Design That Cares

JANET R. CARPMAN, PHD, and MYRON A. GRANT, MLA are pioneering design researchers and wayfinding experts who have worked on hundreds of analysis, planning, and design projects in health facilities, museums, and other complex public facilities. Believing that designed environments should respond to the needs and preferences of the people who use them, Carpman and Grant have involved thousands of users in their work over the past 30+ years. They are authors of Directional Sense: How to Find Your Way Around and two previous editions of Design that Cares: Planning Health Facilities for Patients and Visitors. They are partners in Carpman Grant Associates, Wayfinding Consultants, which helps organizations create and manage facilities that optimize customer experience by making wayfinding as easy as possible.

Acknowledgments xv

Foreword xvii

Authors’ Introduction to the Third Edition xix

About the Authors xxi

Chapter 1: Introduction 1

Learning Objectives 1

Projections and the Direction of Healthcare 1

Healthcare: Changing Within 4

Design as a Component of High-Quality Healthcare 5

Designing for Patients and Visitors 7

Wayfinding Ease 9

Physical Comfort 9

Control over Social Contact 10

Symbolic Meaning 10

The Facility Design Process 10

Pre-Design Programming 10

Design 11

Concurrent Planning 12

Design Review 13

Construction 13

Activation 13

Post-Occupancy Evaluation 13

Summary 14

Discussion Questions 14

References 15

Chapter 2: A Look at Current Healthcare-Facility Design Research 19

Learning Objectives 19

Design Research in Relation to Current Trends in Healthcare 19

Focusing on Marketing 19

Valuing Healthcare-Facility Design 21

Sensitivity to Patient Experience 22

Recognizing the Role and Needs of Visitors 23

Emphasizing Accessibility and Universal Design 23

Conducting High-Quality Healthcare-Facility Design Research 24

Ensure That Research Is Planned and Carried Out by Trained, Experienced Researchers 24

See That the Research Builds On Existing Knowledge 25

If the Research Involves Clinical Investigations, Look Into Institutional Review Board Certification 25

See That the Research Has a Clearly Stated Purpose Related to Healthcare-Facility Design 25

