Power to the People: Unleashing User Insights

Patient centered design has been around for a long time. From Planetree, to LEED for Healthcare  and Evidence Based Design, the importance of the environment to outcomes has been advocated, documented and linked to design and operational decisions. The Beryl Institute is devoted solely to the cause of improving the patient experience. It’s great to have all of these resources. Even better as an architect to have healthcare clients embracing the needs to address the issue. But something gets lost in translation as we go from intent to implementation. Healthcare environments tremendously impact their users, who often have little opportunity to control them. We need to know we are getting it right, not just designing and building attractive surroundings based on precedents.

That’s why I was excited to read about a project recently launched by Penn Medicine in conjunction with the Wharton School of Business. Called “Your Big Ideas Challenge,” the effort reached out to staff throughout Penn Medicine’s system to present their innovative ideas for improving patient care. The top ten will be selected and presented at a town hall meeting. There were many compelling ideas, but what I was most interested in was the process. By empowering staff to think about how they can better serve patients, they were free to do more than air grievances or whine about needing more space. Instead, they could influence the change. Just think about how powerful this process could be when it’s time for the next design project:

Unlock information
There is only so much time at traditional design meetings and only so many staff usually allowed to attend. When you couple that with the fact that most of these people are not adept at reading plans or processing the information we present, counting on meeting feedback is actually a very bankrupt model for design. Instead, after discussing goals for the project with stakeholders, we should frame those goals in the form of questions back to a much more comprehensive cross-section of staff and empower a little innovative thinking that can lead back to either discrete design decisions or the development of design elements that will support an operational change. For example, if you develop a project goal that you want to create a less stressful environment for families, you might ask staff about how they would address commonly encountered family issues or complaints.

Cut a wide swath
Many times, we develop “departmental myopia” on our projects. We forget about just how much impact related departments or core process (lab, housekeeping, maintenance, food service, social services) or groups like infection control and facilities have on a space. Make sure to get the insights of these staff as well. The interchange of things that we don’t even realize happen in a space is often the area most ripe for a design intervention. These extra-departmental folks can provide the lowdown.

Re-integrate Information
So if you follow these suggestions, you now have a bunch of data. Hopefully, you also have a lot of ideas germinating as well. The last and very crucial step in getting the most innovation (and generating the most value) possible, is to re-integrate it back to the project. Invite key players from the extra-departmental group and a more robust sampling of staff from your departmental group to the next design meeting. Provide a recap of the results and how you are planning to use them in design. This allows the innovations to give way to some collaborative discussions, which will give the design team the most useful feedback possible going forward.

The Possibility of Transformation

In the last three weeks of this novena, we will move beyond our exploration of the limitations that are placed on us by others as well as ourselves.  The focus of these last posts will be on transformation and leveraging of strengths. 

As architects we have to believe in the ability of things to be transformed. An empty parcel of land becomes a building, an old building gets a new lease on life, an interior space is remodeled for a whole new use.  What we do is centered around seeing possibilities in existing circumstances and bringing about a change that goes beyond what our clients can imagine.  Tell us something is impossible, and we view it as a challenge to find a solution.  This is an amazing talent.  Too bad we don’t see it that way.  It’s time to start designing your career and bringing to bear all of the same creative skills you would to a creaky old building on a difficult site.  Be your own next project.

The pre-design analysis
Before you begin design, you collect information, determining all of the parameters and possibilities, schedules, budgets, delivery methods.  Take that same analytical view of yourself (see week five post Be your Own Stage Mom, if you don’t know how to get started).  Do your own mini-report that includes:
1. An assessment of your existing conditions, including strengths and weaknesses.  Don’t editorialize, just state the facts. Include a list of opportunities available and required improvements.
2. Benchmark the careers of others you admire in order to collect baseline performance measures
3. A definition of the problem, including goals and objectives.  Note: this is not a proposed solution- just a definition of what you want out of the finished project (your career).  Make your own career space program and schedule so you can begin to understand the magnitude of the task at hand and what things are the main vs. ancillary “spaces”.  Don’t be afraid of making big bold moves or determining that some existing career element just doesn’t work in your new plan and needs to be “demolished.”
4. Make a bubble diagram of your problem so you can start to identify relationships and critical adjacencies related to your program elements.
5. Code check: are there credentials you should be pursuing?
6. A test fit of how your problem, as defined can be addressed. Design options help clients see opportunities and doing the same for your career path helps you see what’s possible as well.

