By: Todd J. Fisher, Founder and Chairman of Intraprise Solutions (Eyedog.US is a Division of Intraprise Solutions, Inc.)

At the end of January, a close family member of mine began to experience heart failure while we were sitting on the couch watching the news. With a jolt of adrenaline, I drove her to the ER, helped her register, and answered questions from clinical staff as they measured her vital signs, performed diagnostic tests, and provided preliminary treatment. Like it is for so many people in hospitals across the US, every single day, the experience was stressful, overwhelming, and emotionally draining.

And, over the next two weeks while she remained in inpatient care, having several tests and multiple procedures, I returned back to the hospital to visit, learn, and serve as an advocate. I was reminded of something I already knew, but had not felt so viscerally before: family members of patients spend a great deal of cognitive energy while supporting their loved ones, often over long periods of time, while hungry, thirsty, and sleep deprived.

In an already emotionally charged, stressful moment, the physical environment of a hospital can exacerbate feelings of anxiety: hospitals are, for a handful of reasons, inherently difficult to navigate. Hospitals often have hundreds of destinations that need to be accessible from any given starting point within and outside the hospital. Large hospitals, on sprawling, multi-building campuses – sometimes merging old and new structures – make navigation less than intuitive. Pedestrians navigating these spaces are often in an emotionally vulnerable state: visiting a hospital as a patient, or as a loved one of a patient, is stressful to begin, and makes navigating an unfamiliar or confusing space feel impossible.

Photo Landmark Navigation: More than Maps

Actually, navigating indoors is tricky even at an emotionally neutral state, especially when using digital wayfinding applications as a resource aimed at ‘simplifying’ the navigation process. We are all familiar with digital navigation systems while driving – in-dash navigation, Google Maps, and Waze have revolutionized the way we find our way while driving.  We don’t think much about how it works, we’re just grateful for the huge improvement over printing out maps, following road signs, tracking mile markers, or heaven forbid, pulling over to ask another human for directions.

As we consider the application of this navigation paradigm to solve a different challenge – finding our way as we move inside large complex buildings – we are quickly reminded that the real feat of Google Maps isn’t so much the tech that makes it all possible, but the simplicity and clarity with which Google communicates directions in cadence with the movement of our navigation. When we can visually match our current location with our surroundings, it becomes easy to see where to go next.

However, when we try to apply this GPS concept to pedestrian indoor navigation, we realize the tech that works wonderfully for navigating in open space while moving at 60mph may not serve us as well in confined spaces at low speed, where our view of the navigation landscape is obstructed by walls and ceilings. What we need is a method that converges with users’ natural way of thinking and effectively accommodates indoor navigation nuances without confusing or frustrating the user.

Thankfully, the scientific community has produced a stable of research regarding how humans think when it comes to matters of spatial awareness. Their key takeaway is our need for visual landmarks, as they are the most efficient way to communicate wayfinding instructions, especially in circumstances such as hospital navigation, where anxiety is high, users are distracted, and cognitive capacity is compromised.

Landmarks allow for fast reasoning because they align with humans’ natural cognitive navigation process. So, how do we incorporate visual landmarks into mobile wayfinding applications? Simple: we use photos!

A method called Photo Landmark Navigation is a more effective technique for indoor mobile wayfinding. Like GPS navigation, it leverages graphing algorithms to generate optimized pathways from one point of interest to the next – think “main entrance to NICU.” The user is presented a narrative sequence of photos showing their surrounding building hallways, rich with design features that serve as visual landmarks. As users reach each new visual landmark, they simply swipe or scroll to the next picture, revealing the next set of landmarks to walk toward.

Unique Hospital Design Means Better Digital Wayfinding

This is where the physical environment of a healthcare campus impacts digital wayfinding, and vice versa. A healthcare facility rich with visual landmarks, unique design features, and noteworthy points of interest makes a great candidate for a wayfinding solution like Photo Landmark Navigation. There are ample visual markers to help users clearly see where they are, and where they are headed. We’ve all visited healthcare facilities with the same paint color lining the multi-floor, multi-building, large campus walls – it’s hard to tell where you are or where to go. With well designed facilities, though, Photo Landmark Navigation works best, because it draws on the natural human instinct to use distinctive physical landmarks to navigate. Seeing those landmark photos on a smartphone screen signals that the user is on the right path. And, in older hospitals with updated designs, periodic additions, and tricky intersections, the same is true: Photo Landmark Navigation solves for wayfinding pain points no matter the setting, because it utilizes existing landmarks as an effective tool for navigation.

At Vail Health Hospital, in Vail Colorado, patients, visitors, and staff have access to a digital wayfinding solution called Eyedog, which uses Photo Landmark Navigation to deliver clear pedestrian directions to users. The solution, designed to eliminate common (and often overlooked) challenges around indoor navigation, enhances the patient experience by providing intuitive walking directions that resolve problems that often cause stress for the entire community, before they arise.

Great digital wayfinding meets consumers where they are, both physically and technologically. At Vail Health Hospital, the Eyedog digital wayfinding solution provides intuitive pedestrian directions that acknowledge the fact that our digital and physical environments have merged. This specific initiative provides effective and efficient digital wayfinding, because it utilizes familiar digital elements that fit seamlessly into the patient experience, ensuring that patients, visitors, and staff can focus on the task at hand, rather than the logistics of finding their way. The Eyedog solution works well at Vail Health Hospital because it eliminates concerns about the fail-points that commonly accompany other types of digital wayfinding, with third party dependencies.

An example of how Photo Landmark Navigation can resolve common challenges associated with digital wayfinding in the healthcare setting, Vail Health Hospital effectively utilizes unique hospital design features as the groundwork for great pedestrian directions via Eyedog Photo Landmark Navigation, merging the physical design elements with an empathetic technology solution.

Changes to the Physical Environment Can Create Confusion

Frequent changes and updates to the physical environment of healthcare facilities are inevitable; updates are a necessary and exciting part of keeping the hospital relevant, competitive, and well-fit to serve the needs of its community. But, those design changes introduce the potential for hidden difficulties for staff and patients, particularly those who are returning patients experiencing the changes in a facility they have visited before: changes to the environment can cause unexpected obstacles in an already turbulent experience. Change is difficult, and clear communication is a key way to reduce the impact of such change. Amid changes in a healthcare facility, Photo Landmark Navigation provides clear communications that extend beyond basic walking directions. Because of the frictionless and intuitive nature of such directions, they can drastically reduce the stress and anxiety felt while navigating confusing healthcare facilities.

Because of the nature of hospital growth, many facilities opt to add or grow in phases. Adding to existing, often older buildings can create confusing, difficult-to-navigate building landscapes; signage is just one piece of a complex puzzle required to effectively provide directions. Staff, who are also learning to navigate a new facility, often find themselves responsible for helping patients to navigate, as well, taking their time and attention from other duties and responsibilities to provide directions. With renovation comes confusion and stress for those working to navigate unfamiliar facilities.

