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Featured Article:

Engaging Patients, Families and Community Members in the Design Process

Amy Douma, AIA, HGA Healthcare Design Principal

With a growing emphasis on wellness and preventive care--and increased pressures to monitor overall community health--community engagement has taken on renewed importance in healthcare delivery. Through a well-planned community engagement process, healthcare organizations can better understand and address their community’s health needs, obtain specific feedback to improve current care programs and facilities, and solidify relationships with their patients and the broader community.

While community engagement initiatives can occur at any time and may take a variety of forms, tying such initiatives to facility development offers unique opportunities to rethink existing processes and align investments with community expectations.

Designing the Process
Among the most important steps in planning a community engagement initiative is establishing the purpose and scope. Clearly defining the intent, parameters and timeframe sets the foundation for all future activities.

Other important tasks include establishing a process to identify participants and determining the level of participation desired. The following chart illustrates five commonly used patient/community engagement participation levels, listed in order of increasing responsibility.

Level of Participation

Participant Involvement

Typical Tools/ Format

Outreach Gain awareness only Fact Sheets
Open Houses
Consultation Provide feedback on pre-developed ideas and proposals Surveys
Public Meetings
Focus Groups/ Advisory Boards
Involvement Actively propose ideas Public Meetings
Focus Groups/ Advisory Boards
Collaboration Engage in problem-solving and proposal development (typically over time) Focus Groups/ Advisory Boards
Shared Leadership Share in decision-making responsibility Advisory Boards


Project leaders must also establish the criteria for evaluating feedback. Common criteria include the following:

  • Improves patient safety or clinical effectiveness
  • Enhances patient or community experience
  • Cost

Clearly communicating the criteria and establishing ground rules (such as setting time limits for individual speakers in public meetings) help ensure that the process proceeds smoothly and efficiently.

Throughout the community engagement process, leaders must manage expectations, communicate how and when decisions will be made, share the results with participants, and identify further opportunities for input. Taking these steps helps build trust with all parties, even when some suggestions cannot be incorporated.

The following case studies demonstrate how two healthcare organizations have achieved measurable benefits by engaging the community and patients as they planned new facilities.

Whittier Clinic (Minnesota)
Hennepin County Medical Center is an urban safety net system based in Minneapolis. When HCMC leadership decided to relocate and expand a community clinic in the diverse Whittier neighborhood of south Minneapolis, they conducted a lengthy engagement process to better understand the needs of their patients and community. The design process involved numerous meetings with focus groups, advisory boards and the general public, with each group contributing at crucial steps from project programming through detailed design.

For example, patient focus groups selected by HCMC contributed to pre-design discussions on improving the patient experience. Feedback from these groups led to development of a unique care model designed for efficient and seamless care delivery, in which a dedicated care coordinator monitors activities within each clinic module, and all staff members--from technicians to providers--share central workstations to ensure coordination.

Neighborhood participation occurred through a dedicated community task force, meetings with neighborhood businesses and open community feedback sessions. These groups offered suggestions and opinions on the clinic’s exterior materials, its connection to the neighborhood, and site amenities. In addition, a patient and family advisory board representing a variety of cultural backgrounds, ages and levels of mobility were consulted on specific design decisions involving wayfinding, artwork, and interior finishes.

The input from each group was documented and evaluated by a project leadership team against the key project goals of enhanced patient and community experience, clinical effectiveness, and cost effectiveness. Decisions on the final direction--and the reasoning behind the decisions--were shared openly with process participants.

The success of the process is illustrated in the clinic’s growth and improved satisfaction scores over the previous clinic location. Within the first year of opening, patient volume increased 31 percent, including significant growth in target populations. In addition, a recent post-occupancy evaluation* (POE) confirms a high patient satisfaction rate. For example, “first impression of waiting area” and “comfort of waiting area” achieved satisfaction scores of 100 percent.

Verde Valley Medical Center (Arizona)
Another healthcare organization, Northern Arizona Healthcare/Verde Valley Medical Center (VVMC) in Cottonwood, also reached out to the community when planning three new outpatient clinics in the communities of Cottonwood, Sedona, and Camp Verde. Rather than approaching each facility with a pre-established template, VVMC sought to develop designs that showcased the unique identity of each community--and even solicited input on each facility’s proposed programmatic functions.

The pre-design process began with community-focused, multi-media surveys to understand system-wide awareness and current perceptions, followed by focus groups and public forums to establish project visioning, desired services, and community partnership opportunities.

While the three communities are geographically close, the engagement process uncovered significant demographic, economic and cultural differences that influenced both facility design and functions. Camp Verde--a community with deep agrarian roots and a rich Native American history--emphasized the need for urgent care and expanded primary care services. Sedona--a thriving tourist destination and magnet for affluent retirees--expressed interest in community education space, a demonstration kitchen, and fitness facilities. All communities desired expanded options for senior housing, reflecting a growing desire to “age in place.”

The three communities also exhibited distinctly different aesthetic preferences, reflecting the natural materials native to their respective areas. The area’s famous red rock was clearly identified with Sedona, while Camp Verde preferred the soft white limestone employed for centuries in its Native American settlement sites. Cottonwood, on the other hand, embraced the multi-hued river rock native to the nearby Verde River. While the aesthetic preferences were markedly different, each community strongly desired to showcase its unique landscape and heritage through vernacular-inspired forms and locally produced artwork.

The quantitative and qualitative results of the VVMC engagement process are now being used to inform the design of the three proposed clinics. While the facilities are still in various stages of design and construction, it is clear that the engagement process has strengthened ties with each community.

With expanded demands for improved clinical outcomes and increased pressures to reduce costs, healthcare organizations have much to gain by viewing members of their served communities as partners in the healthcare delivery process. Community engagement initiatives help organizations strategically target services to specific community needs and can provide opportunities to grow market share and build philanthropic support. Most importantly, however, these initiatives--when conducted in thoughtful and intentional manner--help build communication and trust with community members, creating the foundation for productive, long-term healthcare partnerships.

* Franqui, D. (2014), Doctoral Dissertation, Clemson University.

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