In this episode of "Laying the Foundation," our architect Angela discusses the art and science of designing healthcare spaces that promote healing and enhance the patient experience. From creating calming environments to optimizing the layout for efficiency, Angela shares some of the key design elements that are crucial for healthcare spaces. Whether you're a healthcare provider, a patient, or simply interested in the intersection of architecture and healthcare, this episode is not to be missed. Tune in to learn more about how CMBA Architects is redefining healthcare design.
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Episode Transcript
Skyler: Welcome to another episode of Laying the Foundation.
Skyler: Welcome back everybody to Laying the Foundations. I'm here with Brian of course, and then Angela is here with us as well.
Angela: Hello.
Skyler: Angela's going to be talking to us a little bit about the healthcare world, and some of the key elements towards healthcare and design within the healthcare as far as architecture goes. So I'm going to let you just kind of jump right into it, Angela.
I mean, not to put you on the spot or anything, but I know you're the expert here. And just kind of some of the key components to great architecture spaces within the world of healthcare.
Angela: Wonderful. Thank you, Skyler.
Skyler: Yeah.
Angela: And Brian, feel free to jump in.
Brian: You bet.
Angela: When you feel like there's some burning desire you have. But I think when we talk about designing healthcare spaces, and wanting to make spaces that are patient-forward, so creating spaces that have the patient in mind, I think whatever elements that we can do to bring down that anxiety level, and help them feel at home at a time that can be really stressful, is the right choice.
For me, it's always the right choice to give patients the opportunity to feel more at-home in their space. Oftentimes, that is providing spaces for a family member to be with them, if at all possible. That it went away a little bit during Covid-time, but anything we can do to encourage that social support from their family members is going to be a great option for them.
Especially when emotions are high, they may not be listening to all the instructions that they need, and to have that support system later on when they leave the hospital is going to be key.
Other things that we can do are bring the natural environment in. Great large windows, natural lighting. This is a great design element inside and outside of healthcare. But anything to bring in natural colors and lighting into their space is going to really help just make that a calming environment for them, and bring that stress level down.
As design changes and as our technology changes around us, technology has a place in healthcare. I'm not a super-gadgety person, but rooms that have customizable features are becoming popular in healthcare. It can be a simple display board where you can put the patient's name, put their nurse's name, put why they might be visiting the hospital for that particular reason. Something to customize the space.
Some of our rooms are offering the ability to change lighting or play music, connect with a tablet, change their TV stations. Those technology items that we're seeing in smart homes have a place in our patient rooms as well, the ability to customize those rooms for their stay.
Skyler: Wow, okay. Very cool. Yeah, being able to really individualize a person's-
Angela: Absolutely.
Skyler: Because like you said, it's a stressful time. It's a stressful environment. I mean, you're hearing beepings and who knows what, people running back and forth outside of your room. To be able to have something that feels safe, and secure, and reassuring is so key. And being able to personalize that would definitely come into play with that. That makes sense.
Angela: And you brought up a couple really great points in your comment too, Skyler, about the privacy aspect. Making sure that the sounds that we're hearing within our room, and the conversations that we're having within our space can't be heard outside of the space. So keeping our noises inside of our room, and keeping the outside environment outside where it belongs.
Skyler: Yeah, that makes a lot of sense.
Angela: That really adds to that feeling of safety, and security, and privacy that we want our patient to experience in our spaces.
Brian: I am just going to jump in a second. You were talking about technology, and how it can enhance the patient experience. But it also can enhance the staff experience as well.
Angela: Absolutely.
Brian: From patient tracking, that we can make sure that the staff is aware of where that patient is, possibly in a procedure, step-by-step. If they're in the OR first, but then also into recovery, and then into their pre and postop room, possibly.
It's a mechanism that allows visibility on that process. And I guess that can also translate into the patients, and to their family member sitting in the waiting room that are wondering, is mom out of surgery yet or not? What's going on? It kind of helps, again, bring that calmness to the situation if they understand where their loved one is in that process.
Angela: Absolutely, and oftentimes when the CMBA team is designing for healthcare we talk about our patients, we talk about our providers or our staff, and we talk about our visitors and our family members. And Brian touched on all of those user groups with that design element. And that is something that we want to be aware of when we're designing our spaces, is how those three groups of people are going to be interacting.
