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 xvForeword xviiAuthors’ Introduction to the Third Edition xixAbout the Authors xxiChapter 1: Introduction 1Learning Objectives 1Projections and the Direction of Healthcare 1Healthcare: Changing Within 4Design as a Component of High-Quality Healthcare 5Designing for Patients and Visitors 7Wayfinding Ease 9Physical Comfort 9Control over Social Contact 10Symbolic Meaning 10The Facility Design Process 10Pre-Design Programming 10Design 11Concurrent Planning 12Design Review 13Construction 13Activation 13Post-Occupancy Evaluation 13Summary 14Discussion Questions 14References 15Chapter 2: A Look at Current Healthcare-Facility Design Research 19Learning Objectives 19Design Research in Relation to Current Trends in Healthcare 19Focusing on Marketing 19Valuing Healthcare-Facility Design 21Sensitivity to Patient Experience 22Recognizing the Role and Needs of Visitors 23Emphasizing Accessibility and Universal Design 23Conducting High-Quality Healthcare-Facility Design Research 24Ensure That Research Is Planned and Carried Out by Trained, Experienced Researchers 24See That the Research Builds On Existing Knowledge 25If the Research Involves Clinical Investigations, Look Into Institutional Review Board Certification 25See That the Research Has a Clearly Stated Purpose Related to Healthcare-Facility Design 25Provide a Clear Research Design and Related Hypotheses 25Carry Out the Project as Objectively as Possible 25Skillfully Word Questions 26Use Visual Images, if Possible 26Carefully Sample Respondents 26Make Sure Participants Give Informed Consent 27Use State-of-the-Art Data-Collection Methods 27Use Multiple Data-Collection Methods, if Possible 27Use State-of-the-Art Data-Analysis Methods 27State the Limitations of Findings and Their Generalizability 27Consider Whether or Not the Research Is Replicable 28Make Design Implications Explicit 28Communicate Findings in a Way That Is Clear to Non-researchers 28Research Claims 28Integrating Design Research into the Design Process 29Characteristics of a Humanistic Design Process 29Objectives for Future Healthcare-Facility Design Research 31Awards for Buildings Sensitive to User Needs 31Training for Designers in Research Methods 31Training for Researchers in Design-Relevant Research 32Long-Term Studies of the Effects of Healthcare Facilities on Users 32Translation of Research Findings into Design Guidelines 32More Research Funding 32International Research Agenda 32Summary 32Discussion Questions 33References 34Chapter 3: Arrival and Exterior Wayfinding 37Learning Objectives 37Traveling to a Healthcare Facility 37Arriving by Car 38Arriving by Taxi or Van 38Arriving by Public Transit 38Exterior Wayfinding 40Exterior Signage 40Environmental Cues 42Exterior Handheld Maps 43Main Entrance Drop-Off Area 45Parking 46Valet Parking 47Parking Lots 47Parking Structures 48Park-and-Ride Options 49Long-Term Parking Rates 49Transition between Parking and the Building Entrance Area 49The Main Entrance Area 50Becoming Oriented 50Access for People with Functional Limitations 52Waiting in the Main Entrance Area 54First Destinations 55Information Desk 55Admitting or Registration 55Visitor Information 58Summary 59Discussion Questions 60Design Review Questions 61References 69Chapter 4: Interior Wayfinding and the Circulation System 71Learning Objectives 71Finding One’s Way through a Health Facility 71Costs of Unsuccessful Wayfinding 73Building Layout and Landmarks 76Floor Numbering 77Room Numbering 79Sign Messages 81Symbols and Pictograms 84Sign Updating 85Sign Spacing and Location 85Interior You-Are-Here Maps 88Color Coding 91Signage and the Americans with Disabilities Act 93Directions Given by Staff 93Wayfinding during Periods of Construction 93Wayfinding Technology 94Corridor Functions and Amenities 94Carpeting 95Lighting 96Handrails and Seating 97Traveling from Floor to Floor 98Elevators 98Stairways 100Unplanned Uses of Corridors, Elevators, and Stairways 102Summary 103Discussion Questions 104Design Review Questions 105References 114Chapter 5: Reception and Waiting Areas 119Learning Objectives 119Entering a Reception and Waiting Area 119Reception Areas 120Waiting Areas 123Size and Location 123Waiting-Area Activities and Television 125Seating Arrangements 126Seating Comfort 128Flooring, Wall Coverings, and