morris switzer e n v i r o n m e n t s f o r h e a l t h

Dawn LeBaron, FACHE, CHFM Vice President, Hospital Services

Fletcher Allen Health Care

The Healthcare Facility Design Process T h e I m p e r a t i v e f o r I n v o l v i n g P a t i e n t s a n d F a m i l i e s

William D. Repichowskyj, AIA Partner, Director of Design MorrisSwitzer~Environments for Health

Designing an Inpatient Bed Replacement Project

morris switzer e n v i r o n m e n t s f o r h e a l t h

Patient & Family-Centered Based on direct input from patients and families:

Patient Immersion Study Patient Study Group Poll Patient and Family Centered Design Group

Focus on safety and high reliability Multi-disciplinary patient care and teaching Efficiency, energy conservation, sustainability Flexibility for future

Overview

Patient-Centered Principals and Process

Patient and Family User Group Results

Design Integration

morris switzer e n v i r o n m e n t s f o r h e a l t h

Patient and Family Engagement

Patient Immersion Research

Patient Centered Design Team Patient Satisfaction Surveys (Press Ganey and

HCAHPS )

Improving the Patient Experience Steering Committee “pilot” projects

“results and findings to inform the design process”

morris switzer e n v i r o n m e n t s f o r h e a l t h

morris switzer e n v i r o n m e n t s f o r h e a l t h

Patient Immersion Research Questions

Tell me about your experience being admitted to the hospital.

How does your routine in the morning/evening compare here to when you are at home?

Tell me about what could make your stay better.

How has the experience been for your family and friends?

Has anything surprised you?

Tell me about your expectations for your stay when you got here.

When did you feel the most comfortable during your stay here?

Describe for me what you did when you first got to your room.

Tell me about the best part of your experience so far.

How does this compare with other hospital visits you have had in the past?

How has your experience been with your doctors and nurses?

morris switzer e n v i r o n m e n t s f o r h e a l t h

Emotional Needs

“It’s not that you lower your standards [pause], you abandon yourself.” Naps

“Why the hell are we here if we’re not getting any sleep? It’s ridiculous.” The Importance of Family “We need to lay eyes on the people we love.” Interactions with Staff “The nurse walks in, says ‘Make sure you tell him that the rooms are too

small,’” to which the patient agrees. Limitations of Physical Space and Objects in Room “Not ‘sharing the daylight’ is a problem. I only see artificial light. The

curtain is an important ‘demarcation line’ but it blocks the sunlight.” Privacy and Roommate Issues “The curtains are a ‘facsimile’ of privacy.”

Patient Immersion Research Common Themes

The 10 Principles of Patient-Centered Design 1. Respect Privacy

2. Facilitate communication, collaboration and trust

3. Encourage patient and family participation

4. Empower patients

5. Promote safety and security

6. Provide accessible accommodations

7. Create a comfortable environment

8. Facilitate healing

9. Support staff’s goals through design

10. Look for design opportunities to respond to unmet needs

morris switzer e n v i r o n m e n t s f o r h e a l t h

morris switzer e n v i r o n m e n t s f o r h e a l t h

Focus Topics

Privacy Nurse/Staff access/observation Family amenities/participation in the

room or elsewhere Bathroom features Safety Comfort Choices and self determination Noise Lighting Unmet needs

Patient & Family User Group

morris switzer e n v i r o n m e n t s f o r h e a l t h

Overview

Patient-Centered Principals and Process

Patient and Family User Group Results

Design Integration

morris switzer e n v i r o n m e n t s f o r h e a l t h

Privacy

morris switzer e n v i r o n m e n t s f o r h e a l t h

Privacy

Proximity to the nurses' station

As much patient control over privacy options as possible

Auditory privacy - patient information & staff conversations

Glass windows and doors to hall

WiFi Access - technology to address isolation for non-mobile patients

Patient controlled shades/curtains

Addressing patient isolation/call system for patients to reach out to nurses

Patient transport elevators separate from public elevators

A way to let patient know staff is in the room knock/alert/request to enter

Requesting patient permission on teaching rounds

morris switzer e n v i r o n m e n t s f o r h e a l t h

Nurse/Staff Access/Observation

morris switzer e n v i r o n m e n t s f o r h e a l t h

Nurse/Staff Access/Observation

Have multiple nurses stations instead of one

Put vital equipment/IV pole all one side of room to avoid staff going around the bed

An alert so that patients know staff is responding to their call

Design room and equipment so that room can be cleaned quickly and efficiently

Avoid making the patient feel like they are on exhibit

Create a way to have selective observation – sometimes needed

Line of sight for nurses' stations to rooms

morris switzer e n v i r o n m e n t s f o r h e a l t h

Bathroom Features

morris switzer e n v i r o n m e n t s f o r h e a l t h

Bathroom Features Grab bars in bathroom

Walk-in shower with curtain or door

Sliding door for bathroom

Seat or fold down bench in shower

High toilet seats

Touch sensitive faucet or shower

Shelf for personal items in bathroom

Chair or seat in bathroom for changing/drying

Non-skid flooring

Wide entrance for access with IV pole

Clothing hooks

High quality shower head

morris switzer e n v i r o n m e n t s f o r h e a l t h

In-Room Family Amenities

morris switzer e n v i r o n m e n t s f o r h e a l t h

In-Room Family Amenities 24-hour access for family members

(case-by-case basis, patient choice)

Flexibility to have an actual bed for family members

Dual purpose chair/bed for family members

Storage for family members

Guest room service

Outlets for family members

Place for snacks/coffee/tea/mini fridge in-room

Comfortable day bed for family members

Plants/flowers in room

Screen/curtain to separate family member space from patient

morris switzer e n v i r o n m e n t s f o r h e a l t h

Common Area Family Amenities

morris switzer e n v i r o n m e n t s f o r h e a l t h

Common Area Family Amenities

TV in family room

Bathrooms for guests

Kitchenette with fridge coffee/tea, etc.

