The Design Planning Process
A collaborative planning process involving patients and families creates opportunities to learn from their perspectives and experiences of care “in such a way that they provide meaningful input to the architects and designers on what contributes to a healthy environment.” (The Family Perspective on Creating a Healing Environment, Children’s Hospital and Regional Medical Center, Seattle, Washington).
In implementing a renovation or construction project, most facilities find it helpful to adhere to a structured design planning process. Nine key steps should be considered.
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Parents chaired one of the three committees charged with planning the new newborn intensive care unit at Christiana Hospital, Newark, Delaware. They planned the Hall of Hope as a way to create positive, inspiring first impressions. |
1) Bring an architect or design firm into the design planning process early on. A multidisciplinary selection committee composed of key stakeholders (including patients and family members) should take care to select an individual or firm that will be best qualified to respond to the facility’s needs and priorities. (Selecting an Architect.) An important consideration is a demonstrated willingness to listen and respond to client needs and priorities.
2) Organize the planning committee and other issue-specific workgroups. These committees and workgroups should be multidisciplinary, including a variety of health professionals and design specialists, and should be comprised of one-third to one-half patients and families.
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A Children's Advisory Council created drawings and contributed ideas that shaped the design of the stained glass for the chapel at the Medical College of Georgia's new Children's Medical Center in Augusta, Georgia. |
3) Learn together. Some approaches to self-education taken by design planning committees have included: holding a kick-off event or retreat, conducting focus groups, touring existing space, and planning thoughtful site visits to other facilities. Patients and families should be included in these learning activities. (A detailed tool for use in site visits, “Health Care Environments: An Assessment Tool,” is included in the guidance publication Collaborative Design Planning.)
4) Envision the ideal health care setting. Consider what works well in the current setting, how the space is to be used by staff, patients and families, how the space should feel, and the needs of various patients, families, and staff who will use the space. Brainstorm and be willing to think “outside the box.”
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At Griffin Hospital in Derby, Connecticut, senior citizens and other consumers participated in efforts to plan a new hospital building. Seniors wanted both privacy and companionship in the hospital rooms. These needs were addressed by designing L-shaped semi-private rooms that are enjoyed by patients and staff alike. |
5) Develop specific goals and priorities for the project. Ensure that the philosophy of care is clearly articulated and reflects how patients and families will experience care.
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| At The Children's Medical Center in Dayton, Ohio, the nurse leader for the newborn intensive care renovation project lead a process that was guided by a clear set of goals. The planning participants always looked to these goals in making the many decisions and compromises necessary to carry out the project. |
At Baycrest Centre for Geriatric Care in Toronto, both client advisory groups and family advisory groups meet regularly to share concerns with staff, collaborate in planning educational programs, discuss center policies and their impact upon clients and families, and participate in quality review and improvement initiatives. They also participated in planning the recently opened residential and chronic care facility.
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This facility has many design elements that are sensitive to the physical and cognitive challenges of its residents, while conveying respect for their dignity and individuality. An illuminated shadow box outside each resident's door contains mementos and photographs that serve both to help others learn something about the patient and also to help the resident in wayfinding. |
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The home-like environment respects privacy and independence, and the layout of the facility supports family participation and a feeling of community. Each floor has six home units, called "houses," with 13-14 single-patient rooms each. The floor level and entryways are clearly marked with large numbers and familiar symbols. |
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Each two houses share a kitchenette that serves as a place where residents or families may prepare light snacks. The kitchenette also serves as the staff work area, replacing the traditional nursing station. Charts and computers are hidden in cabinets when not in use. |
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A playroom for children on each floor encourages connection and support across generations. |
The design and construction of the Woodwinds Health Campus in Woodbury, Minnesota was guided from the very beginning by a clearly articulated vision, purpose and model of care:
The Woodwinds Health Campus’ purpose is to promote health and healing of body, mind and spirit for all through relationships, choices and learning.
Their vision is to be the innovative, unique, and preferred resource for health by fundamentally creating the health care experience in a way that has not been done before.
For their model of care, Woodwinds believes in holistic care that recognizes and respects the primary role of the individual and his/her family in the management of their health care experience.
It supports families in their natural care giving roles, promotes healthy patterns of living and ensures collaboration and choice in the provision of services.
The Woodwinds Care Model is delivered in a healing environment and culture that fosters partnership with patients and families.
More information about the Woodwinds health Campus is available at www.woodwinds.org.
6) Use a variety of approaches to visualize the design of specific spaces and their adjacent areas. Build full-scale mock-ups and encourage both staff and consumers to use and review them.
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For Hasbro Children's Hospital in Providence, Rhode Island, models helped families, who were participating in the collaborative design process, visualize the exterior and interior of the building along with the adjacencies. |
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Blank Children's Hospital in Des Moines, Iowa recruited families from outside their already busy Family Advisory Council to participate in the design planning process for a large pediatric and newborn intensive care renovation project. A full-scale mockup was developed that both staff and families studied carefully to assist in the process of making key design decisions. |
In redesigning the NICU at The Children’s Medical Center in Dayton, Ohio, architects proposed a “pinwheel” design for layout of the infant beds in the unit, with three beds to each pinwheel. The new design concepts were presented with a floor plan showing the layout of the patient care area and a scale model of an individual headwall unit. The model created a more hands-on presentation and facilitated a better understanding, by skeptical team members, of how the bed space would function.
7) Visualize the ideal. Afterwards, examine resources, physical constraints, and other challenges and choices. Compromises are a significant part of every design and construction project. Revisit the project’s goals and priorities before making compromises. If the goals and priorities are clear, then wiser compromises will be made.
In designing the new NICU at Children’s Hospital in Dayton, Ohio, architects initially proposed a pinwheel arrangement for layout of each group of four infant beds. The design had to be modified because the arrangement was too large for existing space.
8) Communicate throughout the planning process. Helpful tools for communication include the use of visuals, a timeline, a bulletin board, handouts, a newsletter, a project section on a website, or even an entire website. Periodic town meetings to solicit input and share progress can be helpful. Regardless of the communication medium chosen, make sure the information is available to the families you serve.
Vanderbilt Children’s Hospital in Nashville, Tennessee uses a newsletter to communicate about design and construction progress with its staff, faculty, donors, and the community.\
9) Recognize that details count. Often how patients and families “live” in a space and the ease and efficiency with which staff work in a space depend on the details. Examples of the thousands of details to consider include the comfort of a chair, the placement of lighting/switches/electrical outlets, location of cabinets and their height, and how doors open.
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In the Family Resource Centre at The Chedoke Child and Family Centre in Hamilton, Ontario moveable shelving is used for maximum flexibility of the environment and for ease of adaptation to the needs of individual users, many of whom have disabilities. |
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The height of the nursing stations was very important to families involved in planning the Children's Hospital at Providence in Anchorage, Alaska. They felt that a 36 inch height would encourage interactions with children and families and be less intimidating than the traditional higher counters for these staff work areas. |
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The placement of the oxygen and other equipment to support care for both mother and infant was very important to efficient care in this Labor Delivery Recovery Postpartum (LDRP) room in the maternity center at Iowa Methodist Hospital in Des Moines. Wood panels keep this equipment out of sight when not in use. |
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Conveniently located wall-mounted hair dryers are placed in the postpartum patient rooms at Lancaster General hospital in Lancaster, Pennsylvania. |
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In Blank Children's Hospital in Des Moines, Iowa, the full scale mock-up for the new newborn intensive care unit helped designers learn that the placement of cupboards in the work area outside the patient room would result in nurses hitting their heads as they used computers. Modifications were then made before construction to make this area more functional. |
Patients and Families as Advisors »