Designing for community engagement: user-friendly refugee wellness center planning process and concept, a health design case study

BACKGROUND

Refugee and immigrant populations have diverse cultural factors that affect their access to health care and must be considered when building a new clinical space. Health design thinking can help a clinical team evaluate and consolidate these factors while maintaining close contact with architects, patients' community leaders, and hospital or institutional leadership. A diverse group of clinicians, medical students, community leaders and architects planned a clinic devoted to refugee and immigrant health, a first-of-its-kind for South Philadelphia.

METHODS

The planning process and concept design of this wellness center is presented as a design case study to demonstrate how principles and methods of human-centered design were used to create a community clinic. Design thinking begins with empathizing with the end users' experiences before moving to ideation and prototyping of a solution. These steps were accomplished through focus groups, a design workshop, and iterations of the center's plan.

RESULTS

Focus groups were thematically analyzed and generated two themes of access and resources and seven subthemes that informed the design workshop. A final floor plan of the wellness center was selected, incorporating priorities of all stakeholders and addressing issues of disease prevention, social determinants of health, and lifestyle-related illness that were relevant to the patient population.

CONCLUSIONS

Design thinking methods are useful for health care organizations that must adapt to the needs of diverse stakeholders and especially populations that are underserved or displaced. While much has been written on the theory and stages of design thinking, this study is novel in describing this methodology from the beginning to the end of the process of planning a clinical space with input from the patient population. This study thus serves as a proof of concept of the application of design thinking in planning clinical spaces.

Assessing Spatial User Experience for Design Guidelines: A Comparative Study of Outpatient Waiting Rooms With Conventional Versus Modern Features

OBJECTIVES

Identify waiting room design features that are most appreciated by outpatients and their companions in conventional and modern waiting rooms. Evaluate if end users evaluate the environment differently from experts and in what aspects. Provide evidence-based design guidelines that orient designers and healthcare managers.

BACKGROUND

Built environments are relevant in patients' evaluation of overall healthcare service. For outpatients, waiting frequently consumes the largest amount of time; thus, waiting room interior design has great potential to enhance their experience.

METHODS

This study compares perceptions of two types of waiting rooms-conventional and modern-based on the spatial user experience (SUE) model. In the first stage of the study, we compared user evaluations of conventional waiting rooms (n = 137) and modern waiting rooms (n = 426) with respect to the eight SUE model dimensions using multigroup structural equation modeling. In the second stage, an expert ergonomist and two professional interior designers assessed both types of waiting rooms.

RESULTS

Results showed that modern waiting rooms were perceived to be significantly better in all SUE dimensions. We also found experts' evaluations were overall consistent with users' perceptions. Discrepancies were only found in temperature perception, signage evaluation, and spatial appreciation.

CONCLUSIONS

Participants valued modern style waiting room features such as good quality signage, use of armchairs and sofas, a controlled environment, and decoration. We suggest involving end users in the design process to respond to their needs and promote a positive experience. Finally, we provide easy-to-adopt design guidelines to improve patients' waiting room experience.

Does Perceived Control Matter in the Outpatient Waiting Room?

OBJECTIVE

The study examined perceived control in the context of the outpatient waiting room to further understand the extent to which patients want to exercise control in that environment. Background: In Ulrich's theory of supportive design, research shows more evidence for positive distraction and social support than for perceived control; its role in outpatient settings has not been examined.

METHOD

This between-subjects experimental design, in which participants read a written scenario varying the number of patients waiting (1 or 5) and the control available (no information provided, personal controls, and room controls), examined the effect of those variables on stress, satisfaction with the environment, extent of perceived control, and participants' schema of who should control the environment of the waiting room.

RESULTS

Having individual controls available in the waiting room favorably impacted the perception of the environment but did not significantly impact stress. The data show that people likely have a schema of appropriate behavior in a doctor's waiting room, which does not encourage manipulation of environmental elements.

CONCLUSIONS

In the doctor's office waiting room, having individual controls, such as on-off knobs on table lamps next to each chair, can improve evaluation of the environment and increase people's perception of control.

Using Architectural Mapping to Understand Behavior and Space Utilization in a Surgical Waiting Room of a Safety Net Hospital

OBJECTIVE

To use architectural mapping to understand how patients and families utilize the waiting space at an outpatient surgery clinic in a safety-net hospital.

