How do healthcare designers address the evolving needs of young patients and their families? Principals Terry Barker, Robin Guenther, and Chuck Siconolfi kick off our Healthy Conversations series.
Terry Barker: What is the fundamental challenge of delivering pediatric care today?
Chuck Siconolfi: We are in a period of very rapid scientific advancement. That advancement is leading to new care models—that is, new ways of treating disease, especially diseases that were previously untreatable. So we must listen to the clinicians and the researchers to understand how the care models are changing. And we must listen to the technologists to see how modern technology can support those new care models. Only then we can begin to determine how the space program changes. And as the buildings are organized differently, we create adjacencies that respond differently. There are so many ways in which the care models drive the architecture.
TB: Can those care models enable children to participate in their own healing? How?
Robin Guenther: Certainly they can. In our work at Lucile Packard Children’s Hospital, at Stanford, pediatricians talked about how learning stimulates healing. We created a triad of mind-body-spirit, ensuring that learning (the mind), stimulates healing (the body), which boosts restoration (the spirit). Ultimately, this is about encouraging recovery. It’s a framework that links sustainability to health. And at the intersection of where children grow and heal, there are so many sustainable ideas. We began asking ourselves, “How does everything we do intersect with one or more points in that triad? How do we create a building that gives equal weight to all of those?” So when you’re talking about bringing children into their own healing, you’re talking about immersing children in the three points of that experience. And we believe that children do have a role in their own healing. It happens whether or not they realize what we’re doing or notice their role in that process.
CS: There are many ways that we can encourage children and their families to have roles in healing and in maintaining health. Yet the youngest of patients will experience pre-natal or congenital conditions, genetic defects and early childhood cancers. So while their capacity to participate in their own care develops over time, we must make every effort in the program and the design to accommodate the special needs of these patients. We must guide the process in ways that reduce the burden of fear and anxiety that patients and their families experience, and facilitate the bravery we ask of them. It’s really about what we as care providers, and parents, and as a society can do.
TB: Many of our children’s hospital clients want to create “the healthiest hospital,” but get stuck when articulating what that means and connecting those strategies to the experience of the building. How can we help?
RG: It begins with promoting healthy behaviors in the building. We put stairs adjacent to elevators, for example, and provide easy access to inviting, active outdoor spaces. We introduce play equipment, exercise areas, treadmills, even spas where parents can get a massage to reduce stress. For staff, it’s about ergonomic seating and standing desks. These healthy strategies extend throughout the building, from the materials we select to operations, where children’s hospitals offer food options that are organic, free of pesticides and antibiotics, and are locally grown, and use “green cleaners” to improve indoor air quality. As you move beyond the four walls, health is demonstrated through minimizing the use of fossil fuel energy in buildings and transportation, which creates localized air pollution that aggravates asthma and respiratory issues in the immediate community. Finally, this belief in health is broadcast community-wide through the goals of sustainable design. These include the restoration of natural habitats and demonstrating health stewardship beyond the building. At Packard Children’s, for example, the construction of the building actually resulted in 3.5 more acres of natural habitat than existed before the building was there!
If you only think of hospitals as places for sick people, the building itself is no longer part of a healthy objective. But hospitals are a place where people are restored to health, so they have a real mission of restoration. As we make health the objective for everything we do, the built environment should model and demonstrate a commitment to health.
TB: Framed in this way, hospitals are almost a vehicle for social and environmental justice.
RG: Yes! Hospitals and health systems do not exist in a vacuum. Whether it’s burning of fossil fuels or generating waste, hospitals are connecting their operations with their environmental and health impacts. When healthcare leaders connect antibiotics in the food supply and antibiotic resistance in patients, they take a step back and look at reversing the conditions that contributes to these consequences.
Children’s hospitals are at the forefront of that evolution. The changes begin at the smallest scale, at the patient level, and we see a focus on the chemicals in building materials, food, and the “stuff” of healthcare delivery. At the scale of the building itself, it’s how it interacts with nature and daylight to support circadian rhythms, active living and health. Then the scale moves outward and you’re looking at its urban and ecological impacts—how it manages transportation, stormwater and ecological systems.