Design build phase
Now that you have your big idea and goals in place as well as a good handle on the parameters in which you will be operating, it’s time to get to work. 
1. Plan. Using all of the elements you identified, create a blueprint of how things will work.  Just as with a building, you will discover ways to combine program elements, circulation routes and guideposts will emerge and you will likely find that you need to add program elements.
2. Visualize in three dimensions. A building shouldn’t be the result of an extruded plan.  Neither should your career.  Allow the particular choices you have made about implementing your goals to add to the richness of your career design, informing you about further opportunities and really giving you the opportunity to create the form that follows the function.
3. Detail.  Embellish your career design with details that support and reinforce it.
4. Monitor implementation. You can get too caught up in the process of implementing your career design and lose sight of the purpose.  Revisit your goals often to make sure that your efforts stay on track.

Post occupancy
Your career is a work in progress.  You will never stop needing upgrades and remodels, even some radical demolition from time to time.
1. Conduct a post-occupancy evaluation.  What’s working and what isn’t?  Survey others to see if they can see your vision.  The best strategies are the ones that are easy to explain and that other people can understand.  Note: this doesn’t mean that you should avoid the unconventional or stop taking risks, just that your strategy is clear and trackable.
2. Measure your performance results every year.  Assess how well you are doing at meeting six month, one year, and five year goals as well as whether you want to add, remove, or change goals.

You can have the career YOU want, you just need to envision, design and implement it.  Thanks to your wicked skillz as an architect, you already know how.  Nothing is impossible.

What We Really Learn from Benchmarking

It’s typically one of the first steps taken when designing a new healthcare facility.  We look at data from facilities modeled similarly to what our client wishes to consider.  There may even be tours, surveys or interviews with staff from the comparative institutions.  This knowledge ostensibly helps our user groups to understand clearly the pros and cons of a given design model and sharpen their own vision for the project at hand.  But....benchmarking is relative.  Unless you presume to be in the prototype business and use post occupancy analysis and benchmarking to keep improving your model, nothing you look at with a client will be exactly like what you design for them. To avoid going astray with your efforts, observe the following benchmarking protocol:

Determine what "best" really means
The idea of benchmarking is rooted in comparison- ideally you find the best performer in the industry and look at ways to compare their results to your own.  Where you are lacking, you look to the means and methods applied by the benchmark and try to incorporate them into your model.  In the design world we have a small problem with that idea- who is really the best?  There are so many variables that might make a given hospital a good performer that may be unique to their circumstances. These same strategies may fail miserably if applied within your client’s market and culture.  Make sure that you spend time defining the needs and wants of your client and developing a discrete list of objectives. Place only institutions that dealt with these issues in design and operations on your benchmarking list.  Because you can learn from failure as much as success, it is important for your benchmarking to be based on a set of predefined criteria that has been addressed by every hospital you study. 

Understand your extrapolation
It’s unlikely that you will literally copy design features straight from another facility. You will be instead applying elements and concepts to your design problem.  Make sure that you understand what made something work for the benchmark facility- was it a combination of placement and protocol?  If you don’t understand the dynamic behind the result, you can copy design elements and not achieve the goal. Create a matrix that lists facilities across the top and then contains rows of your client's design objectives. In each cell, discuss specifically how a particular facility dealt with that client objective.  Leave room at the bottom to expand the objectives if a particular benchmark inspires the client to change or add a priority. 

Don’t exploit the process
Many times, we want so badly to sell our client on a given design solution. If they are not on board, benchmarking of similar institutions is used as a brainwashing technique.  Ethics aside, you may be very sorry later when the design you ramrodded down the client’s throat doesn’t perform well for them.  It’s equally as important to not allow administration or staff to become enamored by a facility and want to emulate it if it won’t provide similar benefits for their organization. Use facility tours to look at trends and filter out what will have lasting benefits vs. quickly becoming outdated. 

Benchmarking is a useful tool, but only after clear needs, goals and priorities are set by the client.  It is about setting standards for best practices, and that can be a highly subjective undertaking.  The Evidence Based Design process embraced by the Center for Health Design champions benchmarking as part of the initial research needed to define the problem.  I agree that benchmarking belongs firmly in the learning phase of the project, a source of information and a contributor to how the design problem at hand will be defined.  How have you successfully used benchmarking on a project and how did you work to remove bias from your facility selections and review of data?  Please join the discussion and share your thoughts.