Jackie Gonzalez receives care at the University of Miami's Sylvester Comprehensive Cancer Center after her pancreatic cancer went into remission.
When she was taken on a recent site visit for a new facility, she noticed a long hallway and suggested designers put in some benches so that a patient who needs to take a rest can stop along the way.
Gonzalez is part of a group of volunteers made up of current and former patients of the University of Miami Health System (UHealth) and their families. More and more, health systems are paying attention to how the design of a facility impacts a patient's recovery, seeking input from health care architects as well as the people experiencing and providing the care, like doctors and nurses.
“I’m truly passionate about it,” said Gonzalez, who joined UHealth's Patient and Family Advisory Council in 2021. “I’m a nurse by training, but I’m very clear when I’m here — I’m here as a patient.”
She told WLRN that she and her peers have been asked to test furniture and look at design.
"When we meet, they'll show us the design and what they're trying to achieve," she said. "And then they'll ask, 'Do you think this will help achieve that?' "
On another site visit, she and her group looked at a check-in counter they thought was too high for some visitors of a facility.
“We looked at it from the adult side in a wheelchair perhaps, or if you’re a child you’d be jumping up and down,” Gonzalez said. “It didn’t allow the contact with the registrars that you want, to have that feeling of being heard or understood. So they made that change.”
Recently, WLRN went on a tour of a UHealth facility under construction in Doral with Soudabeh Eskandari, a senior project manager with UHealth Design and Construction. Eskandari listens to input from the council.
Eskandari, who survived cervical cancer, knows as a former patient that smaller details matter a lot.
“I didn’t know where to put my purse. I always hung it from my chair,” she said about her experience getting cancer care in South Florida.
So she made sure that the infusion rooms of the cancer treatment unit have closet space and space for caregivers to sit with loved ones in the same room.
“The caregivers, they sit there in comfortable furniture — a round table, and that table has a charger so they can charge their phone or they can put their laptop and work.”
Instead of harsh fluorescent lighting, this glass-covered building will let in lots of natural light.
“By bringing that light in, we can help to lower the stress and also help patients to elevate their moods and accelerate the recovery process,” Eskandari said.
A study from 2022 found that certain lighting can even affect the rate of falls for long-term care residents.
“Changing out lightbulbs in nursing homes can impact fall rates significantly,” said Dr. Diana Anderson, a geriatrician and professor of medicine at Boston University. “Of course, falls are things we don't want to happen. It causes a lot of economic burden, of injury burden and hospital system-use burden."
Anderson, who's also a health care architect at global solutions firm Jacobs, came up with a term for her expertise in the intersection of medicine and architecture: dochitect.
“It is a term that I created and trademarked, registered as sort of a brand that I think really helps illustrate the fact that these two professions can be integrated,” she said.
She says she strongly believes their integration can help patients significantly. Too much is at stake with the volume of people getting care at a facility like a hospital over the years.
“That's a pretty strong statement to make, to say that the building you're in is as powerful to your health as a pill you might take, or a surgical procedure you might have in the hospital," Anderson said. "But there is evidence to show this is the case.”
She points to research including how close a patient’s room is to a nursing station, color patterns, and even floor lines to help patients with dementia.
The health care model in the U.S. depends a lot on patient satisfaction because it’s a payer model. Anderson’s calling on health systems to care about the design of spaces for staff.
“What we often see in design now is what we call this onstage-offstage model, whereby patients will often get the shiny lobby with the art, the window and the sculpture or fountain, and staff will get a lounge at the back of the building without any windows, with barren walls," she said.
The well-being of staff may affect the care and the work they deliver. Until design is made for all of the people inside the walls of a facility, then equity will still be lagging.
“What I think is really neat is that doctors and nurses and other clinical professionals really want to think about design,” Anderson said. “I have people calling me saying, ‘I really, really want a certificate program or a degree because I think it can impact how I deliver care in the operating room, in the clinic space.’”
Health care delivery has no shortage of complex problems. The experts to solve a lot of them are already working at a hospital, and Anderson says having more of them gain expertise in design will yield even better results.
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