The Re-Socialization of Patient Care

True Patient-Centered Care Requires a Holistic Approach to Meeting a Patient’s Physical, Mental, Spiritual and Social Needs

October 28, 2019

Healthcare Partner, NBBJ

Editor’s Note: This essay was originally co-authored by Rich Dallam and Ryan Hullinger for the December 2018 issue of A+U. It is reprinted here with the permission of the publisher.

Healthcare has seen a widespread shift in focusing on the patient experience. While this encompasses many, sometimes competing, priorities, for NBBJ a major concern is the social aspect of care. Hospitals today are increasingly building single-patient rooms to reduce infection and improve the patient experience; however, true patient-centered care requires much more than maximizing comfort: it requires a holistic approach to meeting a patient’s physical, mental, spiritual and social needs.

This approach brings many different clinical specialties — physicians, nurses, mental health professionals, dieticians, physical therapists and more — together to work for the patient’s benefit. As a result, examination and patient rooms are frequently expanding in size, even as cost concerns drive healthcare providers to reduce square footage wherever possible.

To accommodate these diverse specialties without inflating space needs and construction costs, NBBJ has adopted rapid prototyping in the planning of examination and patient rooms. This process engages clinicians, patients even cleaning staff to role-play within full-scale mockups of a proposed room, and then to quickly reconfigure and iterate the layout to not only better accommodate staff workflows, but also to holistically meet patients’ needs.

In an April 2013 workshop with the Canterbury District Health Board in Christchurch, New Zealand, rapid prototyping aimed to design a multi-patient room that would improve healing by increasing socialization amongst both staff and patients, while still meeting contemporary needs for privacy and infection control. NBBJ is now using three-dimensional scanning to import physical mockups like this into digital models — a process referred to as digitally augmented rapid prototyping — which enables designers to document, analyze and make adjustments to a layout in real time and arrive at solutions faster.

Working with Native populations — particularly in Alaska and the Pacific Northwest, in addition to the Maori of New Zealand — challenges the prevailing notion that de-socialized, private patient rooms are always the best solution. In tight-knit Native communities, the social aspect of a person’s well-being is tied to their cultural identity. That’s why several integrated healthcare clinics designed by NBBJ for Alaska Natives and the Umatilla people of eastern Oregon are organized around a central gathering space, where people can connect and support each other through their healthcare journeys.

Lessons from this work with Native populations are now informing other projects, by finding new ways to incorporate patients’ families in the healing process. This has long been done, and amenities are continually improving, but new design concepts take this further by enabling the patient room to flex throughout the day to accommodate work, socializing, family meals and overnight guests — allowing daily life to continue even during an extended hospital stay.

For times when families are unable to join their loved ones in the hospital, NBBJ is now prototyping an augmented reality patient room that will enable them to be virtually present. The concept utilizes projection mapping and surround sound to create an immersive, 3D environment customized to the fixed perspective of a patient lying in bed. With this technology, the patient room can virtually disappear, replaced by a live view into the home that allows patients to remain connected to their families. This technology can also create immersive natural environments, as exposure to nature — even if only simulated — is proven to reduce stress and help people heal faster.

Like digitally augmented rapid prototyping, the augmented reality patient room utilizes the newest design tools and features. Most importantly, however, that technology is always employed in the service of increasing social connections and improving the human experience.

The potential — and challenge — of integrating new technology into the patient room suggests a new frontier for patient care: flexibility. When social demographics and technology are undergoing massive changes, too quickly for fixed infrastructure to keep up, how can we design an environment for rapid adaptation? Only when healthcare environments are flexible enough to keep pace with our evolving communities, as the ways in which people live and socialize inevitably shift, will we truly be prepared to provide the healthcare of the future.

Banner image courtesy Benjamin Benschneider/NBBJ.

All other images courtesy NBBJ.

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‘It Is Crucial That We Send the Message That Behavioral Health Patients Are Valued.’

A Conversation with Tammy Felker, Registered Nurse and Architect, NBBJ

October 11, 2019

Partner, NBBJ

Editor’s Note: The number of people reporting behavioral health issues is on the rise, a crisis often compounded by lower-than-average funding, a lack of psychiatric beds and high occupancy rates of behavioral health facilities. This week we are posting interviews with experts in behavioral health, following an NBBJ-hosted panel discussion, to learn how different parts of the country are addressing the crisis.


NBBJ: You plan spaces across specialties, but you are especially focused on behavioral health facilities. Given your expertise, how should these spaces evolve?

Tammy Felker: In the past, behavioral health spaces were designed like jails and featured prison-grade materials, such as tamper-proof lighting fixtures and plumbing. As a result, these environments feel institutional and cold.

Thankfully a shift in mindset is starting to transform the industry, creating a normalized care experience so patients feel safe, but also valued. Fixtures are becoming less institutional-like, and there’s a holistic emphasis on providing warm and therapeutic spaces.

One specific area we’re investigating is the integration of circadian lighting. Regulating sleep-wake cycles is especially important to the behavioral health population for healing, and it is ripe for further study and analysis.


