Pulse
Customer Service
After years of designing hospitals and clinics for staff and equipment, architects are finally focusing on patients.
Nearly two dozen employees have gathered in a conference room at Hennepin County Medical Center (HCMC) on a Thursday afternoon to learn how to be amateur anthropologists.
The group of physicians, nurses, administrators, interpreters, and others who work on the front lines with patients are being taught how to observe—to notice how patients find their way to a clinic, how they check in, what they do while waiting to see the doctor. They then practice interviewing: Tell me about your most recent experience at the clinic. What did you like? What could have been better?
Each leaves with a journal, a disposable camera, and instructions to go into HCMC’s clinics and watch and interview six patients or family members and bring back stories. Those stories will become the foundation for the design of a new 50,000- to 60,000-square-foot family medicine clinic near Lake Street and Hennepin Avenue in Minneapolis and a new ambulatory care facility on the downtown Minneapolis campus.
“The idea is to understand the voice of the customer,” says Brent Peterson, an industrial engineer with the Minneapolis architectural firm HGA, which is leading the design process for HCMC.
Understanding what customers, or in the case of a hospital or clinic, patients and family members, want is at the heart of “lean” thinking, a process-improvement strategy that has found its way into HCMC and other health care organizations as a mechanism for reducing errors, eliminating waste, and now designing facilities. But whether they’re using the lean process, conducting focus groups, or just asking for opinions, more and more provider organizations are seeing the value of getting inside the heads of patients before drawing up blueprints.
The Forgotten Voice
Ironically, hospitals haven’t always been built with patients in mind. During the wave of hospital construction that took place from 1945 to 1974, patient comfort took a backseat to the need to accommodate new technology and make work more efficient for staff. “The most traumatic, the most joyful, the saddest experiences in people’s lives may be centered around a hospital. … Yet for years, we left them out of the mix,” says Terri Zborowsky, director of health care education and research for Ellerbe Becket, a Minneapolis architectural firm.
By the mid-1990s, that started to change. Hospitals found themselves competing for patients. In order to capture marketshare, they had to offer new services in environments people didn’t find impersonal or confusing. To be successful, they needed advice from the end-users—patients and family members. “Suggestions from patients … are critical to designing spaces that enable patients to heal,” C. Robert Horsburgh Jr., M.D., wrote in a 1995 New England Journal of Medicine article on healing by design.
Around the same time, Planetree, a nonprofit dedicated to promoting healing environments, developed principles to make architecture and design more patient-centered, and the Institute for Family Centered Care began offering advice to architects and interior designers on how to involve patients and families in improving the built facility. The institute recommends that “when setting up a formal planning process, consumers should comprise one-third to one-half of the design planning committee’s membership.”
“Patients are the people who at the end of the day are impacted most greatly. They’re the most vulnerable user group, and they need to be advocated for in the design process,” Zborowsky says.
What Patients Want
One way architects and health care organizations are bringing those users into the dialogue is with patient advisory groups. “Traditionally, we would take our design work and go to one of their meetings,” says Zborowsky. “Now we’re including them in the design meetings.”
Carolyn Olson, R.N., a case manager at St. Cloud Hospital’s children’s center, began involving the families of pediatric patients in facility design four years ago prior to the renovation and expansion of the pediatric ward and pediatric intensive care unit. Olson says staff from the hospital and the architectural firm met with 10 families, asked them questions, and had them walk through the existing rooms and point out what they liked and what could be improved. The hospital then constructed a mock-up of a new room and brought some of the families back to further refine the layout.
In the end, family members helped create rooms that were private and had space for the family on one side of the bed and the medical equipment on the other, a couch that converts to a bed and a table top that folds out to accommodate a laptop computer, a data port on the family side of the room, additional closet space for family members’ belongings, and a way to display pictures and drawings on the wall at the foot of the patient’s bed. The hospital also built two lounges based on the families’ suggestions—a quiet lounge without a television and another with access to computers and soup, sandwiches, and coffee so parents wouldn’t have to leave the floor for meals.
“The families provided invaluable feedback for us,” Olson says. The hospital is currently setting up five focus groups that include members of its patient advisory council to help with a $200 million expansion.
Deb Sweetland, senior director of strategy management for HCMC, who is directing the construction projects, says HCMC got its first taste of what patients want when it started planning for additional capacity in its critical care unit last summer. The hospital is building a new 48-bed unit and a 15-bed observation unit. The observation unit is scheduled to open in the next few months.
Last July, administrators brought in three patients to talk about their experience at the hospital. The patients told stories that took the group on a journey of coming to the hospital, being admitted, being on the unit, and going through discharge. “We heard quite a few things that changed a lot of what we did,” Sweetland says.
For one thing, patients wanted private rooms that were inviting and colorful. “They didn’t want the standard hospital white, antiseptic look,” she says. And they wanted less noise, which led to the idea of having areas between rooms that house computerized equipment monitors and have a charting area. Nurses will be able to look through windows on either side to check on patients and take readings without having to wake or interrupt them as often. The designers also used textured wallpaper and fabrics to absorb sound.
Patients wanted space for their loved ones, too. Sweetland says they ended up designing the rooms a little larger than anticipated to accommodate a seating area for the family and to place all the equipment and medical gas hook-ups on one side of the patient—a strategy that helps reduce errors and makes it easier for nurses and physicians to access what they need during an emergency.
Sharing Stories
Two weeks after being sent out to collect stories, the amateur anthropologists at HCMC regroup.
They share their observations about the distance between where patients check in and where they wait, exam rooms not having standard equipment or supplies, nurses taking vital signs in hallways, patients waiting in hallways, and staff members having to yell over background noise when talking on the phone. They share patients’ stories about a doctor turning his back toward them to look at the computer screen, not knowing how to check in at the front desk, having difficulty finding the entrance to a clinic, being asked for their Social Security number in front of a long line of people, and having to wait in a large, open room with no magazines to read, toys to occupy children, or privacy.
“It bubbles up what’s truly most important to people,” says Sweetland. She explains that HCMC recently formed a patient advisory committee and plans to involve those individuals as the design process moves ahead.
“We think that because we’ve spent long careers delivering patient care and have been patients ourselves that we know what they want,” says Steve Sterner, M.D., one of the physicians taking part in the planning process. “But we’re surprised by some of the things people tell us.” Sterner recalls a time when staff selected an infusion chair for the cancer center after touring other facilities. When patients tried the chair, they hated it. Then they had patients pick the chair they liked. They’re now trying to get patient input “on the front end,” he says. “We want to start with the patient’s
experience and build from there.”—Kim Kiser