In the 1908s, Roger Ulrich discovered hospital patients recover faster and request less pain medication when they have views of nature. Spaulding Rehabilitation Hospital, built on a former brownfield in Charleston’s Navy Yard, and MGH’s Yawkey Outpatient Center, both in Boston, seem to be guided by this essential finding.
At Spaulding, patients recovering from traumatic injury are rejuvenated by good medical care, but also sunlight, garden terraces, and views of the surrounding Charles, Mystic, and Chelsea Rivers. The hospital landscape is a multi-functional therapeutic space where therapists aid patients in the air and sun. In a tour of the 132-bed facility at the 2017 Greenbuild, Jeffrey Keilman, an architect with Perkins + Will and Sean Sanger, ASLA, principal at landscape architecture firm Copley Wolff Design Group explained how the facility heals, but is also one of the most sustainable and resilient…
This is an example of how a small addition to a working environment, even a scary working environment, can make things a little less scary.
Last summer, Mary Beth Heffernan, who is an art professor at Occidental College, became obsessed with Ebola — particularly the images of the health care workers in those protective suits, or PPE as they’re called for short.
“They looked completely menacing,” says Heffernan. “I mean they really made people look almost like storm troopers. I imagined what would it be like to be a patient? To not see a person’s face for days on end?”
And what really got Heffernan is that as far as she could tell, there was an easy fix.
“I found myself almost saying out loud: ‘Why don’t they put photos on the outside of the PPE? Why don’t they just put photos on?'”
Here was her idea: Snap a photo of the health worker with a big smile on their face. Hook up the camera to a portable printer and print out a stack of copies on large stickers. Then every time the worker puts on a protective suit they can slap one of their pictures on their chest, and patients can get a sense of the warm, friendly human underneath the suit.
I agree with one of the commenters from the original story I would have liked to have heard a little bit more from the patients’ perspective, since the nurses and doctors all commented on its benefits. But overall I think this is great and wish more people would be willing to take risks like this to help, even if it doesn’t “change the world” it made the world, and in this case a scary, grueling, impoverished world, a little better.
We know children tend to be wiggly, but we’ve also seen them sit stone still when they are engaged in a good book or toy or enraptured by a movie. A hospital in the UK is tapping into that enraptured engaged stillness.
Many adults find the procedure of having a brain scan, which involves having to lie still for an hour or more while images are analysed, an unsettling experience.The process is no less daunting for young children, who are usually given a general anaesthetic when they have the procedure.
However, a pilot scheme at University College Hospital in London is helping young people have a scan without being sedated, by teaching them about it through play.
One hospital has a goat on their property that patients can see. One way to keep things engaging and fun and not feel like “a hospital.” (Photo credit: Jen R)
It’s not as silly as it sounds; in fact it’s genius!
Hospitals could improve patients’ quality of life, satisfaction and even health outcomes if they simply model adult hospitals after the ones designed for children, according to an opinion piece written by a fourth-year medical student in this week’s Journal of the American Medical Association.
Mark A. Attiah, who attends Perelman School of Medicine at the University of Pennsylvania in Philadelphia, writes in the piece, “Treat Me Like a Child,” that adult hospitals should take a page from pediatric facilities by creating surroundings that distract and reduce stress and making clinical practices more patient- and family-oriented rather than more convenient for caretakers.
Attiah was inspired to write the opinion piece after encounters with two pediatric patients during a rotation and another who transitioned into an adult hospital, according to an announcement about the editorial. The children’s hospital was bright, had longer visiting hours and allowed families to stay at the child’s bedside throughout the night. In addition, pediatric patients enjoyed the distractions of group activities, arts and crafts, and concerts. “If I ever get sick, I’d want to be taken here,” he writes.
Kid’s hospitals keep stuff light, upbeat, and optimistic. which is exactly what we need to get healthier, and want to go back to a particular hospital for our next ailment, since most hospitals care about that sort of thing.
Hospitals and medical device makers are coming to the conclusion that making medical spaces and medical practices more user-friendly and less scary leads to speedier recoveries, shorter hospital stays, and overall just good medicine.
One way to do that is to make the devices less scary, a la a Medi-Teddy. 🙂
The product is called Teddy the Guardian, a plushie installed with sensors that measure heart rate, blood pressure, oxygen levels, and temperature, and then relay that data via Bluetooth to a parent’s phone. The sensors are scattered around the bear’s body; pressing a finger to the bear’s paw, for instance, takes heart rate and oxygen levels.
The idea behind disguising medical tech as a lovable toy is to provide parents and pediatricians more accurate, consistent data points. When a child is stressed out about going to the doctor, his or her vital signs will be skewed. Taking data points when the child is in a neutral emotional state can give doctors a wealth of good information to compare against when something is wrong.