What are the most impactful changes that could be made to how behavioral health spaces are designed?

The first change is to rethink spatial density. Studies show that too  many people in a small space can increase aggression. In behavioral health centers, giving enough square footage beyond the code minimum, so everyone has their own space, can make a difference in creating a normalized environment.

Another is to provide room for physical activity, from yoga to treadmills. Research demonstrates the positive benefits of exercise on anxiety and depression. Current building codes for inpatient behavioral health units don’t require exercise areas, but as a result, they are missing a great way to support the link between lifestyle choices and behavioral health.

A third element to consider is nature integration, ideally with access to the outdoors. Design that addresses our primal connection to nature can help decrease blood pressure and the use of pain meds. Even an area for horticultural therapy and opportunities to take care of plants can help.


Why should investments in treatment and design go hand-in-hand?

Our spaces and places convey meaning, and it is crucial that we send the message that behavioral health patients are valued. In fact, it may be more important to have a well-designed behavioral health facility than a typical healthcare space. That’s because behavioral health patients typically spend very little time in their bedroom and are constantly interacting with staff and other patients. Meals are usually in a group setting, and there are different therapy sessions, from art to group to individual sessions. Design needs to be supportive of this treatment model.


What makes you hopeful when it comes to addressing the behavioral health crisis?

The first is the Affordable Care Act and healthcare parity laws that require treatment of mental illnesses just like physical illnesses — and that people can get insurance that covers behavioral healthcare. Funding to train more doctors, nurses and other staff that specialize in behavioral health is another. In Washington State, Governor Jay Inslee is proposing an initiative that puts funding in place for a new 150-bed behavioral health teaching hospital in Seattle, along with community behavioral health centers across the state.


Images courtesy Sean Airhart/NBBJ.

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The More We Talk About Behavioral Health, the Better the Outcomes

A Conversation with Dr. Delaney Ruston, Filmmaker, Speaker and Stanford-Trained Physician

October 10, 2019

Planner/Healthcare Architect, NBBJ

Editor’s Note: The number of people reporting behavioral health issues is on the rise, a crisis often compounded by lower-than-average funding, a lack of psychiatric beds and high occupancy rates of behavioral health facilities. This week we are posting interviews with experts in behavioral health, following an NBBJ-hosted panel discussion, to learn how different parts of the country are addressing the crisis.


NBBJ: Could you tell us a bit about your upcoming documentary, Screenagers NEXT CHAPTER, about children with anxiety?

Dr. Delaney Ruston: We live in a screen-saturated world, and we’re examining how this affects teens’ emotions and communication preferences. In our film, we speak with teens about their personal stories, and talk with parents as well as schools — about what they are doing and how they can better support our teens. The film also explores my daughter’s experience with depression and my role as a parent.

A key goal of our film is to help all teens develop and build skills to thrive with hard emotions, such as stress, clinical depression and anxiety. We’re also motivated to raise awareness, to increase the national discussion surrounding teens and mental health. There are lots of interactive interventions, but it can be complicated and painful for our teens (and parents, too).

We’re so excited that this film uncovers lots of different solutions to a troubling situation. It also ramps up the science that shows why the teenage years are such an emotionally complex time. Teens are not just moody — their brains are undergoing rapid physiological changes.


What are the most impactful changes that could be made to how behavioral health is handled in the United States?

The first is that we could revolutionize the system to fully appreciate the magnitude of solutions available, particularly people power — our support teams, teen peer groups, school psychologists, etc. From my personal standpoint, my father with schizophrenia bonded with his case workers in such a profound way. I think we need to further contemplate and build this task force. The power of positive, supportive relationships is fundamental.

The other is integrating medical and behavioral health into one. Behavioral health is complex, and for some conditions, like depression, we need lots of mental health and social services support. To strengthen the link between the two healthcare areas, while training professionals (and paying them a living wage) as well as community members and peers, would go a long way.


What is an innovative approach/treatment you — or another institution, city, state, country, etc. — are working on when it comes to behavioral health treatments?

As a Fulbright fellow, I made films in India. During my time there, I spoke with and filmed mental health workers across the country and examined their peer-training system. Globally, I think the peer movement needs more funding and resources, particularly targeting college-age groups and above as mentors.


Traditional behavioral health facilities are seen as socially isolating or unpleasant to the senses. How should the design of behavioral health facilities transform to better serve patients (and their families and visitors) and staff?

If the right presentation and program is offered through a medical setting, the community will come. Seattle has a “birds and the bees” program, where parents come with pre-teens to discuss the impacts of puberty. It is critical we create welcoming spaces for behavioral health discussions, programs, training interfaces and more.


What makes you hopeful when it comes to combating the behavioral health crisis?

People are so eager to talk about these issues — and adolescents are overall being raised in environments that are more open to talking about these topics. Thankfully, this cultural mindset of greater acceptance is pulling the cover off the silence around mental health issues. It only hurts the situation by not discussing it. By seeing positive stories and showing that talking more about behavioral health leads to better outcomes, we’ll continue to benefit, as a community, in our families, and as individuals.


Banner image courtesy of John Durant/NBBJ.

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