I think most hospitals still haven’t really made those connections visible—but there are a few hospitals that do. Our Spaulding Rehabilitation Hospital, for instance, tries to minimize the distance between people and nature. Operable windows bring you the outside even when you’re in the building. And the hospital café is on the waterfront so patients and families eating lunch are eating right there with joggers and dog-walkers and folks enjoying the waterfront.
Hospitals can certainly be scary places, and quite distinct from anything children, especially new patients, may have experienced. Tell me how you design for the emotional needs of children.
CS:We want to maximize the extent to which the environment appears familiar to these patients. The potentially frightening high-technology equipment from which patients may experience pain are kept out of sight. Entries, corridors, waiting spaces, bedrooms exam rooms and procedure rooms should be designed to function smoothly yet look as normal and welcoming as possible.
We must also recognize the sense of a loss of control that accompanies with being ill and in the hospital. We can identify areas where patients and families can have control, and feel secure. Our designs address the emotional needs of children and the families that are caring for them. And there are many specific ways of doing that. We allow children to choose how their immediate environment looks and feels. They can change color of lighting, decide what kind of artwork they want in the room, and be in charge of the video connection to people back at home.
RG: It’s also key to allow family to participate. We reduce barriers to family participation at every level. Especially when attending to young children, families can now stay over in patient rooms. That participation extends to things like parents accompanying a child through the anesthesia process and being there at the moment of regaining consciousness. It’s key not to let parents be shut out of that care taking. Children’s hospitals today are doing a more sophisticated job of allowing families that level of participation without interfering with optimum care-giving. And it’s far from over. It’s an evolutionary process as it has been in all of medicine. We’ve certainly come a long way from a world where the clinical team is all-knowing and we simply accept what they say. Given all the resources today, people are more fully engaged with health than ever before. And it’s important to help caregivers recognize and facilitate that awareness.
CS: Additionally, there are new ways to connect kids to one another using technology. I did a study for a hospital here in NYC, where kids could “draw” on the surface of the building, which had LEDs that were connected to their tablets. They could create forests and animals and birds and they could do it with other kids in the hospital. Their footwalls also displayed the images, so the kids could what they were doing, and the public could see it as well. The same technology—communication with the footwall—could allow kids to attend class, to go to birthday parties, and so on. They could even engage in play with children in a pediatric hospital across the world, and brag about it to peers elsewhere. It establishes some level of normality, some level of control in their care episode.
TB: Relative to adults, how do younger patients place distinct demands on the planning decisions made and the care provided? In addressing these demands, what are the latest trends you are seeing?
RG: One of the things we talked about at Packard Children’s with families was that, the moment you enter a hospital with your child, the child is distracted by everything around them—kids want to move around and be entertained. Parents, meanwhile, are often incredibly stressed. They have one thing in mind—to arrive at their destination. Kids should have no sense of anxiety regarding their arrival and their presence. So while the parents will be anxious no matter what, what we really try to do is provide the most easily navigable, simplest way for everyone to get from point A to B to C while simultaneously occupying kids and helping parents focus on the task at hand. It’s very layered and experiential.
TB: So you’re setting up a split approach to programming that carries itself through the rest of the hospital?
CS: Yes. Amid all the patient care, you’re programming all the life functions of adult family members and siblings. You’re thinking through the activities of daily life, and facilitating those. Everything from where family members can sleep, to places where they can hold private phone calls or connect to the internet—whether work-related or care-related, they can continue to do what they need to do: Laundry rooms so you can wash your kids’ clothes on your own, tech centers, business centers, lots of food and recreation options for well kids and anyone who tagged along for the day. These are today’s hospitals.
TB: What do the children’s hospitals of tomorrow look like?
CS: I can say that the care experience of the future will be radically different. There will be new models of care, new technologies, and the ability to treat diseases and conditions currently not well treated. And more care will be deliverable in outpatient settings, and virtually, at home., And that is the healthiest and most normal environment. So we should expect our buildings to be differently organized, to contain different elements, to look different, and to be highly augmented by virtual components.
Stay tuned for more Healthy Conversations between leaders at the forefront of healthcare design!