Graduate School Insights That Still Matter

1. Visibility is King (or Queen)

Both staff and patients surveyed were surprisingly tolerant of the design of their spaces until it came to the desire for visibility. For patients, that meant a pleasant view from their room of the outdoors…or at the very least a window. For staff, however, they wanted the opposite: a better view of the patients. This was most notable in infusion centers, where reactions are seen before they are heard.

Does a patient’s color look slightly off? Are they fidgeting more than normal? Cues like these allow staff to quickly assess the patient — but only if they can see them easily. And ironically, these two views sometimes conflict with each other. Facing a patient toward the window can mean their back is to the staff. Finding a way to marry the two ideas can mean better satisfaction for both. For instance, designing a room to orient patients in parallel with the windows means staff can still see their faces, but still allows the patient to see out the window – and potentially make amenities, such as TVs, easier to access.

This is a timeless goal in healthcare. Visibility allows staff to perform their jobs more effectively and deliver high-quality care while reducing one of the major stressors that can lead to burnout. And for patients, it can affect their experience of care and even improve their health outcomes.

2. Holistic IEQ Matters

Indoor Environmental Quality (IEQ) looks at everything that can impact the space contained within the walls of our buildings. Light, glare, temperature, sound, colors, scents, airborne particulates – it’s fascinating to discover what all is there after you spend time roaming them with IEQ sensors (or “robots,” as we used to call them in grad school…that’s what they looked like!). I think of IEQ in two ways: the more subjective parts (such as the visual and audial perception of the space) and the more easily measured components (such as decibels, light levels, and particulate counts). The two, though, must be accounted for hand in hand.

For instance, color palettes are hugely impactful to patient and staff mood, but their perception can be altered by the more “technical” parts of the space. Are they being designed in coordination? Or does a cool draft from a supply vent when a patient is sitting near cool blues and greys make them feel even colder? Does a busy design element combined with machine beeps and alarms create visual and acoustic clutter that elevates staff stress? Windows are great, but without appropriate daylight management, glare can cause issues for both patients and staff trying to use those spaces. All these considerations matter.

Spending the time to coordinate how patients and staff experience their space beyond the the basic function of the room, with all the various technical and design components, can go a long way in helping the space inspire hope and support whole-health goals.

3. Engagement Holds the Answers

Successful design depends on talking to everyone who uses the space. They can tell you what’s working and what isn’t. They know every workaround. It’s not difficult to glean areas for improvement — the key is simply asking thoughtful questions. In fact, it was more than questions; the nurses were very eager to participate and be heard. Chatting with them before patients arrived led to incredibly open dialogue and revealed so much.

I will never forget talking to a nursing staff and hearing how nervous it made them when they couldn’t see their patients’ faces directly when walking by, for fear of missing early warning signs. It’s a reminder to ask the “little” questions about their day-to-day interactions. Even today, when I ask staff where they go for respite, it’s often the same answer: a bathroom stall, despite the facility providing respite rooms. Probing deeper, we found that staff won’t use respite spaces off unit for fear of being too far from their patients. Or the rooms are being used for some other purpose.

By their nature, hospitals can be chaotic and messy and imperfect, the result of very smart, hard-working people adapting to do their jobs to the best of their abilities. As architects, our job is to be astute listeners and to transform what we hear into something special for everyone occupying these spaces. While my thesis was originally intended to connect the dots between things like poor lighting => eye strain => frequent headaches => staff sick days, the lesson I really learned was how listening and engaging can lead to better outcomes for all who use our buildings.

An unexpected outcome of Angela's thesis was a lesson in engagement that still holds true for every project she touches.

 

 

These philosophies in healthcare design may not have changed dramatically in the 10 years since I graduated, but our ability to execute better spaces for patients and staff has. New technologies and coordination mean we can be more targeted in how we design spaces to ensure that patients and staff don’t just come to hospitals to get better, but to thrive.

 

Angela Kolosky, AIA, ACHA, NCARB, LEED AP BD+C | Associate Principal, Healthcare Planning Market Leader

As a Healthcare Planner, Angela uses her experience, client data, and national benchmarks to create solutions where design can create positive outcomes for patients and staff. She brings this thinking to every project and has a passion for creating impactful, positive spaces for a critical and vulnerable population. Angela is an ACHA board-certified architect and was named one of Healthcare Design’s Rising Stars in 2020. Angela speaks and writes nationally on healthcare planning topics for Healthcare Design and Healthcare Facilities Symposium and is responsible for leading healthcare planning across both of DesignGroup's offices. She’s also a founding member of the Ohio Chapter of Women in Healthcare where she advocates for the advancement of women in healthcare outside of the field of architecture.