Patient- and family-oriented design of imaging facilities responds to changing demographics and can help build business.
At a time when the patient population is exploding, the health care system is experiencing a lack of skilled professionals. There is a dire need to change the typical model of health care as the existing experienced staff is not enough to support the 78 million Baby Boomers who will place a strong demand on the available resources. In addition to staff deficiencies, hospitals are experiencing a need for patient education to improve health illiteracy, financing options, and access to care.
These problems taken together, according to a recent report from the Bethesda, Md-based Institute for Family-Centered Care, require a complete redesign of the health care system with a focus on patients and families. “Patients and families, too often neglected in policy and program deliberations, are key to every step of the process,” says the report, titled “Partnering With Patients and Families To Design a Patient- and Family-Centered Healthcare System.” The idea is that this kind of approach will help speed recovery and move patients through the system as successfully and efficiently as possible while providing the best possible experience. Evidence-based design of health care facilities has begun to provide insights into what the future patient- and family-centered health care system may be.
In search of operational, personnel, and space efficiencies, new facilities will consolidate functions where possible and eliminate redundant staffing. The direction will be toward architecture that reduces stress for patients, families, and caregivers alike, while promoting both healing and productivity. These environments will focus scarce human and technological resources on patients’ and families’ needs.
A Patient- and Family-Centered Department
New and renovated facilities are already demonstrating the effectiveness of these design concepts. An excellent example is the recently renovated Diagnostic Imaging Department at St Joseph’s Hospital in Hamilton, Ontario. As in most hospitals, St Joseph’s had, over the years, installed new imaging specialties wherever available space could be found in the facility. This separation of modalities caused an operational disconnect among each specialty, a way-finding nightmare for patients, and long travel distances for staff.
The relocation and renovation provided the opportunity to consolidate six modalities into a single 27,000-square-foot Diagnostic Imaging Department, to include CT, fluoroscopy, MRI, general radiology, ultrasound, and women’s health.
By consolidating these six imaging specialties into a single location, the department can now be effectively operated by significantly fewer medical and support staff, instead of several per shift, to register and direct patients. In fact, administration reports a one-time savings of $300,000 on staff and inventory that it credits to the redesign.
The Benefits of a Healing Environment
Going to the hospital causes great stress for many patients and family members. It is an unfamiliar place, often designed with long sterile corridors, monochromatic tile floors, bright-glaring lights, and drab windowless rooms. The doctors, nurses, and staff who work in these dreary places often seem overworked, hurried, and disinterested, adding to the patient and family stress.
St Joseph’s Diagnostic Imaging Department addresses these problems with an inviting, open, colorful, and easy-to-navigate design that provides a low-stress environment for not only patients and family members, but also the health care professionals who care for them.
Best of all, the right design can deliver results. Administrators at St Joseph’s report 54% improvement in clinical efficiencies and 8% increase in patient efficiencies?all due to the facility’s facelift.
The imaging department is located just inside the hospital’s ground level entrance. As a patient walks through this door, the primary waiting area is located directly to the left within the main concourse. This two-story concourse is flooded with natural daylight by 20-foot-high windows along one side. Placing the waiting area here provides a hospitality feel from the initial impression.
Just across the hall from the waiting area is the registration area with an extensive desk clad in stone and wood separated with full-height frosted glass panels for patient privacy. A large wood mass, or box, surrounds and defines registration and is a key way-finding element. Across from the wood mass is a magnificent stone wall, which slides through the registration area and into the main concourse identifying the department entry.
Once patients have registered, they proceed through frosted glass doors where they are greeted at a reception station in sub-waiting. The departments and their respective waiting areas are located directly within the glass doors. Each imaging area is identified with prominent signage on a bright, emerald green wall accented with lighting to ensure ease of way-finding.
The sub-waiting areas feature comfortable, lounge-type furniture. Lighting is indirect with table lamps being the main light source. Educational kiosks are provided in each area with drapery panels for privacy. The kiosks enable patients and family members to access the hospital’s medical library and research the test or procedure they are undergoing. An illuminated glass wall, etched with trees, spans down the entire sub-wait corridor, giving the illusion of a view into nature.
From the sub-wait area, patients leave family and friends and go to changing rooms and gowned waiting?which are designed not as they are in a traditional hospital, but like a spa. An illuminated tree glass wall, similar to the one in sub-wait, provides a positive distraction while patients wait. Each change room has a hardwood louvered door. A full-height piece of millwork within the change room provides a drawer for clean linens, a flush full-height mirror, coat hooks, and a cushion bench.
Patients move from gowned waiting to the imaging room. Each of these rooms is designed to reduce stress and improve comfort for both patients and staff. A warm gray color was used on all walls to reduce glare. The floors have a wood look to add warmth. In addition, a 6-foot or 10-foot diameter backlit ceiling image is provided for the patient to focus on during their procedure.
The MRI area takes the design concept a step further. Located along the exterior wall, it features floor-to-ceiling windows with a landscaped garden view. This, in addition to a backlit ceiling image of nature, provides a temporary escape for the patient, and can help ease those who feel claustrophobic during MRI exams. Both patient and staff can enjoy the scenes and natural lighting during the procedure.
Administrators at the facility have kept a log of comments from patients. One patient, who was also a professional football player (he had visited many MRI departments in the past), had this to say on opening day: “This is the most beautiful MRI department I have been in. I have had most of my examinations in hospitals in Florida, and this is the best I’ve seen; you could charge admission.”
One key element in the success of the department was the separation of inpatient and outpatient traffic. Inpatients enter the department from a separate entrance at the back of the department. If an imaging room is not available, inpatients wait in holding areas. Each holding area has an 8- x 12-foot landscape mural at the foot of the bay. The murals are recessed into the walls and are emphasized with accent lighting. Above each bay is an indirectly lit circular mural of fluffy white clouds in a blue sky to replicate a skylight.
Although the traditional mindset is that these unique design features and amenities will surely exceed the budget, on the contrary, the design was very cost conscious. When challenged by administrators to provide written cost justifications, the designers studied the figures and produced the following results, proving that a beautiful and functional approach to design can be achieved within budget:
- Wood-look flooring (vinyl) was the same cost as previous hospital projects; carpet even less than vinyl flooring;
- Enhanced lighting was .002% of the total construction budget (1% of electrical component of budget);
- “Rock” walls were .0006% of construction budget;
- Glass feature (tree) wall was .0014% of construction budget.
While design is only one aspect of creating a patient- and family-centered health care facility, its holistic integration is fundamental. Its success can only be determined when applied to the entire project, flowing from one space, one department, one room to the next. From inpatient rooms and outpatient surgical suites to examination rooms and family waiting areas, no space should be overlooked.
Health care providers have only just begun to transition out of traditional design and into partnering with innovative architectural designers to create better patient- and family-centered health care environments. As the demographics of both health care workers and health care recipients continue to change, the need to use every possible tool to speed patients’ recovery will lead to more?and improved?patient- and family-centered facilities and programs.
Dennis L. Kaiser, AIA, LEED? AP, is Principal and Market Sector Leader with Perkins+Will. Ideas+buildings that honor the broader goals of society. Kaiser can be reached at 617.406.3433 or .