Provide a Clear Research Design and Related Hypotheses 25

Carry Out the Project as Objectively as Possible 25

Skillfully Word Questions 26

Use Visual Images, if Possible 26

Carefully Sample Respondents 26

Make Sure Participants Give Informed Consent 27

Use State-of-the-Art Data-Collection Methods 27

Use Multiple Data-Collection Methods, if Possible 27

Use State-of-the-Art Data-Analysis Methods 27

State the Limitations of Findings and Their Generalizability 27

Consider Whether or Not the Research Is Replicable 28

Make Design Implications Explicit 28

Communicate Findings in a Way That Is Clear to Non-researchers 28

Research Claims 28

Integrating Design Research into the Design Process 29

Characteristics of a Humanistic Design Process 29

Objectives for Future Healthcare-Facility Design Research 31

Awards for Buildings Sensitive to User Needs 31

Training for Designers in Research Methods 31

Training for Researchers in Design-Relevant Research 32

Long-Term Studies of the Effects of Healthcare Facilities on Users 32

Translation of Research Findings into Design Guidelines 32

More Research Funding 32

International Research Agenda 32

Summary 32

Discussion Questions 33

References 34

Chapter 3: Arrival and Exterior Wayfinding 37

Learning Objectives 37

Traveling to a Healthcare Facility 37

Arriving by Car 38

Arriving by Taxi or Van 38

Arriving by Public Transit 38

Exterior Wayfinding 40

Exterior Signage 40

Environmental Cues 42

Exterior Handheld Maps 43

Main Entrance Drop-Off Area 45

Parking 46

Valet Parking 47

Parking Lots 47

Parking Structures 48

Park-and-Ride Options 49

Long-Term Parking Rates 49

Transition between Parking and the Building Entrance Area 49

The Main Entrance Area 50

Becoming Oriented 50

Access for People with Functional Limitations 52

Waiting in the Main Entrance Area 54

First Destinations 55

Information Desk 55

Admitting or Registration 55

Visitor Information 58

Summary 59

Discussion Questions 60

Design Review Questions 61

References 69

Chapter 4: Interior Wayfinding and the Circulation System 71

Learning Objectives 71

Finding One’s Way through a Health Facility 71

Costs of Unsuccessful Wayfinding 73

Building Layout and Landmarks 76

Floor Numbering 77

Room Numbering 79

Sign Messages 81

Symbols and Pictograms 84

Sign Updating 85

Sign Spacing and Location 85

Interior You-Are-Here Maps 88

Color Coding 91

Signage and the Americans with Disabilities Act 93

Directions Given by Staff 93

Wayfinding during Periods of Construction 93

Wayfinding Technology 94

Corridor Functions and Amenities 94

Carpeting 95

Lighting 96

Handrails and Seating 97

Traveling from Floor to Floor 98

Elevators 98

Stairways 100

Unplanned Uses of Corridors, Elevators, and Stairways 102

Summary 103

Discussion Questions 104

Design Review Questions 105

References 114

Chapter 5: Reception and Waiting Areas 119

Learning Objectives 119

Entering a Reception and Waiting Area 119

Reception Areas 120

Waiting Areas 123

Size and Location 123

Waiting-Area Activities and Television 125

Seating Arrangements 126

Seating Comfort 128

Flooring, Wall Coverings, and Lighting 129

Waiting-Area Amenities 130

Main Lobby 137

High-Stress Waiting Areas 138

Summary 139

Discussion Questions 140

Design Review Questions 141

References 147

Chapter 6: Diagnostic and Treatment Areas 151

Learning Objectives 151

Accommodating Patients’ Needs in Diagnostic and Treatment Areas 152

Undressing and Dressing 152

Waiting While Wearing a Hospital Gown 155

Maintaining Privacy 155

Optimizing Comfort 157

Considering Lighting 159

Reducing Noise 162

Listening to Music 164

Experiencing Positive Distractions 166

Using Digital Devices 168

Using Restrooms and Water Fountains 168

Facilitating Contact between Patients and Staff 169

Accommodating Companions 169

Summary 169

Discussion Questions 170

Design Review Questions 171

References 177

Chapter 7: Inpatient Rooms and Baths 183

Learning Objectives 183

Acute Care Inpatient Rooms 183

Size and Layout 183

Number of Occupants 190

Control Over Social Contact 191

Color 195

Lighting 199

Style in Healthcare Settings 202

Inpatient Room Furnishings 202

An Outside View 212

Reducing Noise on Acute Care Units 215

Using Music Therapeutically 215

Inpatient Bathrooms 220

Inpatient Lounges 226

Accommodating Visitors 228

Providing for Mealtimes 229

Providing a Place to Spend the Night 229

Family Lounges 229

Intensive Care Units 231

Providing Control Over Social Contact 232

Addressing Sensory Overload and Challenges of Maintaining Family Support 233

Reducing Noise in ICUs 235

Music in ICUs 240

Patient Comfort in ICUs 240

Addressing ICU Visitors’ Needs 241

Summary 243

Discussion Questions 245

Design Review Questions 246

References 261

Chapter 8: Access to Nature 273

Learning Objectives 273

The Importance of Nature in Healthcare Facilities 274

Facilitating Recovery from Stress 275

Facilitating Recovery from Mental Fatigue 275

Valuing Access to Nature in Healthcare Facilities 279

Designing Outdoor Spaces for Healthcare Facilities 282

Planning and Designing Outdoor Areas during New Construction 283

Creating a Preferred Nature Setting 284

Bringing the Outdoors In 295

Views to the Outdoors 296

Summary 298

Discussion Questions 299

Design Review Questions 300

References 307

Chapter 9: Users with Disabilities 311

Learning Objectives 311

Statistics Regarding Users with Disabilities 312

Federal Legislation on Disability Rights 314

Americans with Disabilities Act 314

Patient Protection and the Affordable Care Act 315

Section 504 of the Rehabilitation Act of 1973 316

Designing to Comply with Federal Legislation on Disability Rights 316

Universal Design 317

Design Considerations for Patients and Visitors with Mobility Disabilities 323

Guidelines for Accessible Exam and Treatment Rooms 324

Guidelines for Accessible Medical Equipment 326

Design Considerations for Patients and Visitors with Hearing Disabilities 327

Design Considerations for Patients and Visitors Who Are Blind or Have Low-Vision 329

Design Considerations for Older Patients and Visitors 332

Physiological and Psycho-Social Changes 332

Design-related Issues for Older Patients and Visitors 334

Design Guidelines Regarding Older Patients and Visitors 335

Design Considerations for Obese Patients 348

Guidelines for Inpatient Rooms for Obese Patients 349

Guidelines for Furniture and Medical Equipment for Obese Patients 350

Summary 350

Discussion Questions 351

Design Review Questions 352

References 367

Chapter 10: Special Places and Services 373

Learning Objectives 373

Special Places 373

Food Service Areas 373

Sacred Spaces 376

Consultation and Grieving Spaces 377

Emergency Departments 379

Rehabilitation Units 391

Patient and Visitor Information Areas 394

Special Services 396

Overnight Accommodations 396

Shops 397

Hair Care 398

Fitness Centers 399

Spas 399

Summary 400

Discussion Questions 401

Design Review Questions 402

References 413

Chapter 11: User Participation in Healthcare-Facility Design 421

Learning Objectives 421

What Is User Participation in Design? 422

Benefits of User Participation 422

User-Experts in the Design Process 423

The Evolution toward Co-designing 425

Examples of User Participation in Healthcare-Facility Design 426

Developing a User Participation Process 429

Necessary Conditions 429

Mechanisms for User Participation 429

Techniques for Information-Gathering 431

Timing of User Participation 433

Selecting Participants 434

Managing User Participation 435

Implementing Resulting Recommendations 436

Documenting the User Participation Process 436

Summary 437

Discussion Questions 438

References 439

Index 443