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The Design Journal
An International Journal for All Aspects of Design
ISSN: 1460-6925 (Print) 1756-3062 (Online) Journal homepage: http://www.tandfonline.com/loi/rfdj20
Informing hospital design through research on
patient experience
Margo Annemans, Liesbeth Stam, Jorgos Coenen & Ann Heylighen
To cite this article: Margo Annemans, Liesbeth Stam, Jorgos Coenen & Ann Heylighen (2017)
Informing hospital design through research on patient experience, The Design Journal, 20:sup1,
S2389-S2396
To link to this article: http://dx.doi.org/10.1080/14606925.2017.1352753
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Design for Next
12th EAD Conference
Sapienza University of Rome
12-14 April 2017
doi: 10.1080/14606925.2017.1352753
© 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under
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distribution, and reproduction in any medium, provided the original work is properly cited.
Informing hospital design through research
on patient experience
Margo Annemansa, Liesbeth Stama, Jorgos Coenena, Ann Heylighena*
aUniversity of Leuven (KU Leuven), Department of Architecture, Research[x]Design
*Corresponding author e-mail: ann.heylighen@kuleuven.be
Abstract: The material environment impacts on patients’ wellbeing and healing
process. In complex and hard-to-enter healthcare settings, architects and other
designers have difficulty to collect information about patients' experience; hospital
boards and facility managers experience difficulties to approach their familiar
environment from a patient perspective. This paper explores how information on
patient experience resulting from research in care contexts can be usefully and
conveniently translated to designers and healthcare professionals. This should
support the development of spaces, products and/or services that seek to improve
patient experience. Case studies explore what different stakeholders expect to gain
from information on patient experience and how it can be provided in the most
valuable way. How the information is presented turns out to be key in how it is
used. So far the format was custom-made for each specific case. Further research
should investigate how the available experiential information can be disclosed to a
wider audience.
Keywords: Case Studies, Healthcare, Hospital Design, Information format,
Patient experience
1. Introduction
To be able to think of and realise well-designed environments, products, services, and processes in
the healthcare sector, those involved in the design processes need to understand how the
experience of the most vulnerable users – the patients – is affected by their specific state of mind –
being stressed, feeling sick or nervous, and staying in an often unfamiliar environment. While truly
placing oneself in someone else’s shoes is hardly possible, being aware of this and making design
decisions based on the best available information is. Providing nuanced and easily accessible
information from research on patients’ experience of hospital environments could raise different
actors’ awareness of the gap between the experience of various profiles involved in (the design of)
healthcare environments. The aim of this paper is to explore how experiential information (video
recordings, pictures, interviews, …) resulting from research in care contexts can be translated to
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MARGO ANNEMANS, LIESBETH STAM, JORGOS COENEN, ANN HEYLIGHEN
designers (architects, product and service designers) and healthcare professionals in a useful and
convenient manner. The use of this information should allow them to develop or adapt spaces,
products, and services that impact on patients’ and other users’ experience. To study this translation
in an adequate way, case studies are set up in close collaboration with designers and hospital boards.
In these case studies the available experiential information is analysed in terms of its relevance and
the format in which it is presented is evaluated. Insights gained in this way are on a regular basis
presented and discussed with a broader group of facility managers, and designers. The case studies
allow us to present concrete, relevant, and practically applicable examples of the benefits of using
experiential information in the design of healthcare environments.
2. Background
Various studies show that the designed environment – products, services, and spaces – has a
significant impact on patients’ wellbeing and as such can add to their healing process (Ulrich et al.,
2008; Huisman et al., 2012; Desmet & Pohlmeyer, 2013). Most product and service designers,
architects, and hospital boards are convinced of this impact but often lack accessible information
that offers a nuanced insight into patients’ experiences. Ideally this information is obtained through
interaction with real users, allowing designers to develop a more thorough understanding of and
empathy with them (McGinley & Dong, 2011). However, since time and money restrictions in a
typical design process very often result in a minimal user engagement (Cassim, 2010), designers are
unable to obtain this direct input from users and become dependent upon indirect sources of human
information (McGinley & Dong, 2011).
As designers do not always have direct contact with the people they are designing for, various
techniques – like target-group and context analysis, scenarios, personas, participatory & co-design
workshops- have been developed to bring them closer to these people’s experience (Kouprie &
Visser, 2009; McGinley & Dong, 2011; van Rijn et al., 2011). Most of these techniques aim to foster
empathy. People’s specific situation affects the degree to which actual interaction can be achieved.