BACKGROUND

The waiting period is an important component of patient experience and satisfaction. Studies have found that patients value privacy, information transparency and comfort. However, approaches common in the architecture field have rarely been used to investigate interactions between patients and the built environment in a safety-net healthcare setting.

METHODS

This was a prospective observational study in a general surgery outpatient clinic at a safety-net hospital and level 1 trauma center. We used a web-based application generated from the design and architecture industry, to quantitatively track waiting space utilization over 2 months.

RESULTS

A total of 728 observations were recorded across 5 variables: time, location, chair selection, person/object, and activity. There were 536 (74%) observations involving people and 179 (25%) involving personal items. People most frequently occupied chairs facing the door (43%, n = 211), and least frequently occupied seats in the hallway (5%, n = 23), regardless of the time of their appointment (p-value = 0.92). Most common activities included interacting with personal phone, gazing into space, and talking face to face. Thirteen percent of people brought mobility devices, and 64% of objects were placed on an adjacent chair, indicating the desire for increased personal space.

CONCLUSION

Architectural behavioral mapping is an effective information gathering tool to help design waiting space improvement in the safety-net healthcare setting.

Seating in Doctors' Waiting Rooms: Has COVID-19 Changed Our Choices?

OBJECTIVE

This study investigates preference for five different seating arrangements (e.g., rows, clusters) in a doctor's office waiting room, whether these reduce stress and improve judgments of medical care, and how such choices may have changed over the pandemic (2013 vs. 2021).

BACKGROUND

What is called the doctor's office layout, with chairs lining the perimeter of the waiting room, is criticized by designers, yet little empirical evidence exists to support that assessment.

METHOD

Data collected in 2013 and 2021 used sketches of five different seating arrangements; people saw just one of these. The study examined the effect of time and seating arrangement on anxiety, need for privacy, situational awareness, evaluation of the environment, and perception of the doctor.

RESULTS

There was no significant impact of the seating arrangement on any of the dependent variables, but ratings were higher for situational awareness, need for privacy, evaluation of the environment, and aspects related to the physician in 2021. In addition, seating preferences favored end, not middle seats, and chair selections with the chair back to a wall.

CONCLUSION

In this study, no evidence exists that the doctor's office layout is less preferred than four other seating arrangements, but seat choice shows people prefer end seats (not middle seats) across arrangements. The doctor's office layout may offer a supportive familiarity to people; also, given the percentage of people who visit the doctor unaccompanied, layouts designed to encourage social interaction may not always be appropriate.

The role of waiting area typology in limiting the spread of COVID-19: Outpatient clinics of Erbil hospitals as a case study

In the post-healthcare context, protecting patients against pandemic diseases like COVID-19 has become designers' responsibility; the amount and effectiveness of change are unknown, particularly in terms of future design. This study explores the potential significance of waiting area typology within outpatient clinics in generating a healthy and therapeutic environment for patients and users in terms of social distancing, as well as whether there is a relationship between outpatient and the provision of social distancing. This study employed a quantitative approach based on space syntax theory, through four different syntactic maps (Isovist, Axial, Convex and Visibility Graph Analysis), to depict hospitals in Erbil city by adopting five outpatient layout typologies such as centralized and decentralized (linear, lobby, sectoral and mixed), through measuring wayfinding, accessibility, privacy, density and circulation as outpatient layout typology factors. Results identified that there is a clear effect of outpatient layout typology factors on providing social distancing especially in waiting areas, the decentralized outpatient layout represented by both sectoral and linear typologies is the most useful typology based on social distancing compared to others. Given the influential role of outpatient layout in providing a healthy and safe healing atmosphere with more social distancing for patients, research findings provide a useful resource for healthcare designers, particularly for waiting areas within outpatient clinics.

Evidence-Based Design for Waiting Space Environment of Pediatric Clinics-Three Hospitals in Shenzhen as Case Studies

This study explores the waiting space environment of pediatric clinics in general hospitals and the relationships between the use of space, behavioral activities and overall satisfaction. Patients often spend a lot of time waiting for doctors, and child patients waiting to be seen are particularly likely to feel bored, depressed and anxious, which negatively affects their overall experience of seeking medical attention. Since the launch of China's second-child policy, the number of children born in China has surged. As medical resources for children are in short supply and of uneven quality, it is urgently necessary to carry out research on optimizing the design of children's waiting space in Chinese hospitals to improve their medical environment and experience.

