Patient Feedback Gives Hospital Project Teams a Dose of Reality
BY NOVID PARSI
PORTRAITS BY SIMON RIDGWAY
Charlotte Scully, project manager, Royal United Hospital Bath, Bath, England
THE HEALTHCARE INDUSTRY IS RETHINKING THE SOURCE OF HEALING POWERS.
Rendering of Jim Pattison Children's Hospital in Saskatoon, Saskatchewan, Canada
As hospitals and other facilities raise the bar on health outcomes and experiences, teams are shaping projects from a patient's perspective—and it starts long before anyone seeks treatment.
Whether they're building new care centers or introducing new technologies, teams at healthcare facilities are putting feedback front and center to keep projects aligned with patient needs and preferences. Their insights are designed to deliver strong ROI for hospitals—a strategic essential with spending on healthcare construction projects reaching US$400 billion in 2019, a 4.4 percent increase over the previous year.
A comprehensive patient feedback loop was at the center of design and construction phases for the CA$285.9 million Jim Pattison Children's Hospital in Saskatoon, Saskatchewan, Canada, which was completed this year. The result: large rooms that can accommodate an entire family when a child needs treatment, plus dedicated spaces where women can labor, give birth and recover in the same room during their entire stay.
But such tangible benefits are possible only when teams carefully gather the right insights from the right patients. Minimizing patient feedback or ignoring it altogether can open the door to post-project revisions that drive up costs.
“It's absolutely key that we listen to our patients to get the best possible outcome,” says Charlotte Scully, project manager, Royal United Hospital Bath, Bath, England. “After all, they are the ones using the service we're providing.”
Teams must engage with patients from the start to make sure they don't overlook opportunities. That means taking steps to identify the most valuable sources of feedback long before designs are created or any construction starts, says George Tingwald, MD, director of medical planning, Stanford University Medical Center, Stanford, California, USA. “You want to know the difficulties before you build the project, not afterwards,” Dr. Tingwald says.
—George Tingwald, MD, Stanford University Medical Center, Stanford, California, USA
During planning phases for projects at Royal United Hospital Bath, healthcare staff members distribute questionnaires while patients sit in waiting rooms or exam rooms. Televisions in waiting areas tease upcoming projects and request patient feedback. When future projects are announced on social media, project teams reach out directly to potential patient participants. Project managers also comb through existing patient data for complaints about an existing facility.
Teams also must give serious thought to the survey questions and have a firm grasp of the intended audience and the insights they hope to gain. For a survey deployed at Massachusetts General Hospital, senior project manager Donna Rusinak and her team first tested the questions with a pilot group of patients. Then she used that feedback to tweak the survey's language to make it more user-friendly. For instance, the team replaced the term “skilled nursing facilities” with “rehab facilities” because patients were more familiar with the latter phrase—an effort to “make sure we were speaking a language they understood,” says Ms. Rusinak, Boston, Massachusetts, USA.
Zeroing in on patient experiences helps teams identify and prioritize common pain points at existing facilities. That helps project teams for new facilities eliminate those problems or introduce new services or amenities that can make sick people feel more comfortable. At healthcare facility construction and renovation design firm HOK, teams interact directly with patients and their families during the planning phase. “We ask patients about their experiences in existing spaces, what they feel is good and what could be improved,” says Scott Rawlings, director of healthcare, HOK, Washington, D.C., USA.
—Scott Rawlings, HOK, Washington, D.C., USA
For instance, HOK surveys patients, families and staff to determine the five things they would change about an existing facility. In the past, respondents’ feedback has ranged from better communication and being informed about what they can expect to a wider range of healthier food options. HOK assesses the viability, cost, schedule and operational impact of the patient suggestions, then presents them to hospital clients.
—Charlotte Scully, Royal United Hospital Bath, Bath, England
Improving the healthcare experience must extend beyond patient feedback. Gaining deep insights from the entire healthcare facility staff can help raise red flags and reveal when tailoring projects to patients’ perspectives introduces risks.
For example, teams can engage healthcare professionals at a facility to review a patient group's wish list to identify when a request might interfere with patient safety, operations or confidentiality, says Scott Rawlings, director of healthcare, HOK, Washington, D.C., USA.
HOK works closely with user groups of physicians, nurses and other healthcare workers, and on some projects it creates groups with as many as 300 people. “When we talk with physicians, we get their perspective of what they need to best do their job—how they can safely, efficiently, humanely care for patients,” Mr. Rawlings says.
At Royal United Hospital Bath in Bath, England, project manager Charlotte Scully holds regular meetings during the design phase that bring together architects, designers, project managers and clinical staff, as well as patients. “So we get input into the design from every angle,” she says.
Doctors and other healthcare staff also can validate patient feedback, which helps build buy-in for patient-centric design changes, Mr. Rawlings says.
“Frontline workers truly want to do everything they can for patients and their families, so if a patient group has a good idea, they champion it all the way up to the executive offices if necessary,” he says.