Lighting 129Waiting-Area Amenities 130Main Lobby 137High-Stress Waiting Areas 138Summary 139Discussion Questions 140Design Review Questions 141References 147Chapter 6: Diagnostic and Treatment Areas 151Learning Objectives 151Accommodating Patients’ Needs in Diagnostic and Treatment Areas 152Undressing and Dressing 152Waiting While Wearing a Hospital Gown 155Maintaining Privacy 155Optimizing Comfort 157Considering Lighting 159Reducing Noise 162Listening to Music 164Experiencing Positive Distractions 166Using Digital Devices 168Using Restrooms and Water Fountains 168Facilitating Contact between Patients and Staff 169Accommodating Companions 169Summary 169Discussion Questions 170Design Review Questions 171References 177Chapter 7: Inpatient Rooms and Baths 183Learning Objectives 183Acute Care Inpatient Rooms 183Size and Layout 183Number of Occupants 190Control Over Social Contact 191Color 195Lighting 199Style in Healthcare Settings 202Inpatient Room Furnishings 202An Outside View 212Reducing Noise on Acute Care Units 215Using Music Therapeutically 215Inpatient Bathrooms 220Inpatient Lounges 226Accommodating Visitors 228Providing for Mealtimes 229Providing a Place to Spend the Night 229Family Lounges 229Intensive Care Units 231Providing Control Over Social Contact 232Addressing Sensory Overload and Challenges of Maintaining Family Support 233Reducing Noise in ICUs 235Music in ICUs 240Patient Comfort in ICUs 240Addressing ICU Visitors’ Needs 241Summary 243Discussion Questions 245Design Review Questions 246References 261Chapter 8: Access to Nature 273Learning Objectives 273The Importance of Nature in Healthcare Facilities 274Facilitating Recovery from Stress 275Facilitating Recovery from Mental Fatigue 275Valuing Access to Nature in Healthcare Facilities 279Designing Outdoor Spaces for Healthcare Facilities 282Planning and Designing Outdoor Areas during New Construction 283Creating a Preferred Nature Setting 284Bringing the Outdoors In 295Views to the Outdoors 296Summary 298Discussion Questions 299Design Review Questions 300References 307Chapter 9: Users with Disabilities 311Learning Objectives 311Statistics Regarding Users with Disabilities 312Federal Legislation on Disability Rights 314Americans with Disabilities Act 314Patient Protection and the Affordable Care Act 315Section 504 of the Rehabilitation Act of 1973 316Designing to Comply with Federal Legislation on Disability Rights 316Universal Design 317Design Considerations for Patients and Visitors with Mobility Disabilities 323Guidelines for Accessible Exam and Treatment Rooms 324Guidelines for Accessible Medical Equipment 326Design Considerations for Patients and Visitors with Hearing Disabilities 327Design Considerations for Patients and Visitors Who Are Blind or Have Low-Vision 329Design Considerations for Older Patients and Visitors 332Physiological and Psycho-Social Changes 332Design-related Issues for Older Patients and Visitors 334Design Guidelines Regarding Older Patients and Visitors 335Design Considerations for Obese Patients 348Guidelines for Inpatient Rooms for Obese Patients 349Guidelines for Furniture and Medical Equipment for Obese Patients 350Summary 350Discussion Questions 351Design Review Questions 352References 367Chapter 10: Special Places and Services 373Learning Objectives 373Special Places 373Food Service Areas 373Sacred Spaces 376Consultation and Grieving Spaces 377Emergency Departments 379Rehabilitation Units 391Patient and Visitor Information Areas 394Special Services 396Overnight Accommodations 396Shops 397Hair Care 398Fitness Centers 399Spas 399Summary 400Discussion Questions 401Design Review Questions 402References 413Chapter 11: User Participation in Healthcare-Facility Design 421Learning Objectives 421What Is User Participation in Design? 422Benefits of User Participation 422User-Experts in the Design Process 423The Evolution toward Co-designing 425Examples of User Participation in Healthcare-Facility Design 426Developing a User Participation Process 429Necessary Conditions 429Mechanisms for User Participation 429Techniques for Information-Gathering 431Timing of User Participation 433Selecting Participants 434Managing User Participation 435Implementing Resulting Recommendations 436Documenting the User Participation Process 436Summary 437Discussion Questions 438References 439Index 443