By Andrea Kingsbury, IIDA, LEED AP ID+C, Interior Designer, and Sam Pruitt, AIA, Healthcare Designer
As cities and states continue to reopen, the thought on everyone’s mind is, “How do we re-enter public spaces and businesses safely?” While essential businesses such as grocery stores and pharmacies familiarized the public with what life may be like in our “new normal” world, businesses are quickly adapting to meet CDC guidelines as they begin to reopen.
If you live in an area where restrictions have been lifted, you may have experienced practices such as reduced seating in restaurants, employees wearing protective equipment including face masks and gloves, or even waiting in “socially distant” lines. But what about our healthcare spaces? What will the new normal be like as we visit our doctor’s offices, dentists, emergency care centers, hospitals, and ambulatory centers? What design opportunities are there for healthcare facilities to help mitigate patient and visitor concerns during this transition and in a post-COVID-19 world?
Reentering Healthcare Spaces
With about 1 in 10 people acquiring a healthcare-associated infection (HAI)1, patients and visitors understandably may have reservations about reentering healthcare spaces. However, if patients ignore their symptoms or appointments, they could be postponing life-saving treatments2.
Making patients feel safe begins before they arrive at the healthcare facility. With the recent surge in telehealth visits3, healthcare systems should continue to use those platforms to speak with their patients and prepare them for what to expect when they come in for an in-person visit.
And what will the experience be like for patients as they arrive for their appointments? Much like the practices being observed by workplaces, healthcare facilities will need to establish screening protocols prior to allowing entry to any visitors. Typically, this will include a series of questions related to how they feel and what they have been exposed to, a temperature check, and often some form of validation that they have completed the screening procedure, such as a wristband or badge.
While these protocols are meant to keep everyone safe, they can be somewhat off-putting. To ease visitors’ anxieties, facilities should look at design solutions to integrate these screening procedures into their existing spaces so they feel natural but can be easily removed if screening measures should lessen.
One solution is through movable furniture components4 that can replace traditional greeter’s desks while also facilitating the necessary health screenings. Lightweight furniture solutions provide a cost-effective solution for facilities without disrupting existing built spaces. While partitions are advised to separate visitors and staff, screens that are simple, unobtrusive, and feel open will help connect patients with caregivers to further mitigate concerns.
Reconfigured Waiting Areas
Waiting areas, much like other public spaces, will need to be reorganized to meet appropriate social distancing measures. While seating will certainly be reduced as spacing increases, reorienting seating layouts into smaller groupings separated by low partitions, screens, or planters will not only give visitors a sense of comfort and safety but will feel like a natural change.
To balance the reduced seating capacities, facilities may look at how restaurants process customers waiting for available tables. Utilizing apps, text messaging, or phone calls to alert visitors when their clinician is ready to see them will allow patients to choose how they wait to be seen. Whether waiting in their car, finding places to walk about the campus, or selecting a seating nook within the space, this control over the waiting process gives users a sense of security and freedom.
In addition to modified seating arrangements, visual cues that signify social distancing and circulation paths that feel intuitive will naturally guide visitors through a space and help reduce anxiety. These cues can be subtly suggested through flooring patterns, furniture solutions, and additional signage. Similar to how well-designed wayfinding systems seamlessly lead users through a space, integrated social distancing guidelines can reduce stress as patients reenter healthcare spaces.
Providing hand sanitizer, masks, tissues, etc. combined with signage related to the best ways to combat the spread of germs reinforces to the public that they are in safe facility. Distributing sanitation stations7 with PPE materials in public spaces will not only encourage good practices with the public but alleviate some concern around staying healthy in public areas.
While material selection and specification have always been central to the healthcare design process, healthcare systems should examine the materials they use in their spaces and how those materials interact with both visitors and staff. High-touch surfaces such as furniture, counters, privacy curtains, and door handles should be specified in materials that are easy to clean and disinfect. Seamless materials, without cracks, joints, or crevices, will support disinfection and mitigate the transfer of pathogens if maintained properly. Advancements in the use of metals such as copper and silver, which are inherently antimicrobial, into materials like countertops, furniture, fabrics, and draperies will naturally ward off microbes.
In the future public spaces could include more automated, touchless elements6 such as automatic doors, hands-free controls, and app- or voice-activated devices. Self-cleaning rooms such as restrooms or other spaces that can be sealed and disinfected on a regular basis will offer another layer of protection from contamination. The use of UV lighting and vaporized hydrogen peroxide to disinfect spaces will grow in popularity and are another way to control the spread of viruses.
As the pandemic has increased uncertainty and anxiety throughout society, consumers will find comfort and security in the familiar style, colors, and tones of home. Healthcare spaces can react to this need for stability by introducing biophilic principles to reflect nature, especially in more urban environments. Facilities can introduce design features that stimulate the parasympathetic nervous system and mute the sympathetic nervous system (fight or flight response) as well as employ measures to distract and delight users to reduce stress and welcome the community to return to care environments. The creation of “sanctuary spaces” that feel safe, secure, and welcoming to users will instill calm and exhibit a focus on physical and mental health reflected through design.
Access to Telehealth
As indicated above, a primary measure that can be taken to ensure a safe return to the physical healthcare environment might be avoiding the traditional healthcare setting altogether. Health systems can ensure the health and safety of both their care team and their patients by offering virtual visits and appropriately separating patient populations. Telehealth can allow a vulnerable patient to be seen within the safety of their home – reducing their risk of exposure to contagion while minimizing the number of patients that are exposed to illness and capable of subsequent spread. While this is not a new technology, it is one that has seen marginal adoption in certain markets. Now, necessitated by COVID-19, health systems are seeing exponential increases in their virtual visits. In a talk hosted by the Center for Health Design, one Northeastern health system cited 1,500-2,000 average monthly appointments. In eight weeks following the outbreak of COVID-19 they had seen 200,000 virtual doctor visits. With the virtual barrier breaking down, healthcare providers can expect to see continued reliance on telehealth in the coming years.