How design can empower patients

How design can empower patients

To designer and architect Michael Graves, paralyzed from a rare virus and in a wheelchair since 2003, the ultimate indignity came one day while he was a patient in a top-ranked hospital: “I was in a Hoyer Lift.” (a body sling mounted to a metal structure, used to help lift and move a patient). “The nurse was moving me from the bed to the chair, when another nurse came to the door and called to her friend, ‘Come on, it’s time for our break.’ After initially saying that she had to finish moving me first, my nurse changed her mind … and went on break with her colleague. So she left me dangling in the sling, midway between the bed and chair.”

For a moment hearing this, words escaped me. “What did you do?” I finally asked, horrified.

“My room was close enough to the nurses’ station that I was able to call out and eventually get somebody to come and help me.”

Yikes. I can’t imagine the indignity to any human being, let alone the stark contrast in respect this represented for an internationally-renowned captain of industry. But for Graves, it was only one of many moments that would fuel the next chapter he’d embark on as a designer.

During long weeks in eight rehabs and hospitals following his sudden paralysis, Graves was appalled to find patient rooms too tiny to accommodate his wheelchair (rooms designed for people in rehab); faucets and plugs out of reach; and décor (a euphemism) that prompted him to blurt “I can’t die here; it’s too ugly.” (Though the lobbies and public spaces of these nationally ranked facilities, he says, were gorgeously outfitted in granite and marble). Graves decided to turn his designer’s eye to creating tools and environments that made sense for patients, as well as for those who take care of them.

I interviewed Graves some months ago, for how we need more simplicity and common sense in the way health care is delivered to patients. Who better to help us figure out the intersection of health care and design — design meaning common sense, frictionless user interface, form following function — than Michael Graves? With oodles of design awards, honorary degrees, a bunch of medals, plus libraries, resorts and company headquarters to his credit, (think the Swan and Dolphin Hotels at DisneyWorld, and scores of everyday products at Target Stores), he’s arguably the dean emeritus of how design can empower — or dis-empower — a patient.

Which brings us back to the day Graves was left dangling in mid-air. It’s a story he tells for one reason: to illustrate how important it is for a hospital to have a culture of care — and how egregious harm to body and spirit can occur when it’s absent.

“These workers aren’t bad people. I don’t blame them. They may have been trained medically, but they haven’t been trained in any culture of care.”

Graves points to how other companies work from the top down to create this unified approach.

“Apple, for instance, has its VP of sales interview and train managers, who in turn train secondary managers, who in turn interview and train every single worker and helper, so the interaction with the customer is consistently up to the same high standard. That’s what it takes.”

Absent this level of attention, Graves says, Apple might lose a customer’s business. In a hospital, the loss can be much worse.

Graves’ better designs range from hospital furniture that’s easily moved, accessed and cleaned, to walking canes that zip into satchels. They offer a glimpse into a future where every person’s dignity and control is honored as a birthright, regardless of physical limitation.

“There’s a huge unmet need for products and services that help care for aging parents now and in the future.”

It seems to come down to consciousness — something Graves promotes by having new hires at his firm spend time in a wheelchair. As for the world at large, Graves’ story about how he was abandoned in a Hoyer lift, as wrong as it was on every level, is also indicative of the far more insidious harm that occurs when we devalue a person’s basic human dignity — or shrug when it happens. Bring up the subject of indignities suffered by patients, and see what stories come up — like a grown woman sobbing for a tissue at 3am because the bed table with the tissue box has been moved out of reach (and no one’s answering the call button), or a grandmother, asking to be taken to the bathroom, being told, “It’s shift change. If you can’t wait, you’re going to have to go in the bed.”

These humiliations, both large and small, degrade not just the person experiencing them; they diminish all of us.

Pat Mastors is the author of  Design To Survive: 9 Ways an IKEA Approach Can Fix Health Care & Save Lives. She blogs at Islands of Excellence, where this post origially appeared. She can be followed on Twitter @pmastors.

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  • FFP

    On a tangent, the mentality so wonderfully illustrated in the first paragraph is why I never call most nurses “(healthcare) professionals”. I’ve seen it happening too many times.

  • Suzi Q 38

    I have had nurses that were very good. If they were, I would write about them via Press-Gainey.

    After my cervical anterior disscection, I wanted to go to the bathroom.
    I knew that the nurse would have to take my catheter out, I would then have to make sure that I could bear my weight after a complex surgery, and then walk to the bathroom with my I.V. pole and beeping machines.

    I had my daughter call the nurse. The nurse came and listened to my request. I apologized that this would take a lot of time to set up.
    She left to go do something and then returned with a bed pan.

    I told her that I didn’t need that, and the bedpan was not what I asked for. I realized that I had to go over it step by step with her.

    “Please remove my catheter.” Was my next request.

    The woman in the bed next to me was a nurse, as well as my daughter was.

    She just laughed at the entire verbal exchange.

    “What did she think you wanted?” She asked.

    “I knew I wanted to use a toilet, but she wanted me to use a bed pan.”
    I answered.

    I knew that if I decided to stay in the hospital for a few days, that it was going to be a long few days.

    Thankfully, the nurse on the night shift was fantastic.
    My room mate and I thanked her all night, and asked her to stay with us the next day.

    When she left, I got another visiting nurse who was just as bad as the first one.

    I begged to go home, and checked out of the hospital.
    There are some things that can not be changed no matter what you do.

  • anurseintime

    Everyone who works in healthcare has faced a choice that was presented in the beginning, and in the end, of this article. Given how human nature works, I’m sure nearly all of us have made the wrong choice. I hope most of us, myself included, have not made a choice as egregious as the first example. What I enjoy most about healthcare is it is a balance of priorities on a maslow level hierarchy. If a patient is coding, I have no choice but to prioritize that patient’s needs in place of my other patients. The challenge comes when I may need to explain to the other patients why they have been ignored. Have I made a patient wait 5 minutes so I could use the bathroom or eat for the first time in 8 hours? Absolutely. Have I left a patient in a compromised position, like in a lift, so I could leave the room for anything? I hope not, because to me that is grounds for termination.
    What the author does well in this article is talk about how design impacts our ability to care. How many tables, chairs, etc.. did the nurse need to move to get the patient from chair to bed? I am lucky that at my hospital, we have ceiling lifts and I can get most patients from chair to bed in less than 5 minutes.
    Patients come to the hospital for 24 hour nursing care, and the second tragedy is that we have not made our voices heard in hospital design to help us properly care for our patients. The most telling line in the article is the last, when I feel like I am unable to care for my patients how I would like, I feel very small.

  • Anthony D

    Great looking pictures! Keep up the fine work!

  • RahRahAmerica

    Revenge is built into the system: These health care professionals eventually are hospitalized themselves.

    • Pat Mastors

      I would call it karma…but still so sad that anyone has to learn that way…

  • Robert Steed

    When I was in my internal medicine residency, I was on call one night when we received a patient in transfer. When I went to see him in the ER, he was lying on a gurney in his hospital gown, shivering. I knew where the ER had a hot box full of warm blankets, and I went and grabbed him one before I checked him in.

    He was very grateful, and thanked me for what I had done. A few weeks later, I happened to pass him in an outpatient clinic hallway. He stopped me, thanked me again, and recounted for his wife the story of me giving him that warmed blanket.

    His heartfelt thanks was one of the high points of my residency.

    • EmilyAnon

      I’m so impressed you remembered his gratitude, and also for the patient in giving it.

  • Chris Gates

    What a great story. Design of things from large systems like a hospital to handy day-to-day living devices can enhance or take quality away from people’s lives. Cheers to great design and keep it coming!