Elements-of-a-Healing-Environment

1. Elements of a Healing Environment DESIGN STRATEGIES FOR MID-SIZE HOSPITALS

2. India’s healthcare system is run by the government and private sector across setups of various sizes- big, medium and small. According to NITI Aayog[1], a small hospital has less than 100 beds, a mid-sized hospital has between 100–300 beds and a large hospital has more than 300 beds. Large hospitals are well organised in terms of specialisations, staff ratios, beds, core health, and diagnostic services – which result in better productivity and a holistic experience. On the other hand, medium and small hospitals are efficient, but they often lack the necessary infrastructure for softer aspects, including patient comfort, caregiver convenience, ambience, and comprehensive healthcare practice. A healthcare facility’s focus on efficiency and functionality is understandable, yet undeniably, the overall experience affects the patient both physically and emotionally. Progressive thinking in the healthcare space necessitates a comprehensive healing environment in the patient's recovery journey. The Indian Healthcare industry is predicted to grow by 16–17% CAGR, driven by better awareness, higher incomes, lifestyle diseases, and access to insurance. This is bolstered by the growing number of well trained medical professionals and increased spending by the government. Source: IBEF 02 ELEMENTS OF A HEALING ENVIRONMENT

3. Factors that define a successful healthcare system Equipment Infrastructure Caregivers Operations To run a successful healthcare system, factors like infrastructure, operations, equipment and caregivers need to be in tandem. In a given situation, if any of these factors is not in sync or adequate, the system can collapse. Inefficiency across these areas can also result in shrunken faith in the hospital’s services. 03 ELEMENTS OF A HEALING ENVIRONMENT

4. Today, the Healthcare business focuses on creating environments that support patients and their families during the healing process. These healing environments are based on efficiency, empathy and wellbeing of all stakeholders – Patients, Caregivers and Doctors along with their staff. Godrej Interio believes that the bedrock of healing environments should be patients and their relatives, it should help caregivers in being efficient and ensure doctors’ comfort. This can be achieved through various design approaches for products and space. Godrej Interio’s Healthcare Solutions are based on the philosophy that comes from a HUMAN CENTRIC APPROACH. 04 ELEMENTS OF A HEALING ENVIRONMENT

5. Human-centred care The Institute of Medicine defines patient-centred care as “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.” This approach requires a true partnership between individuals and their healthcare providers, one where the individual’s needs and aspirations drive both healthcare decisions and how outcomes are measured.[2] Only when a human-centric care model is approached health care spaces can become more comfortable and receptive. The 4 C’s of patient-centred care Culture Care Communication Collaboration 05 ELEMENTS OF A HEALING ENVIRONMENT

6. We at Godrej Interio sought to take a broader look at the circumstances of various stakeholders in mid-sized hospitals through a pan India study. We analysed the challenges faced by healthcare staff, patients and caregivers. Additionally, we studied their needs while in a healthcare space. Our aim is to create a healing environment for patients, improve efficiency and ensure the wellbeing of medical staff and caregivers. We have identified some key considerations that will aid the design of healthcare spaces and allow everyone involved to feel comfortable and relaxed.[3] 06 ELEMENTS OF A HEALING ENVIRONMENT

7. User’s opinions Doctor Patient “The hospital I chose was small, with no facilities for patients and caretakers’ comfort. But since my doctor was associated with the hospital, I had to opt for the same.” “During my shift when I want to relax for a while and detach from work, I am forced to sit in a noisy canteen. It doesn't make me feel calm but only increases the stress. The staff don't have a quiet space to relax.” Family/Relatives “While my mother was operated on for fracture, the mobility aids in the hospital were limited and the space provided inside the room was not appropriate for using the walker.” Caregiver “We spend the whole day either at the nursing station or with the patients, it would be nice to have a room where we can sit down and take a small break.” “The bed provided was basic, with no adjustments. It was difficult for me (caretaker) to lift my father (patient) to a sitting position even to have food.” “It’s a lot of effort to keep cranking the bed to the desired level; my body pains quite often.” 07 ELEMENTS OF A HEALING ENVIRONMENT

