People receive care in pop-up hospitals, doctors and nurses share a family’s last moments with a loved one over Facetime, new mothers give birth without the loving support of their families, and only one parent is allowed at baby's first check-up. Each story provides an example of human resiliency and the heroism of healthcare workers. Still, for healthcare designers, it is hard not to feel like we have regressed and that the patient and family experience we’ve dedicated our careers to improving has now been compromised.
Of course, all of these measures to achieve physical separation are about protecting human life. In a crisis, we accept conditions that would normally be unacceptable. Now, as we start to envision the post-pandemic landscape, it is our challenge and responsibility in this new world to find ways to maintain empathy, dignity and humanity in the design of healthcare environments.
In many ways, there has always been a latent tension in the design of healthcare environments. The needs of sanitation and clinical efficiency are often at odds with our very human needs for comfort and companionship. Through evidenced-based design, we have come to learn how impactful many qualitative features can be to clinical outcomes. Armed with this evidence, we have been able to balance this tension and advocate for positive changes in our care environments, such as: providing patients and staff access to daylight and nature, bringing the family into the care space to be part of the care team, and providing respite for both families and staff.
We hope that these design elements have improved the conditions for those dealing with this crisis. Still, as the crisis response has expanded, we see how many of these improvements are the first to go. As hospitals and governments searched for surge bed capacity, daylight access and respite spaces fell to the bottom of the checklist. Loving family members, once a vital part of the care team, are now vectors of disease to be limited or removed from the patient’s room. While all of this may have been necessary, one has to ask: What are we losing? What are the long-term consequences that we are not yet seeing? How do we make sure this doesn’t become the new normal? How do we provide safety in healthcare settings without losing our humanity?
One of the most heartbreaking consequences of the pandemic is the removal of loved ones from the patient bedside. Beyond the obvious role family members play as an emotional comfort to patients, they also play a vital role in patient care. They are a patient’s most important advocate. Loved ones are an extra set of eyes and ears as conditions change. They help convey history and knowledge to the clinicians, and ensure proper care after the patient is discharged. Losing this voice in the care environment may have lasting harm to the continuum of care. This may be especially true for patients who have historically required greater advocacy within the care environment due to disability, language barriers, or racial and cultural bias.
Since we will likely need to continue some limits on the number of people allowed in our care spaces for the foreseeable future, we need to begin thinking about how we can mitigate this loss. One obvious solution is technological. Greater use of in-room technologies can allow patients to connect with loved ones and allow family members to be present for crucial conversations. These technologies were already beginning to be leveraged, but the pandemic will push greater adoption. This could ultimately have a positive effect on patient care, even as providers are able to fully reopen.
This can be a positive consequence of this crisis, but it cannot be a complete replacement for a loved one’s physical presence. Additionally, as we consider the most vulnerable populations we serve, we must recognize that access to certain technologies may be limited for some of the patients most in need of that family advocacy. We need to find ways to maintain family presence at all points along the care continuum and ensure that our solutions are not further exacerbating existing inequities in our healthcare system.
The lack of family in the care space can be a further tax on the clinical staff. While clinical staff have always provided comfort and support to their patients, the emotional burden now falls more squarely on their shoulders. This, while they are dealing with a work environment that has become exponentially more stressful.
Most clinicians are well prepared to handle the emotional strains associated with illness and death, but in this pandemic, we are asking clinicians and all hospital workers to endure much more than they ever expected. Going to work and doing their jobs now puts them and their family members at very real risk. Some hospital workers have had to make extremely difficult choices to be able to continue doing their jobs, including segregating themselves from loved ones to keep them safe.
This risk is only being exacerbated by the lack of adequate personal protective equipment (PPE) in many facilities, and the use of temporary and alternate care facilities. Hopefully, this crisis will be the last time we see shortages of PPE in our hospitals, but it highlights the impact that the feeling of safety, or lack thereof, has on the mental health of our healthcare workers. It is incredibly important that space design and operations align to make everyone feel safe. In addition to safety, the added stress makes the need for staff respite especially critical. Staff spaces can no longer be first on the chopping block: we need to take care of hospital staff, so they can continue taking care of us.
Looking forward, how can we recapture what may have been lost? First, with any intervention or change it is going to be vital that all operational procedures align with the physical space—and that clear communication is provided so that everyone inhabits our spaces safely and feels safe as they do it. The following are some suggestions for areas that deserve design study and consideration:
- Separate entrances and circulation paths for visitors isolated from other public flows
- Visible protocols for cleaning and personal protection
- Clear separation between clinical and family spaces in patient rooms
- Spaces that truly provide staff respite
- Faster adoption of socially connective technologies with physical space
The post-pandemic future of healthcare is still largely unclear. The future of human health, and the ability for people to once again feel comfortable seeking and receiving care depends upon a holistic, humane approach. It is the design community’s responsibility to ensure that the spaces we design for the care of humans truly considers the humanity of the staff, patients and families within them. Additionally, as the pandemic has plainly revealed many of the inequities across our society, it is crucial that we as designers seek solutions that create greater equity and don’t contribute to existing barriers of access.
Challenges lead to innovation, and the pandemic has presented immense challenges throughout our society and particularly our healthcare spaces. Designers and engineers are inherently problem solvers, and we are positioned to have an enormous impact on the ways in which these problems are solved. SmithGroup’s brand promise has never more clearly been a call to action: Design a Better Future.