Healing Alone, Healing Together

What Is the Human Cost of Patient Privacy?

October 17, 2013

Healthcare Partner, NBBJ

The Affordable Care Act, now lurching forward in fits and starts in the U.S., puts a spotlight on healthcare costs and a renewed emphasis on patient outcomes. Embedded in this new course of action is the chance to re-assess some long-held assumptions about how people best heal. One area I have been studying: the benefits of healing alone versus healing together. When it comes to a stay in the hospital, most Americans equate a private room with higher-quality care and feel as though sharing a room with one or more patients would be overly stressful or an undue burden. We want our space, and we want our privacy — even if it means spending long periods of time alone and bedridden with no one to talk to but the TV.

This American sensibility around privacy, space and boundaries is now being coopted by many BRIC countries as they introduce more sophisticated healthcare models. Newly created institutions often associate American culture and social structures, including healthcare delivery, with having and being “the best.” A private room signals that patients are receiving the finest care available. And to be clear, in some instances it is absolutely imperative that patients convalesce in a private room. To that end, we have dedicated ourselves to rethinking the design of private rooms to improve patient experience, quality of care and safety levels. But more often than not, the need for a private room is a perception, not a reality.

What many fail to mention about single-patient rooms is that they are expensive, require more space, increase travel distances to provide care, and increase the number of staff needed to provide care in perpetuity. They also create an environment where patients are isolated and have limited contact with staff and other patients. All this calls into question whether moving to single-patient rooms is indeed the only “right” answer.

In a thought-provoking column for The Atlantic, Richard Gunderman, a doctor and Indiana University professor, questions the move toward such seclusion, arguing that the serious nature of health events taking place in hospitals creates the type of situations that most require companionship and human connection:

“Sometimes our zeal for privacy gets the better of us, short-circuiting opportunities for compassion and community. It is hard to be ill and in pain, especially seriously so, but such burdens are often magnified when we shoulder them alone… Typically, the events taking place in hospitals represent experiences when we need one another most… Shared suffering enables [us] to forge a common bond.”

In fact, there are many examples around the globe of cultures that prefer to heal in a communal setting when the level of care needed is low or recuperation time is long. Maternity wards in some countries are communal, for example, to allow women to socialize and provide comfort and aid to one another as they tackle the new and at times mysterious duties of motherhood.

At NBBJ, the design firm I work for, we have been experimenting with a hybrid room concept that allows for both privacy and a high level of human connection and community — a larger, modernized version of a traditional four-patient room. It allows for excellent lines of sight from staff-to-staff, staff-to-patient, and patient-to-nature. It also accommodates different levels of acuity of care and recovery needs and styles, while remaining highly conscious of cultural, budgetary, safety and efficiency needs.

As we “export” healthcare practices to other countries, we should be mindful of how healing practices mesh with the cultures they migrate to. Perhaps the idea of healing alone in the U.S. can be balanced with co-healing strategies. When we design, perhaps a little cultural empathy is in order — empathy to the cultures for which we design, and toward those who heal alongside us.

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