Tamara Phillips, Algonquin College | Ottawa, ON

1. UIA/PHG Healthcare Forum 2013 Toronto Balancing Clinical Care Needs with Optimizing the Patient and Family Experience:a case for interdisciplinary design research and collaboration Tamara Phillips, Algonquin College | Ottawa, ON David Allison, Clemson University | Clemson, SCThomas Garvey, Carleton University |Ottawa, ON

2. Re-thinking the Patient Room

3. “unsupportive design has effects that work against the process of healing” -Roger Ulrich, 1991 The healing process can be supported through better design of patient rooms.

5. Healthcare Design = Complex Problem The complex nature of healthcare design problems requires the input of many people and the collective vision of various stakeholders More unified approach to design is needed

6. More design research is needed to look at the role of patient room features that address family caregiver needs and what specific features significantly contribute to overall family satisfaction in the patient room.—Hamilton & McCuskeyShepley, 2010

7. Assumptions about acute care patient room design Family are important to the healing process and have unique needs from patients and other stakeholders Patient room design is complex and a more integrated approach to design is needed

8. Research Questions What elements and features contribute to patient and family perception of a supportive patient room environment? How can these elements and features be better integrated into acute care patient room design to support patient-and-family centred care?

9. Approach

10. Interviews Healthcare Design Experts from Industry and Academia Hospital Administrator Clinical Staff Healthcare Product Manufacturers Patients and Partners in Care Students

11. Survey Questionnaire Context: Patient Room Attributes Sample: Patients and Family 18+yrs. Stay in an acute care hospital within past 12 months Questions: 23 Questions, Multiple Choice, Likert Scale, Open-ended Sections:Demographic/ Physical Environment Concepts: Physical, Emotional, Social

12. Observations HOSPITAL TOURS 3 Acute Care Hospital Patient Room Tours (2) Us (1) Canada PARTICIPANT OBSERVER Patient Room Prototype Project

13. Findings Although family were considered helpful in terms of patient safety prevention as well as in reducing nurse workload strain, the specific needs of family in the patient room setting were not always identified.

14. Survey Questionnaire 32% age 31-50 42% age 51-70 61% female Patients 21 % Family 79% Length of Stay 58% 1-6 days 42% 7 or more 73% medical/surgical 59% semi-private room

15. GENERAL FINDINGS Patient room elements that patients and families wanted some sense of control over and affected their overall comfortand satisfaction in the patient room.

16. “in this setting, the smallest adjustments positive or negative can have a disproportionate effect in enhancing pleasure or becoming an irritant” The little-big things Adjustable reading light Height of chair in relation to patient bed Soft fabrics Lockable storage Places for personal display Colour/natural materials

17. “one big chunky chair—very uncomfortable and if the patient was sitting in it, where else to sit except the window ledge?” “chair was awful to sleep in” “I have seen things sometimes [set down] on the over bed table and even on the patient” “softer, dimmable lighting” “have the equipment blend into the surroundings so that it does not seem so cluttered” Physical Attributes Furnishings/Seating: Seating and sleeping for family/guests Personal Storage/Display: personal, secure storage; dedicated place to display items Temperature/ Lighting: adjustability, control , intensity Design/Layout: Size/viewing angle of television Materiality/Décor: Natural, colour/overall appearance of room

18. “would have stayed with my wife overnight the whole time” “access around the bed was difficult so to hold the patient’s hand...I had to sit on the window ledge” “more than one had to stand. You feel you are ‘on display’” “ability to read or watch tv without disturbing the patient” Social Attributes Passing Time and Keeping Occupied: Ability of family as well as patients to control setting Visiting, Socializing and Comforting: Consider visual and physical proximity of patients and family Design, scale, location of seating can affect interaction Comfortable sleeping accommodations

19. “felt like a nomad...had to drag stuff all around just to go get a tea” “invasive equipment” “blank walls” “technological feel” “like I was in somebody’s workplace” Emotional Attributes Peaceful and Relaxed: reduce clutter, balance sensory overload Adjustability/ Control: lighting, temperature, furniture/décor personal space Sensory Experience: Eliminate/reduce noise, décor, ambiance, odors

20. Adjustability/Control Family: personal use of electronic devices Lighting room seating Patients : angle of television personal electronics

21. Elements for perceived comfort Family: Furniture Medical equipment Clock Patients : Fabrics/linens Natural materials View

22. Items that Most affected Comfort Equipment, furniture and layout are almost as important as a view in supporting perceptions of a healing environment.