Especially during a time when staffing is really critical, our nurses are asked to do lots of tasks with fewer people and those technology aspects can help them track the patient without taking as many steps.
Skyler: Definitely.
Angela: Truly, some of the planning that we do comes down to, how can we minimize the number of trips, or the number of steps that they take to go visit someone?
Skyler: Absolutely. And then you also mentioned family and people visiting the area. What about things that we're kind of putting together within the designs that relate to maybe their accessibility, or something along those lines perhaps?
Angela: So accessibility in terms of mobility issues is something that we always want to keep in mind within our facilities. Nice, wide spaces for our wheelchairs to turn around.
Healthcare, the amount of maneuvering space is always a really critical conversation, especially as we have our different beds moving through the spaces, and we're pushing patients in different spaces. So that's definitely something we want to be aware of. As well as having different seating options. Offering high tables or low tables, or the ability to move chairs around and customize a visiting space is really important too.
Skyler: Absolutely.
You had mentioned the smart rooms before, and the area within integrating smart devices into the technology within the room. I could definitely see how that would be really convenient for, like you said, lack of mobility, somebody that's kind of stuck within the hospital bed, or whatever the case, or wheelchair. Not having as much access to go turn something on or turn something off. So I could definitely see how that would really be a key aspect to all of the space in general, and all the assets within the space potentially that run on electricity, of course.
Angela: Right, and really just offering useful distractions.
Skyler: Oh, sure.
Angela: Anything that we can do to help take people's mind off the reason that they may be there. Anything that can distract them, be it music, or the ability to customize the lighting, or change what's going on the TV, or stream something if it's a tablet. Something that can make that patient experience all the more pleasant is going to be helpful.
Skyler: Absolutely.
Brian: Yeah. And that display typically has been a whiteboard. And on that whiteboard you'll see a scale of pain basically. So they've got the faces of different levels of pain, and the nurse will come in and ask the patient ... Because I've sat in those rooms with my parents fairly recently, and they ask, how are you feeling today? Are there any pain? And they'll note that on there.
Well, that can also, I mean it's a static display if it's a whiteboard. Well that information is also being put into the computer, so why can't they talk to one another? Why couldn't that be displayed electronically, not only in the patient record, but physically within the room, basically also back at the nurses station, so that people can instantly know how that patient is doing without going step, by step, by step in essence. Is there some technology that can increase access to that information for the caregivers, potentially?
Angela: And allow you to track that, and see how they're progressing during their stay. Or the different metrics that you're using improving their stay, or improving their condition. I think that's really critical.
Brian: The shift changes that happen within a healthcare facility. The nurses change every eight hours, eight of 10 hours. And what's the name? Do they write their name on the board or not? Sometimes they forget to do that. They're busy with other things, totally understand.
But if a family member comes in and they see a nurse come in and they're not sure what to call them, well, if I can see their name, it's pretty easy. And it's updated as soon as they come on shift from a technology that helps.
Angela: Right. It seems like a really simple thing, but there's nothing more welcoming than having someone call you by name, or having someone recognize you in that way. And it's just one small thing that the design of the space can do to improve that situation.
Skyler: One of the things that I am ... I have the notes that you gave me before, that I saw on here that kind of caught my eye was the intuitive way-finding. And as somebody within marketing and design, that was something that we kind of discussed within the classes that I've taken in the past, and looked into my career, of being able to create signage that accurately leads somebody through a space that might be a bit complicated. And I would argue that hospitals are one of the most complicated spaces to try to navigate in.
You've got multiple floors with different service areas in each floor that all offer different things. The person you might be looking for, or the facility that you might be looking for, I mean, it can be hard to find because it's such a big space. So what are we doing as far as, like you mentioned the intuitive way-finding to really help minimize those kind of things.
Angela: Well, I think there needs to be a balance between offering no signage and too much signage. And a lot of times it's simple visual cues, like certain colors are going to indicate certain departments.
I think when there's too many posters or too many signs it just becomes noise, and then you don't know what to pay attention to. A lot of the facilities we work with have multiple additions or changes, and so helping to give those visual cues of what may have changed since someone was at the facility.
