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Healthcare Design: The View from the Gurney

Bruce Raber, Vice President, Practice Leader Healthcare, Stantec Architecture

Like most healthcare architects, I always thought of myself as sensitive to the patient’s journey through the healthcare system and the hospital environment. But I learned the hard way that until you go through it yourself, you can’t really know what it’s truly like.

My personal awakening began in February of 2011 when I went to the hospital for a routine cardiac stress test in the Cardiac Diagnostics department which I had designed years earlier. Five minutes into the test, they told me to stop and asked me to lie down on a gurney. I felt fine. I had no idea there was anything wrong with me, let alone that I might have heart disease. But they wheeled me into the emergency department (which I also had designed) and later transferred me by ambulance to the cardiac catheterization lab at a major hospital (which I had also designed). The angiogram showed that I had three blocked arteries that couldn’t be fixed with stents. And so started my journey as a Cardiac outpatient.

My cardiologist decided to start by treating me medically, and I was to make a number of changes to my lifestyle. Take some drugs (prescription), eat plenty of fruits and vegetables- and a lot less red meat, leave work every day at 5pm, exercise six or seven days a week, participate in a Cardiac Rehab Program, and spend weekends with family and friends instead of my Blackberry. The weird thing was that I hadn’t felt any symptoms when I went in for that “routine” test.

And so 9 months passed of my new healthy life style, but it was time for the next reality check. On the advice of my general practitioner, two cardiologists, and my medical student daughter, I decided to become a member of the “Cracked Chest Club” and undergo triple bypass surgery to avoid a potentially fatal heart attack (“or worse,” as my surgeon joked). On February 15, 2012, I began my journey as an inpatient. I thought of it as the second phase of the Bruce Raber Action Research Healthcare Project.

I was lucky that I had a great surgeon, and everything went as well as one could hope for. And really, everybody in the hospital was amazing! But experiencing the hospital facility as an inpatient was eye-opening.

For one thing, way finding is something we healthcare designers pay a lot of attention to. However, even though I was in hospital that I thought I was familiar with—I’d been part of the Stantec team that remodeled the building—when I arrived for surgery at 6am, I was so nervous, I couldn’t find my destination. It’s a real challenge to design circulation and signage so that even someone who’s very anxious—as arriving patients are likely to be, especially that early in the morning—can easily get where they need to go.

The next thing I noticed was the complete lack of privacy. Architects and Designers are always trying to figure out how to give patients more privacy, but we’re not there yet. After the staff welcomed me, they gave me my gown and slippers and sent me to the changing room. Those gowns, of course, don’t tie in the back. So you step out of that change cubicle with your clothes in a shopping bag and your butt hanging out. There was no separation between gowned patients and other patients and their families who are arriving. It was like a comedy show.

The pre-surgery consult with my surgeon and anesthetist was done in an open room with about a dozen stretcher bound patients all waiting surgery. No privacy at all, as we heard each other’s fears, prognoses, and watched as surgeons felt penned our bodies with their arrows, happy faces, and “cut here” reminders.

The next thing I noticed was how anxiety-producing it is to be wheeled to surgery. Never been so scared in all my life! You’re left all alone outside the operating room—an area that’s not really designed to be comforting. My blood pressure must have been off the scale. Let me tell you, even though I’d designed these rooms, they look totally different when seen from the gurney.

Surgery took three and half hours. Next thing I knew, I woke up in the cardiac intensive care unit. As I became more conscious, I watched the travelling medical theater—eight to ten medical staff going from bedside to bedside. There was zero privacy here too, as through my half closed eyes I peered through a maze of tubes, hanging IV bags, and beeping monitors to spy, snoop and “eavesdrop” on the patients around me; and them onto me. Yes, we definitely need private, single rooms for ICU’s!!

Finally I was transferred up to my room, which I shared with one other patient. The hospital does have single-patient rooms, but they’re reserved for patients with infections. So, 4 nights in hospital, in a double room, with 3 different roommates. The last night spent with a bi-polar, manic depressive post-surgery heart patient, sharing the visitors’ lounge as there were no more beds available.

The recent trend toward decentralized nursing stations has a lot of benefits. Instead of having one centrally located station, several of them are dispersed throughout the floor, which means nurses can respond more quickly. But having a nursing station outside your room does have a downside as I discovered—more noise right outside the patient rooms, which makes it hard to sleep.

To some degree, of course, lack of visual and audio privacy is an inevitable part of the hospital experience; but does it need to be? If you agree to go to the hospital, you are going to witness the stories of other patients—that’s just part of the bargain, and perhaps that’s okay. But it can be stressful. I had three different roommates over the time I was there, and one of them was having a hard time dealing with his surgery. Sure, there was a curtain between us, but that doesn’t block the noise. The current trend toward more single-patient rooms will help address privacy, noise, and infection risk, so yes, private rooms get my vote! But I also wonder if it will make things a little less efficient for the staff, already often few in number who have to keep track of so many patients all now hidden away in their own room. Perhaps this is where new technologies will help.

I spent a total of 96 hours in the hospital, which was shorter than most for open-heart triple bypass surgery. That was in mid-February of 2012. By April, I was well enough to participate in my first Vancouver Sun Run—finishing all 10 kilometers in two hours. Don’t get too excited; that was walking, not running it. A couple weeks later, I came back to work.

It’s now been another year of Rehab, healthy eating, exercising, and focusing on reducing stress. Doing my part to lessen the burden of chronic disease on our healthcare system.

I’ve learned a lot from my stint as a cardiac patient over the last two years—I think I’m a lot more sensitive to the patient journey now, and I believe it’s made me a better communicator in the design process. I knew so much about healthcare design after 25 years, but never from the inside before. Although I’ll stop short of recommending that every healthcare designer undergo open heart surgery to see what it’s really like, I’ve been thinking…maybe whenever we tour a hospital facility from now on to start a new project, we all should be riding on gurneys.

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