In the case of vulnerable groups like hospital patients, practical and ethical restrictions make it hard
for designers to actually engage with them.
In previous research, we collected insights regarding various aspects impacting on patients’
experience (Annemans et al., 2016, 2017; Van der Linden, Annemans & Heylighen, 2016; Van
Steenwinkel, Verstraeten & Heylighen, 2016). This information consists of ethnographic data
collected in various (health)care settings, both hospitals and (residential) care facilities. These could
provide hospital boards and designers with much of the needed information to gain insight into
patients and residents’ experience and start empathising with them. Yet the scientific articles, in
which this research is mostly presented, are not the number one source where designers look for
information (Annemans et al., 2014). Possible explanations for this are that designers are rather
motivated by visual communication and like information to be presented graphically (Lofthouse,
2006) or that they often feel mistrust towards data that have already been interpreted (Restrepo,
2004). They prefer raw data in a format that is condensed down to be design-relevant (McGinley &
Dong, 2011).
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Informing hospital design through research on patient experience
3. Case study approach
3.1 Study design
The project reported on in this paper aims to gain insight into both the content and format needed
to usefully and conveniently translate experiential information resulting from research in care
contexts to designers and healthcare professionals.
The study design is set up as a multiple case study enquiry. A case study is defined as the study of a
case (person, place, event), selected for its particularity, and 'bounded' by physical, temporal,
social/cultural, and conceptual features. Case studies are the preferred strategy to gain an in-depth
understanding of a contemporary phenomenon in a real-world context (Yin, 2012; Flyvbjerg, 2006).
Their main strength is depth — detail, richness, completeness and within-case variance.
In the context of this project, a case is defined as “a design issue in the healthcare context”, being
either a question raised by a hospital board with regard to their current or future (designed)
environment or an issue involving patient experience in a design process.
3.2 Case studies
In this paper, we report on four case studies conducted as part of the project, two induced by
questions from hospital boards, two initiated from a designer perspective.
The first case study with a hospital board took place at a local hospital confronted with severe
wayfinding problems amongst patients and visitors. The hospital board aimed to gain insight into the
origin of the wayfinding problems and to formulate concrete solutions for it. We organised three
workshops with hospital staff with diverging functions, providing them with different techniques to
obtain these goals. In a first session, the making of personas was introduced to confront the
participants with some specificities of patients’ experience - being nervous, unfamiliar with the
building and the signage. They were asked to explore different routes through the building from a
patient perspective in small groups and document the route they followed by taking pictures. In a
follow-up session, they were presented information from previous research on wayfinding through a
structured webpage which provided theoretical concepts on wayfinding, illustrated by patients’
testimonies of how they experienced wayfinding and by photo and video material showing patients
moving through a hospital. Participating staff was then asked to match the pictures of the route they
followed with the concepts. As such bottlenecks in the wayfinding system were identified. Finally,
the group developed strategies to solve certain problems based on their enhanced understanding of
patients’ spatial experience.
In a second case study in another hospital, the hospital board did not want to address an existing
situation but aimed to gain insight into how, in the future, they could use technological devices to
inform patients and how this would impact on their waiting experience. A new ambulatory centre,
currently under construction, has been designed with a large common waiting area where patients
would be tracked and informed through technological devices. To collect information on this, we set
up three workshops that started with a hands-on activity in which voluntary patients were asked to
act out different waiting scenario’s (waiting in small or large areas, with or without information)
while being informed through mock-ups of different devices (public screens, a smart phone, or a
pager). During the second part of each workshop, participants’ experience was discussed in a
focusgroup interview. The results from these workshops were analysed and communicated to the
hospital management.
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MARGO ANNEMANS, LIESBETH STAM, JORGOS COENEN, ANN HEYLIGHEN
The first case with designers was conducted within an architecture firm working on the design of a
new hospital building. In this context, they wanted to profoundly update their knowledge on hospital
organisation. To do this in a carefully thought out manner, they needed criteria to judge information
on the trustworthiness of its content and its relevance for architectural design. We provided them
with a framework to collect, analyse, and evaluate literature in terms of scientific value and
relevance for architectural practice. This yielded insight into how and why (scientific) literature is
used by designers.