8. Challenges faced by mid-size healthcare facilities Poor Communication Hospital Facility and the Staff • Insufficient or no information shared between health care professionals, patients and their families • Hospital layout is complex and wayfinding is arduous • Unavailability of a specialist in a comfortable hospital and vice versa • Inconvenient hospital location without the convenience of all facilities under one roof • Undertrained and overworked staff Hospital Infrastructure Substandard Hospital Experience • Crowded waiting zones • Lack of ergonomic and comfortable infrastructure • Inadequate relaxation zones for the staff • Lack of empathy and time for patients • Absence of consideration for the needs of patients and their caregivers • Tedious billing processes • Compromises due to the financial situation Hospital Room • Inappropriate layout and environment • Inadequate infrastructure support for patients' mobility *Study conducted across mid size hospitals in India 08 ELEMENTS OF A HEALING ENVIRONMENT

9. The healthcare environment is not the only medium for healing. But it can promote behaviours and emotions that aid healing. The environment can encourage happiness and rejuvenation, augment control and functionality – all prerequisites to healing.[4] Exploring the Concept of Healing Spaces, Jennifer DuBose et all 09 ELEMENTS OF A HEALING ENVIRONMENT

10. Earlier approaches to healthcare space design were essentially based on functionality, such as designing hygienic spaces, creating powerful tools, or increasing medical record efficiency. stress of patients and staff, increase satisfaction, and promote overall well being. However, this approach is limited to only big hospitals with planned spaces.[5] In order to open up avenues for the growth of medium-sized private hospitals in India, we recommend exploring the relationship between healthcare spaces and design. Today, healthcare facilities must dispel the feelings of unease and fear that many associate with the sterile atmosphere of a hospital. It must also ensure the wellbeing and comfort of healthcare professionals who spend long hours on their feet or in uncomfortable positions assisting patients. Improved and advanced healthcare spaces are likely to attract more patronage for patients, caregivers and staff. Making necessary changes in this segment will ensure that hospitals make effective and efficient use of space. The same will also guarantee happier users. Additionally, healthcare spaces should be aesthetic and mindful of user experience. Hospitals must aim to ease the 10 ELEMENTS OF A HEALING ENVIRONMENT

11. Healthcare Design Healthcare design is not a one-size-fits-all solution. As we plan, design, adapt, remodel, and build, it is crucial to consider the varying demographics health systems are serving. Factors such as infrastructure, layout, spacing, aids for mobilisations, and ergonomic infrastructure – which promote overall well-being, should be brought into healthcare spaces during the planning phase. Create a Rejuvenation Space for the Staff Design Invest in the Future: Infrastructure Patient Centred Spaces Invest in the Future: Technology Provide Ergonomic Infrastructure Setup a Welcoming Waiting Area 11 ELEMENTS OF A HEALING ENVIRONMENT

12. Setup a Welcoming Waiting Area On an average, patients wait for 30–35 minutes in the OPD despite a prior appointment irrespective of the first time or a check up. Source: Godrej Interio Study Alleviate stress Provide comfort Maintain clear layouts • Provide expansive views with natural light using large windows • Ensure ample seating using ergonomic furniture that can be cleaned thoroughly and is durable enough to stand continuous use • Ensure registration area is organized with separate registration and query counters • Use light coloured paint that bounces light off the walls and makes it look spacious • Ensure clear signage and colour codes for easy navigation to all departments • Install WiFi and power points for use – users can work and/or keep themselves occupied • Connect with nature- using artwork, planters, materials for furniture and furnishings, small water bodies whether an indoor or outdoor space • Ensure ample seating of various types to cater to all needs • Create a play area for children to engage them and reduce discomfort • Arrange an eating zone using a vending machine or food court 12 ELEMENTS OF A HEALING ENVIRONMENT

13. Design Patient-Centred Spaces Spaces should be created keeping in mind patients’ needs to make them feel at home. A healthy and colourful environment that radiates positivity should be preferred to ensure patients are morally motivated to recover. Create a homely environment Ensure a good layout / space • Create pockets of colour – using walls, planters and artwork to reduce the appearance of an institution and improve comfort • Ensure access to services like washbasin for all users including healthcare staff • Ensure sufficient circulation space to move around with a crutch/ wheelchair • Maximise connection with nature using large windows for sunlit external views and indoor plants • Provide adequate storage for belongings using bedside tables and wardrobes • Place controls of TV and lights near the patients and caregivers to ensure control and ease • Provide a wide bed for the caregiver to rest 13 ELEMENTS OF A HEALING ENVIRONMENT