And, for brand new patients, there is an inherent feeling of stress that accompanies navigating an unfamiliar facility. Photo Landmark Navigation is so effective and efficient in all of these settings because it combines high resolution photos of the campus with directional arrows and written directions, designed to help users navigate, regardless of their familiarity with the campus. Because users see on their smartphone screen their exact, current surroundings, a building’s confusing landscape, or out-of-date signage does not negatively impact the effectiveness of the directions.

Attention is Valuable

Photo Landmark Navigation gives patients and visitors intuitive access to effective indoor wayfinding that does not require a lot of attention to use; there are few barriers to entry, enabling successful wayfinding that can reduce the stress and anxiety commonly associated with navigating a new (or changing) healthcare facility. With the option to view a personalized photo route ahead of an appointment, users find a sense of control within their clinical experience.

Enhancing existing wayfinding systems, Photo Landmark Navigation works without requiring any hardware, making it quick to deploy and affordable to maintain. Photos obviate the need for indoor positioning, thereby removing the need for beacons, which are expensive to install and maintain. Such a digital wayfinding solution allows healthcare systems to capitalize on the opportunities afforded by offering an app-less mobile wayfinding solution, dramatically increasing the likelihood of usage and adoption. Instead of only appealing to those users who have taken the time and attention to download an app (likely a tiny percentage of all visitors), you can now offer mobile wayfinding to any visitor with a smartphone. Photo Landmark Navigation technology is unique in that it is complex behind the scenes, but incredibly simple for healthcare systems and their patients, making it manageable and maintainable for everyone involved.

And, we can’t forget that Photo Landmark Navigation is designed to be an addition to traditional wayfinding methods. Effective indoor wayfinding is multifaceted; Photo Landmark Navigation presents directions that use digital technology, but also leans on effective signage, healthcare design, volunteer & staff participation, and community engagement to successfully improve indoor wayfinding woes.

Put simply, Photo Landmark Navigation alleviates the challenges often associated with indoor digital navigation, while spotlighting the unique and beautiful design of a healthcare facility, saving on costs, and improving the patient experience. A creative twist on the driving navigation we all know, love, and rely on, Photo Landmark Navigation is the simple, frictionless, intuitive solution for navigating within complex healthcare facilities. Together with signage, design, and digital wayfinding, healthcare systems can take their digital transformation and patient engagement strategies to the next level, leaning on healthcare design to promise an improved experience for the entire healthcare community.

About Eyedog.US

Eyedog.US offers the world’s leading indoor and campus-based pedestrian wayfinding solution. Using photo landmark navigation technologies, Eyedog.US offers a human-centered wayfinding approach that promises to reduce stress and anxiety associated with navigating a complex campus. Learn more at https://eyedog.us/

By: Christina Olivarria, MSPM, PMP, LBBP, HACP, Director of Business Development and Communications, Yellow Brick Consulting Inc

I think it’s fair to say the lion’s share of us working in healthcare did not get into this field to learn about regulations, compliance, and accreditation. In fact, some of you may even cringe at the thought of developing policies, reviewing scopes of services, or verifying that staff files are up-to-date and inspection ready. Let’s face it, as much as we may dislike the headache they often bring, healthcare regulations are a necessary component to maintaining our healthcare system. As healthcare professionals, we are responsible for keeping abreast of the latest regulatory trends so that we always bring our best, most informed self to whatever setting may need that information.

As a non-clinician, I have challenged myself to become more educated about the various aspects of regulatory compliance. When activating a new healthcare facility, surveys and site inspections are often the final hurdles project teams must overcome before Day 1 Activation. Each year, as part of my regulatory education, I work with our Regulatory Specialist, ask probing questions, attend webinars, and do lots of reading. Below is a summary of prevalent regulatory hot topics across the country.

Behavioral Health Patient Risk Assessments

The CMS Hospital Condition of Participation, “Patient’s Rights” (42 C.F.R. §482.13(c)(2)) establishes the rights of all patients to receive care in a safe setting and is intended to provide protection for a patient’s emotional health and safety as well as his or her physical safety.

The Joint Commission identified patient safety risks as one of the goals listed in the 2023 National Patient Safety Goals. Specifically, reducing the risk of suicide through thorough environmental risk assessments is a top priority of the TJC and CMS, and many healthcare organizations, particularly as Behavioral Health, becomes a more prevalent topic. Evaluating ligature risks within healthcare settings where high-risk patient populations are cared for should be a top priority of healthcare leaders to mitigate the risk of self-harm. Currently, only psychiatric hospitals and hospitals psychiatric units are mandated to be designed to be ligature resistant. Those of us in healthcare understand behavioral health patients are treated in almost every type of healthcare environment, so it is important to be aware of potential risks and have the plan to minimize them.

Some recommendations include:

• Evaluation of the physical environment through a standardized risk assessment tool
• Ensure all patients are being screened for suicidal ideation
• Develop and maintain policies and procedures should a patient be identified at risk for suicide, including continuous monitoring and staff safety
• Develop and provide training to staff
• Follow policies and procedures related to discharge counseling and follow-up care

Workplace Violence Prevention

The data paints a bleak picture.

• Healthcare and Social Services workers are five times more likely to experience workplace violence
• Workplace violence comprises 73% of all nonfatal workplace injuries
• 80% of serious violent incidents reported in healthcare settings were caused by interactions with patients
• The “healthcare and social assistance” sector had 7.8 cases of serious workplace violence per 10,000 full-time employees compared to other large sectors that all had fewer than two cases per 10,000 full-time employees

As a result of this problem riddling our healthcare teams, the Joint Commission issued new and revised workplace violence prevention standards on January 1, 2022. The Occupational Safety and Health Administration (OSHA) plans for a Small Business Regulatory Enforcement Fairness Act (SBREFA) review of rulemaking for workplace violence prevention in health care and social assistance to ensure all healthcare providers are compliant.

The Joint Commission’s glossary defines workplace violence as “An act or threat occurring at the workplace that can include any of the following: verbal, nonverbal, written, or physical aggression; threatening, intimidating, harassing, or humiliating words or actions; bullying; sabotage; sexual harassment; physical assaults; or other behaviors of concern involving staff, licensed practitioners, patients, or visitors.” Healthcare leaders are now faced with the arduous task of incorporating these new standards into existing policies and procedures.

