the long-term child patient. It looks beyond the palliative, and sometimes counterproductive, elements that traditionally dominate pediatric design, such as bright colors, cartoon figures, animal images, and other Disneyesque imagery. Instead, the Perkins+Will design brings to bear a set of technological, spatial, aesthetic, and detail-conscious strategies to meet the fundamental needs and interests of child patients, their families, and their caregivers.
This design transforms the hospital environment for child patients by focusing on four fundamental needs articulated through an intensive research process:
Sense of control
Connectedness with life outside the hospital
The innovative features found in the prototype rooms, including defined family spaces, patient environmental controls, a dynamic “magic” headwall, and an intensely patient-sensitive floor plan, all work to address those fundamental needs.
This article traces the development of the project from its genesis as a consumer-driven idea to its completion.
Addressing a need and exploring solutions
The prototype project emerged from Perkins+Will's collaboration with the Adopt A Room foundation, a nonprofit organization dedicated to upgrading rooms at children's hospitals to a boundary-breaking standard through corporate and private sponsorship. The foundation was created by two Minneapolis-area men whose children had suffered from terminal conditions that necessitated long hospital stays. Based on their experiences, the men believed that the hospital environment ought to better meet the needs of young patients confined for weeks or months at a time and provide more support for their families.
Perkins+Will designers at the company's Minneapolis office, working largely pro bono, tackled the problem by embarking on an intensive research project to understand the needs and interests of all the key participants in a child's hospital experience: the patient, family members, and care providers. For the designers, gaining a deep understanding of the unmet needs of patients and families was a fundamental challenge.
In December 2004, the Perkins+Will team collected a crucial body of information through a creative study of the most important source: the people involved. Perkins+Will brought together people with vast experience of the hospital environment for the long-term child patient: kids who have experienced long stays, their families, and their caregivers. Meeting in the Perkins+Will offices, children, parents, and caregivers provided detailed answers to carefully drawn questions that probed in acute detail the ambience, daily life, and functionality of hospitals. While identifying problems grounded in personal experience, the queries also sought aspirational ideas. For example, the designers asked, “What are the qualities of a dream room?”
To give participants the maximum opportunity to share their perspectives, the Perkins+Will team also provided scale models of hospital rooms, with moveable pieces of major design elements that gave participants a physical image and tactile vehicle for expressing their ideas. The models were analogous to a doll house and proved a particularly fruitful means for children to convey their views.
The interrogative and demonstrative research methods yielded long lists of perceived problems in conventional hospital environments, along with suggestions for design elements that would represent welcome change. Commonly identified problems included bathroom inconvenience and accessibility, noise and clutter from medical equipment, lack of space, and lack of control of the environment. Ideas for positive changes included family and parent spaces within the room, more comfortable accommodations for parents, food and beverage facilities within rooms, Internet access, and a general sense of control over the environment.
In analyzing the results of the user group study, the Perkins+Will team zeroed in on four essential qualities that needed to be part of the long-term hospital environment children: a sense of control, comfort, a sense of connectedness with life outside the hospital, and family environment.
The idea of control was articulated by the need for privacy, the ability to personalize and transform a room by users, and a desire for more and different storage spaces. Children and parents sought comfort elements that echoed aspects of hotel suites and apartments. Alternative seating and family spaces were seen as important. There was strong interest in amenities related to food and beverages, such as refrigerators, microwaves, and coffee pots.
A number of convenience issues centered around basic activities such as play, food preparation, and bathroom activities, such as proximity of the bathroom to the bed, the ability to move from bed to bathroom with privacy and unencumbered by equipment, and the ease of use of facilities.
Both children and parents emphasized the importance of staying in touch with their regular lives while marooned in the hospital. Children yearned to stay in touch with friends, siblings, and school. Parents felt a strong need to stay connected with their work lives. The needs of parents who invest huge amounts of time with their children in the hospital were prime considerations. Parent-specific spaces and opportunities to keep in touch with the outside world, particularly work, were highlighted.
Ultimately, users sought a normal home life as well as could possibly be replicated in a hospital setting.
Well-informed by the people who live in the rooms, the design team developed the technological, spatial, aesthetic, and detail-conscious solutions that would meet these needs. Perkins+Will worked from a perspective of trying to integrate all available design opportunities, from the broadest environmental level to the most intimate detail of the room environment. The process yielded striking innovations, such as the environment controls and “magic wall” in the project, as well as subtle decisions, such as a floor plan that provides maximum privacy for child and parent.
Qualities of a better hospital room
This section presents an overview of the creative mix of features that became part of the final design, offering a perspective on how these features address the four fundamental needs that informed the design.
Functional Organization. In searching for a truly innovative solution, Perkins+Will designers began with the conceptual functional organization of the room itself. The design team saw the conventional arrangement of provider/patient/family zones from the corridor side of the room to the window as counterproductive in this setting. Instead, the view that the family is an active and integral part of the care program is a fundamental tenet of the design strategy. The family zone is strategically positioned on the inboard side of the room, immediately adjacent and in close proximity to the caregiver work area. This position yields two major benefits: It fosters close collaboration and sharing of information between parent and caregiver, and parents can quietly come and go while the child is napping or sleeping without having to cross the room.
