On the Holmes and Rahe stress scale, major personal injury or illness is the sixth most stressful life event a person can experience—one that in itself can contribute to stress-related health problems.
A hospital stay can be unpleasant, even traumatic, but does it have to be? Before clinical staff provide essential care, it’s the task of architects and designers to design hospital rooms that are efficient for staff—and that can also create a comfortable, healing environment for patients and their families.
The challenges of meeting these goals while complying with unbending health and safety codes are considerable. But as technologies and patient-care delivery evolve, new trends are emerging in health-care design to humanize the experience.
Shifting Toward More Specialized Care
Due to the trend of fewer people getting admitted to hospitals, those who do stay often require more complex care. “Patient care is being delivered on a more outpatient basis as treatments get more sophisticated with the advent of microscopic surgeries,” says Sue Smith, architect and owner of Smith-Karng Architecture, a firm that specializes in health care. “So patients who are admitted for overnight stays are sicker and require more specialized equipment in their rooms.”
This means that new room designs need to be more flexible—and big enough to accommodate imaging and diagnostic equipment. “You want to bring services to the patient, like lab work, imaging, and dialysis,” Smith says. Her firm works closely with equipment manufacturers to obtain Autodesk AutoCAD blocks of the equipment so that designers can incorporate the exact dimensions and required clearances for the equipment.
Smith also cites a recent shift away from hiding the medical equipment, emergency outlets, and other things people associate with hospitals. “Now the thinking is that the patient should see the equipment to instill higher confidence in the care provided,” she says. “Not to mention that when you hide the medical equipment, it’s more difficult for the staff to get to it.”
Managing patients’ mental well-being can be tricky. Feeling out of control is one of the most difficult aspects of hospital stays, with nurses coming and going and patients at the mercy of a labyrinthine care system. Thinking up design solutions for patients to take back control of their environments, even in small ways, improves their experience.
“Allowing patients to control the lighting in the room makes them feel more engaged in their environment,” says Xiajun Lin, a senior health-care architect at OCULUS Architects. This can be achieved through dimmable light fixtures and remotes that can control both lights and window shades. “Getting all the controls for things like lighting and entertainment coordinated on a handheld device is the going trend,” says Smith, who works closely with electrical engineers and lighting product representatives to transfer that control to the patient’s fingertips.
Underlying patient satisfaction and comfort, the primary concern is delivering care and preventing infection. This makes designing from the staff perspective paramount. “Essentially, you want to meet the health and safety requirements,” Lin says. “The goal is patient recovery and to improve recovery times. The room must be functional for the staff who are providing care. And a huge concern is always infection control.”
From Virtual to Reality
Lin has used virtual reality (VR) to create mockups of patient rooms where nurses can experience a new or redesigned room and give feedback on the flow and use of space. “Virtual mock-ups are especially useful in existing hospitals that are in operation and where physical mock-ups are not possible,” she says, pointing to the Kaiser Permanente Oakland Medical Center, a project she worked on prior to her time at OCULUS. “The contractor utilized a VR mock-up to make sure what he was building was what the designers intended, and it helped designers, in the process, verify that what they intended would actually work.”
Many design features for infection control are mandated by health and safety codes, such as the location of a hand sink, preferably near the door, so nurses can wash their hands every time they enter and leave. Another code requirement is to maintain negative air pressure in the room so that contagious air doesn’t spread into the corridor.
But beyond meeting code requirements, it is still up to the designer to make sure that the room is well organized for staff. “You want to make sure that you don’t impede the nurse’s line of sight, that medical gases are within easy reach, and that medical waste containers are well-located, among other considerations,” Lin says. She gathers input by meeting with staff in the programming phase of the project and after the project is complete. “Post-occupancy studies allow us to learn ways to improve design by looking at how the rooms are actually used after they are built,” she says.
Caring for Caregivers
Yet another group that designers must consider is the patient’s family and friends. According to Healthcare Design magazine, “Research continues to prove the benefit of family members as caregivers, yielding improved outcomes and reduced lengths of stay.”
Family members sometimes have to spend weeks in patient rooms, sometimes in a designated “family zone,” usually close to the window. “Often, there is a couch that doubles as a bed to accommodate both daytime and nighttime family needs,” Lin says. “Working with our electrical engineers, we make sure to provide Internet connection and power in the family zone because people are often working remotely while being present for their loved one.”
In his book The Five Invitations: Discovering What Death Can Teach Us About Living Fully, Frank Ostaseski, a Buddhist teacher and a leader in compassionate end-of-life care, writes: “Hospitals are magnets for suffering. They’re environments filled with a great deal of physical pain, fear, anxiety, and other discomforts. Staff tend to get swept up in the technical details of care, overwhelmed by patients’ suffering and their inability to respond to it.”
Spending time in a hospital may never become completely stress-free, but by using tools such as VR, staff interviews, post-occupancy studies, and close collaboration with engineers and equipment manufacturers, designers are aiming to elevate the experience for everyone.