The new prevention standards are comprised of the following components:

• Management of safety and security risks – Conduct an annual analysis of the effectiveness of the workplace prevention program.
• Collection of information to monitor environmental conditions – Establish a process to monitor, investigate, and report incidents, including but not limited to injuries to patients and staff, occupational illnesses, safety and security risks, hazardous materials and waste spills, and utility system problems/failures
• Coordination of ongoing staff education and training – Establish training modules and content for various staff types, including at the time of hire and on an annual/as-needed basis. Content should include roles and responsibilities, de-escalation techniques, and reporting methods.
• Maintenance of a culture of safety and quality – Develop policies and procedures that address workplace violence. Evaluate key performance indicators that can be established to monitor incidents. Ensure support resources are available to staff.

Although this regulatory requirement has left many organizations scrambling, there are several incentives to adopting policies and procedures addressing workplace violence, including staff-burnout prevention, minimizing workers’ compensation claims, and reducing the need to backfill staff who are out due to injury. To access the Joint Commission resource toolkit, click here.

Disaster and Emergency Preparedness

The Emergency Preparedness CoP at §482.15(d)(1) contains requirements for hospitals to train staff and to have policies and procedures aimed at protecting both their workforce and their patients.

In the wake of the Covid-19 pandemic and its impacts still reverberating through the healthcare system, it is unsurprising to see increased scrutiny on emergency preparedness. The Joint Commission has highlighted Emergency Management as key safety topic, focusing on four main areas – preparedness, response, recovery, and mitigation.

Preparedness – Conduct a hazard vulnerability analysis utilizing an all-hazards approach, considering internal and external threats to the organization. Develop an Emergency Operations Plan that addresses identified threats. Validate systems required to support critical services and develop plan to maintain in the event of an emergency.

Response – Develop policies and procedures to support an Emergency Action Plan. Conduct staff training to support outlined policies and procedures to ensure teams respond as planned. Ensure communication and roles and responsibilities are outlined.

Recovery –  Address how and when the hospital will return to full functionality after an emergency or disaster. Consider family reunification and patient identification procedures for unidentified adults and unaccompanied children.

Mitigation – Conduct exercises to test emergency response, including fire evacuation drills, active shooter exercises, mass casualty events, and technology ransomware attacks. Evaluate responses and identify areas of opportunity and gaps in planned responses.

Hospitals must ensure that emergency services will be available when the next disaster occurs while prioritizing investments that will build the healthcare delivery system of tomorrow. For more information, please click here for the Joint Commission R3 Report.

End of the COVID-19 National Emergency and Public Health Emergency (PHE)

Throughout the pandemic emergency, declarations allowed extra funding to be utilized to maintain Medicaid coverage for millions of Americans. With this funding being pulled this year, it is unclear how this unwinding will impact the healthcare system and the millions of Americans who may lose access to insurance come May 2023. Emergency declarations enacted during the Covid-19 pandemic will end, which may result in adjusting ratios, retraining staff onboarded during this period, and adjusting billing for services currently covered under the national emergency declarations.

Organizations should conduct an internal analysis of practices and procedures to prepare for this unwinding period to prioritize the next steps. Communication and coordination with community resources are recommended to ensure patients have the most up-to-date information regarding available benefits and resources.

Although not the most exciting of healthcare topics, regulatory and healthcare compliance education should be a goal of every healthcare professional. What I have found most helpful is understanding what I need to know to be successful in my role and also who my subject matter experts are in the event that I need to consult with them on a topic outside my realm of expertise. Plenty of free webinars and articles are available on the various regulatory agency websites. Should you encounter a situation in which you need consultation, reach out to a consultant that specializes in healthcare. Many are happy to point folks in the right direction. Best of luck on your regulatory educational journey, and be sure to keep these hot topics on your radar in 2023.

BY: Rich Clough and Stefan LaBere, ECG Management Consultants

In Brief: When the excitement of moving into a new facility fades, will your organization fall back on old processes or continue to pursue new efficiencies?

Transitioning to a new and upgraded space presents an opportunity for healthcare organizations to reset and “reinvent” operations to realize new efficiencies. But a new facility alone won’t improve a department’s processes or change its culture. The excitement and optimism that accompany a move to a new space are fleeting; leaders need to promote a culture of continuous improvement to ensure that the advantages of a new space aren’t squandered by a gradual return to the old way of doing things.

The seeds for that culture are planted at the beginning of an activation and transition planning (ATP) project by defining the vision and setting guiding principles for operational excellence. These elements serve as the North Star for all planning activities—they are integrated into project materials, reviewed at key meetings, and championed by executives.

Creating the new facility’s vision and guiding principles demonstrates the organization’s willingness to embrace change and support frontline staff, which in turn encourages department leaders to adopt a continuous improvement mindset during operations planning activities. When done successfully, this enables departmental staff involved in operations planning activities to get creative and reevaluate how their processes can and should change.

Maintaining Momentum

As the opening date of the new facility comes to pass, it is always accompanied by a flurry of excitement and various activities to welcome patients to the new care setting. It can be easy for staff to return to their old habits and processes once operations in the new space reach the new steady state, and the activities completed and ideas shared during operations planning can be at risk of being forgotten.

Often, workarounds and other deviations from the agreed-upon plans prior to opening can become permanent fixtures, which is less than ideal. It is crucial that new or refined processes developed during operations planning, as well as the defined vision and guiding principles, are continually reinforced through training—not only prior to the first patient, but routinely and consistently. This can be achieved through a combination of simulation exercises or in-person training activities to maintain standard workflows and protocols; perhaps more importantly, this can enable the continuous improvement mindset to persist.

Organizational leadership must encourage and enable departmental leaders and frontline staff to utilize existing forums (e.g., daily huddles, regular staff meetings) to reinforce these principles and best practices. Additionally, maintaining select committees established during operations planning (e.g., Opening Readiness Committee) for three to six months after opening day—the stabilization period—can further supplement these efforts.

Sustaining the Mindset

ATP projects typically involve the transition or expansion of existing departments into new spaces. It can often be difficult to capture and sustain process improvements in legacy spaces, so transitioning into a new facility presents a significant opportunity for service lines to “do things the right way.” Reinforcing the new facility’s guiding principles through training and maintaining forums established during operations planning are effective means of sustaining a mindset of continuous improvement. However, it is crucial that these elements are not targeted at one or a few select services in the new facility—these must be broadly applicable to all services and ingrained in the fabric of the entire building. All stakeholders must not only have the ability to contribute, but also feel empowered to do so.

As such, it is incumbent upon organizational and service line leadership to adapt to change and identify new methods for encouraging the adoption of a continuous improvement mindset. How this can be achieved will vary between organizations, but establishing some ongoing structure or process to sustain this cultural change (e.g., creating formal committees comprised of facility service line leaders, conducting facility town hall events) is essential to realize long-term results. Ultimately, organizational leadership must want staff to adopt this mindset, and identify and capitalize on the opportunities available to do so.

by Dr. Wayne Ruga

Innovation is integral with healthcare – throughout the history of healthcare, it has continuously evolved in its effectiveness through progressive innovation.  What is the source of this innovation, who does it, where does it come from, and – perhaps you find yourself wondering, at times – what can I do to contribute my own innovation to healthcare?  If you do wonder this, please keep reading.