As a second case with designers, we organised a workshop at the Design Research Society (DRS)
Conference 2016 . Conference participants could subscribe to take part in a workshop aiming to
provide insight into the impact of information formats on design processes and outcomes.
Participants –one professional designer, four design researchers, and one psychologist– were asked
to design a hospital bed, focusing on the role of products and services in patients’ experience of
(health)care environments. Three groups participated in the workshop, each of these groups was
initially provided with a webpage showing different information formats – video with quotes from
patients, a research paper, and user requirements – to design a hospital bed that would improve
patient experience. Later, each group could use all available information formats to adapt their
designs. The approaches and outcomes of the design processes were discussed with all participants.
3.3 Analysis
For each case study, the material participants generated during the workshops or while working
independently was collected. (Focusgroup) interviews were audio recorded. We then made content
logs or full transcriptions of the recordings depending on the further steps agreed on with the
participating organisation. After each session, a short report was written addressing its strengths and
weaknesses. All of this was then analysed keeping in mind three questions:
• Motivation: What was participants’ (hospital board or designers) motivation to take
part in the case study? What was their information need?
• Information need: What (type of information) did they need to reach their goal?
• Information format: How would they like to be provided with the information needed?
4. Findings
By conducting case studies with hospital boards and designers we seek to obtain a better
understanding of why experiential patient information would be used, what each of them consider
relevant substantively and how they would like to consult it. Answering these questions will help to
identify how information on patient experience resulting from research in care contexts could be
translated to the design and healthcare sector.
4.1 Motivation
Different organisations had different motives to take part in the project and formulated a case study
relevant to their situation. Whereas not all hospital staff members in the wayfinding case believed in
the added value of incorporating insights into patient experience to improve the wayfinding system,
the designers taking part in the conference workshop were convinced of the necessity to have a good
understanding of patients’ experience to be able to design an improved healthcare environment.
Also for the architects it was beyond doubt that they would try to find as much information on
patient experience as possible to support and justify their design decisions.
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Informing hospital design through research on patient experience
Although participants in the case studies conducted with hospital boards would be expected to stand
relatively close to patients, in both cases gaining insight into patients’ experience appeared to be
challenging. In the wayfinding case, we found that enhancing empathy amongst staff was needed as
a first step to enable them to identify bottlenecks in the current wayfinding system and formulate
solutions from a patient perspective. Although those taking the initiative for the case study with the
other hospital were convinced of the importance of consulting patients, they clearly needed support
to gauge patients’ experience before being able to think about new possibilities. For the designers
thinking about improvements of patients’ environment through insight into their experience was
rather obvious. Yet, the case studies did not aim to collect first-hand data on patient experience but
rather focused on putting it to use.
4.2 Information need
When reflecting on the workshops, participants in the wayfinding case study, who had been
presented with a variety of information, explicitly mentioned the lack of best practices, i.e. examples
of good architectural solutions. Although the presented information, combining theoretical concepts
with visual material and narratives on patients’ wayfinding experience helped participants to analyse
the existing situation, they felt that it did not support them in finding solutions for the problems they
were facing. They would have preferred clear-cut solutions which they believed they would find in
best practices. They did not seem to be eager to interpret the information themselves. A similar
sentiment could be recognized at the other hospital. There too, those in charge of decision-making
asked for straightforward and applicable information ready to be used. Although being informed
about patients’ experience was valued, making the connection with the concrete environment
seemed to be appreciated even more.
The case studies conducted with designers showed a different information need. Both the architects
and the designers participating in the workshop expressed their preference for making their own
selection of what to use from the offered information rather than being provided with solutions.
They highly valued the richness and variety of the offered information, although as the case study
with the architecture firm showed, they needed some guidance on how to filter, collect, and
evaluate the information. Since the workshop participants were provided with a selection of
information made by the researchers, they did not express this need. However, they too mentioned
that they appreciated having trustworthy information on patient experience, something that is hard
to gain access to in daily design practice.
Apart from the explicit information need mentioned by hospital boards and designers, we also
identified a need for information that seemed to have a more implicit value. Although the
participants in the wayfinding case study did not mention the theoretical background during the
subsequent workshops, we noticed that the offered concepts were being used as a common
vocabulary between the hospital staff, not used to sit together and discuss this kind of subject. Also
in the focusgroup interview with patients organised as part of the case study on waiting, and in the
case studies with designers we noticed that certain concepts we, as researchers, use were picked up
by participants and formed a basis for discussion.
