HGA experts describe the emerging patient journey, considering the ways COVID-19 and other infectious disease impact patient experience and transform our environment of care through people, process, technology, and space.
As healthcare institutions continue to re-open facilities nationally, many providers are re-examining safety measures to prevent infectious transmission. Many initial precautions—social distancing, masks, limited patient volume, reduced services—responded directly to the immediate health crisis. Now, as it has become clearer that the general population will continue to live with the potential spread of COVID-19 longer term, healthcare institutions are looking beyond immediate needs to longer-range strategies that will transform the patient experience for a “new normal.”
HGA is a healthcare design firm rooted in research and data, but also driven by empathy. We believe solutions should address needs—those of patient, staff, family, caregivers. In the 30 interviews we’ve conducted with healthcare organization leadership this month, each discussed ways that healthcare environments will change, but many also focused on how to “re-start” their business, and avoid another version of pandemic—that of patients deferring care due to fear. In fact, a recent Gallup poll shows that 83 percent of the respondents expressed that they are moderately or very concerned about seeking medical treatment.
In this article and the subsequent downloadable “playbook” The Patient Journey Reconsidered, we start with the needs of the patient, as we’ve come to understand that building confidence is key to restarting healthcare.
Emerging Patient Needs
We have long used tools like Journey Mapping to understand design impact at various touchpoints along the patient journey. Using these key moments in the patient journey, we addressed new and emerging needs as patients navigate the healthcare system from pre-visit to arrival, admitting, diagnostics and treatment, and discharge.
Specific recommendations on how people, process, technology and space support this response is found in the downloadable PDF.
Prior to engaging with care, the patient now needs to feel re-assurance of safety, coupled with a sense of control. With new options for virtual health, new options for diagnostics and testing, patients also need guidance on when, where, and how to access care.
Response: Improve existing processes and create new ones to keep patients out of the hospital or clinic to reduce overall visits to the campus, but also prepare patients for their journey into the new clinical environment.
Once patients arrive at their destination, they need to feel valued and welcome. Clear wayfinding should direct them where to park and how to navigate to the entry. Once at the entry, there should be information on when and how to enter the building. This information is also helpful prior to leaving for their appointment.
Response: Improve the patient experience from the time they arrive on your campus. Prioritize additional wayfinding and directing people before they get to the front door.
Once inside the building, patients need easy and specific wayfinding to reach their destination, coupled with minimal exposure to potential risks (surfaces, air, people). Processes and technology can create limited or zero waiting to remove anxiety and exposure related to proximity to others.
Response: Create a safe and secure environment to reassure patients, with focus on safe routes, safe waiting or elimination of waiting, cleaning protocols, and PPE.
Diagnostics & Treatment
Again, patients need minimal exposure to potential risks (surfaces, air, people), protective measures, minimal movement, and a provision for involvement of family/caregiver, if desired or necessary.
Response: Focus on process improvement to reduce hand-offs, and movement—not just for safety but to create a patient-centric experience. Create a physical environment that is easily and quickly cleanable to maintain throughput and utilization. Provide PPE and hand cleaning options.
Note: Social distancing and access to PPE and hand sanitation for staff is just as important as it is for patients. Provide the ability for staff to be together—or apart—to promote both respite and collaboration.
When leaving the facility easy wayfinding back to transportation, safe places to wait for transport home, and safe PPE disposal is crucial.
Response: Similar to admitting, create a safe and secure environment to reassure patients, with focus on safe routes, safe waiting, safe waiting, and cleaning protocols.
Strategies to Meet Needs
Meeting ongoing needs will require implementing strategies in four categories: people, process, technology, and space. To minimize capital cost, we believe it is important to focus first on People and Process. Specific changes impacting people, process, technology and space to support your responses in each touchpoint are found in the downloadable PDF.
You will need to spend more effort on cleaning to provide re-assurance of safety and to maintain turnaround times. You might consider more 1:1 escorting of patients inside your facility. The post-COVID world may feel more stressful at first; providing safe workspaces and areas of respite for staff will be more important.
Ideas like redesigning arrival and discharge processes support minimizing exposure to potential risks. Some functions can be done off-site; take advantage of this to streamline flow, improve safety, and reduce or repurpose square footage. Use this is as an opportunity to improve processes to be more customer-centric, rather than less.
The exponential adoption of telehealth reduces in-person visits, with long-term strategies needed. For required in-person visits, consider rapidly deployable technologies to reduce exposure to potential environmental risks (screening at entry, cell phones for queue management, automated processes to reduce the need for face-to-face interaction, etc.). Explore alternative disinfection methods in targeted locations. Use of Real Time Location Services (RTLS) technology can track and manage flow of patients through your facility.
Reconfigure existing spaces to create greater social distance and/or physical separations. Modification of HVAC systems and controls can focus on increasing exhaust and air changes. Consider replacement of interior finishes, fixtures, and furnishings to minimize infection risk, but only if not achievable by other means
Your care sites will need to accommodate a mix of planned and unplanned visits, and a wide range of patient vulnerabilities, from the relatively healthy and resilient to the more vulnerable. A chart included in our publication suggests how you might adapt your focus by application.
For details, download The Patient Journey Reconsidered.
- Milly Baker, Medical Planning
- Brent Peterson, Process Improvement and Operations
- Terri Zborowsky, Evidence-Based Design Research
- Kate Bautista, Interior Design
- Dave Guzlecki, Senior Mechanical Project Engineer
HGA has created a hub for our insights and reactions to the COVID-19 pandemic as architects, engineers, interior designers, and problem solvers. Follow the conversation here.