The Symposium has been the leading vanguard for innovation in healthcare design since its very beginning.  In fact, Sara Marberry edited a book called Innovations in Healthcare Design that draws from the most innovative presentations during the first five Symposia.  If you read the ‘Table of Contents’ (posted on Amazon), you will appreciate that many of these select presentations are as innovative today – and impactful in their design influence – as they were more than three decades ago.

Now, thirty-six years after the First Symposium, healthcare design innovation is no less important, now, than it was then.  With the current challenges in our world, for example – shifting and aging populations, environmental concerns, new strains and variants of resistant pathogens, rising energy costs, supply chain breakdowns, and shortages of qualified available labor – the urgent need for accelerated healthcare design innovation is probably even more important, today, than it ever was before.

What – precisely – is ‘innovation’, and how can it be distinguished from other types of advances in healthcare?  From my own personal point of view – being a serial innovator – an innovation must fulfil two requirements.  First, it must make a systemic improvement – this means that it introduces something new, something that never existed before, something that changes the status quo and introduces a new way.

The second requirement is that it must be sustainable – by this, I mean that the improvement is not a flash-in-the-pan, flavor-of-the-month trend, fad, or fashion.  Rather, by sustainable, I mean that the improvement continues to improve over time.

The Symposium is an ideal example of an innovation – nothing like it ever existed before – it changed the pattern.  And, it has sustained the test of time, with tens of thousands of attendees participating in it from across the US and every corner of the globe – carrying its pattern-changing messages back into their own communities in support of making their own local improvements.

As the stories about innovation are told – including even many of the presentations we hear at the Symposium – they tell us about the ‘what’.  Most often, these stories describe ‘what’ the innovation is, or ‘what’ it does.  Rarely, if ever, does the story tell us about the ‘how’ – what was the source of this new idea, and how did it come into the awareness of the innovator?

In keeping with the original inspiration that led to the creation of the Symposium – that is, to initiate an intervention that is an ongoing and ever-expanding quest into the inquiry of ‘how can we design the environment to improve lives?’ – this year’s Pre-Conference Workshop is a candid, truth-telling exploration into the sources of innovation from acclaimed pioneers of innovation – each having made recognized improvements to the healthcare status quo that are both systemic and sustainable.

The ‘what’ story that each one of these innovators will present is breath-taking…but – even more importantly – each innovator will also explain ‘how’ their innovation came into their awareness, and how they each gave their innovation the breath of life, to live on in the world and make a sustainable improvement.  The purpose of this unconcealing of the ‘how’ is to provide workshop attendees with the opportunity to look at the wide range range of these ‘how’ stories, to demystify them, and to introduce ways of knowing that attendees can use to make their own discoveries with.

Every innovator goes on a unique journey of exploration and discovery.  Sometimes much of this journey is extremely unproductive – sometimes it might even take years to arrive at a clear discovery – other times, this journey can occur in a fraction of a nanosecond, with vivid and compelling clarity.  It’s impossible to predict, in advance, what the journey will be like – or, even whether or not it will be a productive journey.

The good news, though, is that there are some common characteristics of how we can prepare ourselves to make innovative new discoveries.  The purpose of the Pre-Conference Workshop, at this year’s Symposium, is to enable ourselves to become acquainted with these characteristics, and to clearly articulate them, with the goal of priming the pump and accelerating a new generation of Symposium inspired innovators.  Appropriately, then, this year’s Pre-Conference Workshop has the title of Breakthrough Innovation: Exploring and Learning ‘HOW I CAN DO IT, TOO’.

The structure of the Pre-Conference Workshop has been designed to cultivate the conditions for learning ‘how’ to innovate.  These conditions include:

1. Specific presentations by accomplished innovators that focus on explaining their ‘how’;
2. Breakout sessions that enable small discussion groups with attendee-selected presenters;
3. A ‘speed-dating’ format of the breakout sessions to provide opportunities to have small group discussions with more than one presenter; and
4. A closing Networking Reception to enable informal one-on-one conversations.

Registration is currently open for this unique Symposium event. This one-time event is a special opportunity for you to have a direct learning experience from those leading pioneers who have already achieved acclaim for their contributions to healthcare, and put your foot on the path that begins your own personal journey of discovery.  Seats are limited, and are available on a first-come, first-served basis.  I encourage you to register quickly – and – I am looking forward to our time together, then.

If you have questions or concerns about this workshop, please feel welcome to be in touch.  I can be reached at:  [email protected] .

Renee Kubesh, AIA, EDAC | Senior Project Manager and Principal | EUA

Healthcare providers increasingly turn to micro-hospitals to deliver quality care to their communities. These fully licensed, 24/7 facilities can help patients with myriad medical issues – including critical care – within a fraction of the space of their full-sized counterparts, typically less than 20,000 square feet.

After more than a decade of operational micro-hospitals, we’ve seen recurring themes in how providers adapt them to meet their evolving needs. We also had the privilege of recently conducting post-occupancy evaluations for two buildings. We offer these top findings as lessons and recommendations for sustaining the success of this healthcare delivery model.

Finding the Right Location

Micro-hospitals can offer convenient and accessible community care when strategically positioned relative to a greater healthcare system’s network. Many existing micro-hospitals are in relatively urban areas. Still, a micro-hospital could be located to reach underserved areas or to enter new markets, even if other providers are already present.

Despite a robust network of hospitals and clinics in the United States, many communities – especially economically disadvantaged and rural areas – lack adequate access to healthcare. Some healthcare systems see micro-hospitals as a solution and a mutually beneficial arrangement: the community gets access to nearby care, and the provider introduces new patients to their system with a relatively small investment. Also, higher-risk patients benefit from connecting to a specialty care network while receiving local, stabilizing, pre-treatment care.

Staffing is vital to this approach. As these facilities are introduced in underserved areas, the municipality and health system have a joint responsibility to foster strong relationships among their constituents and improve local amenities, making the region desirable to medical practitioners as a place to not only work but also live and be part of the community.

Other providers leverage their micro-hospitals to support a “spoke and hub” model of care. Staff triages incoming patients to determine the best care location based on patient needs, staffing and bed availability. This approach works well when assets like a robust network of physicians and access to ambulatory and acute care are already in place. It is also a valuable model for municipalities seeking to revitalize their city centers, as proximity to healthcare is critical in driving downtown living and business development.

Both approaches to locating micro-hospitals have typically assumed the facility will operate as a stand-alone service. But we’ve noticed a trend of using micro-hospitals as anchors for medical office buildings or specialty care services. Patient-centered care and patient satisfaction are enhanced through convenient access to pharmacies, laboratories, radiology departments, ambulatory surgery or specialty care. This allows the micro-hospital to remain true to its core model – lean and efficient – while being able to plug into other services.