23. 2.15 If you could be part of a team to design the next acute care patient room, what ONE element would you ensure was incorporated into the design to make it a healing space? “comfortable furniture and flexible room layouts with balconies” “hide the medical equipment, it is invasive and depressing” “personal choice” “remove the clinical ambiance [equipment]” “less like a hospital room and more personalized materials and furnishings”

24. Case Study: Patient Room Prototype Project (PRPP) Interdisciplinary collaboration between Clemson University and Carleton University Expanding on previous-established project parameters Iterative and participatory research and design process 2012 focus on patient zone (headwall) and family zone (footwall)

25. Patient Room Prototype Project Iterative Cycles

26. Project Team Organization

28. New insight and experience Key Measure of Success: building build on knowledge accumulation from previous cycles while incorporating the collective bias, knowledge and experience of new team members Collective bias and knowledge

29. Key Measure of Success: sharing work with a set of shared values and language forming a common benchmark to build from

31. Key Measure of Success: balance strive for a balance between the larger body of knowledge and experience of real context

32. Focus Group/Participatory Session Clemson University, SC. PRPv2012 Design Criteria Therapeutic:stress reducing Safe:cleanable, promote safe practices Adaptable: universalchassis, variable elements Family accommodation: footwall elements Visual Harmony:minimize institutional clutter Faculty (2) Students (10) Healthcare Architects (3) Nursing/Clinical Staff (3) HC Manufacturer (1) Professors/Researchers (2)

36. Emergent Themes Refinement as progress Accommodate rather than integrate [technology] Push to the point of failure Value of interdisciplinary design Keeping the user at the centre

37. 2012 Prototype Room

38. 2012 Prototype Room

39. 2012 Prototype Room

40. Insights and Lessons Learned

41. Bridging and Sharing there was a common desire to further this interdisciplinary aspect to stretch beyond the boundaries of design disciplines to industry for support in sharing of research, resources and funding

42. Scales of Perspective Input from industrial design was seen as a valuable asset to this collaboration process. More integrated solutions to problems can result when addressed from many scales and perspectives.

43. Making it Real The PRPv2012 allowed for ideas and innovations to be pushed to the point of failure. While there was success in refinement of some elements, many issues were not resolved or failed to meet the scrutiny of the panel.

44. Patients and Familyas Stakeholders The final outcome reflected the goals of control and comfort for patients and family and the users were at the heart of the prototype design. However, future efforts should be made to include participation of patients and family in the overall design process.

45. Interdisciplinary Collaborative Process for Patient Room Design Benefits Challenges • Awareness of various scales of problem • Opportunity to see the problem from different perspectives • Allowed for a transfer of knowledge, skills and insight across disciplines • Fostered inclusive, integrated approach • Provided real-scale feedback in real time • Put the focus on the users experience • Time, communication and logistics between teams and disciplines • Inconsistency of skills and knowledge within teams

46. Conclusion Design for healthcare environments can benefit from an interdisciplinary design collaborative process in which building new knowledge, sharing values and striving toward a balance between knowledge and real life experience are the key measures of success.

47. Contributing Authors Tamara Phillips, M.Des. ARIDO, IDC,, Professor BAA Interior Design Algonquin College, Ottawa ON David Allison FAIA, FACHA, Professor/Director Graduate Studies in Architecture + Health Clemson University, Clemson SC Thomas Garvey, Ph.D., AssociateProfessor/Director School of Industrial Design Carleton University, Ottawa

48. Thank You Questions & Feedback