Designing For the Future
Nursing intuition begets health design intuition. I believed with design training, I could be at the front end of patient care, co-creating the structure that frames our processes and outcomes.
As a nurse, I hadn’t realized my favored linen cart top ‘charting station’ was a workaround. Or writing transfer orders that look something like, “Patient may go to the floor ONLY IF there is a room in front of the nurse station”, was an insightful oddity. Like nurses all over the world, I simply did my best with what I had and reveled in the creative lengths I could go to with tape.
As is true for many of us in nursing innovation roles, I am thankful for serendipity and supportive workplaces and colleagues. Dr. Samuels couldn’t have predicted the effect of his introduction, pulling me into a lunch meeting with Dr. Craig Zimring, an environmental psychologist from Georgia Tech. In the months that followed, grad students shadowed us as we cared for patients and moved about the neuro ICUs at Emory, documenting places and processes, noticing what we overlooked. I began to see there were factors beyond my control – I would later describe these as ‘structure’ – affecting my ability to care for patients and work with colleagues. Critically, the people responsible for designing that structure had no idea how we did our jobs.
Not that designers and architects didn’t try – the Center for Health Design was about ten years old in 2006, and the design community tended to involve end users in their upfront processes. But health design intuition was not and is still not naturally obtained; while classroom, home, and office dynamics are personally familiar to many, patient care will always be novel without training. There are those who suggest empathy as the solution, but I argue that empathy can only ever be an approximation of another’s lived experience. You cannot empathize your way into heart pounding breathlessness while frantically searching for an item during a code, or the sense of ‘all is well,’ brought on by the lulling sounds of trach collar floating over your charting desk. Nursing intuition begets health design intuition. I believed with design training, I could be at the front end of patient care, co-creating the structure that frames our processes and outcomes.
So I went back to school, earning a PhD in Architecture from Georgia Tech, where I focused on patient visibility and surveillance as affecting survival. I’ve had numerous roles during and since, but I now lead health innovation and research at MillerKnoll. I spend my days embedded with clinicians from health systems trying to figure out how to design for the future. I partner with clients and academics to develop new knowledge, testing for what works and then sharing in peer-reviewed forums. I track the latest research findings and issues in healthcare to bring that knowledge to MillerKnoll’s design teams, informing what our brands make in the future to help nurses and care teams.
While the clinical community is growing health design intuition capabilities – the Nursing Institute for Healthcare Design is now over 200 members strong – we need more nurses. Not just to get degrees in design, but to simply pay attention. Notice the patterns in your work. Do patient-nurse ratios and bed assignments technically make sense by patient care workload but actually burden you because you can’t possibly supervise them well? Are novice/traveling nurses appropriately supported and supervised? Can you easily teach others and learn in your work areas? How are patients and families getting ready for discharge? These questions – and many more – are affected by the built environment, tools, technology, and processes. And when nurses pay attention, innovation can happen.
When other nurses hear my story, they often marvel at the unusual match – nursing and architecture! – and ask how I did it. Well, I do have answers to some of that. First, there is never a good time to change the rest of your life. My girls were 1 and 3 when I started school, and my more senior nurse colleagues coached and counseled that the best time to start is now. Which leads to my second “how”: I had incredibly supportive family and colleagues. My attending physician took my patients for 2 hours on Fridays in the middle of my shifts so I could go to statistics class; my husband’s support was immeasurable. My last “how” will be familiar to all nurses – plain determination. Taking weekend shifts to go to class, adjusting typical grad student life to keep going as a wife and mother, and perhaps most importantly, keeping true to my vision. I knew design needed nurses and knew I could do it. What do you know is needed? The time to start is now.