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mind, body, space.

A new type of hospital space that doesn't look to replicate the home but better transitions the individual and family for change.

Photo of Emily
23 22

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Who is your idea designed for and how does it reimagine the end-of-life experience?

The idea is that the new hospital room will not only borrow elements from brainstorm/innovation space that encourage people to think differently and analyse all the information available but yoga rooms that create a sense of relaxation and reflexivity, a hospital to legitimise the expertise within the room whilst also a hostel where its a place to meet knew people and share in experiences. Its not a daunting space, but one full of life.

As an interior designer, I am very passionate about the impact an environment has in our sense making process. A space can generate implicit conversations that develop our insights in which we understand, interpret and respond to our present situations.

With this in mind, I propose that its not about trying to replicate a homely environment in our hospitals, or trying to replicate the idealism of dying in our sleep, but strengthening our mindfulness through our environments. We need to create environments that correctly convey what is happening and what could be.

I suppose with death we all feel a lack of control over our lives, but if our environments strengthen our ability to respond better instead of striving for a sense of anaesthetic, we can make our own decisions of what is and what could be. Which would generate a sense of empowerment and will both of the patient and their family to continue in whichever way they like. To be comfortable with the future and prepared for change.

We must consider, the whole user experience.. a further involvement where possible in the treatment plans rather than being given unknown medications, better lighting to create a sense of privacy and intimacy, unique elements that create a sense of place within a room; a small kitchen to allow the ability to participate in cooking or smelling dinner being cooked, a communal dinning to encourage conversation of people in similar situations, large windows to create a connection with the world around.

What early, lightweight experiment might you try out in your own community to find out if the idea will meet your expectations?

I am currently assisting on a project dedicated to providing a resort for brain and spinal rehabilitation, although not at all end of life, we are discussing with focus groups the key drivers within hospitals that remind people of their injuries and create a mental barrier to a sense of normal and considering the change in mentality of all users.

What skills, input or guidance from the OpenIDEO community would be most helpful in building out or refining your idea?

Architects & Interior Designers Doctors & Nurses Patients of all kinds: long term, short term, regular

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Spam
Photo of Chris Lee
Team

Hi Emily,

I like the idea of using space to help create a more pleasant experience. I see this a lot in office and retail space but haven't seen it carried into hospital roolms. I just spent some time in the hospital and it was a very unnatural, out of control, isolating time. I can see where facing that every day until I died would not put me or my family at peace.
I can also see why the hospital is set up this way: to facilitate the medical process I was a part of.
Do you know what regulations or practicalities are keeping things are they are in the hospital setting? It would be interesting to know how much is regulation is and how much is convenience for the hospital.

Spam
Photo of Emily
Team

Thanks for sharing your experience Chris. For me this idea was only really generated by being a visitor to family members in hospitals and reflecting on my different experiences. In one instance, it was the lack of regular nurse visits, the quietness of the room and the emptiness of the space that kind of mentally informed me that this was the end for my Grandmas. In a complete opposite example, another relative who is regularly in the ICU, has often told me how he prefers to be in ICU enjoying the continual interaction of the nurses and action of those around him. An interesting perspective given, you should really not want to be in ICU.

Its interesting how you mention regulations, obviously integral in hospital design and whilst I haven't ever worked on a hospital interior, it would be great to questions the necessity of all them. For example in the project mentioned above, although it has many hospital like elements because of its resort building classification we remove many regulations and design for user rather than code. 

Spam
Photo of Bettina Fliegel
Team

Hi.
Emily - It is very interesting to note that your relative liked being in ICU due to the constant companionship of staff and action all around.  Is that relative isolated in his regular life?  This insight might be really helpful to him personally if hospital staff knew about it, as they might be able to link him to services in the community that connect him to others for socializing.  Also it is a great insight that might be used when thinking about designing hospital spaces.  On a regular ward one does not need to be monitored so closely so nurses will be in the room much less.  Also years ago there were hospital wards with multiple beds.  We have moved away from that to private and semi private rooms.  Perhaps for some they would prefer to be in larger shared spaces where there are opportunities to speak with other patients and their visitors, rather than being isolated.
Also what about day rooms?  Are they available and do patients know about them?  Are they inviting spaces?

Spam
Photo of Emily
Team

Hi Bettina,

Interestingly, not at all. He is not particularly isolated when he is in the hospital he would have his whole family visit ever day and family events every few weekends.. It just makes him feel easy about his situation he knows that if something goes wrong during his sleep.. a nurse will know about it and similarly for us too! He's not just something they have to routinely check like a "chore" on but closely monitor. 

Funny you mention the group room situation, he is often in a group room on the ward and will bump into people he sees in hospital every now and then or placed with people who have identical illnesses and really enjoys that. However, this is not typically the case and I think theres an interesting stigma hospitals that you must let people rest and be quite etc.. How much joy a small noisey child often brings in these places?

Spam
Photo of Bettina Fliegel
Team

Hi Emily.
Interesting observations!  Yes small children can bring joy, but I think there is some truth in that for some that are ill they do need to rest.  In my experience some, not all, older people are less patient with children that are not family members.  In situations where elderly might gather like a nursing home, or adult day care/ community center I think it might be great to think about a  nursery school that can be co-located in the building as children do bring joy.  In this case the people might be elderly but in good health, and perhaps happy to have noisy kids nearby to interact with.  It can also be great for small children to get the love and attention from elders.  This can be a design idea for these facilities.
 I remember visiting my grandmother as a family with my nephew when he was old enough to walk. She had a cane and he would grab it and walk alongside.  They both held one end of the cane.  It was really cute as he pranced through the halls.  I guess she did not need the cane consistently as she was fine.  They were quite the duo in those moments.   She lived in an assisted living facility.  For her that meant there were staff on the premises, there were meals served in a dining room and there were people to socialize with if one wanted to, at various activities in a common room.  She lived there until she die at the age of 103.  Most folk there seemed to enjoy the company of children when they came for visits.

