A World View on Patient-Centred Care Design

Jill Joseph is a leading healthcare planner and designer, having worked across the US, Europe and the Middle East as a consultant for Herman Miller Healthcare. This year she visited Australia to educate architecture and design firms on patient-centred care and evidence-based design for the healthcare industry.
In working with both new design and redevelopment projects, Ms Joseph has been able to pass on her experience and the information that Herman Miller has gained over the last 40 years. She credits her international experience with the exposure she has had to cultural differences in approaches to care, manufacturing and business models.

“Increasingly, designers of hospitals have a triple aim: they need to reduce costs, improve the quality of their facility, and get more people through the door. We have found the way to plan for this is a convergence of sustainability, evidence-based design and lean manufacturing.”

A key finding from Ms Joseph’s work is the amount of waste that hospitals produce, and this needs to be factored into the facility’s business model. The waste management budget is often one of the largest running costs a hospital faces.
“Take for example patient rooms that need refurbishment or repair. In a traditional fixed design, a tradesperson would come in, pull out the millwork and create a lot of dust, dirt, noise and waste - not to mention shutting down the room which means less patient beds - and this affects many departments negatively. As opposed to new room design products such as a finished architectural wall which is designed to change, with tiles that pop off the wall for reconfiguration and modules for easy insertion or removal,” she says.
This kind of planning, with modular design for flexibility and integration with core systems such as gases and utilities, is how Ms Joseph along with her colleagues in the design world believe is key to ensuring buildings have the ability to not only last for the next 50 years but also grow and adapt to our changing healthcare needs.
Much of Jill’s work is founded on evidence-based design, which is quickly gaining momentum throughout the healthcare design industry as best practice.
Of course there are always obstacles to tackle in healthcare design, with infection control, noise and function versus aesthetics being the common factors to address again and again.
“Funding is a major obstacle for many facilities too. Many organisations find that forming partnerships help.”
Partnerships help not just with the funding, but with solving problems like design ideas and safety standards.
Evidence-based design is described by leading US healthcare design firm Huelat Davis as an environment that results in:

• Enhanced patient safety through the selection of materials that reduce infection, risk, injuries from falls, and medical errors;


• The elimination of environmental stressors, such as noise, that negatively affect outcomes and staff performance;


• A reduction of stress and promotion of healing by the designing of hospitals to be more pleasant, comfortable, and supportive for patients and staff alike.

A focus on patient care and evidence-based design is how companies like Herman Miller and Huelat Davis have come together as part of Planetree, Inc.; a not-for-profit organisation that works with healthcare organisations around the world and focus groups consisting of patients, families and staff to improve the care experience.
Working in the Middle East allowed Ms Joseph to bring new ideas to challenge traditional Western design ideas.
“Design in healthcare spaces is quite different in the Middle East. Religious and cultural considerations meant we had to consider things like separation of sexes in waiting spaces and treatment areas - and even wardrobe design, where their longer garments such as chadors and thobes do not hang properly in our Western-designed spaces that tend to be smaller, only fitting shirts, pants or skirts,” Ms Joseph says.
On the other hand, there were some familiar issues emerging in the Eastern spaces, with chronic lifestyle-related issues such as obesity and diabetes on the rise thanks to the spread of Western culture. Bariatric products have become a necessary addition to the facilities.
Something that she sees all over the world is the demand for better at-home care. As the population ages and the Baby Boomers begin to flood our aged care and hospital facilities, the call has increased for keeping people at home through ageing in place strategies. Jill also notes the surge of voices asking for primary support to care for the chronically and terminally ill in familiar surroundings (such as at home), rather than in acute care.
When it comes to Jill’s ideal hospital, she likes the idea of positive interaction with the environment.
“There is good statistical data proving positive interaction with the environment, and the [US] Facility Guidelines Institute indicate these should be contained within the space.”
“Personally, I like water. I like to see the outdoors. I want to feel healthy, protected, pleasant and serene,” she says.
Planetree.org
Planetree is uniquely positioned to represent the patient voice and advance how professional caregivers engage with patients and families. Guided by a foundation in 10 components of patient centred care, Planetree informs policy at a national level, aligns strategies at a system level, guides implementation of care delivery practices at an organisational level, and facilitates compassionate human interactions at a deeply personal level. Our philosophical conviction that patient centered care is the “right thing to do” is supported by a structured process that enables sustainable change.