We recently spotlighted the work of Miguel Burbano de Lara, AIA, at Pediatric Associates of the Northwest and how his suggestions around workplace flow were brought into being, significantly changing the culture of the clinic as well as its work practices. Miguel has led several of Neenan’s healthcare projects, and we sought some of his time recently to discuss the emergence of a culture of hospitality in healthcare, how that had come about and whether it is truly applicable. Here’s what he had to share with us…

Why hospitality and why now?

A growing societal desire for comfort, as seen in the retail, airline and other industries, and as often demonstrated in the sound, light, smell, and vibration standards of a space is propelling similar expectations in healthcare; even though the industry has largely ignored such aspects of good service. Hospitals have historically been considered an inhospitable places – we go only when we really need something serious to happen to us. They were known in the past as ‘death houses’ and one really didn’t want to stay any longer than they had to. A contemporary focus on high efficiency and sophisticated technology has continued to make this environment, more scientifically clinical as well, in spite of considerable research and empirical evidence that a healing environment does not necessarily need to be highly efficient or technologically grounded. Indeed, Burbano shares, “individuals prefer, desire, and deserve, clean, safe and comfortable environments of care.”

So which dimensions of hospitality are relevant for healthcare settings?

For Burbano, the core question is “what can be done to improve the patient and family experience?” The ancient spa and bath houses in Europe and elsewhere knew the answer to this question — the setting is a health advantage and can provide a significantly more healing experience for its user. These days, Burbano shares, outpatient surgery centers have allowed individuals to experience a different form of hospital, demystifying those events and improving privacy and comfort simultaneously. There has also been an increase in wellness resorts and health tourism, where convalescence in a spa/resort environment has been proven in evidence based design to improve healing, mood and patient satisfaction. For Burbano, such shifts mean that architects and facility providers now focus on providing a new healthcare experience by reducing the amount of discriminators in care environments. The Center for Health Design has recently reported that nature and daylighting, for example, improve recovery in younger patients. “Where such features might have been ‘nice to have’ in the past, these design features now find themselves as ‘musts’ in proposal briefs,” Burbano states. However, such a shift is not free of controversy and compromise.

Where does hospitality live in healthcare?

It’s easy to see the incredible improvements technology has provided in both inpatient and outpatient settings. In some way, hospitality flows from such technological innovation, or at least finds space as a result. Various forms of technology are now at work in healthcare settings that allow more patient-centered and controlled environments. Changes in the very nature of the bed, for example, now make a hospital bed more like your bed at home. Several outpatient surgery centers have transformed their recovery rooms into bedrooms. Many of Neenan’s clinical projects in the Northwest include lobbies which resemble hotel lobbies. “We want to decrease people’s fear and anxiety around the healthcare institution by very deliberately managing sound and light,” Burbano shares. “Our next move is to suggest concierges and greeters as well, just like those that welcome you to a hotel.”

Still, there are some clinical environments that are not like a hotel, and there is increasing discussion about whether hospitality has a place, say, in an Emergency Department. Burbano believes it does, but it takes a different form. “We have to realize that there are particular standards for primarily clinical settings, like an ED or operating room. This does not mean we can’t do anything around lighting, music, furniture and smells, but we need to be cognizant of the clinical safety reasons that dictate why that space is as it is,” he explains.

However, he adds, “You need a radiology guided operating room with robots, but designers can make it better. The machine comes in ugly grey, for example, and we don’t challenge that. There’s an awareness that we are following obscure standards, but we need to question them. There may be better outcomes with less standards, as we can see with the MRI. It was purely an instrument in the beginning — loud, uncomfortable, you had to be sedated to even get into it. Now we have the open MRI which emerged out of trying to make the patient more comfortable. It was a response to the market, to the user. So the challenge to design professionals is that there is always an opportunity to improve the environment for all, and we should not accept all we are dictated without questioning what else we can do.”

So does hospitality start with the patient as center of the experience?

Burbano believes so. He says, “In the early 1900s, healthcare institutions were symbols of illness and death. Technology and medications have decreased that impression in general but the industry has been slow to improve. We like to associate hospitals with bad places, but they are where miracles happen. Incredible things happen every day in these settings, but we forget about the miracles. Transferring control to the patient can bring great rewards. Just changing the locus of control to the patient brings changes in gowns, beds, food, furniture, even decibel levels, and these changes centered on the patient also impact staff. The idea is to demystify healthcare and improve the experience for everyone.”

There is also a connection between behavior and the environment, Burbano contends. Should your clinic greeter act the same as a hotel greeter? Yes, if you want to change the patient and their family’s experience of your facility. Should your patients arrive via a different hallway than the staff? Yes, if possible. Should the hallway itself be free of medical objects and more like a hotel? Most definitely. Burbano adds, “There are very little limitations to pushing the environment, except for facility determined or clinical reasons and the specific environments and conditions that need to be met there. Plastics centers may have different needs than heart or cancer centers, so it is hard to apply universal concepts; but separating traffic, improving patient privacy and hospitality are all accomplishable in these settings.” Finally, Burbano suggests that behavioral change is just as important as design changes. “There is a distinct connection between space and the ways in which we act there. Hospitable places require hospitable behaviors, so those two things must be in alignment, for any breach of patient expectations will be more profoundly felt. A hospitable environment includes everyone. Everyone should feel welcome there. Sometimes this may conflict with our ideas on safety and this is the tension between hospitals and hospitality.”

So will hospitality become the new rule in healthcare facilities? As you can see, there is a lot of evidence to suggest it should, but our cultural and industrial senses of what should happen in these spaces are challenging. If you could design a clinic based on hospitality, how would it look, feel and smell?

With thanks to Daquella manera, Keith Williamson, MShades, and nettaphoto for their wonderful pieces of art!

Kirsti