14. 90% Provide Ergonomic Infrastructure nurses suffers from one or more pain issues *Study conducted by Godrej Interio Musculoskeletal disorder (MSD) is currently recognised as a common occupational injury for which nursing personnel in the healthcare industry have been identified as a high-risk group. 61% complaints of neck pain 43% complaints of wrist pain 51% complaints of knee pain 51% complaints of back pain In a study conducted by Godrej Interio, we discovered the challenges faced by nurses while working. It is due to the below factors that caregivers are at risk: In a medical setting, ergonomics is incredibly important for both patients and medical staff. Whether patients are being operated on, recovering in bed, or undergoing a procedure, their comfort and well-being should be a priority. Doctors and nurses, meanwhile, have long shifts that they spend mostly standing or in uncomfortable positions. For their well-being and for the sake of their patients, medical facilities ought to consider ergonomics for the staff as well. • Long working hours • Job tasks demanding physical exertion • Patient transfer tasks These result in absenteeism, poor work satisfaction and consequently less productivity. 14 ELEMENTS OF A HEALING ENVIRONMENT

15. Provide Ergonomic Infrastructure With appropriate ergonomic intervention, physical stresses can be significantly reduced. It can also reduce the risk of musculoskeletal injuries and, in particular, lower back and neck injuries. Provide adjustable beds Train the staff • Ensure staff comfort via the right ergonomic practices to decrease MSDs • Educate the staff on the correct posture to adopt while caring and working, to reduce physical strain and risk of injury • Adjustable beds increase staff efficiency due to higher safety, comfort, ease of use and cleaning • Implement job rotation in different departments to aid medical staff • Fully-automatic or semi-automatic beds, transfer aids, and walking aids reduce the stress on the patient’s body. It also reduces a patient's dependency on others and boosts their morale • Demonstrate energy conservation techniques including activity spacing – an ideal balance between sitting and standing while working, so the staff doesn’t suffer from fatigue during the shift • One-touch features of automatic beds to switch to a CPR position for emergency medical procedures 15 ELEMENTS OF A HEALING ENVIRONMENT

16. Create a Rejuvenation Space for the Staff “After a long day shift in ICU, we, staff members don’t have a comfortable staff room to rest. The room allotted only has wooden tables and wooden chairs which don’t help relax.” Provide for rejuvenation • Provide rejuvenation areas • Ensure active seating of various types to cater to all needs like working, sitting, and lounging as it will avoid people slipping into a sedentary lifestyle • Ensure this area is separate from patient care and treatment areas • Establish a connection with nature via plants, soothing natural sounds and artwork • Create a lounge, canteen, cafe or library for social connections, professional development, research, and revitalisation • Encourage exercise by ensuring clear floor space, yoga mats, treadmills and other equipment • Install WiFi and power points 16 ELEMENTS OF A HEALING ENVIRONMENT

17. Invest in the Future: Technology A little over 20% of respondents preferred teleconsultation to save time and avoid travel, especially in case of minor ailments. Invest in Technology In-Patient Care • Routine documentation, financial transactions and patient information can be uploaded to a secure, cloud-based system to ensure access from anywhere and at any time • Online consultations and cross-departmental opinions can be provided on a platform to streamline access and improve collaboration • Eliminate the need to touch surfaces by implementing automatic door operators, card readers, no-paper, no-signature, etc. • Integrate video conferencing technology for patients to communicate with their loved ones, especially in inpatient environments and isolation spaces • Implement drive-thru testing sites instead of mixing populations within the care environment of suspected illness • Provide a room for teleconsultation – for minor ailments, it saves times and resources • Use robots to implement no touch dispensing and delivery of equipment and cleaning 17 ELEMENTS OF A HEALING ENVIRONMENT