METHOD

This study identified four first-level indicators and twenty-seven second-level indicators in four dimensions: functional layout (layout and area), flow organization, supporting facilities and environmental details (physical and landscape environment). The research combined subjective and objective methods, including comprehensive observation, a questionnaire survey and interviews, taking three hospitals in Shenzhen as case studies.

RESULTS

The study found that the waiting space in pediatric clinics currently fails to meet key patient needs in areas such as mother and infant rooms, children's play areas and drinking water facilities, and there are widespread problems with the creation of natural environments, such as views of natural scenery from windows and indoor green plants. Six factors were found to significantly positively influence overall satisfaction with waiting space, describing 69.76% of the changes in the respondents' degree of satisfaction with the waiting environment. Supporting facilities and aspects of the physical environment had the greatest influence on overall satisfaction with the waiting space.

CONCLUSION

Optimizing the design of the waiting space in pediatric clinics, with a focus on functional layout, flow organization, supporting facilities and environmental details, can improve overall satisfaction with pediatric waiting rooms. The results are preliminary; they need to be further tested in practice to complete the process of evidence-based design. This will lead to suggestions for refining the design of pediatric waiting units which can be used by architects and hospital administrators.

Specialty Space: Breast Care Centers

As background, breast care centers around the world vary in interior design based on geographical location and the trends of the healthcare design process at the time of construction. However, at the forefront of healthcare interior design is the evidence-based design (EBD) process and the Universal Design (UD) guidelines. The Center for Health Design states that the EBD process differs from the linear design process, in that EBD uses relevant evidence to educate and guide the design decisions. The objective of this study was to support future EBD and UD use in the development of patient areas in breast care center interior design. The methods for this study incorporated an extensive review of the literature, examples of eight breast care centers around the world, observations, an interview, and a staff survey concerning the interior design of a local breast care center. The results revealed that using the EBD process and UD, to develop guidelines for patient areas in breast care centers' interior design, directors could use guidelines to evaluate existing breast care centers or preconstruction for new breast care centers. This study concluded with design guidelines for patient areas in breast care center interior design. The recommended guidelines targeted the following features: robes (vs. hospital gowns), spa-like atmosphere, monochromatic color scheme, use of wood and stone, private check-in areas, wayfinding, room temperature comfort, seating comfort, seating style choices including bariatric, personal items storage, access to natural light, indirect artificial lighting, living plants, views of nature, flooring comfort, and wheelchair accessibility.

Small Garden, Big Impact: Emotional and Behavioral Responses of Visitors to a Rooftop Atrium in a Major Hospital

PURPOSE

To measure hospital visitors' satisfaction with a rooftop atrium and its resultant impact on the visitors' behavioral intentions toward the healing garden, the hospital, and overall satisfaction with the hospital.

BACKGROUND

There is a significant lack of empirical research that links the emotional and behavioral responses toward healing gardens and the hospitals providing them.

METHODS

A purposeful sample of 96 visitors to the healing garden in the rooftop atrium of a surgery building in a major hospital in the Southeastern United States completed a survey based on Roger Ulrich's Theory of Supportive Gardens and the Stimulus, Organism, Response (S-O-R) paradigm.

RESULTS

Findings of this study suggest visitors' experience with the healing garden can lead to overall satisfaction with the hospital and behavioral intentions toward the hospital. Visitors' satisfaction with the healing garden significantly predicted their satisfaction with the hospital, their intend to revisit the hospital, and their intend to recommend it.

CONCLUSIONS

This study demonstrates that a small healing garden can be a powerful enough space to impact visitors' overall satisfaction with the hospital and their intentions regarding their future behavior toward the hospital, such as revisiting or recommending the hospital.

Study of the Physical Environment of Waiting Areas and Its Effects on Patient Satisfaction, Experience, Perceived Waiting Time, and Behavior in China

OBJECTIVES

This study examines the physical environment in the outpatient waiting area and its effects on overall satisfaction, experience, perceived waiting time, and behavior.

BACKGROUND

Waiting can be a frustrating experience for patients. Previous studies on waiting areas in hospitals have been rooted mainly in the Western cultural context, and research focusing on the impact of the physical environment on the waiting experience with the denser patient concentration in China is important.

METHODS

Physical environment measurements, observations, and questionnaire surveys were employed.

