Canterbury District Health Board clearly values nurses’ input into the functional design of hospitals.
“From the executive down, we recognise the value of designing space that’s fit for purpose and nurses are integral to that,” says Nicky Topp, CDHB’s Nursing Director and Nursing Lead for the Christchurch build.
She believes CDHB is unique in their approach, though, and that – despite it making practical sense – consulting nurses on design doesn’t happen enough.
“When you think about a hospital and ward environment, nurses live there 24/7; they’re the only group besides the patients that does so. They understand what the patients need, what it takes to deliver healthcare and what nurses need to do their work.”
Topp is part of the team that runs CDHB’s Design Lab – a large warehouse space where clinicians, engineers, architects and user groups trial cardboard mock-ups of hospital spaces.
The Design Lab was used in the design phase of Christchurch Hospital’s new Hagley Building, currently under construction, with Nicky’s nursing team influencing the way wards in the new building will be laid out.
“Working with a group of architects from America, we’ve pulled apart what needs to happen in a work environment, going for functionality over form,” explains Topp.
“We went into the concept design phase of the adult ward area knowing that not everyone wants single rooms, but the multi-bed environments we currently have are just horrible.”
Working with the nurses, the design team came up with a linear multi bed design for half of each of the eight new 32-bed adult wards. This layout will see eight beds in a row but on an angle so patients can only see the feet of the patient beside them. Each patient has a room with a glass door that can be closed to block out sound, and a window, so it feels like they’re in a private room, but they can easily feel connected to others by leaving the door open.
“It’s very cool,” says Topp, “and has never been done anywhere else in the world.”
Each row of eight beds will have a nursing station situated so the on-duty nurse can see all the patients, and the patients can see them, but maintaining “a perception of privacy”.
Topp describes it as “bringing nurses back to the patients”, a simple change which will lead to more patient-centric care and simplify procedures for staff. “As soon as you decentralise, and put things at point of care, for example clean utility, dirty utility, administration space, it’s easier for nurses to do their job. You don’t have to go anywhere to get anything because it’s there.”
She admits it sounds logical, “but we don’t design hospitals like that. That’s the value of having nurses involved.
“It’s all about getting the people on the floor to do the designing.”
The involvement of nurses in the design process at Elizabeth Knox Home & Hospital in Auckland has resulted in similar ‘private but connected’ outcomes for patients and increased efficiencies for staff.
“We have to drive what we want, otherwise architects keep designing what they have done in the past,” says CEO Jill Woodward. “Innovative new ideas come only if the clinical team are involved.”
Since 2008, the Knox Home Trust Board has focused on improving and developing facilities to contemporary demands with the core concept of the Eden Alternative firmly in mind (care environments are habitats for human beings that should promote health, wellbeing and growth rather than facilities where the frail and elderly stagnate and decline).
“Our philosophy of care influences the way we have designed the environment,” says Woodward. “Our nurses are very much involved in every aspect of development. We sit down and talk about issues such as fall rates and look at what could be done.”
In the new Puriri and Nikau houses, there are no more than 15 residents in each open plan ‘household’. The design is as closely aligned to a modern home as possible, with shared living and dining spaces and an accessible kitchen. “Our design is very much based on people having their own private space but access to communal areas,” Woodward explains.
There are no nurses’ offices in the new builds. Instead, the care base sits off the lounge, where the majority of residents spend most of their time. “Putting the team where the residents are is so important,” says Woodward. “Response rates are better, and it makes the life of the nurses much easier, as time is precious.”
She admits diverging from traditional designs does present challenges. “Unfortunately the building code that age residential care construction must adhere to is outdated and any design that challenges very corridor based and institutional design that’s fit for purpose and accommodates new resident focussed models of care will create considerable time delays in achieving consent and result in additional costs.”
Undeterred, and in a first for the sector, Elizabeth Knox is planning a completely open plan house, with all bedrooms opening off the living space, very much like a bach. Woodward is confident this new layout will show an improvement in quality of care and offer residents a sense of being involved from their bedroom – “a mix of privacy and engagement”.