4.3 Information format
The participants in the wayfinding case study, who were offered experiential information through a
website, preferred the video material as information source and frequently referred to it throughout
the workshop. An important advantage of the videos (combined with a textual explanation) seems to
be the opportunity to offer nuanced insights in a compact way. The workshop with designers pointed
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MARGO ANNEMANS, LIESBETH STAM, JORGOS COENEN, ANN HEYLIGHEN
at the consequences of opting for either type of information format. Those designing informed by
video recordings clearly focused more on the moving aspect of experience than others who based
their design on textual or static visual information.
Whereas the participants in the wayfinding case study stressed the value and necessity of concrete
assignments accompanying the information provided through the webpage, designers appreciated
the opportunity to consult easily accessible experiential information without strict guidance on how
to use it. Being able to make their own decisions on what to apply where, and when in their designs
was considered an advantage. This does not mean that designers did not need guidance in working
with experiential information. Yet, this need is more related to judging and evaluating available
information. A website or database providing information that is reliable would thus likely meet their
needs.
5. Discussion and concluding remarks
Based on the case studies presented above, we explored how experiential information resulting from
research in care contexts could be translated to healthcare professionals and designers in a useful
and convenient manner. The former experience difficulties to approach the environment they are
familiar with from a patient perspective. The latter have difficulties to collect information about
patients' experience on site especially in complex and hard-to-enter environments like healthcare
settings. Whereas it was expected that hospital boards would be most interested in methods to
explicate patients’ experience, it appeared they were more interested in ready-to-use information on
patient experience than in how to collect it. Designers on the other hand, valued broad and nuanced
information, giving them the opportunity apply it to a concrete design. What they longed for were
methods or guidance to obtain this information, being it from literature or by taking part in a design
workshop like the one we organised.
The conference workshop with designers pointed at the consequences of opting for a specific type of
information format. Those designing informed by video recordings clearly focused more on the
moving aspect of patient experience than others who based their design on textual or static visual
information. This observation draws attention to the impact of the information format on the design
outcome, an issue relevant to designers, hospital board in charge of writing design briefs, and
researchers alike. Raising awareness on this impact could be a first step in pointing out the relevance
of broad and nuanced information handed under various forms and through various techniques. The
interest of designers in the impact of information on the design process stands in stark contrast with
hospital boards’ request for straight applicable information and clear-cut solutions.
Each case study conducted so far focused on a specific information need and situation. Both content
and format were adapted to what we were required to provide information on. Bringing the insights
from the various case studies together will be challenging. Substantively, it will be difficult to truly
span the broad range of all aspects adding to patients’ experience. As the format in which the
information on patient experience is presented turns out to be a key issue in how it is used, it will be
important to guard that those consulting the offered experiential information can do so under
various formats, to obtain the nuanced understanding that we want to communicate.
Overall the presented case studies were evaluated by the participating professionals as eye-opening
and relevant. Yet, as stated above each case study was situation-specific, which may have added to
this overall positive evaluation. Further research is needed to investigate how the available
experiential information can be disclosed to a wider audience, considering the divergent needs of
different stakeholders regarding content and format.
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Informing hospital design through research on patient experience
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MARGO ANNEMANS, LIESBETH STAM, JORGOS COENEN, ANN HEYLIGHEN
About the Authors:
Margo Annemans, a postdoctoral researcher at the Research[x]Design group at KU
Leuven, currently coordinates the project From Care(ful) Research to Care(ful) Design. Her
PhD focused on the spatial experience patients in hospitals and its applicability in
architectural practice.
Liesbeth Stam is a PhD candidate at the Research[x]Design group at KU Leuven.
She investigates the interplay between the material and the social in context of
architectural design processes. Liesbeth worked on the project From Care(ful)
Research to Care(ful) Design.
Jorgos Coenen is a researcher at the Research[x]Design group at KU Leuven. His work
centers around interactive technology in public space with a focus on visualizing
information. Jorgos worked on the project From Care(ful) Research to Care(ful) Design.
Ann Heylighen is a research professor and co-chair of the Research[x]Design group at KU
Leuven. Her current research looks into how space is experienced, how space is designed,
and the relation between both.
Acknowledgements: This work was supported by Flanders Innovation and
Entrepreneurship as a Tetra-project under Grant number IWT 140570. The authors thank
all participants in the case studies, for sharing their time and insights and the hospital
boards and architecture firms for their support.
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