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Engaging Patients and Caregivers in Design and Evaluation: A Path to Better Outcomes
What was the challenge, opportunity or issue faced?
In April 2013, Bridgepoint Hospital moved to its new facility. The new building replaced aging infrastructure that was built in 1963 which at the time was designed for a different patient population then those it served when it closed.
We had a unique opportunity to engage patients and caregivers in the design of the new Bridgepoint Hospital, one that would specifically cater to patients with multiple health conditions and those in need of rehabilitation.
What did you do to address it?
As part of user-group consultations in the design phase, two full-scale mock-ups were built to test the new designs and workflow well before construction began. The mock-up gives designers, contractors, and building owners / users the opportunity to assess a three-dimensional representation of a design, so that functionality, esthetics, and quality can be evaluated down to the smallest detail.
Full-scale mock-ups of hospital rooms were built to the architectural specifications at an off-site location. The patient rooms included every fixture from the overhead patient lift, headwalls to electrical outlets and hand-sanitizer dispensers. Over the course of a few weeks 200 staff, physicians, patients and caregivers had opportunity to tour the rooms to experience the layout and provide feedback. Together in teams they had the opportunity to run through realistic, scripted scenarios and provide feedback on how the space could enhance staff work flow and the patient and care giver experience.
Design and Health Research and Post-Occupancy Evaluation (POE)
The central design intentions of the new building were to enhance a patient’s connection to the community, nature and urban environment and to include features that increase social interaction and inspire physical activity. These design intensions include: meaningful views from every position (lying, sitting or standing) in every room, a variety of outside spaces including a rooftop garden, and an abundance of natural light.
The Design and Health study was conducted by a team of researchers, architects and clinicians led by Dr. Celeste Alvaro, Research Scientist at the Bridgepoint Collaboratory for Research and Innovation. The study used a pre- and posttest quasi-experimental research design with a comparison group to compare well-being and health along with the user experience of patients and staff across the existing and new facility. The overall aim of this research was to:
- identify and refine elements of facility design;
- operationalize design intent; and
- assess the impact of specific facility design innovations on psychosocial well-being and health related outcomes.
Mixed quantitative and qualitative methods were used to collect the data. Patient and staff surveys measured impressions of the hospital design with questions that gauged: how connected they feel with the community, city or as a place of wellness, did they feel isolated or that there were opportunities and places to socialize, what spaces they used and what their impressions were of these spaces. Naturalistic observation researchers monitored patients’ patterns of behavior and recorded how staff and patients used different spaces and how they interacted with others. Techniques such as go-along interviews, where a research follows a patient or caregiver and interviews them during their usual daily routine.
What were the outcomes?
Feedback received during the design phase influenced changes to the proposed design including size and placement of family spaces within the room, placement of soap, paper towel and toilet role dispensers in the bathroom, location of power outlet to recharge electric wheelchairs, and closet space.
The POE at Bridgepoint is one of the largest ever conducted for a healthcare facility in Canada. The findings provide us with invaluable insight on understanding of which design elements have the greatest impact on patient experience and health outcomes. Although the final report will provide a greater level of analysis of the data, we can conclude that patients and staff impressions of the new Bridgepoint hospital were more favorable than those at the former Bridgepoint Hospital. Patients and staff reported an elevated sense of belonging to the city, neighborhood and nature in the new facility relative to the former facility.
Design feature recommendations based on user experience in the new Bridgepoint are:
- Patients need a view of their own with a direct site line to the outdoors – whether private or semi-private have an un-interrupted view regardless of whether the privacy drapes are drawn.
- Quality outdoor spaces, not quantity – the spaces require animation to attract users such as furniture to encourage patients and visitors to gather and some element of hospital or social programming.
- Social spaces need to be strategically located by hubs of activity – those that demonstrate higher volumes of usage are the cafeteria and seating located at the main entrance of the hospital
 The research report: http://www.bridgepointhealth.ca/en/what-we-do/resources/research/Path_to_Better_Outcomes_Preliminary_Report.pdf
About Bridgepoint Active Healthcare
Bridgepoint Active Healthcare manages, delivers, researches and teaches leading healthcare practices so that people with complex health conditions can live better. Bridgepoint Active Healthcare includes the Bridgepoint Hospital, Bridgepoint Family Health Team, Bridgepoint Collaboratory for Research and Innovation, and Bridgepoint Foundation.
Located in Toronto, Bridgepoint serves patients throughout Ontario, and is the number one receipient of referrals from acute care hospitals in the Greater Toronto Area. Last year, we discharged over 2,300 patients and provided over 140,000 patient days and 21,000 Ambulatory Care visits. We are one of the only hospitals in Canada with a specific focus on treating and researching complexity. With 1,200 staff, 404 inpatient beds in operation, and an annual budget of approximately $90 million, Bridgepoint Hospital provides inpatient and outpatient services care across the following four program areas:
- Medical Rehabilitation - focused on frail elderly patients, patients with cardiopulmonary conditions, and those living with complex medical needs
- Musculoskeletal Rehabilitation - for patients recovering from complex orthopaedic surgery or trauma, or progressive bone and joint disorders
- Neurological Rehabilitation - designed for patients with moderate to severe impairment from a stroke, brain injury, or neuromuscular conditions
- Specialized Medical and Complex Care - focused on stabilizing, optimizing health, reducing risk, and maintaining function for patients living with significant health impairment, disability or advanced stage disease
Over the last year, we brought our new hospital to life – the first hospital of its kind, devoted entirely to the needs of complex patients. Apart from its numerous award-winning design features this new hospital enabled us to implement our new "active healthcare model” with breakthrough results for patients. Bridgepoint’s new model and standard of patient care was recognized with Exemplary Standing and Stroke Distinction status, from Accreditation Canada.