Traveling from BWI to LAX on United–I had a delightful flight attendant who was concerned because he had “stashed” extra water and blankets on the plane for back-up, and another team had used “his” plane, and the extra stores were gone! He said that he is always concerned that he doesn’t have everything or enough supplies that he needs to make his guests comfortable.
This sounded like outcomes from recent focus groups that I’ve completed with hands-on care givers in long term care settings. Their comments included, “We have to ‘stash’ extra supplies in resident rooms to make sure that we have what we need to make residents and patients more comfortable.” On the surface these may appear to be operational issues, but in many ways, these are also environmental design issues.
Storage spaces are rarely considered during the programming and design phase, yet contribute substantially to the quality of life and potential independence of a resident. For example, if storage was located at point of service and supplied according to operational needs, supplies, materials, snacks, etc. could all be located and accessible for staff, family, residents and patients when needed—the ‘just in time’ opportunity for providing higher satisfaction for everyone involved—as well as improving outcomes.
A few years ago, I was walking through a nursing home of a prospective client that had recently renovated his existing community. It took staff 25 minutes to change a catheter. How could this be possible? The discomfort and potential pain that a resident may endure while waiting to have this minor procedure completed seemed so unnecessary. In speaking with the front line staff, the core of the issue was that the storage of supplies versus nursing areas and the location of the residents were completely disconnected. One storage space next to an elevator opened up inside a dining room–inaccessible when the room was in-use for a meal or activity. After further review, all of the storage spaces throughout the building were located in all the wrong places. In this case, it was the gathering of supplies that took too long—partially because of the environmental layout and partially because of reimbursement—leading to potential and needless suffering.
The programming process clearly did not include the operational overlay and circulation patterns that are part of operating a nursing home. This can impact types and locations spaces, as well as the materials that are specified for areas. I’ve seen this not only in long term care, but also in hospital settings. After presenting at the AHE (Association for the Healthcare Environment: www.ahe.org), I heard a half dozen stories just during the lunch hour on how facility design was not reflective of operational needs. For example, a hospital design included lack of storage and separation between clean materials management and existing trash from the building—circulation required for the trash to be driven straight through clean materials management area. A materials example included within a Labor Delivery Room, vinyl plank was used as the flooring—at first I thought “that is the right solution;” however the designer selected a ‘V’ groove detail between the planks instead of a flush detail. A flush vinyl plank or continuous sheet vinyl would have been the correct flooring choice, but because of the groove, the terminal cleaning required housekeepers to get down on their hands and knees to verify all bodily fluids were cleaned to prevent the spread of infection. Typically, a set number of minutes are allowed for a terminal cleaning so that another patient can be admitted into a room. If this process takes longer, it not only impacts how much harder it is on the environmental services worker to clean the floor, but also the revenue impact of being able to turn a room for the next patient.
As a designer working in long-term care, it is a cliché, but true that we spend most of our time designing bathrooms, because we are always looking for a better, more compact solution that meets not only ADA requirements, but also the actual circulation needed within a resident room for care givers and mobility devices. The other item almost always missing in bathroom designs in healthcare is storage. If a caregiver has to leave a resident in a precarious position to get extra towels, Depends, or any other supply, fall risk increases. With appropriate storage spaces, these types of situations could be avoided.