Design of Acute Care Patient Rooms for Improved Patient/Family Experience: A Case for Interdisciplinary Collaboration By Tamara Phillips A thesis submitted to the Faculty of Graduate and Postdoctoral Affairs in partial fulfillment of the requirements for the degree of Master of Design in Industrial Design Carleton University Ottawa, Ontario © 2012, Tamara Phillips 1+1 Library and Archives Bibliotheque et Canada Archives Canada Published Heritage Direction du Branch Patrimoine de I'edition 395 Wellington Street 395, rue Wellington Ottawa ON K1A0N4 Ottawa ON K1A 0N4 Canada Canada Your file Votre reference ISBN: 978-0-494-93501-9 Our file Notre reference ISBN: 978-0-494-93501-9 NOTICE: AVIS: The author has granted a non­ L'auteur a accorde une licence non exclusive exclusive license allowing Library and permettant a la Bibliotheque et Archives Archives Canada to reproduce, Canada de reproduire, publier, archiver, publish, archive, preserve, conserve, sauvegarder, conserver, transmettre au public communicate to the public by par telecommunication ou par I'lnternet, preter, telecommunication or on the Internet, distribuer et vendre des theses partout dans le loan, distrbute and sell theses monde, a des fins commerciales ou autres, sur worldwide, for commercial or non­ support microforme, papier, electronique et/ou commercial purposes, in microform, autres formats. paper, electronic and/or any other formats. The author retains copyright L'auteur conserve la propriete du droit d'auteur ownership and moral rights in this et des droits moraux qui protege cette these. Ni thesis. Neither the thesis nor la these ni des extraits substantiels de celle-ci substantial extracts from it may be ne doivent etre imprimes ou autrement printed or otherwise reproduced reproduits sans son autorisation. without the author's permission. In compliance with the Canadian Conformement a la loi canadienne sur la Privacy Act some supporting forms protection de la vie privee, quelques may have been removed from this formulaires secondaires ont ete enleves de thesis. cette these. While these forms may be included Bien que ces formulaires aient inclus dans in the document page count, their la pagination, il n'y aura aucun contenu removal does not represent any loss manquant. of content from the thesis. Canada ABSTRACT There has been much study on patient perspectives and overall satisfaction within healthcare settings (Katherine & Gallant, 2006; Sloan Devlin & Ameill, 2003; Leventhal Stem, et al., 2003) but not as much specifically directed toward the family or ‘partners in care’ and their specific needs within the adult acute care patient room. One assumption of this thesis is that families or partners in care have unique needs, which are not always considered in the design of acute care patient rooms. Another assumption of this thesis is that to meet the diverse needs of patients and families as well as other healthcare stakeholders is complex and a more integrated approach to design is needed. Both of these assumptions puts human health and wellness at the forefront of design intent and this thesis uses a case study as a way of Teaming how to learn’ about the complexity of design for health care settings. A survey questionnaire distributed to former patients and families found several interrelated factors that could contribute to a more positive patient room experience. A case study of an interdisciplinary design-research collaboration for a prototype patient room explored how the needs of patients and families could be better integrated into the design of a patient room footwall. The research findings generated design criteria for acute care patient rooms addressing the needs of patients and families, insights into the challenges and success of interdisciplinary design collaboration as well as suggestions for further research. Keywords: healthcare design, adult acute care, patient and family satisfaction, interdisciplinary collaboration, case study, patient room prototype. ACKNOWLEDGEMENTS To my family Kevin and Olivia for supporting me through the thick of it all, and for keeping me grounded. To my supervisors Dr. Thomas Garvey and Dr. Federica Goffi who provided me with an amazing opportunity to learn coupled with relentless energy and encouragement. A special thank you to David Allison for his generous insight, support and encouragement. I could not have completed this document without the many special people that helped and supported me along the way. A warm thank you to Lorenzo Imbesi, Lois Frankel, Won Joon Chung, Valerie Daley, Diane Smyth, Anthony Marini, my fellow grad students at Carleton, my colleagues at Algonquin College and Jessica and Khulood, my PRPP teammates. I would also like to thank everyone who participated in this research with the hope that they truly believe in the importance of design to improve the healthcare experience. In Memory This paper is dedicated to Nelson and Carol Phillips Who with their unending love and encouragement, provided the foundation that supports me in everything I TABLE OF CONTENTS ABSTRACT........................................................................................................................................II ACKNOWLEDGEMENTS...............................................................................................................Ill TABLE OF CONTENTS....................................................................................................................V LIST OF FIGURES...........................................................................................................................IX 1 INTRODUCTION...........................................................................................................................1 1.1 Healthcare, Design and Patient/Family Accommodation.....................................................3 1.2 Rationale and Purpose of Study...........................................................................................................4 1.3 Contribution to Interdisciplinary Design Research..................................................................6 1.3.1 Patient Room Prototype Project (PRPP).......................................................................................6 1.4 Research Question and Overview.........................................................................................................7 2 LITERATURE REVIEW..............................................................................................................10 2.1 Design for Health.................................................................................................................................................................10 2.1.1 Health Supportive Environments and Evidence-Based Design (EBD)........................16 2.2 Patient-and-Family Centred Care....................................................................................................21 2.2.1 Patient and Family Satisfaction in Healthcare Environments....................................22 2.2.2 Accommodating Partners in Care..................................................................................................24 2.3 Human-Centred Design and D esign Thinking..............................................................................25 2.3.1 Interdisciplinary Collaboration...................................................................................................27 2.3.2 Design Research and Participatory Design..............................................................................28 2.4 Patient Room Design..................................................................................................................................30 2.4.1 Trends and Innovations in Patient Room Design....................................................................33 2.4.2 Functional Organization....................................................................................................................34 2.4.3 Headwalls and Patient Zones..........................................................................................................37 2.4.4 Footwalls and Family