Some healthcare systems integrate their micro-hospitals to support a “spoke and hub” delivery model, allowing them to transfer patients, if necessary, to main-hub hospitals or other in-network facilities that offer specialized services.

Integrating Specialty Care

Our healthcare clients increasingly ask for micro-hospitals with more integration and flexibility. They are rightfully concerned about licensing requirements, local patient population needs, and incorporating appropriate demographic specialty care components.

The challenge is meeting those requirements without forfeiting the efficiencies of the micro-hospital model. We often caution our clients from over-engineering or over-programming; the micro-hospitals do not need to meet every patient’s needs all the time. They will still be effective, as staff will attend to patients that require immediate care while stabilizing and transferring others as needed. Over-engineering these facilities can increase the break-even point, slow patient throughput, and hurt patient satisfaction and employee engagement.

If done strategically, it is possible to integrate specialty care while still realizing a micro-hospital’s benefits. For example, one client considered pairing cancer care with the traditional emergency department and inpatient model. With cancer care as a top revenue draw – and considering the distance from the main hospital – this made sense for the provider.

To integrate specialty care effectively and preserve the micro-hospital’s efficiency, healthcare systems should identify the specific components of care early in the building’s design process and review them with the local authority having jurisdiction over the project. The facility may require separate entries, clear identification of dedicated versus shared support areas and code-delineated smoke zones.

In our post-occupancy evaluation, we found it is better to offer radiology as both an inpatient and outpatient service. Radiology for inpatient service is required for licensing, but offering it for outpatient services will increase patient access and lead to a greater return on the high-investment imaging equipment. Future micro-hospital designs should maintain separate access pathways for each type of service to maintain efficiency and reassure patients that they are receiving the care they registered for in the appropriate location.

Supporting Staff and Cross-Training

Micro-hospitals are intended to operate on a lean and efficient staffing model where doctors, nurses, and aides cross-train to provide care to the maximum ability of their licenses. This is a functional approach as long as the staff still find value in their work. Often, burnout is not the result of staff doing too much work but rather from losing touch with the job they once loved.

We’ve heard from staff that they want more time at a patient’s bedside, which allows them to own the patient’s care from arrival to discharge. While it might seem counterintuitive, in a micro-hospital setting, one nurse should provide services ranging from meals to breathing treatments, all at the patient’s bedside. The variety of work counteracts nurse burnout and increases patient satisfaction by developing a deeper relationship with one caregiver.

The hospital’s design should support staff cross-training. A centrally located nurses’ station adjacent to the medication room, lab and storage areas allows staff to help the emergency and inpatient departments during low census counts. At busier times, when both departments may have dedicated teams, the station encourages communication between them so that staff can assist each other.

A centralized nurses’ station allows staff to see what’s happening around them and ultimately deliver better care. We learned from our post-occupancy evaluation that inpatient waiting rooms must be within view of, and ideally adjacent to, the station so nurses can oversee and communicate easily with family members.

Placing the nurses’ station and other support spaces in the center of the micro-hospital makes it easier for staff to respond to patients in all departments.

Incubators for New Ideas and Systems

There is little doubt that micro-hospitals will continue to adopt more technology, and the patient experience will become more virtual. Many providers are leaning into their micro-hospitals as technology incubators because it is easier and more cost-effective to test new technology and workflows in a 10-bed rather than a 100-bed facility.

For example, consider how micro-hospitals might embrace a new registration and check-in experience. Today, patients walk into an emergency department, and the first person they see is likely a receptionist. In the future, this position will be handled by an automated kiosk that scans the patient’s identification and directs them to the appropriate waiting area. Or they may bypass the kiosk altogether; instead, there might be an automated secure door system with advanced wayfinding to support patient self-rooming. The point is that providers are much more likely to try this technology on the micro-hospital scale – with minimal investment – before implementing it in their larger facilities.

Micro-hospitals are also apt testing grounds for improved mechanical systems. We learned from our post-occupancy evaluation that more rooms should have systems that can flex to negative pressure, allowing maintenance staff to respond to potential future pandemics without re-tooling mechanical equipment.

Looking Ahead

Micro-hospitals have a bright future. The model has become increasingly attractive to healthcare systems and patients due to rising construction and healthcare costs. As we continuously look to improve the state of healthcare in our country – whether through enhanced access to care, better support for staff, or new technology – micro-hospitals are fertile ground to test and implement ideas in an already innovative and efficient model.

About the Author: Renee Kubesh believes that architecture makes a difference in people’s lives and is excited to be a part of that dynamic in healthcare. Her healthcare environments empower staff to realize their potential, welcome family and visitors in a relaxing atmosphere, and help patients take control of their treatment and wellness. Over her 30-year-plus career, she has led the creation of spaces that can flex to future needs. She values an evidence-based design approach of understanding and respecting what has worked in the past while making the design and construction process engaging and fun for everyone involved.

About EUA: EUA is best known for designing environments that elevate people’s potential. The respected 115-year-old firm specializes in several markets, including education, workplace, healthcare, senior living, student housing, mixed-use, entertainment, and science and technology. More than 250+ employees in Milwaukee, Madison, Green Bay, Denver and Atlanta demonstrate an unparalleled commitment to the markets, communities and clients they serve. For additional information, please visit the firm’s website at eua.com.

By Robins & Morton Division Manager Eric Groat

Whether you call 2022 the “Great Resignation” or the “Great Reshuffle,” team culture has never been more important than it is now, and with good reason.

Finding qualified and committed people at every level is one of the key challenges facing the construction industry as the labor market remains extremely competitive. At the same time, our clients’ continued emphasis on speed to market, set against volatile supply chains, puts even more emphasis on teamwork.

According to a recent study by MIT, a toxic company culture is the strongest predictor of employee attrition and is 10 times more important than compensation when predicting turnover. The study identified toxic cultures by several elements that included lack of diversity, equity and inclusion; disrespect; unethical behavior; and failure to recognize and reward performance.

All those warning signs of a “bad culture” may seem easily identifiable, but are they as easy to spot in our everyday interactions? More importantly, do we recognize them in time to facilitate change within a team?

To answer this question, our first impulse may be to review the lagging indicators first. In the construction industry, these typically include the critical outcomes, such as staying on-target with the schedule, budget, profitability or employee retention. While these are benchmarks of a successful project, they’re not the first signs of trouble within a culture.

Instead, we should be focusing on leading indicators – Is there trust among our team members? Are we engaged in collaborating? How do we handle unethical behavior? Are team members recognized for their contributions and performances?

When we pivot toward proactively identifying indicators of a healthy or toxic culture, we’re able to determine the proper actions to either maintain that culture or reverse the negative changes we see. However, no matter its state, culture requires work.