RESULTS

The actual lighting intensity and sound level did not meet the national standards. Sound level and satisfaction with the size of the waiting area, signage system, and visual art on the wall were significant predictors (R ² = .463, p = .000) for overall satisfaction. Experiences related to the size of the waiting area, seating, signage system, and restrooms were significant predictors (R ² = .373, p = .000) of overall waiting experience. The experience related to the acoustic environment (β = -.184, p = .006) had a significant relationship with perceived waiting time. The increase in participants' behaviors of looking out of a window and the decrease in looking at other people, looking around, dozing, and looking at a wall might result from a substantial increase in lighting and the availability of a nature view from the window.

CONCLUSIONS

The effect of the physical setting of waiting areas may positively impact patient satisfaction, waiting experience, perceived waiting time, and behavior, which has implications for patient-centered design.

Positive Distractions and Play in the Public Spaces of Pediatric Healthcare Environments: A Literature Review

Background:

A positive distraction is a significant environmental feature that introduces positive feelings by diverting attention from stress or anxious thoughts. Existing research has deemed the application of positive distractions in pediatric environments to be significant. This study investigated the essential positive distractions and the associated health benefits.

Aims:

The aims of this study were to validate and extend evidence on positive distractions and play opportunities in the design of the public spaces in pediatric healthcare environments, translate existing evidence into design suggestions, and identify research gaps in this realm.

Methods:

A four-phased literature review method was employed in the study, including literature search, literature screening and selection, literature appraisal, and thematic analysis and in-depth discussion. Eventually, 27 peer-reviewed publications were reviewed and discussed in detail.

Results/Conclusions:

The gathered materials were grouped into six themes of positive distractions: (1) art and environmental aesthetics, (2) spatial arrangement and atrium, (3) considerations of socialization patterns, (4) play and interactive technologies, (5) sound and lighting interventions, and (6) access to nature. The research indicated that positive distractions in the pediatric healthcare environment provide a series of health benefits for patients, including improved behavioral and emotional well-being, reduced stress and anxiety, enhanced healthcare experience and satisfaction, and facilitated medical procedures and recovery. Yet significant research gaps emerged between positive distractions and play in garden spaces and spatial design to accommodate interactive technology and socialization in the public areas of pediatric healthcare environments. This study organized the understanding on the components of supportive environments and its outcomes for pediatric healthcare design.

Therapeutic gardens as a design approach for optimising the healing environment of patients with Alzheimer's disease and other dementias: A narrative review

PURPOSE

The first half of this paper documents the role of nature in healthcare environments and its impact on wellness, with a particular focus on gardens. The second half presents a scientific evaluation of the role of gardens as a therapeutic intervention to optimise the clinical outcomes in patients with Alzheimer's disease (AD) and dementia, including a review of the innovative application of technologies alongside nature to promote cognitive rehabilitation in this particular patient population.

METHODS

Using search engines such as the Institute for Scientific Information (ISI) Web of Science, PubMed, ProQuest Central, MEDLINE, Scopus and Google Scholar, a relevant literature search on the positive health implications of therapeutic gardens (TG) on AD and dementia patients in the healthcare milieu was conducted.

RESULTS

The health implications of TG for AD and dementia patients span physical, social, psychological and cognitive effects. Virtual reality (VR) technologies that display natural environments also offer positive cognitive outcomes for AD and dementia patients.

CONCLUSION

TG should be used to improve the health and wellbeing of AD and dementia patients, and its application should be extended to other patient populations to promote quicker recovery. Future directions in the design of TG, with a focus on patients with AD and other dementias, is also discussed.

Sound as a supportive design intervention for improving health care experience in the clinical ecosystem: A qualitative study

PURPOSE

Most prior hospital noise research usually deals with sound in its noise facet and is based merely on sound level abatement, rather than as an informative or orientational element. This paper stimulates scientific research into the effect of sound interventions on physical and mental health care in the clinical environment.

METHODS

Data sources comprised relevant World Health Organization guidelines and the results of a literature search of ISI Web of Science, ProQuest Central, MEDLINE, PubMed, Scopus, JSTOR and Google Scholar.

RESULTS

Noise induces stress and impedes the recovery process. Pleasant natural sound intervention which includes singing birds, gentle wind and ocean waves, revealed benefits that contribute to perceived restoration of attention and stress recovery in patients and staff.

CONCLUSIONS

Clinicians should consider pleasant natural sounds perception as a low-risk non-pharmacological and unobtrusive intervention that should be implemented in their routine care for speedier recovery of patients undergoing medical procedures.