Of course, the bear is just as much a tool for keeping parents attuned to their child’s general well-being as it is a medical device. IDerma co-founder Josipa Majić said that for busy parents who don’t have as much time to connect with their kids, the data can show when their child’s day has been particularly stressful or problematic.
Later versions of Teddy will be equipped with sensors specific to different medical conditions, Majić said. Blood sugar level measurements for diabetic children, for instance.
This is such a great idea to keep kids calm and cooperative during boring and possibly uncomfortable medical procedures. Heck, I know a lot of adults that would probably like to use this.
I’ve previously written about making MRI machines less scary for kids by making them space or aquatic themed, and how a natural view out of a hospital window is correlated with speedier recoveries, but what other things have you seen hospitals do to make it more patient-friendly? Let me know in the comments below.
What does it mean to design with a person's wellness in mind? One architect has an idea. Image via Wikipedia
Great blog post from The Patron Saint of Architecture about what it means for her to be an architect and build and design things for people’s overall health and wellness:
As architects, we seek to inspire those who move through the environments we create. It’s also our job to understand how the space will be used and create elements that support that use. The last leg of the stool, a part we often overlook, is the need to make buildings that support wellness. Even architects who design healthcare buildings often forget about this one as they work to meet many other challenges related to budget, program, operational and code requirements. Maybe it’s because wellness is such a slippery term. Much like the term “green,” “wellness” is often bandied about, a buzzword that makes some aspect of a product, design or organization sound like it’s good for us. So how do we know if it really is- much less translate that into design elements? I have been thinking about this issue for a while and even found an interesting website devoted to defining wellness complete with helpful questionnaires.
I’ve come to the conclusion that true wellness is multidimensional and positively impacts our physical, mental and social state of being. With that in mind, I have also observed that, as a profession, we kind of, sort of, dip our toe in the waters of designing for wellness. We embrace sustainable building standards, evidence-based design, lean design, even socially conscious strategies. However, these are just quantifiers. Building blocks of the wellness leg of the architecture stool, but not enough as stand-alones. True architecture of wellness must incorporate all of these measures, but spring from a much deeper intent.
Read her recommendations for building spaces that promote wellness at her blog post: architecture of wellness
Treating the whole patient, including mind and body, is becoming "cool" again. Image via Wikipedia
The faculty at University of Washington is pretty progressive in a lot of its research surrounding neuroscience and the mind, especially when it comes to Mental Health Care:
Researchers and professors at the UW, such as Dr. Jürgen Unützer, are driving innovative ways to improve access to high quality mental health care delivered in a manner that treats the whole person. Their efforts are focused on health care models that integrate behavioral health services into the primary care clinic and other heath care arenas, where the patients already receive care and have established provider relationships. Known as collaborative or integrated care, these models put the patient at the center of a health team – including their physician, a care coordinator and a psychiatric consultant – that collaborates on a patient’s treatment plan.
Unützer says he knew his research into new models of mental heath care delivery was on the right track when a patient described feeling like a tennis ball. This patient had a combination of health problems associated with diabetes along with alcohol problems and depression. As is common in the current health care system, the patient was being bounced around to different specialists to treat his individual symptoms. Dr. Unützer was concerned that patients like this, with a combination of behavioral health and medical conditions, were falling through the cracks and not receiving care that treats the whole person.
“The patient expects that the various providers are all talking to each other, but that is often not the case,” he says. “Who’s connecting the dots? Patients expect their care providers to sync up and know what’s going on with all of their conditions.”
Understanding environmental impacts like vibration can have a positive affect on patient recovery. Image via Wikipedia
I happened upon this tweet today:
@AIASeattle Did you know floor vibrations can affect patient outcomes?
Um, why no, no I didn’t. So I dug around a little bit and affirmed that, in fact, structural vibrations can in fact have an impact on patient recovery:
“Noticeable vibration leads many to fear structural collapse, although such fear is unwarranted in most cases because of the small displacements and stresses produced. Noticeable vibration is nevertheless undesirable in many occupancies because of its adverse psychological effect…It has been observed that continuous vertical floor oscillation becomes distinctly perceptible to people when peak acceleration reaches approximately 0.5 per cent g, where g is the acceleration due to gravity. People in residential, office and school occupancies do not like to feel distinct continuous vibration…
Continuous vibrations, defined here as vibrations lasting more than about 10 cycles, can arise from the periodic forces of machinery, from certain human activities such as dancing, or from vehicle traffic nearby. They can be considerably amplified when the periodic forces causing vibration are synchronized with a natural frequency of the structure – a phenomenon called resonance.”