The recessed room entry provides visual and acoustical privacy. People wandering down the hallways are unable to see the patient and are also visually distracted by the large LCD monitors on the feature wall at the rear of the room.
The floor plan deflects noises in the adjacent hallway from having a direct path into the room. Moreover, the walls are constructed with two layers of gypsum board, along with an acoustical barrier between walls commonly used in the construction of home theaters; these features also keep sound from leaving the room. Absorptive ceiling panels are also used to soften the acoustical environment within the environment.
Managing sound serves to enhance the ability of parents to conduct their personal and professional business without disturbing their child.
The design consciously positions the patient, family, and staff and the flow of their activities. The patient bed is located as closely as possible to the door of the bathroom. Research identified this element as profoundly important to patients. Factors such as medical equipment and the patient's condition can make the journey to the bathroom an ordeal, and bathroom accidents are a deep source of frustration and loss of dignity. The bathrooms feature elements attentive to patient accessibility and comfort, including European sinks, a “let it rain” deluge-style shower fixture, abundant lighting, brightly colored finish accents, and continuous grab bars for guided support.
The patient space also features strategies to screen the child from the functional activities of the room to the highest degree possible, while retaining complete and efficient access for caregivers. The headwall can mask medical equipment and monitors, while curved wood panels are available to provide a measure of privacy in the bed area. The technological nerve center for the room is positioned in a computer closet outside the room.
For parents, the design presents opportunities for a degree of autonomy within the room and a connection with life outside the room. There is a computer workstation for parents that features glass sliding door which can afford a measure of privacy as needed.
Because overnight visits by parents are common, the room contains a bed selected for maximum comfort that can be positioned alongside and on the level with the patient bed, an element suggested by young children.
Some design elements focus on facilitating the interaction of child and parent. A key element in mimicking a home atmosphere is a retreat area within the room that is a center for amenities and that affords a sense of liberation from the bed area. This area features comfortable seating, a refrigerator, a microwave, and a coffeemaker. Research emphasized that engagement with food and beverages contributes to a sense of home. Moreover, it spares parents regular trips outside the room in search of such items.
Another general element is a substantial commitment to storage space. These spaces allow parents to move more effectively into the room as they bring the clothes and other personal items needed for long stays. Ample storage gives children the opportunity to keep more personal possessions at hand. In typical patient room environments, only minimal storage is available for a patient and family members. This room can accommodate personal items, clothing, and bedding, as well as personal care items in the bathroom, by providing numerous opportunities for storage. This feature alone makes the family feel more dignified and closer to replicating their home environment.
Technology. The rooms contain bold technological elements to achieve the sense of control—particularly over room aesthetics—craved by the long-term users. At bedside, a universal LCD screen with touchpad gives the patient power over his or her environment. The patient controls room lighting, light-block shades, temperature, and other technology in the room.
The room's footwall is a “magic wall,” an oversized plasma screen that allows for movies and video games, as well as Internet connections to home, friends, and school. The screen also becomes a source of images from the surrounding area in the vicinity of the hospital via a rooftop, 30×-zoom camera dedicated to the room.
The curved headwall element is designed to “cuddle” children along with the oval shape of the soffit overhead. The headwall is located as close as possible to the patient toilet door to minimize travel distance when dragging IV poles.
At the front door, an LCD panel offers the child a space to display photos, artwork, and messages. This panel also gives care providers a vehicle to communicate with the patient and family without actually entering a room, an element that affords additional privacy and infection control.
Another visual feature can be found overhead with a virtual skylight, consisting of more than 20 LED lights that can vary the color of the room, create a sense of day or night, and even present stars. Some 15 different scenes are available in the skylight, furthering the goal of patient control.
Cumulatively, these elements allow this design to overcome the problem of repetition in conventional pediatric room design, a problem noted by children and parents in the research process. Pediatric rooms often include a visual theme that strives to brighten the environment, although this does carry the liability of being somewhat age-specific in a setting where the actual age range of patients can vary from infant to teen.
Another important element of the technology is redundancy of the control systems, with parents and caregivers able to operate the system from different locations. For example, caregivers are able to change the lighting or other elements in response to a pressing medical need, while parents can adjust the environment when the child is out of the room or asleep.
Furniture. The furniture selected for the room introduces a new approach to seating in a healthcare setting by recognizing that comfort sustained for many hours is crucial. The size of the rooms allows furniture to be rearranged around the room without interfering with nursing care. Height-adjustable tables can be used at bedside or dropped to a lower setting for dining use. Solutions to sleeping arrangements can be accommodated differently in each room.
Environmental controls. By necessity, the rooms feature separate mechanical controls for the general environment. The idea of empowerment demands that users maintain high degrees of control over such environmental factors. Thus, the patient and family can control the level of heating and cooling within three different zones in each room by using the touch-screen monitors or wall controls. A heated bathroom floor warms the ceramic tile before showering.