Multiple family/common spaces

Pods/areas for separate groups

Common room away from elevators to avoid public access

Common room close to elevators as buffer to patients

Puzzle table/shared activity area

Access to linens for guests

Gym/exercise area

Plants/sun/flowers in family room

morris switzer e n v i r o n m e n t s f o r h e a l t h

Safety

morris switzer e n v i r o n m e n t s f o r h e a l t h

Safety

Non-skid floor

Response to call button

Non-cluttered hallways

Handrails in hallways

Multiple locations of call buttons

Clear path to bathroom

Soft corners on furniture

Night lights

Avoid furniture clutter

Tube management - avoid over long cords getting tangled

Safe for patient belongings

Location for critical personal items (eg: dental/auditory pieces)

morris switzer e n v i r o n m e n t s f o r h e a l t h

Comfort

morris switzer e n v i r o n m e n t s f o r h e a l t h

Comfort

Patient controlled temperature

Access to radio

Timely feedback on test results/increased communication with patient

Assurance of room cleanliness, uncluttered, clean lines in room

User friendly bed control/instructions

Closet for patient/guest items

High quality linen

Easy access to linen

Comfortable sleeping surfaces for both patients and visitors

Options for patient clothing/gown ties

Ability to select pillow type

Optional fan

Smooth curtain track

morris switzer e n v i r o n m e n t s f o r h e a l t h

Choices

morris switzer e n v i r o n m e n t s f o r h e a l t h

Choices

Follow up care choices/coordination of infusion services

Choice of being seen by residents or doctors

Menu/booklet that details food options and availability

Special request for mini-fridge/access to fridge for long term patients

morris switzer e n v i r o n m e n t s f o r h e a l t h

Noise

Ability to block hallway noise

Private rooms

Side window for patient monitoring to avoid entering room

White noise

Quiet clocks

morris switzer e n v i r o n m e n t s f o r h e a l t h

Lighting

morris switzer e n v i r o n m e n t s f o r h e a l t h

Lighting

Automatic or motion sensor light in bathroom

Adjustable shades/blinds on windows

Patient controlled dimmers for lights

Multiple easy access switches, including remote control

Avoid harsh lighting/glare

Reading light with adjustable arm

Independent light in family area

Natural light in bathroom

morris switzer e n v i r o n m e n t s f o r h e a l t h

morris switzer e n v i r o n m e n t s f o r h e a l t h

Overview

Patient-Centered Principals and Process

Patient and Family User Group Results

Design Integration

Patient Room Plan

Privacy

Nurse/Staff

access/observation

Family amenities

Bathroom features

Safety

Comfort

Choices and self

determination

Noise

Lighting

morris switzer e n v i r o n m e n t s f o r h e a l t h

Project Orientation

morris switzer e n v i r o n m e n t s f o r h e a l t h

Proposed Site – Aerial View

morris switzer e n v i r o n m e n t s f o r h e a l t h

morris switzer e n v i r o n m e n t s f o r h e a l t h

Existing Site – Aerial View

Proposed Site – Aerial View

morris switzer e n v i r o n m e n t s f o r h e a l t h

Massing Study – Travel Distances

morris switzer e n v i r o n m e n t s f o r h e a l t h

Section Diagram – Building Height

mechanical

bed floor

bed floor

bed floor

bed floor

interstitial space

surgery waiting

ED entrance/shell space ED drop off

NEW BUILDING EXISTING ACC BUILDING

morris switzer e n v i r o n m e n t s f o r h e a l t h

Design Response Modern building Seen architecturally as an addition to ACC Inviting drop off under building Break down scale of building

• Break up building mass • Curved form = diminish height by

increasing vanishing point of perspective • Proportion • Shadow lines • Composition of elements to move the eye

- break down perception of height • Variation in material tone and texture -

subtle visual "pixilation” Relationship to facing UVM campus

architecture

morris switzer e n v i r o n m e n t s f o r h e a l t h

morris switzer e n v i r o n m e n t s f o r h e a l t h

Fletcher Allen Campus

Daylighting Hospital Patient Rooms A Joint Research Study

morris switzer e n v i r o n m e n t s f o r h e a l t h

Amount of light in room depends on area and location of window

Daylighting reduces need for electric light • Lighting energy savings can be as high as 87%

Structural & mechanical systems can be designed to increase ceiling height and improve daylighting

Good outdoor views and daylighting: • Reduces stress & anxiety for patients • Lowers blood pressure • Improves post-operative recovery • Reduces the need for pain medication • Shortens hospital stays

Window Evaluations

morris switzer e n v i r o n m e n t s f o r h e a l t h

Window Evaluations

morris switzer e n v i r o n m e n t s f o r h e a l t h

Window Evaluations

morris switzer e n v i r o n m e n t s f o r h e a l t h

“Can good design help heal the sick?” The University Medical Center of Princeton Case Study:

Higher rated food and nursing care

Patients also asked for 30 percent less pain

medication

Patients sharing rooms provide doctors with less

critical information

The presence of family and friends hastens recovery

“In Redesigned Room, Hospital Patients May Feel Better Already” MICHAEL KIMMELMAN , New York Times, Aug. 21, 2014

morris switzer e n v i r o n m e n t s f o r h e a l t h

morris switzer e n v i r o n m e n t s f o r h e a l t h

thankyou

Dawn LeBaron, FACHE, CHFM Dawn.LeBaron@vtmednet.org

William D. Repichowskyj, AIA wrepichowskyj@morrisswitzer.com