Healthcare Design - December 2015 - 52


In this "around-theclock" layout envisioned
by a group of nurses at
Parkland Hospital, care
delivery revolves around
the patient much like
the hands of a clock so
that the patient is at the
center of care delivery
at all times and care
delivery is efficient.

52

HCDmagazine.com 12.15

highly visible and accessible work area located at the
intersection of two main corridors. A station located
further offstage, however, was much less likely to be
used by caregivers. Furthermore, it appeared to the
data collectors that the out-of-the-way team stations
may have partially accounted for crowding in exam
rooms by patients waiting to be discharged, as they
may have simply been "out of sight, out of mind" for
team members using those offstage locations.

However, the process involved is encouraging. The
case studies reveal and prioritize the underlying problems and value-added design solutions that mattered
for the unique needs of each organization. They drill
deeper into assumptions of patient-centered design,
discovering relationships that inform and redefine
prevailing assumptions for improving patient satisfaction and building project goals. For example, research
shows that cozy-appearing patient rooms at Cleveland

The design research team next facilitated a series
of design charrettes with the clinics' nursing staff,
providing the opportunity to generate ideas for exam
rooms, workstations, and floorplans. After an initial review of the research findings, the participating nurses
dove into the charrette exercises and devised several
design solutions that were different from their current
clinics. One solution to enhance team-based care
was a "provider corral" with standing-height desks
that are off the main corridors and circle around an
interdisciplinary team station. With this concept, the
nurses hoped to keep tabs on physicians' whereabouts without being intrusive and to be closer to
their patients.
Several exam room layouts were also proposed,
such as an "around-the-clock" arrangement, literally
placing the patient at the center of care delivery within
the rooms, visible at all times to the caregiver. While
not all ideas for the exam rooms were adopted for the
new clinics, several were and others will be considered for future projects.
By performing participatory exercises guided by
the research findings, the nurses experienced a fresh
perspective on their current operations and design.
Halfway through one session, a nurse commented on
how her team was recreating their present condition
and how they needed to switch gears to something
more innovative. Such "aha" moments empowered
the nurses to consciously recognize their current challenges and be motivated to recommend novel design
concepts.

Clinic and offstage team stations at Parkland may
not be key drivers to improved HCAHPS scores or
patient experience, and may be of low priority or even
problematic.
Far from discouraging, though, the above provides
ample opportunity for designers and healthcare
organizations to target real value for design interventions. Efforts to collect more and the right type of
data may quantify links between design interventions,
patient satisfaction, return on investment, and other
outcomes. Evidence that supports investment in
expensive facilities should be evaluated with the same
high standards and rigor as other healthcare-related
decisions.
For administrators and caregivers, these examples
illustrate the need to be less reactive to the ticker tape
of HCAHPS scores and to support research initiatives
that can identify design solutions that will bring value.
Design researchers should also step up to collaborate
with frontline providers and leading healthcare quality
and satisfaction researchers to broaden the study of
outcomes that are most meaningful to the patients
and for clinical outcomes-research that may even
discover that a design intervention isn't the best bang
for the buck or part of the solution.
This concept shifts design research to the front end
of building project delivery, to target design goals that
provide the greatest return on investment before the
predesign phase. In the future, requests for proposals,
budgets, and schedules should have preliminary design research and integrated teaming as a given. HCD

Out of the gray and into light
The above case studies are from institutions undertaking design research to address unanswered
questions relevant to their needs. The findings aren't
currently available in peer-reviewed sources and
shouldn't be generalized.

Nicholas Watkins, PhD, is a director of research
with BBH Design. He can be reached at nwatkins@
bbh-design.com. Zishan Siddiqui, MD, is an assistant
professor and attending physician with the Department of Medicine of Johns Hopkins University. He can
be reached at zsiddiq1@jhmi.edu.