For some, it's a flooring, or coloring on the wall, or different textures that are going on with the wall that might indicate this is a continuation of your path, and this is where you want to go. It can be very simple design decisions that help lead people through a space.
Skyler: Very cool. Very cool. Using not just the traditional, here's a square sign and it's telling you, pointing in this direction or this direction, like you said, use the floor, use the walls that are around or continuations of color designs or textures as opposed to something that's just really go this way or go this way because especially with language barrier. That one's a really big one as far as that goes. You want something that anyone can look at and ideally understand where it is that they're supposed to go to versus putting everything in English and then only English speaking people are knowing where to go throughout your hospital facility.
Angela: And some of the facilities we work with will have registration desks or kind of checkpoints along the way of people to guide them, but for some they don't have the space or that maybe isn't the right choice for them, and so we want to offer them some options that are somewhat more intuitive.
Skyler: Absolutely. I mean, as somebody that was in one recently to go get pictures of a space, I kind of got a little bit lost because I had to go through a different exit that didn't have a front desk immediately accessible so someone could tell me where to go. So totally relate to that.
Brian: I've seen, and this is a basic way of doing it, but they'll put a pattern in the carpet that lead you to a department. Let's say it's blue for imaging and there's a sign at the entryway and follow the blue line to get you to the imaging department for your x-ray, your CT or lab's a different color. And it's a real basic way of doing it. It's probably not a preferred way of doing it, but that is one way in which facilities have introduced the color to get you to follow basically.
Because most people, and I would probably challenge all of us now that I'm going to say this, look at our feet when we walk, right? We look downward. We don't typically look up, we don't really notice the signs that are hanging from the ceiling above us. We don't even notice the ceilings for the most part, unless you're in this grand space. Sometimes you'll look up, but for the most part you're looking ahead or you're looking down. So how do we create lineage wayfinding that helps stay within your vision, your cone of vision without potentially causing issues for those that can't look up? Maybe there's a back issue maybe, they're an elderly. There's a lot of different factors, but if we can keep it within a certain margin of distance, height vertically, most people are going to see that. We have to think about those things too.
Angela: And our signage also needs to be thoughtful on the exterior of our building as well. As you mentioned, buildings with multiple entrances, buildings that maybe could benefit from more lighting or improved lighting on their signage, especially our emergency departments. You're trying to find them during a very stressful time and is that intuitive to find that location? So signage is incredibly important when we talk about maneuvering ourself inside and outside of a building.
Skyler: Absolutely. So one of the things that you've mentioned on the notes that I have too is the patient journey and all the aspects that kind of stem down from that, which obviously there's a lot. I mean, a whole hospital facility has a lot of different areas and each patient is going to be different, but what are those different aspects that we're looking to sort of target within the patient's journey that we haven't maybe already talked about necessarily that we want to really focus on when we're designing spaces or we're adjusting the design for spaces?
Angela: So I think a lot of times, at least when we begin a project, it's really critical to think about the different nodes or the different checkpoints in the building that the patient may be asked to go and model or mock through the walk of a patient. And so thinking, okay, we're going to start at the emergency department, they're going to start at this desk.
They may be asked to go to lab and map out some journeys that a patient may have while using the building and understand where they might falter along the way or where they might have benefited from some of the wayfinding things. How is that patient going to be attended to? Will they be by themselves? Will they have a staff person? Oftentimes we talk about back of house areas where it's staff only or areas where the patient is always going to be attended to with a staff person versus areas where you're going to ask them to be circulating by themselves.
And so understanding where those zones live and how best to move them from one place to the other efficiently, safely, without causing too much confusion and also being sensitive to their privacy, knowing that their neighbor next door, they may not want them to know why they're at the hospital for a specific reason. And so being conscious of areas where there may be doors that are opaque or doors where you can close off an access area to provide that privacy.
Skyler: Okay, gotcha.
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Skyler: And then another point that you made on here was so you have the vehicle and pedestrian traffic. And I know I actually heard kind of an interesting point to this earlier today, we had a meeting and Brian, I think you were there for the goodwill industry's project, and they talked about Canopy for just the simple purpose of let's say it's raining and we need to get one of these people might be in a wheelchair and sometimes the vehicles that have the wheelchair installations take a while to get a person out of the car.