While every industry and business is different, there are five red flags that I’ve found most universal in identifying the early stages of a toxic culture:

1. Lack of communication. It’s alarming when two people who are on the same team are working from wildly different sets of information or have a completely different understanding of a goal or outcome. It’s a clear signal that there’s a broken link in the management structure, and that the team doesn’t understand their objective. In addition to chaotic and unproductive exchanges, not understanding desired outcomes also stifles innovation, which limits the potential of the project or work product.
2. Lack of decision-making. Decisions fuel all forward progress. Developing a clear structure of decision makers and processes to tackle particularly challenging questions are foundational for a functional working relationship. When we see environments that don’t encourage timely responses to critical decisions, we could pull back the curtain and find dysfunctional relationships with managers, fear of company leadership, and team members who are unclear about the mission of their organization. Although no employee wants to make an error, positive and learning-focused environments recognize that people are fallible and will make errors. Our reaction to those errors directly reflects our culture.
3. Withholding information or support. Not all information is fit for public consumption – whether it’s unconfirmed, too detailed for most, or simply irrelevant – but there’s a difference between filtering and withholding information. Filtering is done with good intentions to provide a team member with the information they need and clarity to complete their task. Withholding information is adversarial, often used as an instrument to influence power dynamics. If a team member begins withholding information, it’s a warning sign that they don’t want to work together to solve a problem.
4. No action taken as a result of feedback. Feedback is a necessity for improving any workplace or team environment. When people place their trust in a team and provide constructive feedback, it can be a vulnerable experience. Another sign of a toxic culture is expecting team members to enter that vulnerable place with no intention of addressing their concerns.
5. No motivation to improve. The final sign of a toxic culture can be summarized into a single word: apathy. If there’s one thing we can be certain of, it’s that we’ll experience change – personally, professionally and often at an exponential pace. Without a motivation to improve, a culture will become stagnant, leading to dissatisfied and frustrated team members.

While some of these signs may sound familiar, the good news is that it’s never too late to course correct. Here are a few tactics that have been successful in my experience:

1. Provide a platform for feedback. Creating a mechanism for feedback is the first step to building trust with your team. Provide several avenues for team feedback such as performance reviews for one-on-one conversations, team health assessments, and companywide people satisfaction surveys. No matter how the feedback is collected, holding ourselves accountable to be transparent about what we received and how we plan to address it is essential to maintaining culture.
2. Get the right people in the room. When working to address cultural problems, we naturally gravitate to having hard conversations with those whom we already have the greatest rapport. While those conversations may serve as a great sounding board, they’re unlikely to result in meaningful change. Only when we engage everyone and commit to healthy conflict among the team members who can initiate changed behavior can we truly expect an improved outcome.
3. Hire and promote emotionally intelligent leaders. People will always be any organization’s greatest resource and having leaders who can navigate interpersonal relationships will make the difference when facing a culture crisis. One way to support this within your teams is to ensure you’re providing growth opportunities, and the only way to know what that may look like for a team member is by getting to know them. Establish a review structure for all team members, ensuring every employee has a structured touchpoint with their manager, at least twice year. There are also specific mentorship programs within the company that can help them reach their professional goals. However, most team trust is built in the day-to-day conversations – it’s why we emphasize the importance of teambuilding activities. All of these elements will help you get to know the strengths of your existing team members, and you can build a strong management structure as a result.
4. See red flags for what they are. It’s easy to categorize a challenging interaction or an undesirable outcome as a one-off, but harder to admit when it may be a sign of a more significant problem. However, we’re better positioned to tackle incremental change than an entire cultural shift. Surfacing an incident before it becomes a long-term issue is a proactive solution to reduce the red flags, one by one.
5. Pursuing partnerships that are culturally aligned with your organization. Business can be a lot like marriage. The phrase “opposites attract” isn’t often the case – two married people may have different hobbies or social batteries, but it’s rare that they have a completely different value systems. It’s a similar quandary in construction, with numerous long-term project partnerships. Inevitably, there will be friction between teams that don’t share collaborative and transparent practices. Projects are at their best when teams share critical values. While every business partnership won’t be a perfect match, prioritizing working with companies that share fundamental cultural characteristics has a greater opportunity for success.

Although there is no one-size-fits-all approach to developing and maintaining culture, its building blocks are grounded in respect for people – respect for your employees, your business partners and your community. Using that as your culture’s guiding principle can assure a successful foundation for your team – no ping-pong table required.

Eric Groat is the Division Manager of Robins & Morton’s San Antonio office. He has more than 20 years of experience managing complex construction projects and is an advocate of Lean construction principles. Groat believes that an emphasis on culture, partnership and respect for people is key to revolutionizing the construction industry.

By Dr. Wayne Ruga, FAIA, FIIDA, Hon. FASID

In our world that is circumscribed by histories, beliefs, and biases – our true heritage – the natural human agency, to express ourselves freely, that we were each born with, gets increasingly constrained as we progress in our development, an inescapable paradox that most of us are blind to. ‘Structure’ – such as norms, rules, and policies – is the insidious and ever-present constraint to ‘agency’, and for many of us, reproducing and producing more limiting structure is what we unknowingly become practitioners of, and rewarded for, rather than drawing upon our own natural agency to liberate ourselves, and those around us, to become more of who we were originally born to be.

At the Seventh Symposium, our Keynote Speaker was Bernie S. Siegel, a surgeon, who encouraged us to examine how this ‘agency-structure paradox’ creates limitations in our ability to achieve greater personal health, deliver more compassionate healthcare, and live our lives in ways that are more fulfilling. The theme of his presentation was captured in a compellingly simple photographic image, that he presented, of how nature is unstoppable in its pursuit to express its agency – even in the face of the most severe limitations of structure.

Dr. Siegel’s image was of a dandelion that had forced its way up through a newly paved and striped urban roadway – a road where the asphalt was still shiny in its newness and the yellow painted center line was, as yet, untrodden by vehicles – and this dandelion was the only natural element in this sterile urban setting, beaming triumphantly in the rays of the sun, having become the brilliant dandelion that it was created to be. Of course, the point of the image was to encourage us to each become like this dandelion.

Anais Nin expressed this same point with breath-taking eloquence, when she said – ‘And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom’. Through these simple words, we can begin to see the fact that we do have a choice – it’s not an easy choice – but it is a choice that is available to each one of us. Do we choose to remain as a bud – constrained by structure, or blossom – as an expression of our natural agency?

Of course, since we all want to choose to blossom – why is it so challenging and difficult? To suggest that it is simply a matter of beliefs is to oversimplify the situation. However, our beliefs are key to what we choose. For example, in The Doctor and the Soul, by Viktor Frankl, we see a dramatic example of how the power of our believing that we have a choice, and making it, can profoundly inform our experience – even in an extreme situation where pain is involved. In Viktor Frankl’s chilling personal account of being tortured, he describes how he chose to be triumphant over his situation, drawing a direct parallel to Dr. Siegel’s brilliantly radiant dandelion image.