Some of the environmentally qualitative elements such as cooking facilities and coffee pots require a complete HEPA filter for cleaning the air and removing odors. The research process successfully framed the design issues to be confronted in meeting the needs of the daily users of the rooms.
User's guide. A final element of the design is an instructional video for the use of the room. Produced by Perkins+Will, the video addresses the informational needs of both children and parents by outlining the features available and giving clear and easily comprehended guides to using systems and facilities.
How it all fits
The four needs that drove the project show how the Perkins+Will design team integrated a variety of innovative strategies to make a hospital room that is a better living space for children and their families.
Sense of control. The child can exert control over his or her surroundings. The room temperature, amount of daylight and color can all be electronically manipulated from the bed. The headwall provides access electronically to the outside world via the Internet and through the rooftop cameras. There is ample personalized space and storage for those things from home important to the child. The availability of cooking facilities and food storage lend a strong hint of the qualities of one's home kitchen. Privacy features and a convenient bathroom help the child maintain a sense of personal dignity.
Comfort. The headwall offers a rich variety of entertainment and distractions. The environmental controls allow the child to shape the surroundings to his or her personal tastes. The extensive ability to control light and color provide a sense of ease as well as offering opportunities for creativity and amusement. Easy access to a broad range of foods and beverages within the room adds a homelike quality. The floor plan places emphasis on shielding the child from hospital bustle as much as possible, while medical monitors and machinery within the room are screened from the child.
Connectedness. The headwall mines all available technological opportunities to keep the child in contact with friends, siblings, and school. The rooftop cameras offer a different and appealing connection to the outside world. The family accommodations make it much easier for parents to spend long hours at the hospital and create a less stressful environment by giving both parents and children their own spaces.
Family involvement. Many aspects of the design make the hospital room inviting for parents and allows them to carry on a productive connection with outside life. The floor plan gives the parents a space for sleep, work, and privacy, all of which makes it easier and less stressful to stay at the hospital and maintain quality, relatively normal interactions with their child. Details such as the cooking facilities, food storage, and storage spaces all make the environment more inviting and functional for the parent.
Forging alliances with professional partners was another essential aspect of the effort to create a new kind of hospital room. One of Perkins+Will's clients, the University of Minnesota Children's Hospital Fairview, which is in the midst of planning a replacement hospital, expressed interest in the project and dedicated both space and funds. The hospital agreed to convert three existing rooms containing five beds that were already scheduled for renovation into a pair of model rooms designed according to Adopt A Room principles as expressed by Perkins+Will architects.
Beyond the design work, professional partnerships were vital to the development of the innovative hospital rooms. The major players all brought a high level of commitment to the project and donated time and resources. Still, the ultimate goals that each partner brought to the project differed somewhat.
For Adopt A Room, the project represented a template that ideally would be replicated as a widely used standard for that part of healthcare that is the organization's particular interest. Perkins+Will shared an interest in the idea of an innovation that would flourish into broad use in pediatric hospitals. The Perkins+Will team also recognized that elements developed in the project have broader applications and can be advanced into adult hospital environments. Fairview viewed the project at a more functional level, as the rooms directly affect the hospital's daily operations. While the project could significantly influence the design of rooms in the replacement hospital, the showcase rooms are working rooms in Fairview's current facility.
Fairview's contribution to the project is notable in that, despite a high patient census rate, it was willing to give up five traditional hospital beds to accommodate the two single-bed Adopt A Room suites. As a practical matter, adding beds to the prototype rooms would have made sense for the hospital. As a model for wider application, however, the idea of larger, private rooms was seen by the other partners as essential. Fairview eventually recognized that necessity, bringing a consensus on the direction for the project.
In addition, Kraus-Anderson committed to a high level of flexibility on the construction side. The ability to affect change orders with unusual latitude and adjust design elements as they came on-site facilitated efforts in the construction stage.
This project created working prototypes of an innovative patient room design that focuses on the quality of life in a hospital room for long-term hospital patients and their frequent and long-staying visitors. This concept emerges in a pediatric setting where, because of the age of the patients and the premium placed on extensive involvement of families, the need is most profound. Moreover, the project was driven by highly motivated consumers and by the emergence of a nonprofit organization that potentially can generate a new layer of funding to support the concept.
Nevertheless, many elements of the copyrighted design hold promise for elevating the patient environment throughout the healthcare system.
Patient-focused design that enhances the patient experience is a familiar goal in hospital design. This project presents a tangible prototype for dramatic steps forward. However, the model does represent an additional financial investment in patient spaces—the showcase suites cost $1.8 million, although that figure is somewhat inflated by special circumstances surrounding the project. In particular, the use of custom-designed items and the need to retrofit existing spaces required a significantly larger investment than would have been required in ground-up construction.
Perkins+Will plans an aggressive research process to track and analyze the experience of users to refine an idea that the company sees as an opportunity to enhance the hospital experience and care of long-term patients. HD