And so if it's raining for instance, you're getting a ton of rain coming down on this person while they're trying to exit the vehicle and having this canopy over top is going to keep them from doing that. So you brought up the vehicle in pedestrian traffic and what are there other really interesting aspects that we try to design spaces ideally for that coming in from the vehicle and then getting into the hospital or the parking situation or whatever the case I guess.
Angela: So our hospitals tend to have either no one there or everyone there, and so we need to account for all of those situations at the same time. And so to your point about canopies, it's very common that the person visitor at the hospital is going to get dropped off in a safe space. Their person dropping them off is going to park, sometimes have to be further away. And so another way to provide that comfort is to allow a safe space for them to be safely off to the side.
Our campuses, our healthcare campuses tend to have lots of different parking areas, and so we want to be really cognizant of who's crossing where, does the staff maybe park further away to allow the patients a better experience possibly, but then how are we allowing safe paths for them to walk from that further away staff parking area to the front door or to their staff door? And so just being really conscious of looking at the campus as a whole, looking at all of the parking, moving in conjunction with our signage and making sure that all of those things really mesh really beautifully together.
Again, going back to our signage, making sure that people know where the appropriate spot for them to be if they're parked on one side of the building, but then have to walk internally to the opposite side of the building. Could signage have made that a better experience for them?
Skyler: You mentioned this before about getting the staff safely from where and the patients as well safely from parking to interior, and one of the notes that you made on here was about the security of a hospital, which obviously is key. We recently did an episode talking about security within schools and making sure that you have a safe environment. What sort of ways can we, or what are some of the key elements to designing hospitals when it comes to security or healthcare spaces in general?
Angela: Well, I would say there are probably very similar conversations in healthcare that are going on in the education space about checkpoints, about who is able to come in at what door and how do we certify that they're the person who should be there. That could be a series of locked doors that could be a series of, for lack of a better term, a ring doorbell where there's someone at the camera end able to see that person visually.
Each facility, that's a very personalized conversation, and I would say we haven't come up on one exact right answer that's one size fits all right. Some of our rural communities feel that they need less security. Some of our more urban facilities are wanting more security.
Some of that could be the type of glass that we're using, safety glass, lots of our reception areas both as a reaction to Covid having those temporary panels, but also for safety reasons. We're seeing them install safety glass or bulletproof blazing that protects them from the outside or at least gives them this sense of security that they're separated.
Emergency departments are a area that we typically see more security due to their hours due to them being open all times of day with limited staffing at nighttime and the types of people that would come at all times of day just to allow them to have that sense of security.
Brian: Just to tie in with that emergency side, there's some amount of mental health issues that are being more of an issue on a daily basis in emergency departments. There's also domestic violence things that we need to keep in mind. For that security piece, protection from for the staff one, but potentially for patients because there could be someone following them to the emergency department that we need to protect that patient from as well.
So it's interesting in that situation, there's definitely a discussion going on of societal issues in outside of just the hospital walls, we'll say what's happening in the culture, in the society, in that community that need to be taken into account as we design those entry and exit points. But specifically the emergency departments because they're the frontline for sure, after hours.
Angela: Yeah, absolutely. And you touched on behavioral health and that has been an incredibly sensitive and important topic, especially in our emergency rooms of, like you said, that's the frontline. That's where a lot of those patients are presenting and designing spaces that are flexible so they can safely accommodate a patient that would need that type of safety, but also can be used for other patients for a more typical or standard room and not feel uncomfortable, have all patients have a comfortable experience.
Skyler: Right. One of the things that you noted as well was the possibility of an influx of patients in handling an influx of patients. Say it's like 4th of July is probably one of the most popular times for a hospital to be just really bustling with a ton of people that may have suffered some in injuries due to a variety of different reasons during that holiday.
So what sort of strategies are we using or what can be implemented to handle situations where a hospital might, like you said, there's either everyone's there or no one's there. So how do we regulate that with the space?
Angela: So some of that is the flexibility of our rooms, so having certain areas be able to accommodate a variety of needs. Brian touched on this beautifully when we were talking about technology of allowing the staff to fewer staff members to check in on lots of patients and how we can facilitate that with different cameras or different monitoring, all of those types of things.
