Designing Hospitals in Collaboration with Patients and Families

During a visit to Nemours Children’s hospital in Orlando, I had the privilege of walking through a facility that was built from the ground up using lean principles. As I walked the hallways, I admired its beautiful architecture and state-of-the-art technology. The hospital was so aesthetically pleasing that I even forgot I was in a hospital. I was impressed by the sky-blue painted walls and the central monitoring, but even more exceptional was the hospital's dedication to focusing on the needs of patients and families. I quickly learned that this hospital asks and listens to what customers really want.

Early in the layout definition process, the hospital team brought in parents from its Family Advisory Council to work on the planning and design of the hospital – not just on the building design, but on every aspect of patient care.

Here are some of my favorite examples of how team members listened to patients and families: Patient Rooms

• When painting the ceilings, the hospital had the option of using a mirrored or a matte finish. Parents told the hospital: “If my child were recovering from surgery, he could look up at the ceiling and be frightened by his own image with tubes in his nose or arms. He wouldn't see his usual reflection.” The hospital then chose the matte finish, thus ensuring that this would not happen.

• The sofas in patient rooms have removable cushions and look like extra-large double beds. That way, parents can rest comfortably while staying close to their children. Parents helped choose the color and fabric of the sofas. When they asked for an outlet near the sofa to charge their cell phones, they got one.

• There is a full-length mirror in the bathrooms so that children, still in bed, can see their mom or dad brushing their teeth.

• All patient rooms have refrigerators, movable tables and chairs so that parents can eat with their children, work, etc.

• Outside each patient room there is iPad-like technology linked to the child's electronic health record. Seconds after a team member enters information into the record, it appears on the iPad. For example, if a physician determines that a child can no longer take food by mouth, this appears immediately on the iPad with a special icon.

• Staff badges are scanned by a sensor positioned on the ceiling of patient rooms at the entrance. A photo and a name appear on a screen so family members know who is entering the room. This important safety measure also ensures that families know the name and title of the person providing care.

• Cameras were installed in patient rooms. If a paramedic who is monitoring all inpatients from mission control sees a sign of irregularity in vital signs, for example, he can ask permission to instantly get a view inside the room.

Staff

• Family Advisory Council members were trained in interviewing techniques, and parents interviewed the finalist candidates for a staff position. These mothers and fathers interviewed more than one hundred candidates for physician positions.

• Hospital leaders truly value family feedback. In fact, the president said there were two finalists for the position of Chief Administrative Officer and that it was the parents' feedback that led him to offer the job to the person he chose.

Facilities Management

• Each medical unit or floor is painted in different energetic colors. To help patients and families not get lost in the hospital, each pod or cluster of beds also has different colors associated with different animals. For example, the third pod on the fifth floor is orange and has a picture of a butterfly above the door of each room.

• Most patient rooms have the same setup so that patients don't have to be moved to another room if their diagnosis changes. This saves staff time, prevents rework and minimizes stress for patients and families.The exception is fewer than ten rooms that have two beds (in the case of siblings) or intensive care rooms that have additional capacity for life-saving equipment.

In the book “Lean Product and Process Development,”the late Al Ward wrote: “For success – for consistently profitable operational value streams (in this case, efficient patient care) –we need to know what customers want.” He spent much of his time teaching people how to integrate this information with the design of the environment and the customer experience. While many healthcare organizations in the United States do not have the option of building their facilities from the start with all the necessary parties involved –this particular hospital has the benefit of being in Orlando, a place with donors and a lot of local sponsorship –what matters here is the lengths the hospital went to in order to meet its customers' needs. This is a lesson we can carry with us no matter what we do or where we work. How do you integrate the voice of your customer into your daily work and a broader organizational strategy? How well do you know your customers? For me, I know there is always room for improvement.