Healthcare Design

Experiencing the link between environment design & patient experience

As a researcher who is interested in the design of hospitals and its impact on patient experience, I couldn’t help but take note of the design of the Addenbrooke’s A&E department, which I visited in June 2011 as a patient. Here are the notes I wrote a day after my visit:

I felt sharp pains in my stomach at 11:30 at night, and cried like a baby. With my husband my side, knowing that the pain had not eased as we had earlier hoped, we decided to go to A&E.

Our local A&E is at the Addenbrookes Hospital, the largest hospital in Cambridgeshire. We drove their silently. As we approached the hospital it wasn’t clear where we supposed to park. There was a sign directing people towards the main car park but there was no sign for A&E parking point or drop off. We continued through the emergency route as it was late at night. As we came in front of the A&E department we realised that the parking bays were disabled only – and though they were all empty, my husband being the ethical man he is, decided not to park there.

Ahead of me, I could see some parking spots, but again as there were no signs we were unaware if we were allowed to park there. My husband decided we should just go to the main car park. He had no idea which way to turn. Fortunately I had visited the hospital before as the University of Cambridge Medical School is based there. I directed him towards the main car park. And with pain and agony, we walked hand in hand towards the A&E entrance.

First obstacle, the door wouldn’t open. We then realised there was a sign saying dial the intercom, however without an arrow so it took a minute or two locating this bell. We rang it, fortunately someone answered straight away.

As soon as the doors opened there was a loud male quite authoritarian voice saying ‘ please wash your hands before entering’. I really should have taken a recording of the sound to make you visualise the rather frightening sound. As someone who was in rather a lot of pain, it certainly didn’t put me at ease, and felt too clinical.

Though of course I understand the importance of washing hands before entering any ward, but I just think it would have been reassuring to have heard that in a voice that wasn’t so harsh (preferably a woman’s voice) and some kind of welcome would have put me at ease too. I would suggest they change their recording transcript to: ‘Welcome to Addenbrookes. Please wasn’t your hands before you enter to avoid the spread of MRSA. Once you have washed your hands, our staff will be with you’.

So after the handwashing procedure another set of double doors and then this sign:

Addenbrooke's A&E entrance

First of all we weren’t quite sure whether we should stand in front of the double doors, as the space between the double doors and this sign was very little. So we stood there nervously waiting for a nurse to come. She approached, said hi and asked what the problem was. I briefly explained the situation. She then went and stood over behind a booth with a paper and pen to fill in the admission form.

At this rate I wasn’t sure if I was allowed to join her (please note that red stop sign in the image above), though I knew she wanted my details (and I was in no state of mind to scream them across). So I just stood there, and then she said, ‘you can come across y’know’. I felt embarrassed.

After filling the forms in we were then sent over to reception and who asked for my personal details, and told us to take a seat in this waiting room:

Addenbrooke's A&E waiting area

After a long wait I was then treated in the treatment area:

Chair in Addenbrooke's A&E

Addenbrooke's A&E wall

The doctors and nurses where friendly and helpful, but the physical environment seemed to have a larger impact on my experience than I had anticipated. Though I have read many research papers on the impact of healthcare environments on patient experience (such as the review by Ulrich et al., (2008)), experiencing it really brought home a true understanding of the scientific work.

References:

Ulrich, R., Zimring, C., Zhu, X., DuBose, J., Seo, H., Choi, Y.S., Quan, X. & Joseph, A. (2008) A review of the research literature on evidence-based healthcare design. Health Environments Research & Design Journal, 1 (3), p.p.61–125. Available at: http://edinnovation.com.au/documents/attachments/58-hcleader-5-litreviewwp.pdf [Accessed February 7, 2011].