Telehealth has become really critical for a lot of our rural hospitals, and so a lot of those rooms are set up with video equipment for monitoring in that way and allowing our hospitals to offer a variety of services and specialties that they could maybe not have the bed population to attract. That doesn't speak directly to your question of being bustling, but really offering flexibility in our spaces I think is the best way to approach that.
Brian: And just to think about that a little bit differently. So rural communities, you can have a mass casualty event eventually, and that doesn't need to be a school shooting, something in a true extreme negative situation. But we have chemical issues in rural communities, especially in the farming communities. So you might have a spill of some sort that a few people have gotten pneumonia or anhydrous... cheese, I can't think of it right now. Ammonia, excuse me, on them potentially, or different types of chemicals. I'm not a chemist.
Skyler: No. Yeah.
Brian: Anhydrous ammonia. That's what I was trying to say. So are there ways in which we can receive those multiple patients at one time in the emergency department taking into account that they may not be able to come into the hospital right away? Are there some soft spaces that we can create through some temporary enclosures outside to decontaminate that situation, then allow them to enter into the facility in a more controlled, a more non-hazardous way. We'll say it that way.
So are there ways in which we can set up our spaces around the hospital to provide areas that we can set up temporary facilities to allow for that mass influx of people potentially. Right now, if you think about it, there was a massive train derailment in Ohio, and I'm sure there was many people that had to be treated because of that scenario or potential out of that incident.
The intake process at the hospital, what was that process? We have to think about emergency preparedness for these facilities because we don't know, or a tornado comes through and there's a mass issue there, especially in the Midwest, that's where we live. So there's a lot of scenarios that we have to play through, especially on that high influx of patients potentially at an emergency department.
Skyler: I mean, at least all the questions, the direct questions I guess, and topics, but if there's anything else that you want to add in there, Angela, that you can think of specifically that as far as the healthcare goes.
Angela: How much time do we have?
Skyler: I guess-
Brian: I was going to ask you your thoughts, hospitals are a staple of our rural communities. What does a hospital mean to our smaller communities in Iowa, Nebraska, South Dakota?
Angela: So I think time and time again, they have become the hub, the heart of that community. They are the economic driver in ways that I don't even think we can quantify our wrap our minds around. I think we talk about them as being our major employers, but also a sense of vitality. I think communities that have hospitals really pride themself on that level of care, and we see it in the communities that we work in across all of those states. It's the constant that we hear about. They want to care for their community, but then it's also their source of outreach to the outside surrounding communities and how they can bridge that gap to surrounding areas.
Brian: You can definitely see their impact in the communities that they serve, that they truly... it's their friends, it's their family that come to the hospital that see them. So they care. And I know people in urban scenarios or urban situations care for their patients. That's not what I'm saying, but it's just a little different. It's a level of care because they are related, essentially. They do see them at church on Sunday morning. They do. There's just a different level of commitment I think, potentially there.
Skyler: Well, thank you so much, Angela, for sitting down with us.
Angela: Thank you.
Skyler: Yeah, absolutely.
Brian: Yeah, thanks Angela.
Skyler: Giving us some insight in the world of healthcare architecture and design and getting to see a little bit more of the more inside discussion of that that we don't necessarily get to see when we're just, I got hurt and I need to go to the hospital and they're pushing me through on a wheelchair and giving me a surgery or something like that. There's so much more today, the whole process for sure. So awesome. Thank you, again.
This has been another episode of Laying the Foundation. Be sure to follow us wherever it' is that you listen to podcasts, whether that be Spotify, iTunes, Google Podcasts, or anywhere else you can find us there. Of course, check us out on social media and you can see the amazing projects that we've worked on or are working on, whether that be Facebook, Twitter, Instagram, LinkedIn. You can find us on all of those. And then of course, be sure to check us out on cmbaarchitects.com. That's our website. And if you happen to be an architecture student or maybe a recent graduate or architecture design professional that's seeking a employment opportunity or internship, be sure to also head over to our website's career section and take a look at that and hopefully send us an application because we'd love to get in touch with you. Once again, this has been Laying The Foundation.
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May 4, 2023