Getting feedback on existing facilities helped Royal United Hospital Bath make adjustments for a project completed last year to renovate the radiology department. The department had two physically separate areas: one for X-rays and another for performing all other scans. Two departments created inefficiencies for staff and frustrations for patients. After analyzing 200 patient questionnaires, the team found that the divided layout was confusing and unclear for patients. All patients sat in the same waiting area and became frustrated when some patients arrived later but were seen first. They didn't understand that different scans had different wait times.
For the remodel, the design team combined the two radiology sections into one while creating distinct waiting areas for different scans. Now patients instantly know where to sit—and naturally understand the process a bit more. “So they feel it's a fairer process,” Ms. Scully says. “They feel more respected and looked after.”
HOK leaned on patient feedback to design the NewYork-Presbyterian David H. Koch Center in New York, New York, USA.
PHOTO COURTESY OF HOK
HEARING ALL VOICES
Understanding that different patients have different perspectives helps teams create patient feedback groups that represent diverse backgrounds and projects that meet diverse needs. At Stanford, each patient group has a mix of ages, cultures and socioeconomic backgrounds. “We want to make sure we're not missing a critical element of our patient population,” Dr. Tingwald says.
Case in point: Designers creating hospital signage must engage with older patients to ensure the characters are big enough for everyone to read. “Signage designers tend to be 28-year-olds with really good vision,” Dr. Tingwald says. “The fonts are beautiful, but you can't read them.”
Here and below, the Omaha VA Ambulatory Care Center in Omaha, Nebraska, USA was designed to expose patients to natural daylight.
Younger patients have unique needs, too. By talking to parents, HOK has been working on updating the traditional interior design of pediatric outpatient facilities. In the past, facilities focused on keeping kids occupied with stuffed animals and static displays. But with parent feedback, HOK now focuses on education and interactive technology. On an interactive video wall in a waiting area or exam room, children can now play digital tic-tac-toe or touch an image of a giraffe to learn more about it.
“Talking with children and their families changes the way we look at the interior design every time we engage with a new children's facility,” Mr. Rawlings says.
Teams also customize patient feedback groups based on specific illnesses or care conditions. For example, hospitals typically have patterned floors that show fewer marks or less dust. But when Stanford Medical Center designed its Neuroscience Health Center, the team learned that neurology patients can have difficulty looking at patterns. So that facility has a neutral, pattern-free floor.
Hospitals that specialize in the care of military veterans also must tailor facilities based on feedback. Teams working at medical facilities run by the United States Department of Veterans Affairs (VA) learned from their patients that they benefit from a calming, low-stress treatment and recovery environment. So the VA has designed systems where the treatment infrastructure is detached from rooms to reduce patient anxiety, says Stephen Black, medical center director, Robley Rex VA Medical Center, Louisville, Kentucky, USA. Healthcare workers enter and leave patient rooms through back-channel hallways and work areas.
“At Disney World, you never see what's behind the scenes. It's the same with all our clinics: We design them so that patients never see the operations behind the scenes, so they have an anxiety-free experience,” Mr. Black says.
—Stephen Black, Robley Rex VA Medical Center, Louisville, Kentucky, USA
The rooftop garden at BC Children's Hospital & BC Women's Hospital + Health Centre, Teck Acute Care Centre in Vancouver, British Columbia, Canada
The benefit of culling patient feedback is clear: It helps a project team meet the primary objective—satisfy the end users. But that benefit won't be realized just by collecting patient feedback. Teams have to incorporate that insight into their plans.
“If you listen to patients and take notes and say, ‘Thank you for being here,’ and then what ends up being built is not what they wanted, guess what? They go to the CEO and complain—because you haven't satisfied them,” Dr. Tingwald says.
Tracking patient and staff satisfaction is part of all post-closure evaluations for Ms. Scully. At the end of the radiology renovation project, her team surveyed about 250 patients. Of those, 98 percent had only positive things to say about the new space. “It was really heartening to see there were very few complaints about the environment,” Ms. Scully says. But she also shared the feedback with the project sponsor, National Health Service (NHS) to show there was clear payoff. “The NHS Trust board saw those findings and could see this was money and time well spent,” she says.
Teams also have to ensure patient feedback is collected and documented in a way that protects patient privacy. To ensure patient confidentiality, HOK teams receive patient comments from its clients in aggregate, with no names listed. As a result, whenever team members look at the design brief, they merely see comments from the patient user group, not specific patients.
It's another way teams can build patient confidence and project support, which in turn helps secure honest and useful feedback and creates more project champions across the stakeholder spectrum.
“It's about engagement. We listen to what patients say, and we act on it,” says Dr. Tingwald. “People say, ‘We don't like to bring patients in because they will look at things from a different experience that may be difficult for us to deal with.’ Well, that's exactly the point of patient feedback.”
It's not just construction teams integrating the patient's perspective. As healthcare tasks become increasingly automated, teams must ensure that technology won't disrupt patient recovery. Patient feedback can help teams fine-tune digital upgrades and ensure virtual innovations become a seamless part of the care experience.
