Empathy at the Centre Stage of Hospital Designs
"GOOD DESIGN IS ONLY AS GOOD AS ITS ABILITY TO CONNECT AND FORGE RELATIONSHIPS WITH THE PEOPLE WHO ULTIMATELY USE IT"
– Idris Mootee
For a long time, the infrastructure of healthcare facilities has been primarily service oriented. Functions, life cycle costing, planning standard, future proofing, efficient operational practices were the design drivers. But with the escalating competition, increased awareness and active participation of the client, design development took on a ‘User Centred’ approach in the 90’s. During this period, the emphasis was on the needs of the user. However, this approach was found wanting of essential technicalities that could only be incorporated by the process of research, theories, interviews and observations. The new millennium saw an evolution in design across the world. The approach shifted to ‘Co-Design/ Co-Creation’, where users became a part of the design process and played a significant role in idea generation and concept development.
Today the world is moving towards empathy-driven design where how the user ‘feels’ forms the backbone of design. The Indian design community is also gearing up towards the same. Prominence to preventive and conducive healthcare in the latest National Health Care Policy, 2017 is a testimonial to that.
My first moment of realization about how crucial empathy is, as a design driver in hospitals, happened during my thesis where I designed a Cancer hospital in Calcutta based on the concept of Biophilia (which means affinity for life). I interviewed Cancer patients and their family members at Tata Cancer Hospital, Mumbai. One particular experience was common for all patients. “I feel so humiliated lying on the stretcher and waiting in the corridor for the doctor. Every time people move in the corridor, they keep pushing me as if I am not a fellow being but an object without feelings,” he said. Unknowingly, we designers are responsible for such a situation. While designing hospitals, we provide dedicated space for waiting areas but forget about the people left standing and blocking access.
I was inspired by Griffin Hospital in Derby which has made empathy an integral part of their whole system. They have a unique recruitment process where if anyone joins the hospital in any position, he/she needs to spend several days in an offsite retreat facility with a total stranger and experience things like feeding them, walking blind folded on the ground. The idea is to train the staff to be cognizant of the feelings of patients and understand them from an empathetic perspective. The will help them deliver authentic, patient-centred care.
As designers, we need to acknowledge that the primary aim of a hospital is to make patients healthy again. It is a fact that along with physical well-being, mental and emotional health is equally important. It seems to be an effort in futility if we create world-class hospitals having optimum space usage with latest technology and facilities that cause inconvenience to patients and their family members.
During their stay in a hospital, patients mainly focus on treatment. However, various infrastructural and design concepts can create a pleasant experience.
Since empathy driven design is based on how people ‘feel’ in those spaces, the first step in designing such a hospital is to find out the negative connotations that people link to hospitals and find positive feelings for each one of them. Here is one of the lists of Negative, Positive emotions (source: Case for Empathy Based Design, Ian M. Sinclair)
The second step is to find those crucial touch points in the hospital where the users spend most of their time or frequently visit. Next, to create a coloured survey form containing images of such spaces followed by an extensive survey with different users including patients, family members, doctors and other para-medical staff to understand what feeling they associate with these spaces, for e.g.
HOW DOES THIS IMAGE MAKE YOU FELL?
And finally, the most important step is to analyse data from the survey. Find the typical colours, objects, arrangements from those images and put it on an empathy map to create a list of findings that can help create more empathetic hospitals.
The following are the findings from research carried out by Ian M. Sinclair- Case for Empathy-Based Design in a Cancer hospital:
- Parking garages evoked universally negative emotions, regardless of the design.
- Waiting rooms, whether stark or luxurious, tended to evoke negative emotions including anger and frustration.
- Inpatient bed images tended to elicit emotions of pain, loneliness, worry, anxiety, helplessness and dread.
- Chemotherapy infusion chairs were viewed as stressful in general, particularly if there was insufficient space for a caregiver/support person. Images of more starkly designed rooms further evoked negative emotions than did those with views to nature, and natural light.
- Although most respondents scored “home-like” images positively, they qualified their response in discussion to say that “home-like” designs may be more appealing to inpatients who spend more time in the facility, however, as an outpatient, all you want to do is “get home” after a day or clinic time, chemotherapy or radiation therapy. They said, “That is not my home”, which only caused them to feel sad and expressed guilt.
- Formally designed gardens evoked more negative emotions such as loneliness, anxiety and confusion as they implied too much “control”, something they now have very little of.
- Distraction was seen as a relief as it eases the complexity of the cancer journey.
- Gardens were particularly appealing after chemo treatment. They induced a sense of “welcome”.
- Images of different seasons were very appealing to all, (used the word “love” to describe images of the seasons) particularly after treatment. It evoked a sense of hope to be able to “survive to see all the seasons.”
- In general, images of internal gardens were well received; however, images of “big nature”, like a mountain, evoked emotions of hope and illumination as it reminded them that “the world goes on”.
- Images of sculptures were viewed neutrally overall. If too complex or busy, respondents felt threatened and more anxious.
- Hallways with colour offered a positive transition.
- Technology (PC, cell phones) at the bedside tended to evoke positive emotions as they allowed for control and connections to loved ones.
- In general, respondents scored much of the art images with positive emotions including solitude, joy, calmness, tranquil, happy, hope, bravery and well-being. However, some abstract art evokes anxiety and negative emotions. It was noted, that the inclusion of images of the “artist” did not evoke positive emotions as anticipated.
- Images of family and friends tended to evoke positive emotions.
- Images of animals, particularly those with a prosthesis, drew out emotions of hope, inspiration, “life worth living”, and fearlessness. Images that were viewed as having clarity and order evoked positive emotions for all categories
- Images that induced memories of music while in treatment were viewed, in general, as soothing.
Findings would vary with change in demographics, culture, age group, education and hence the core group for the survey should be selected based on the type of hospital and speciality planned.
Hospital Infrastructure is used by people when they are facing a difficult situation. Keeping this in mind, one should create designs that link spaces with the desired feelings. Empathy would not only create more effective road maps for design but also humanize the whole experience. When healthcare facilities adopt empathy, it truly becomes a place for holistic healing.