Staring at Walls: Who Are We Designing For?

by Tiffany Christensen, CPXP

As funny as it may sound, the topic of “environment” within the Field of Patient Experience is somewhat controversial. Some professionals in this industry feel environment is the primary variable in patient experience while others are frustrated that it’s even part of the conversation at all. The Consumer Perspectives on Patient Experience 2018 study from The Beryl Institute shows that patients and families rank listening and communication as the key ingredients to a good experience while the age of the facility and parking are low on the list of importance. So how does environment fit into the puzzle of providing a good patient experience?

Safety

I went to see a friend of mine in ICU days after she’d had an unexpected brain bleed and hours of brain surgery. She had just come off the ventilator so this visit fell during a critical and tense time. During my visit, my friend began to vomit and appeared to be having difficulty clearing from her mouth and throat. I attempted to get help but, when I poked my head out the door, the nurses’ station seemed to be miles away and there were no clinicians in site. I went back into her room and attempted to get her on her side so she wouldn’t choke and fumbled around for the call bell. After a few minutes, a nurse came in and my friend was given the care she needed.

For days and weeks after that visit, that moment haunted me. What I remember most was the profound sense of being ALONE in there with a friend who was very, very sick. The ICU itself was beautiful and very large. So, large, however, it felt unsafe to have sick patients down long hallways far from any central point. Clinicians helping each other had to be far away from the patient they were caring for, essentially leaving patients unattended.

It strikes me that this ICU was an area of pride for this hospital; extremely high tech, modern, and, did I mention…large? But, that describes an environment that appeals to healthy people. From a clinical perspective, the mark was missed because those for whom the building was designed needed their clinician nearby, something this design failed to prioritize. It made me wish that I could ask the architects: “Who are you designing this for?”

Sanity

For patients being cared for over time, there are often stages of recovery. In my life as a CF/Transplant patient, my hospital visits have usually had the same progression:

1. Arrive, sick, tired and with the sole goal of getting into bed to rest
2. Begin feeling better, get more engaged in my care plans and ask about discharge
3. Feel better, get more and more irritated with everything in the hospital and anxiously await discharge
4. Almost time to go home, consider writing a letter with everything I am noticing could be improved and wait, like a dog at the front door, for the next clinician to come by and give me news
5. Go home, feel grateful for my care and recovery, forget all about the “improvement letter” and work on building strength to get back into my life

It may come as no surprise that, during steps 1 and 2, the environment around me doesn’t hit my radar (Unless it appears dirty. In that case, I worry about catching something new while there.). During steps 3 and 4, however, my environment impacts my state of mind. Staring at blank walls or signs that say “Call Don’t Fall” do little to help me distract myself from being enclosed and antsy. Soothing colors, wall art I can dive into with my eyes and options for natural light can bring some comfort. There is actually science around this but it’s not a science we use often in healthcare. (For one great example of this, explore the work of Danish artist, Poul Gernes, who believed that colors could have a stimulating effect on hospital patients and help reduce pain and suffering.)

During a recent stay in a hospital, I took a photo (see adjacent picture) of my primary visual focus during the time I was in-patient. This sliver of a window facing the hallway was the one part of the room with life and hope; watching people bustle by and wondering if this would be the next person to knock on my door. This window is most of what I remember from my hospital stay. This is what I would call “the lived experience” of a healthcare environment. 

Space

I got a call early on a Monday morning that my mother was at our local ED after suffering a stroke. My 3 siblings, 2 brothers-in-law and my father all descended on the ED to sit with her through the testing and admission process. Well, perhaps I should say “stand with her.” Like many EDs, there was little space for the family beside her bed, even if we went in 2 at a time. That was alright for my siblings and I but my father is in in his mid-eighties, has trouble walking and was distressed over his wife’s sudden change in health status. In some ways, I worried more that there was nowhere for him to sit than I worried about my mom at that point. 

Watching him, and others, struggle with long walks from A to B (the walk from the ED to the in-patient unit actually required a car ride for him) and, once in a room, he seemed to receive little consideration as an elderly family member, made me wonder how often we consider family when designing spaces.

I have seen beautiful hospital lobbies with piano players and comfortable seating. I have seen hallways with compelling art pieces lining the walls. I have seen fountains and gardens on the grounds of healthcare facilities that take your breath away. These spaces are wonderful but are used quite infrequently in comparison to the space at the bedside, gurney-side or chair-side of a loved one seeking and getting care. I can’t help but wonder what might happen if we invested more in the spaces that most impact the patients and families rather than we often do on the common spaces? What if we focused on designing an environment that:

• Was always built for safety before aesthetics
• Supported the staff and clinicians in delivering efficient care without wasted steps, etc.
• Enabled the shortest path from A to B
• Was soothing and pleasing to the eye
• Had room for family and clinicians so that all felt comfortable and valued at the bedside

Perhaps the “controversy” about how much emphasis should be placed on environment is less about how MUCH it matters but more about WHAT matters in supporting the human experience of healthcare. Considering these elements and working to understand the true lived experience of those really using the healthcare spaces, would surely make “environment” a key driver in experience.

Tiffany Christensen, CPXP
Vice President, Experience Innovation
The Beryl Institute