http://www.HCDmagazine.com

Table of Contents for the Digital Edition of Healthcare Design - December 2015

Healthcare Design - December 2015
Contents
HCDmagazine.com
Editorial
Show Talk
Monitor
The Center
The Inside Story
Hitting the Mark
View From the Top
Echoing the Landscape
Master Class
Research
Special Supplement: 2015 Remodel/Renovation Competition
Remodel/renovation Competition
Special Advertising Section: Remodel/Renovation Directory
Special Supplement: 2015 Product Innovation Awards
Product Innovation Awards
Special Advertising Section: Product Innovation Gallery
First Look
Healthcare Design - December 2015 - Healthcare Design - December 2015
Healthcare Design - December 2015 - Cover2
Healthcare Design - December 2015 - 1
Healthcare Design - December 2015 - Contents
Healthcare Design - December 2015 - 3
Healthcare Design - December 2015 - HCDmagazine.com
Healthcare Design - December 2015 - 5
Healthcare Design - December 2015 - Editorial
Healthcare Design - December 2015 - 7
Healthcare Design - December 2015 - Show Talk
Healthcare Design - December 2015 - 9
Healthcare Design - December 2015 - Monitor
Healthcare Design - December 2015 - 11
Healthcare Design - December 2015 - 12
Healthcare Design - December 2015 - 13
Healthcare Design - December 2015 - 14
Healthcare Design - December 2015 - 15
Healthcare Design - December 2015 - The Center
Healthcare Design - December 2015 - 17
Healthcare Design - December 2015 - The Inside Story
Healthcare Design - December 2015 - 19
Healthcare Design - December 2015 - 20
Healthcare Design - December 2015 - 21
Healthcare Design - December 2015 - 22
Healthcare Design - December 2015 - 23
Healthcare Design - December 2015 - 24
Healthcare Design - December 2015 - 25
Healthcare Design - December 2015 - Hitting the Mark
Healthcare Design - December 2015 - 27
Healthcare Design - December 2015 - 28
Healthcare Design - December 2015 - 29
Healthcare Design - December 2015 - 30
Healthcare Design - December 2015 - 31
Healthcare Design - December 2015 - View From the Top
Healthcare Design - December 2015 - 33
Healthcare Design - December 2015 - 34
Healthcare Design - December 2015 - 35
Healthcare Design - December 2015 - 36
Healthcare Design - December 2015 - 37
Healthcare Design - December 2015 - Echoing the Landscape
Healthcare Design - December 2015 - 39
Healthcare Design - December 2015 - 40
Healthcare Design - December 2015 - 41
Healthcare Design - December 2015 - 42
Healthcare Design - December 2015 - 43
Healthcare Design - December 2015 - Master Class
Healthcare Design - December 2015 - 45
Healthcare Design - December 2015 - 46
Healthcare Design - December 2015 - 47
Healthcare Design - December 2015 - 48
Healthcare Design - December 2015 - 49
Healthcare Design - December 2015 - Research
Healthcare Design - December 2015 - 51
Healthcare Design - December 2015 - 52
Healthcare Design - December 2015 - Special Supplement: 2015 Remodel/Renovation Competition
Healthcare Design - December 2015 - Remodel/renovation Competition
Healthcare Design - December 2015 - 55
Healthcare Design - December 2015 - 56
Healthcare Design - December 2015 - 57
Healthcare Design - December 2015 - 58
Healthcare Design - December 2015 - 59
Healthcare Design - December 2015 - 60
Healthcare Design - December 2015 - 61
Healthcare Design - December 2015 - 62
Healthcare Design - December 2015 - 63
Healthcare Design - December 2015 - Special Advertising Section: Remodel/Renovation Directory
Healthcare Design - December 2015 - 65
Healthcare Design - December 2015 - 66
Healthcare Design - December 2015 - 67
Healthcare Design - December 2015 - 68
Healthcare Design - December 2015 - 69
Healthcare Design - December 2015 - 70
Healthcare Design - December 2015 - 71
Healthcare Design - December 2015 - 72
Healthcare Design - December 2015 - 73
Healthcare Design - December 2015 - 74
Healthcare Design - December 2015 - Special Supplement: 2015 Product Innovation Awards
Healthcare Design - December 2015 - Product Innovation Awards
Healthcare Design - December 2015 - 77
Healthcare Design - December 2015 - 78
Healthcare Design - December 2015 - Special Advertising Section: Product Innovation Gallery
Healthcare Design - December 2015 - 80
Healthcare Design - December 2015 - 81
Healthcare Design - December 2015 - 82
Healthcare Design - December 2015 - 83
Healthcare Design - December 2015 - 84
Healthcare Design - December 2015 - 85
Healthcare Design - December 2015 - 86
Healthcare Design - December 2015 - 87
Healthcare Design - December 2015 - First Look
Healthcare Design - December 2015 - Cover3
Healthcare Design - December 2015 - Cover4
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