Design on My Mind

Psychology as design tool.

Patient-Centered Hospital Design = People + Place

A user's design psychology eye-view.

Courtyard in Massachusetts Hospital's New Lunder Building
Ever hear of Cushing’s Disease? Neither had I until my 23 year old daughter was diagnosed with this rare condition. Luckily it can be treated by removing a (usually) benign tumor from the pituitary gland at the base of the brain. But all I had to hear was “tumor,” and this mother became a pit bull in search of a bona fide, world-class Cushing’s team able to cure my dear ‘pup.’ I found that team at Boston’s Massachusetts General Hospital.

Since a loved one’s operation is a scary prospect, I climbed into my Ph.D. gown, put on my Environmental Psychology cap, and coped by keeping “design (rather than blood) on my mind.” Ah yes: ‘Participant observation.’ Why not chronicle and thereby objectify my daughter’s (patient) and my (caregiver) journey through the healthcare world as we lived it, especially given my current work in healthcare Design Psychology? (1)

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Anthropologist Edward Hall first stressed that the environment, a ‘hidden dimension,” has an important impact upon us. (2) Before setting foot on any hospital steps, however, I had to survive the invisible yet omnipotent landscape of the healthcare insurance bureaucracy. Navigating it certainly distracted me – more like drove me to distraction. Sound familiar? No details necessary? (Think smoke rising from the heads of already stressed patients and caregivers.)

An internet, word-of-mouth hospital search later, I forgot about any red tape or fire extinguisher when every Mass General administrator, doctor, nurse and volunteer streamlined my daughter’s appointment-registration-pre-admission process. My first conclusion was that having your organizational act together from the first point of contact is a must when it comes to the intangible aspects of patient-centered healthcare environments.(3)

Soon, on a beautiful day in May, we arrived in Boston, rode right along the river, through historic streets, to the hospital garage. Not only were the streets and the garage easy to access by car, the garage was less than 500 feet from the hospital’s main entrance. Mass General maps and floor plans (previously sent to us) as well as its compact campus (4) and clear signage made it hard to get lost at the (breathe in) moment of arrival when patient/caregiver anxiety rises.

A mix of restaurants, supermarkets, cafes, a metro stop and even the hospital’s new museum (5), suggested that there were walkable options right there when we wanted a fresh-air respite. “Accessibility and community context count, since patients’ healthcare place experience extends well beyond the hospital four walls,” I thought. I wondered, however, if medical, financial, real estate, design, etc. professionals often over-focus on their own services and products rather than relying on a strong visioning process that prevents the “big picture”-- the community setting, from getting lost.

Upon entering Mass General’s main lobby and making our way to the Wang Building’s doctors’ offices, the lab and then the ground floor cafeteria, I was surprised that things didn’t look more up-to-date. After all, the way a hospital looks, sounds, smells, or feels are all an important part of “symbolic identification,” (6) the messages that an organization sends you about its people and place. Any questions I had were quickly dispelled by not only the professionalism but the personal, sensitive quality of the Mass General staff and system. Once my daughter was in the operating room, for example, volunteers in the family waiting area regularly sought me out to update me on her condition rather than my having to constantly question them.

Does this mean that all of our angst about the physical and psychological importance of hospital design is needless - - that beautifully designed hospital spaces aren’t important after all? On the contrary, after her operation my daughter was transferred to a single-bed room in the new Lunder Building’s neuroendocrine unit. There we experienced the best of both worlds. The large green-leaf motif against the unit’s white corridor walls was fresh and uplifting. The room’s privacy and good acoustic quality eliminated the usual hospital clatter. A couch that adapted into a bed in each patient room and lack of strict visiting hours helped create a more private, family experience. Apropos of research regarding views of nature (7), the room also had a wonderful view overlooking the Charles. The fact that doctors and nurses often dressed in what seemed like regular street clothes made them more “real” than “official” and encouraged conversation. Truly successful hospitals include a combination of patient-centered staff and patient-centered place.

As my daughter slept, I arranged to tour Mass General with the hospital’s Senior Project Manager (8). She guided me to a wonderful healing garden at on the hospital’s rooftop with a magnificent lookout, a new radiation oncology unit with Zen-like, calming décor, and the historic “Ether Room” rotunda where the first public demonstration of the use of ether occurred.

Have I painted too rosy a picture of this place? Throughout my emotional and my daughter’s physical journey at Massachusetts General Hospital there were opportunities for fine-tuning: In the parking garage people regularly pushed “1” instead of “G” and exited, confused, at the first rather than the main floor. Lack of easy-to-move visitor chairs in each room meant I couldn’t sit up close to my daughter and just hold her hand. There wasn’t always an obvious way to enter Mass General’s wonderful garden/retreat spaces. The hospital gown my daughter wore was a ‘downer’ in an otherwise ‘up’ environment.

It’s nothing new to say post-occupancy evaluations that utilize environmental psychology techniques such as tracking, interviewing, photo-documentation and observation (sometimes participatory!) can help perfect even the most successful healthcare place. It IS something new to say that, after two+ years . . . my daughter seems cured now. Thank you, Massachusetts General Hospital.

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1) See Oasis by Design, LLC www.oasisbydesign.net and Robe to Wellness www.robetowellness.com

2) Edward T. Hall, The Hidden Dimension (New York: Doubleday, 1966.)

3) For more on patient-centered care see www.planetree.org

4) Lack of land for expansion in recent years required Mass General to build ‘up’ rather than ‘out.’

5) The Paul Russell, MD Museum of Medical History and Innovation www.massgeneral.org/history/russellmuseum/

6) Fred I Steele, Physical Settings and Organizational Development (Reading, Mass.: Addison-Wesley, 1973.)

7) Roger Ulrich, “The Theory of Supportive Design for Healthcare Facilities” in Journal of Healthcare Design. Proceedings from the Ninth Symposium on Healthcare Design, August 1997.

8) Wendy Krum, Senior Project Manager, Partners Real Estate and Facilities

*NOTE: The Lunder building received the 2012 HEALTHCARE DESIGN Citation of Merit Award, an announcement that was made the same day this blog was posted.

Copyright Toby Israel, 2012

 

Toby Israel is an environmental psychologist who studies design psychology.

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