Patient Experience Healthcare Planning and Design

By Bill Sabatini and Barbara Audet

Experience + Empathy

Expressing empathy through design is always received with gratitude from both patients and their families.

When designers take to heart a patient’s emotional outlook and state of mind, patients encounter a more positive experience when undergoing treatments and procedures.

Providing the patient with a sense of control throughout the healthcare experience is the key to establishing a sense of trust between the patient and hospital staff. The design of hospitals interested in providing an empathetic approach must address multiple issues to assure a positive medical outcome. The issues to consider are ease of navigating the facility, private communications between patient and staff, visual privacy in exam areas and when patients are transported through the facility.

Navigation + Access

One of the initial ways of providing a sense of control comes in the form of the way the patient navigates the facility. A clear path of travel from the entrance to the site to their final destination should be defined by signage, points of interest, and human contact to ask for direction. Some facilities offer valet service and volunteers to assist wheelchair bound patients to their destination. The patient does not need to rely on family members to attend an appointment, thus offering a sense of independence to the patient. Pairing these efforts with additional scheduling options and appointment times as well as easy “Access to the location hospitals, clinics and physician offices… transportation… and special services” dramatically improves a patient’s access to care, and important part of building a patient-centered system as discussed in Picker’s Eight Principles of Patient Centered Care as explained by the nonprofit OneView.

Privacy + Patient Interaction

Privacy + Technology.  Privacy is key factor of the patient experience.

Experienced design teams see an underlying parallel: privacy in the exchange of personal information is just as important as physical privacy within an exam room.

Privacy begins at the point of registration when personal information is conveyed.  In order to gather the required information while still preserving confidentiality, front desk design is critical.  Providing patients with an enclosed booth or consult room increases their comfort level.

At the same time, to avoid the verbal exchange of information where possible, healthcare providers can utilize alternate methods of data collection – electronic devices, for example.  Providing patients with a tablet device to self-navigate and answer questions ensures privacy.  In some healthcare systems, patients can check in with their own devices, even before they arrive at the facility.

Interaction + Connection.  The way providers interact with patients is always important, but especially in situations where patients are undergoing multiple treatments for the same condition, such as dialysis or chemotherapy treatments.

For these patients, the continuity of seeing the same providers and support staff is an important part of their treatment, as they form relationships with the staff members they regularly see.  In many cases, according to OneView, “During focus groups, patients express feeling vulnerable and powerless in the face of illness… proper coordination of care can alleviate those feelings” (OneView, Eight Principles of Patient Centered Care). Care coordination helps minimize these concerns as much as possible by offering patients a consistent and reliable source of support.

Providers who can understand their patients’ emotions and the effects of the medications they are providing, develop a strong human connection, provide a sense of comfort and stability for patients. The way in which providers and staff speak to one another in front of the patient and family members can have an effect on the patient’s wellbeing, as noted in the white paper, “Achieving an Exceptional Patient and Family Experience of Inpatient Hospital Care” published on the website for the Institute for Healthcare Improvement.

This connection plays a powerful role in a patient’s overall experience.  A critical aspect at this point is acoustics: if a patient is expressing how they felt before medication (calm vs. anxiety, or perhaps if they are having difficulty focusing), a physician needs to connect and really listen but the only way to do that is by having an acoustically quiet place: through the use of white noise or some way to block out activity outside the room.

A Patient’s Experience in the ER

The patient’s experience at the emergency room is dramatically less predictable than a typical office visit and necessitates specific design attention. In the emergency room, patients often arrive in distress, and with unpredictable patient volumes, a large ER waiting room greeting patients can feel terribly impersonal and intimidating.

The increase in the use of freestanding ERs demonstrates a comfort level for patients to approach a building in their neighborhood as opposed to a large hospital in a different part of town. This daily reminder of emergency care just down the street builds a feeling of trust and control.

In the ER, after patients go through triage, they see a doctor and await next course of treatment.  High visibility design choices reassure patients that they are visible to staff and their needs are being addressed.  Sliding glass doors with blinds are a strategy that provide flexibility: they can be open for patient supervision or closed for privacy allow patients to rest without feeling isolated.  The comfort of knowing care providers are keeping an eye on them helps patients relax and remain composed amidst sometimes exceedingly frightening circumstances.

A Patient’s Experience in Surgery

Surgery prep.  A close second to an ER visit, surgery is also a highly stressful experience for patients.

Following the patient’s perspective of a typical surgery experience—inpatient and outpatient—offers insights for providers.

So much is happening before, during, and after surgery, design can play a role in making the entire process smoothly unfold.