18. Invest in the Future: Infrastructure Medical needs and modes of treatment keep evolving. Therefore, hospital spaces must be designed keeping flexibility in mind. Designing for flexibility translates to “future-proofing” hospitals. Embed flexible design in layouts Repurpose existing spaces • Use fixed dimensions for selected rooms e.g. patient and consultation rooms, and OPDs, to create modules to meet a variety of care needs • Consider using flexible furniture to adapt to usage patterns E.g., Adapting under-used facilities like inpatient facilities for teleconsultation, ORs etc., or converting the canteen to an inpatient facility in times of crisis • Provide easily accessible services (electricity, HVAC, water, waste) and maintenance using modules 18 ELEMENTS OF A HEALING ENVIRONMENT

19. Healthcare has a growing number of dimensions, several revolving around experience and wellness. To achieve efficiency and deliver to evolved expectations, it is important to account for user perspective as well. Hence, principles of comfort, design, and ergonomics must be relied upon to establish a wholesome space. In order to open up avenues for the growth of medium-sized private hospitals in India, we recommend exploring the relationship between healthcare spaces and design. Improved and advanced healthcare spaces are likely to attract more patronage for patients, caregivers, and staff. If hospitals in this segment make the necessary changes, it will ensure that they make effective and efficient use of the resources available – space and humans, to deliver a holistic healing experience. Apart from delivering on current needs, an ideal space should accommodate even the anticipated future needs of patients, caregivers and medical staff. In parallel, it should have pleasing and aesthetically superior interiors to expedite healing and foster a positive experience for everyone. 19 ELEMENTS OF A HEALING ENVIRONMENT

20. About Godrej Interio Disclaimer Godrej Interio (GI) is India’s premium furniture brand in both home and institutional segments with a strong commitment to sustainability and centers of excellence in design, manufacturing and retail. This paper represents the opinions of the authors and is the product of professional research. This report has been prepared for the exclusive use and benefit of the addressee(s) and solely for the purpose for which it is provided. Unless we provide express prior written consent, no part of this report should be reproduced or distributed. While every attempt is made to ensure that the information contained in this document is true to its best. However, Godrej and Boyce Mfg. Co. Ltd., its employees, representatives, affiliates or any of its divisions, etc. shall not be responsible for any reliance made on this paper or for any errors / omissions in information obtained from the source while preparing this paper. Led by the largest in-house design team in the country in the furniture category and awarded with 42 India Design Mark Awards till date, GI aims to transform spaces with its thoughtfully designed furniture to create brighter homes and offices with products that have the highest design quotient in aesthetics, functionality and technology. With consistent pursuit of excellence and a special focus on health and ergonomics, GI’s product portfolio comprises a massive range. Today, we design and manufacture furniture for office spaces, homes, educational institutes, healthcare facilities, laboratories and more. Along with furniture we offer Audio Visual and 360 Degree Turnkey solutions. Each of our product range revolves around comfort and aesthetics while delivering well-designed, fun and functional furniture solutions. Briefly, Godrej Interio transforms dream spaces to life! Currently present in over 650 cities with 250 exclusive showrooms and 800 dealers, GI is one of the largest divisions of Godrej and Boyce Mfg. Co. Ltd., part of the Godrej Group, one of India's largest engineering and customer product groups. References [1] https:/ /www.niti.gov.in/sites/default/files/2021–09/Dis- trict_Hospital_Report_for_digital_publication.pdf [4] https:/ /www.healthdesign.org/sites/default/files/civicrm/per- sist/contribute/files/Exploring%20the%20Concept%20of%20Heal ing%20Spaces%282%29.pdf [2] https:/ /healthleadsusa.org/resources/patient-cen- tered-care-elements-benefits-and-examples/ [5] https:/ /www.healthdesign.org/sites/default/files/civicrm/per- sist/contribute/files/Exploring%20the%20Concept%20of%20Heal ing%20Spaces%282%29.pdf [3] https:/ /www.healthdesign.org/sites/default/files/civicrm/per- sist/contribute/files/Exploring%20the%20Concept%20of%20Heal ing%20Spaces%282%29.pdf 20 ELEMENTS OF A HEALING ENVIRONMENT