Now, in its 35th year, the Symposium has a proud legacy of being a highly fertile field, providing the essential conditions that enable its participants to blossom – the extreme opposite of the newly paved urban roadway or the torturous conditions that Frankl survived. The Symposium is a unique place with an established history of supporting positive beliefs in our ability to improve the world, supporting our choosing to blossom, and actively encouraging our blossoming because of the invigorated agency that our courageous Symposium community supports our access to.

In fact, in support of our belief that we can each improve the world by making better tomorrows – we have compelling evidence that the Symposium accomplishes precisely what Dr. Siegel encouraged us to do: by providing the conditions that support our liberated expressions of agency, the Symposium enables improvements to our personal health, it has championed a more compassionate delivery of healthcare, and has enriched a vast number of human lives. Rather than contributing to the already-too-much-structure, the Symposium supports expressions of agency – bold agency, courageous agency, agency that enables our community of believers-in-better-tomorrows to actually create better tomorrows, day after day, and year after year – in the face of the ever-increasing structure that continuously attempts to constrain our expressions of agency.

As an original creation – unlike anything that existed before it – the Symposium was created to be a community of like-minded individuals. It was intended to be an annual ‘place’ to learn from each other and to share resources. The very name, ‘Symposium’, was carefully chosen to express the value of ‘discussing together’ – the non-hierarchical and inclusive activity that gives its flourishing community an infusion of vitality and a taste of the splendor of openly expressing our uniquely individual agency. As active participants in this experience of ‘discussing together’, we can feel the warmth of acceptance and a valuing of difference.

One of the original hallmarks of the Symposium was its open invitation to all stakeholders in health, healthcare, and design to engage in a new, and very different kind, of collaborative discussion – to provide this new and ever-expanding global community with the opportunity to hear new voices and different perspectives, to learn new ways, as well as for your voice to be heard and appreciated, for you to be seen and recognized, for your ideas to be openly expressed, for your resources to be shared and valued, and for you to learn in ways that open your mind to new possibilities.

The Symposium is a place for YOU to blossom: as an attendee in the 3-day long annual event, with ongoing discussions with Symposium community members between the times of the annual event, through the special relationships that develop through these discussions, and through the positive reinforcement that being in community with like-minded colleagues – those who believe in making better tomorrows – can encourage and support.

As this year’s 2022 Symposium returns ‘home’ to California, the state of its ‘birth’, YOU are invited to return ‘home’ to the fertile conditions of the annual Symposium where you will be encouraged to blossom, and to re-discover being the triumphant active agent that you were born to be. I am looking forward to our further blossoming together in Long Beach, in September.

By Jenni Eschner AIA, EDAC, LEED AP

Telemedicine as a mode of patient care delivery is here to stay. With the $1.5 trillion Consolidated Appropriations Act, 2022, coverage has been extended for telemedicine services, sending a message of support to ensure better healthcare access. Over 80% of surveyed physicians agree that patients have better access to care due to the availability of telemedicine (AMA 2021 Telehealth Survey Report).

Increasing professional satisfaction, telemedicine has allowed providers to find better work-life balance. According to a 2019 survey by American Well there is a correlation between physicians’ interest in using telemedicine and physician burnout. Specialists are among the most burnt out and are also most willing to practice via telemedicine.

Patients like it, too. A Jones Lang LaSalle surveyshows that seventy-six percent of all respondents who have had a telemedicine visit since July 1, 2021 would prefer to use this option in the future. For parents with multiple children, not having to find childcare or not having to take both healthy and sick children in for a clinic visit is a huge satisfier. The ability to do a virtual visit after hours and not have to take time off work for minor illnesses saves precious paid time off.

Architects are asked to help our clients figure out effective and affordable ways to implement this care model. What are best practices when designing telemedicine spaces? It depends on the situation.

Two Scenarios: Care Team Integration

To ensure the continued success of telemedicine, it needs to be integrated into the care team continuum. While technology allows us more mobility and flexibility, it needs to be deliberately planned, tested, and implemented.

Two scenarios need to be considered.

One telemedicine version is where a patient is in-person at a healthcare facility and interacts with care givers at a different location, either on or off site. This might be a visit with their provider and additional care team, such as social workers, pharmacists, psychologists, and other coordinated care. FGI 2018 Guidelines provides requirements for this scenario which include acoustics, lighting, finishes, patient orientation and equipment placement. These will be expanded in the upcoming FGI 2022 version.

The second telemedicine option is when a provider and/or staff interact with a patient and either the patient or both patient and caregiver are remote. According to the AMA 2021 Telehealth Survey Report, 80% of physicians are in a clinic during a virtual visit, while 64% are at home. 95% of patients typically connect from their home setting.

Three Models: The Comparison

There are three programmatic areas architects plan with clients to achieve this integration.

Model 1: Existing Exam Room

This option gives providers the ability to do both virtual and in-person clinical visits within the same work period without having to physically relocate. The same support staff is available to the provider during these visits and the same clinical supplies and tools are also available without duplication. This is a familiar and branded experience for the patient since the visual background they see is the same as during an in-person visit.

There are downsides to using an existing exam room. Renovations may be required to provide the right environment and infrastructure for connectivity. This might mean that additional equipment such as a microphone or camera would need to be added. Using an existing exam room also ties up space that could be used for in-person visits. And our clients are sharing that it can be challenging for providers to switch back and forth between a synchronous virtual visit to an in-person visit. The fact that you don’t need as much physical space for a telemedicine visit also makes this an inefficient option for a healthcare facility from a $/SF standpoint. Along with the size of the room, a virtual visit would not require the same medical equipment/amenities in the existing exam room for telemedicine.

Model 2: Dedicated Telemedicine Room

A dedicated room can be smaller and simpler, so organizations don’t overspend on equipment, millwork, and plumbing. Having these rooms also frees up traditional exam rooms so that more care can be provided at the same time. As with using an existing exam room, the same support staff and supplies are readily available.

What gets omitted from projects when clients can’t afford everything they want? Often, it’s staff support areas. We’ve been riding the prioritization wave of “patients’ needs first” for the past 15+ years in healthcare planning. There is now a shift to a more holistic systems approach, in which the entire life cycle of providing quality healthcare is considered and prioritized. When not in use as telemedicine space, these rooms can flex as multi-purpose use, small meeting, dictation, off-stage or staff respite space.

While simpler and less expensive, in an existing facility there is still the cost of space reallocation and renovation in creating dedicated telemedicine rooms. These rooms are ideally near the provider. In a new project, this can change the planning module of the department and add additional space to the overall footprint.