Patient privacy again enters into the equation during surgery prep, where pre-op patients all too often gowned for surgery with privacy consisting of nothing more than a curtain.  Rooms with fixed walls allow patients to feel substantially more secure during this phase.

Surgery.  Next, patients briefly meet the surgical team, discuss anesthesia, and are transported to the operating room, picked up from a gurney, and placed on the operating table – often a very cold surface.

It is essential for ORs to be kept cold to satisfy equipment needs, but provider can consider ways to create balance for patients.  For example, the table itself can be heated, or heated blankets can be used to keep patients much more comfortable.

Post-surgery.  Patients coming out of surgery often feel vulnerable, so it’s more important than ever to ensure their comfort and wellbeing.

After surgery, informing patients where they are headed gives them a sense of control over their situation.  Personal recovery rooms – again, with fixed walls, rather than curtains – provide an appropriate level of privacy for patients as they re-orient themselves after an operation.

Most facilities do not allow family members past a certain zone, so patients can quickly feel isolated and unsure of their surroundings.

The presence of a familiar face—the nurse or surgeon—will help put the patient’s mind at ease.  The use of decentralized nurse stations bring the nursing staff closer to the patient bay for direct observation

For outpatient procedures, the experience doesn’t end until they reach their vehicle, so the experience of departure becomes especially important.  Patients who are in pain and/or wrapped in bandages may feel uncomfortable traveling through busy or even congested lobby areas.

Some hospitals provide a separate exit for post-surgical patients leaving the facility.  Ideally, these spaces allow a family member to have immediate vehicular access to a covered walkway where patients can have a quiet departure, at a comfortable pace.

Patient experience continues even after the hospital stay ends. OneView states that “Patients express concern about their ability to care for themselves after discharge” and indicate that careful instruction significantly improve post-surgery or post-stay outcomes (OneView, Eight Principles of Patient Centered Care).

Consult Rooms + Family Experience

Care providers will deliver a diagnosis and discuss treatment plans in consult rooms. these spaces can be distressing places for patients and their families.

Simple features like providing a monitor where providers can pull up information or show films gives patients more information and empowerment in decision making.

Tools, such as a white board to draw what they are discussing the use of various types of technology/electronic devices, help deliver more information to patients, enabling doctors to further explain and clarify.  Sound-proof walls keep sensitive information private and allow patients to freely express themselves.

Considering family members is also important.

Having family present is more than just a source of comfort to patients receiving a diagnosis.  Family members are often the keepers of information and will also likely be the ones filling out the patient experience evaluation.

The family experience is almost as important as the patient experience in terms of what they have access to, how they are treated, and where they wait.  Offering sound deadening booths to make calls can support this effort. According to OneView, “Providing accommodations for family and friends, involving family and close friends in decision making, and supporting family members as caregivers” makes a patient’s diagnosis easier to handle (OneView, Eight Principles of Patient Centered Care).

Everyone responds differently in these situations, so it is important to provide for a variety of patient and family needs.  Options can include immediate access to an outdoor garden and/or a spiritual space like a chapel, as well as access to vending machines or cafeteria for a snack or meal while waiting

The final aspect of the process for patient satisfaction is how the appointment or procedure is concluded.

During a consult, the physician may suggest follow-up treatments.  If these are not carefully tracked during the appointment, the onus will be on the patient to schedule.  This is an added burden to patients who are already sick or injured, and possibly overwhelmed.

Providing patients with all the resources they need to schedule the suggested follow ups, or even having patient advocacy staff who will arrange those appointments, is a relatively small effort that makes a significant difference for patients.

Context + Perspective. 

Healthcare designers aim to always be thinking from the point of view of the patient, staff, and families.  This involves relating to an actual experience, not an abstract, this is tangible and real.

There are exercises designers and architects can do to build awareness of what it is like to move through facilities: being in a wheelchair for a day or wearing a blindfold and moving through building.

Bringing that personal knowledge of what it is to use a hospital is key to also understanding from the staff side that they have to feel efficiency has been planned in so that they can bring a positive attitude to the experience.  At the same time, staff need awareness of post-traumatic stress/experiences and how it will affect a child or an adult the next time they have to visit, if not for themselves then for a friend.

Barbara Audet, RID, NCIDQ, CHID, Leed AP, is Coordinator / Interior Designer with Dekker/Perich/Sabatini. She can be reached at Barbaraa@dpsdesign.org.

Bill Sabatini, FAIA, FACHA, is Principal with Dekker/Perich/Sabatini. He can be reached at bills@dpsdesign.org.

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