Not only is shaking a problem, but there is also more and more research coming out that discusses the effects of the overall environment on a care-givers’ professional performance as well as a patient’s healing process:
“In a review of more than 600 articles, researchers found that there was a link between the physical environment (i.e., single-bed or multiple-bed patient rooms) and patient (e.g., fewer adverse events and better health care quality) and staff outcomes (e.g., reduced stress and fatigue and increased effectiveness in delivering care).
“There have been five other significant reviews of the literature relating to the physical environment and patient outcomes. Nelson and colleagues10 identified the need to reduce noise pollution and enhance factors that can shorten a patient’s length of stay (e.g., natural lighting, care in new/remodeled units, and access to music and views of nature); according to their study, patients can benefit from the skillful utilization of music and artwork. Ulrich and colleagues7 found research that demonstrated that the design of a hospital can significantly improve patient safety by decreasing health care associated infections and medical errors. They also found that facility design can have a direct impact on patient and staff satisfaction, a patient’s stress experience, and organization performance metrics. Three other reviews found that hospital design, particularly when single-bed rooms are employed, can enhance patient safety and create environments that are healthier for patients, families, and staff by preventing injury from falls, infections, and medical errors; minimizing environmental stressors associated with noise and inefficient room and unit layout; and using nature, color, light, and sound to control potential stressors.11–13
The Seattle branch of the AIA (that’s the American Institute of Architects) has hosting a talk specifically about how to design better, less drum-like floors, but is a nice indicator of how serious architects, designers, and other groups are taking this need to design and create better care facilities:
“Vibration criteria for hospital floors have become more stringent in the 2010 Edition of the Guidelines for the Design and Construction of Health Care Facilities (the FGI Guidelines). These new vibration requirements will increase structural construction costs in Healthcare construction. Understanding vibrations sources, criteria and benefits of different structural and non-structural approaches will provide healthcare designers with effective strategies to mitigate vibration issues and minimize cost impacts of the new requirements.”
For those who live in Seattle, there is a class on December 14th, 2011.
I’ve found some great examples of designing better medical facilities, but I’d love to hear about other projects you’ve seen, experienced, or even read about. Leave a comment with your thoughts.
Old hospital style: not very healing. Image by reallyboring via Flickr
Getting sick and not feeling well is scary, so it’s good to see hospitals becoming more in-tune to the whole user experience. Here is one such case, with a new hospital opening up in Enumclaw, WA.
“The innovative designs at Swedish/Issaquah and St. Elizabeth Hospital in Enumclaw, like other new hospitals, include big windows that let in natural light, rooms with pullout couches for overnight visitors, and even hospital beds that ask patients questions in different languages…
…The design highlights food and spa and wellness products. The hospital opens into a five-story atrium surrounded by a mall, and its lobby includes a fireplace and a destination restaurant with a wood-burning oven.
The changes are driven in part by competition for patients with good insurance, the Seattle Times reported, Outpatient services, giving prime space to medical offices and centers that provide chemotherapy and radiology were emphasized.
The new St. Elizabeth in Enumclaw opened in February with beds programmed to provide information and to ask questions in 20 languages. For example, a bed might tell a patient in Spanish: “You have a tube in your throat to help you breathe.” The realization that critically ill patients may not speak English prompted the purchase.
St. Elizabeth and the new $365 million Swedish campus are part of a U.S. hospital building boom in suburbs and fast-growing communities that is now evident in urban areas as well.”
More research is also finding that people who have views of nature heal faster when they’re sick or recovering from surgery, so bring on the light, bring on the green!
An interesting social experiment as well as clinical study, from the Wall Street Journal; while the study itself, which looked at using Lithium to treat ASL (Lou Gehrigs disease) found the treatment didn’t work, they DID find that using social networks to recruit people for the study turned out to be incredibly effective.
The new study, published online in the journal Nature Biotechnology, represents an early example of how social networking could play a role in clinical trials, an area of medical science with strict procedures that many would consider especially difficult to apply in the online world.
“The approach has tremendous potential,” said Lee Hartwell, a Nobel Prize-winning scientist now at Arizona State University, and formerly president of the Fred Hutchinson Cancer Research Center. Standard clinical trials play a central role in the research enterprise of both of those institutions.
Dr. Hartwell, who wasn’t involved in the study, said social-network trials aren’t likely to replace conventional randomized, double-blinded, placebo-controlled trials, the gold-standard for generating medical evidence. But such trials have become so complicated and time-consuming that new models are needed, he said.
I think this is a great example of the power of communities, whether they exist online or are geographically-based, or both. People with illnesses and their families need support networks, which they find online. I think this is great that doctors and clinicians are also able to tap into these communities and ask for their input and insight into the treatment. Not only is it a great instant resource for the doctors, it loops the patients back into the whole treatment process.
Spaulding Rehabilitation Hospital / Steinkamp Photography 
Mental Flowers 