When hospitals in the U.S. state of Texas this year deployed robots to complete tasks such as taking samples to labs and bringing new towels or sheets to rooms, teams discovered patients were eager to interact with the bots. So the teams programmed the robots to be more engaging by adding features like flashing heart eyes and the ability to wander the floors when they had no activities, so patients could take selfies with the bots.
At Metro North Hospital and Health Service in Brisbane, Australia, a team looking to improve its IT services this year sat in exam rooms and observed the interactions between patients and their healthcare providers to find out how the systems help or hinder patient care. “I wanted to observe firsthand how the patient and clinician use our ICT systems and look for ways we can improve the delivery of healthcare,” says Russell Hart, CIO, Metro North Hospital and Health Service, Brisbane, Australia.
After asking a physician to suggest an oncology patient and after obtaining the patient's consent, Mr. Hart sat in on an appointment. Mr. Hart realized the physician had to constantly switch back and forth among different screens and applications to access and discuss the patient's various lab results. “The patient struggled to follow as the physician kept clicking between different screens,” Mr. Hart says.
That firsthand observation convinced Mr. Hart to change the scope of a three-month IT project. Initially, the project intended to consolidate the information sources that physicians access from within the hospital. But Mr. Hart expanded the scope so that it also consolidated the information from outside sources, such as external pathology exam results. “We will bring it all into one interface, so the patient can focus as the clinician explains the cancer treatment they're going to receive,” Mr. Hart says.
Although the patient-engagement approach on IT projects is new, the early benefits make it easy to show sponsors and other stakeholders why teams increasingly will incorporate it at Metro North.
“Before, the IT projects were driven more by the medical staff and the IT team, without taking the patient into account,” Mr. Hart says. “Now, the IT people realize they're not here to manage a database. They're here to make sure the database supports the system that supports the clinician who treats the patient. And that's helped them look at delivering projects differently.”
—Russell Hart, Metro North Hospital and Health Service, Brisbane, Australia
PHOTOS COURTESY OF DILIGENT ROBOTICS (TOP) AND THE STATE OF QUEENSLAND (BOTTOM)
Nurses at Metro North's Caboolture Hospital in Caboolture, Queensland, Australia
WINDOW OF HOPE
At Stanford Health Care's new hospital, nothing illustrates the patient-centric focus more than the floor-to-ceiling windows in each room. Beyond a healthy splash of sunlight, patients get a clear view of the parks, mountains and bay that surround the hospital.
“They're the first and most impressive thing you see when you enter a room here,” says George Tingwald, MD, director of medical planning, Stanford University Medical Center, Stanford, California, USA.
Patients helped drive designs and decisions from the start of the US$2 billion, 824,000-square-foot project, which was completed in November. From nurses stations with noise-absorbing surfaces to help maintain a calm and restful environment, to private rooms that create more space for visiting family and friends, each of the carefully crafted details was the result of a rigorous patient-feedback process that began more than a decade ago.
Dr. Tingwald helped create a patient advisory council in 2008 to help the team glean critical insights for designing and building the new facility. What started as an 11-patient group has grown to a robust 500 members, all of whom will help provide targeted insights to shape future hospital projects. For example, a team building a new neuroscience center can focus on patients with Parkinson's and other neurological diseases, while the team building the eye institute will focus on patients who have lost or impaired vision.
The team made sure to include patients with chronic diseases: If it could meet the needs of people who had been in the hospital for weeks or months, the team also could satisfy those with shorter stays. “We focused not on the person coming in for a two-day hip replacement but on our most complex and vulnerable patient population,” Dr. Tingwald says.
During the one-year design phase, the team met monthly and in person with the patient group to gather and analyze feedback. The design team used patient feedback to build full-scale mockup rooms, then documented the patient group's feedback to those rooms. This approach reinforced to all stakeholders the value of patient-centric planning, Dr. Tingwald says.
“Since the architects and design team were responsible for documentation, they heard from patients directly—no middleman,” he says. “This let the design team know that we were serious about our commitment to patient engagement. And it let the patients know they were equal players on the same field. This was critical to success. Patients felt they were truly engaged—because they were.”
In each private room, for example, the extra space allowed the team to add sofas that convert to beds so patients’ parents or other family members can stay with them overnight.
“When a patient may be nearing death and a family member is told they have to leave at night and come the next morning, that's inappropriate,” Dr. Tingwald says. “We had to provide settings that are about the patient and family experience, not about the staff. It's an environment where a patient and family can spend a significant amount of time healing.”
IMAGES COURTESY OF RAFAEL VIÑOLY ARCHITECTS
The impact of patient feedback extended beyond care rooms. The team even asked patients how parking could be improved, so going home could be a more seamless process. The result? Rather than having an underground parking facility where patients had to wind through dark tunnels, the team created street-level parking directly in front of the hospital's main entrance.
“We asked about a lot of things you might think are the same wherever you are, but they're not,” Dr. Tingwald says. PM