Integrated Stroke and Adult Rehabilitation Ward Design
Auckland City Hospital (ACH) has plans underway to design a new Integrated Stroke and Adult Rehabilitation ward, bringing together the functions of several existing wards into a single integrated facility. It will house impressive new technology for responding to Acute and Hyper-acute stroke patients, as well as providing for the longer term rehabilitation needs of adults recovering from a range of conditions.
Our part in this project has been to initiate patient and whānau participation in the design process, with the aim of facilitating a human-centred approach that ensures patients’ experiences are included in the designs and decision making. Our study contributed to the discovery phase of the wider project and was limited in scope to presenting our findings to the architectural group and steering team who are driving the design and implementation. It is our recommendation that further patient and whānau engagement is sought as part of the detailed design phase.
We conducted in-depth, semi-structured interviews with current and previous patients and their whānau who had been treated in the existing Acute and Rehabilitation wards in ACH. While discussions around specific existing spatial and design features were pursued our predominant approach was to seek understanding of their experience of being in hospital; what really mattered to them and shaped their perceptions. It is these kinds of findings that are valuable to overall design concepts and help build a more holistic understanding of who we are designing for. The results were rich in detail from the personal stories and observations our interviewees shared with us.
Five key themes emerged from our analysis of the interviews, with sub themes grouped within these. Responses ranged from discussions around specific aspects of experiences to wider concepts around care, wellbeing and recovery. The five key themes and their sub-themes of our findings were:
Rehabilitation: Physical rehab; Motivation; Mind and Spirit
Interpersonal relationships: Family & whānau; Patient community; Care
Engagement: Positive distraction; Normality; Connection with the world
Empowerment & independence: Accessibility; Information & communication; Privacy
Everyday needs: Sleep; Food; Personal care
From our findings we collated a series of ‘design opportunities’ in the form of ‘how might we…?’ questions to direct designers’ attention toward areas of particular concern or rich in potential for design solutions. Some examples of design opportunities presented:
How might we utilise information technology to enhance and inform self-directed rehabilitation?
How might we ensure care routines are patient centred and support staff to continue to provide the level of care that patients value so much?
How might we enable a healthy perception of time?
How might we create a safe environment where patients and whānau can receive clinical information and be included in decision making?
How might we support patients’ circadian rhythms?
Our interviewees also made specific requests or ideas for things that they felt would make a difference to the ward environment – some seem very obvious needs, others may be beyond the scope of the project, however they all help to identify a need or wish for how they could be better provided for. Some examples of these specific requests:
More access to the gym and walking assistance
Facilities for family to stay overnight
Access to music
A patient library
Computer tablets issued by the hospital
Accessible call bells
A fridge for patients to use
Elements of nature in the indoor environment
Affordable parking
Personal care services (e.g. hairdresser)
Motivational speakers
While our study was focused on stoke and rehabilitation patients there are elements of their stories that could guide design exploration in other projects that are seeking to incorporate patients’ experiences of healthcare and the hospital environment. The involvement of patients and whānau helps put their emotional, physical and environmental needs at the centre of the design process.