Zones.............................................................................................................38 2.4.5 Patient Room Furnishings and Finishes.......................................................................................40 2.5 Summary of L iterature Review...........................................................................................................41 3 METHODS....................................................................................................................................42 3.1 Introduction..............................................................................................................................................................................42 3.2 Approach and Study Design Overview.............................................................................................43 3.2.1 Case Study Selection.............................................................................................................................44 3.2.2 Expert Interviews....................................................................................................................................45 3.2.3 Former Patient and Family Survey Questionnaire..............................................................47 3.2.4 Observations.............................................................................................................................................48 3.3 Qualitative Data Analysis....................................................................................................................49 3.4 Research Plan/Schedule..........................................................................................................................50 3.5 Validity and Reliability..........................................................................................................................50 3.6 Limitations of the Methods....................................................................................................................51 3.7 Ethical Considerations............................................................................................................................52 4 FINDINGS AND DISCUSSION..................................................................................................53 4.1 Introduction..................................................................................................................................................53 4.2 Insights from Patient and Family Survey Questionnaire.....................................................56 4.2.1. General Findings....................................................................................................................................58 vi 4.2.2 Physical Attributes...............................................................................................................................59 4.2.3 Summary Physical Attributes and Design Implications....................................................66 4.2.4 Emotional Attributes..........................................................................................................................67 4.2.5 Summary Emotional Attributes and Design Implications................................................68 4.2.6 Social Attributes....................................................................................................................................70 4.2.7 Summary Social Attributes and Design Implications.........................................................73 4.2.8 Ideal Healing Space: The N ext Acute Care Patient Room ................................................74 4.2.9 Sense of a Healing Space & Overall Satisfaction................................................................77 4.3 Key Differences Between Patients and Family..........................................................................78 4.4 Case Study: Patient Room Prototype Project (PRPP).............................................................82 4.4.1 Introduction/Background.................................................................................................................82 4.4.2 Patient Room Prototype Project (PRPP).....................................................................................83 4.4.3 The Design Process..................................................................................................................................91 4.4.4 Hospital and Prototype Tours, Observations and Expert Feedback.........................98 4.4.5 Concept Development (Footwall)................................................................................................103 4.4.6 Interim Mock-up Fabrication and Observations..................................................................104 4.4.7 Design Fabrication, Implementation and Final Prototype............................................106 4.5 Summary Patient Room Prototype Outcomes........................................................................113 5 CONCLUSIONS..........................................................................................................................117 5.1 Insights and Lessons Learned.............................................................................................................117 5.2 Suggestions for Further Research.................................................................................................122 5.3 Conclusion...................................................................................................................................................123 REFERENCES APPENDICES LIST OF FIGURES Figure 1. Conceptual diagram for literature review.............................................................................9 Figure 2. Physical Environment Process Leading to Stress...............................................................11 Figure 3. Example of high levels of complexity visual stimulation..................................................12 Figure 4. Example of low stimulation and visual interest..................................................................14 Figure 5: Health Supportive Design Criteria and Outcomes.............................................................18 Figure 6. Physical Environmental Stimuli Diagram..........................................................................20 Figure 7. Benefits of Accommodating Patients and Family..............................................................25 Figure 8. Patient Room: Factors that impact occupant health and well-being..................................31 Figure 9. Healthcare Users and Stakeholders diagram......................................................................32 Figure 10. Design criteria for patient rooms......................................................................................33 Figure 11. Patient Room Activity Zones...........................................................................................36 Figure 12. Preliminary Affinity Diagram..........................................................................................49 Figure 13. Visual representation of research design.........................................................................50 Figure 14. In-patient Footwall Design and Floor Plan, JGH Pavillion K.........................................55 Figure 15. Conceptual Mapping of Survey Questions......................................................................56 Figure 17. Multi-Sensory Content Analysis Patient Room..............................................................65 Figure 18. Mind Map Sketch (Family).............................................................................................72 Figure 19. Mind Map (family)...........................................................................................................72 Figure 20. Overall rating of experience in patient room. Responses to the question 2.14................78 Figure 21. Patient vs. Family Preferences: control of elements.......................................................79 Figure 22. Patient vs. Family Preferences: elements for comfort......................................................81