Spam
Photo of Chris Lee
Team

Hi Bettina,

Your observation that the "joy" of children depends significantly on the condition of the person experiencing it triggers another thought in my mind about a talk by Malcolm Gladwell on Spaghetti Sauce and happiness (https://www.ted.com/talks/malcolm_gladwell_on_spaghetti_sauce?language=en).
The short of it being that there is no single thing that makes everyone happy.
But we build and act as if there is - probably because it costs more to build the variety required to allow for choice. Choice is messy. Choice can't be as easily proceduralized and cost reduced.
What can be done to design for choice?
Office spaces might be starting on this trend: Reconfigurable personal workspaces, movable desks, multi-purpose rooms (quiet work areas, private meeting rooms, open work areas, social areas, etc).
How would this apply to a hospital or end of life care setting?

Spam
Photo of Bettina Fliegel
Team

Chris Lee and Emily -
Great insights and questions Chris.  There is a hospice in the Bronx, NY that I heard was wonderful.  When I checked their website I saw that they have a cafe space that services patients and visitors.  I thought this was great and unusual as in most hospitals I have been in patients do not access the same areas for shopping (gift shops) or eating (cafes) that visitors do.  Why not create places where they can pick up things for themselves or perhaps they want to pick something up for their loved ones?  That is one idea I like. 
Another observation I had was that in hospitals in other countries there are common eating spaces for patients.  If they are well enough to leave their room they can sit together in a dining area to eat.  I think this is great for socialization.  Not sure if there are regulations around this in the US.
 Speaking to users to get their ideas on what they would want would be the best place to start I think.  I think this would include patients, visitors and staff.  I would also include conversations with ancillary staff - kitchen staff that bring up meals, housekeepers, patient escorts, phlebotomists etc. - they are around all the time and therefore could be great sources of information and observations on the needs of patients throughout the day/night cycle.  
A simple thing I have noticed about medical facilities and I think this is ironic - they often have the name of the disease state on the building - ex) The name of the donor who contributed to pay for the facility and then the disease - ÔǪÔǪCenter for Excellence in Breast Cancer.  To me this is a breach of privacy.  As someone who appears ill walks in it becomes obvious what their illness is.  We have so many rules around privacy in medicine, HIPAA, but these signs stand out and announce what the issue is.  I always wonder about that.  How can design contribute to maintaining privacy and dignity?  Does everything need to be labelled on the outside?

Spam
Photo of Emily
Team

The ABW of hospital design... I like it. 

I think maybe the key point of both Bettina and my comments regarding children is not specific to children but the unexpected interaction, the ability to observe life and not be stuck in a box.

Spam
Photo of Aaron Wong
Team

Chris and Emily,

I haven't worked on a hospital project either, but if you compare it to standard interior design projects, it's about the programming - specifically, where the money comes from. When it comes to hospitals, I believe they would prioritize operating rooms and less so on recovering or waiting areas. The majority of what hospitals would probably spend their money on is equipment and cleanliness/sterility. This is represented by the amount of detail that is paid on choosing the right materials, and technology in a space. 

A good way of thinking about it are through these diagrams:
https://www.wbdg.org/images/hospital_2.gif
https://www.wbdg.org/images/hospital_3.gif
As you can see from these diagrams, everything is centered around "Diagnostics and Treatment", which it should be. Seeing these diagrams, I think the challenge is not necessarily a new room for a new function, but instead, might be to tie all the rooms together through an overarching new function that would seep into the design of all spaces.

To give you a better idea of how Hospitals are currently designed, it is very straight forward and "logical"- an example is the VA's guideline: https://www.wbdg.org/ccb/VA/VADEMAN/dmidhonh.pdf
These guidelines are based on ease of access, cleanliness, affordability, etc. There hasn't been nearly as much publication, research, or money spent on dissecting successful hospitals as there is towards workplace environments. Perhaps if people understood that a hospital with better mind/body space can save money, hospitals would more readily adopt new ideas.

In my opinion, hospital design specialists still haven't "cracked the code" yet. When we think of the new workplace, we think of places like google and facebook, but from reading this challenges discussion, there is no benchmark or new standard for hospitals yet. When reading Anne-Laure Fayard 's link to https://hbr.org/2015/10/better-healing-from-better-hospital-design, its points are shockingly similar to productive workplace environments and healthy living conditions - i.e. indoor ecology.

Spam
Photo of Chris Lee
Team

Hi Aaron.

Those are interesting diagrams. My experience with doctors and hospitals has been that they are very much about "fixing" a pathology as a business problem. Business asks for efficiency. It seems like the best model of efficiency we have is a factory. Unfortunately, a factory invites the things flowing through it to be treated as interchangeable things. Emphasis on THINGS.
People and sickness, especially as we face a terminal situation that can't be "fixed," upends this focus on efficiency and pathology. It becomes about a person's expectations and ability to reconcile the actuality of what they are going through with their stories of what they are going through. Kind of like the Placebo effect writ large: how do you create an environment where the process is about "treating" the expectation instead of the (unfixable) condition (end of life)?

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