Life-and-Death Design

Good design is more than just a better-looking egg beater. In some cases, it's the difference between life and death.

Kathy Hoffman, a nurse at Northwest Community Hospital in suburban Chicago, bustles into a room where an elderly woman suffers from labored breathing. Hoffman gets on her tiptoes, stretching to reach a switch for the heart-rate and blood-pressure monitors mounted high on a tower behind the bed. The look she throws across the room says a lot: The tower is designed to fit the "average" person, but not shorter people like her. Deborah Sheehan, director of health-care design at Chicago-based architectural firm OWP/P, notes the frustration.

Sheehan and a team of architects have spent months shadowing doctors, nurses, and patients at Northwest as they plan a new emergency room and inpatient wing. OWP/P has set up learning labs that mimic parts of a hospital, including that awkward monitor tower. It has also created role-playing workshops that confront the realities of patients, nurses, and doctors.

Hospital design has gone through several upheavals over the decades, moving from the sterile institutions of the 1950s to, most recently, "patient-centered care." The next iteration, what OWP/P and its clients aspire to, is far tougher: hospitals and ERs that work for everyone--patients, staff, and families alike.

So Tara McCay, an architect with OWP/P's Phoenix office, has watched nurses and doctors save countless lives in trauma rooms. Her initial thought was that the rooms had to be far bigger. "You would see all these people crowded around the patient in this tiny space," she recalls. But after months of observation, McCay changed her approach. "Nothing is haphazard in a trauma room. It's so highly organized," she says. Bigger rooms would have upset the choreography, forcing people to take more steps to reach critical tools like crash carts, she says. "What they really needed was better space, not bigger space."

The result: OWP/P developed designs for a wider entrance to the room so that a dozen people and their machines could rush in without colliding. And inside, everything was placed within hands' reach. "Architects and designers often think about what will be aesthetically pleasing," says Kevin Matuszewski, a medical planner formerly with OWP/P. "Now when I draw the blueprints,

I pencil in where everything--and I mean everything--should go, not where it looks best. Where are the glove dispensers? Where are the electrical outlets? Where are the doctors and nurses going to be standing?"

While "shadowing" reveals how people use existing hospitals, the learning labs and role-playing spark designs that users might not even know they need. How does an architect feel when forced to wear revealing hospital gowns? "Vulnerable," Sheehan says after spending 10 hours in her underwear beneath a gown that didn't quite fit. "That's not something you want to feel as a patient. You want to be engaged, secure, and comfortable so you can make good decisions about your health care." The solution: a gown that's easily pulled off by caregivers but offers more coverage.

Two OWP/P architects took the role-playing further, documenting on video their 12 hours on a hospital gurney. They lay in hallways waiting for space in semiprivate rooms, where patients must be paired up according to level of illness or type of disease. Which is why, when Northwest's facility opens in 2009, patients will be wheeled exclusively into private rooms--relieving waits and reducing the risk of contagion. That's what can happen when design considers everyone involved--and when designers understand what it feels like to wait on a gurney. For hours on end. In flimsy gowns.

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