Model 3: Separated Space/Call Center

The final option we look at with our clients is a separate or off-site facility. This can range on a spectrum of one provider working out of their home to a large call center type of office space. The lower cost of construction and overhead for this space type makes it worth investigating and it (or the provider) can be located anywhere. This is a big advantage for facilities with a limited footprint, as they can prioritize available square feet for higher acuity care.

Another benefit to a physically separated space is that it can more easily adjust to varying volume demand. When rent is cheap and lease terms are short, it is not difficult to relocate. Because of this scalability, healthcare organizations can more easily increase quantities of providers and potentially reach new patients, even outside of a demographic area.

However, expanded access of virtual care to a wider population increases the responsibility of healthcare organizations to ensure their providers’ licenses and credentials are in good standing (“Managing provider licensure amid expanding Telehealth” April 2022). During the Public Health Emergency of COVID-19, all 50 states waived state licensure requirements. Now that most states have reinstated them, healthcare systems that want to use a large call center to reach patients in various states need to monitor that their physicians on staff are licensed in those locations.

The demands of technology on an organization can be a barrier to having off-site virtual visit locations. A healthcare system’s IT department may not be set up to manage the demands that arise, especially when it occurs in a provider’s residence.

Another drawback to a separated virtual visit model is that the support team and resources are not all in the same location. It may not be practical to use a synchronous care team approach (MA + Physician in one visit) from a staffing and scheduling standpoint. This could lead to additional work for staff. There is also the risk of less oversight and accountability.

And finally, patient experience might be diminished if there are too many steps or transitions in the virtual visit process or if it feels disconnected from the healthcare organization. Sure, it is convenient to be able to speak with a physician at 9:00 p.m. while they are in their living room. But doesn’t it feel just a little weird and unprofessional? For this reason, health systems need to work hard on the technology piece to make sure it feels familiar and consistent with the quality of care one would get during an in-person visit.

Takeaways

There is no one-size-fits-all solution for telemedicine. My recommendation is that as stewards of our clients’ buildings, we should “be flexible but stick to [our] principles” (Eleanor Roosevelt). Design spaces so they can adapt to new technologies and uses, but don’t overbuild. Work with your clients to help them figure out what will serve their needs best. If one thing has become clearer over the past couple of years, it’s that we are scrappy and resilient and need to do more with less. And we can!

By Laurena Clark, Tim Eastwood, and Natalie Petricca

A story can mean so much. Hearing about the experiences of patients and family members can affect us deeply, injecting us with focus and propelling us forward as we design with a particular end user in mind.

Experience-based design is more than just understanding the clinical flow or asking patients for input on design decisions. It’s looking at the experience of an event. It’s hearing the stories that patients carry with them, and the impact of their experience on all five senses. While it’s important to design a functional healthcare space, it’s also vital to maintain a human touch. How can you combine function and experience? Patient experiences are sensitive and personal, so how do you gather and apply these experiences of patients and their families to design spaces that improve experiences?

We’ll share some lessons learned from a rewarding project in our hometown of Toronto, Ontario. Adopting an experience-based design approach to healthcare design – especially on pediatric projects – can have a big impact on the healthcare experience.

Blood and marrow transplant/cellular therapy unit

We incorporated experience-based design while working on the redesign of the blood and marrow transplant/cellular therapy (BMT/CT) unit at The Hospital for Sick Children (SickKids), which provides care for patients from across Ontario and Canada’s Atlantic provinces.

This unit is home to some of SickKids’ most vulnerable patients, who stay in isolation rooms for weeks to months at a time and require stringent infection control measures because of their compromised immune systems. In the unit, children can receive treatment for leukemia, lymphoma, aplastic anemia, sickle cell disease, and other conditions.

Staff on the BMT/CT unit have delivered care in the current space for 25 years. Patient rooms are small and require upgrades to support new technology, individual washrooms, physical therapy, and comfort for patients and their families.

During the beginning stages of our redesign of the unit, which took place prior to the COVID-19 pandemic, we had the opportunity to use one larger patient room as a prototype. We used the room to sample different technologies and materials, and enabled care teams to think about how they might work in the new space.

This project gave us the opportunity to engage with end users – children, youth, and their families – which provided a key element of the design process. The experience of patients or caregivers in this type of environment is critical because the extended hospitalization allows people to think about how they might change the space. We knew we needed to hear their perspectives.

Engagement: Learning about experiences

When it comes to experience-based design in pediatric healthcare environments, you need to approach the engagement process carefully. Aside from being empathetic – especially when working with current patients and their families – here are some ideas to consider, taken from our work on the BMT/CT unit:

• Journey mapping: Can you learn about milestones before the engagement starts? Before meeting with users, we asked care team members about the major milestones of a patient’s experience, from arrival to discharge. This provided us with a structure for our interviews with users, where we could later walk through a patient’s journey. Then, we placed posters on the wall with five different steps in a patient’s journey, asking questions like, “What was the experience like? What would you wish was different about the experience? What were positives and negatives about the experience?” Patients and families wrote their experiences on sticky notes and attached them to posters.
• Preparation: Before you begin your sessions, make sure you have materials ready for people to describe their patient journeys. Bring samples so users can pick their favorite tiles or floor materials. Provide paper and drawing tools for users to illustrate what their experience was like or to sketch out an ideal room design. For some children and youth in our SickKids session, we asked how they’d design a new patient bedroom for the next patient that needed treatment.
• Dual format: It’s useful to conduct interviews via a dual format, where you book appointments with some people but also provide an open, drop-in session. This provides a hybrid of structured and unstructured engagement and gives options.
• An invitation to share: You may not even need to ask many questions during an engagement session – it’s more about inviting people to share their experiences in an informal way. Be prepared for some emotional moments. While working on the project, it touched us to hear some of the sacrifices that caregivers made for their children, including caregivers that slept over for months or traded shifts with their partners so they could maintain their jobs while their children were in hospital. Caregivers told us they didn’t want to leave their child’s room because they didn’t want to miss important information from a doctor.

From stories to design details

After conducting your engagement, you can look at ways to enhance your design with the feedback you have received. Dive deep and immerse yourself in that experience. Imagine every possible way you can make the experience better for patients and the family members (whose wellbeing is so important, given the important role they play in the care of their child).

For example, rather than just painting a wall, could you add a marker board for children and youth to doodle during their stay? Your design decisions can help create something more than a space of healing.

A well-rounded process

In pediatric healthcare, an experience-based approach to your design can lead to a well-rounded process that reflects the unique needs of young patients and their families. We’re driven by the balance between leaning on our technical knowledge and incorporating stories we hear from families. While working on the BMT/CT unit, we always put ourselves in the position of the people we were designing for – such as the child and caregiver staying in the hospital for weeks.

When projects like these, it’s all about listening. And the more you listen, the better you design.