The patient experience has long been seen as a journey, but that journey has drastically changed in recent months in light of COVID-19. Healthcare providers were once focused on offering safe and accessible care; however, they now need to expand that emphasis to consider patient health and well-being in every basic movement and action.

In order to facilitate new safe and healthy behaviors such as social distancing, spatial awareness, and touchpoint interactions required during the coronavirus pandemic, the healthcare environment needs to have visual reminders and amenities that support, educate, and guide these actions.

Planning stages
Stantec has spent several months brainstorming, analyzing, testing, and documenting what factors are most important as we re-enter healthcare spaces. Considerations included the practicality, simplicity, and immediate deployment needs for short-term (1-6 months) and medium-term (6-18 months) solutions, as well as ideas for long-term (18+ months) implementation and a more permanent duration.

Short term: Among the first steps is the immediate deployment of informational graphics, signage, and wayfinding with easily recognizable messaging related to now familiar social distancing and hygiene protocols. These elements should share a common visual language and color palette that reflect the tone and user experience of the building environment and convey a friendly yet authoritative voice of professionalism. Hospitals can quickly adapt by utilizing a temporary kit that includes visuals for safety reminders, traffic flow patterns, and hygiene
stations.

Medium term: Early-phase operations, protocols, and signage reinforcing new norms and expectations from the general public may be tested for effectiveness, then adapted as part of a more permanent strategy. For example, new arrival zones and traffic patterns of staff, visitors, and patients might become a more fixed part of a facility with permanent signage for parking and flow.

Long term: Short- and medium-term solutions are the most pressing needs to reinforce healthy interactions and safety measures. However, considerations for long-term signage require more thought for design, development, and implementation. For example, branded graphics can clearly identify permanent safety and infection control solutions such as handwashing stations, voice-activated elevators, and covered and heated outdoor areas to wait for appointment times. Facilities can also invest in technology for appointment processing and wayfinding to decrease time spent indoors during visits and reduce exposure to airborne and surface pathogens while waiting for appointments or traveling through tight corridors and waiting rooms.

Key considerations
Creating a unique branded identity for COVID-19 protection initiatives can provide quick recognition for the user in need of guidance, information, and reassurance while orienting to a specific building environment. Designing a unique program of graphics that differs but complements a facility’s standard designs will add recognition to a campaign. For example, using a contrasting color, font, and images will make safety information “jump out” to patients and visitors. A tone that’s proactive, friendly, and engaging has the potential for building trust in management preparedness; creating an emotional connection with the campaign; and even making safety “cool,” which increases the chances of adoption.

To implement these responses, an experience-based design process is beneficial, looking at all typical key points for a person’s journey, including before they leave home and their interactions at the healthcare facility. Pre-visit orientation is an important part of the arrival sequence, so visitors understand the rules of engagement with the facility before they arrive, which can help reduce stress. Facilities can use email, a proprietary app, or text messaging to inform patients where they need to park, what entrance to use, what protocols are in place, and what to expect once they’re in the facility. Hospitals and health systems should understand the barriers and challenges of all users, including patients, clinicians, and facility teams.

Analyzing their experiences via a journey map will reveal important nuances in the process and path as they try to reach their destination, identifying the various needs of each group.

Upon arriving on the grounds, clearly marked parking areas and entrances can help with social distancing and overcrowding of major entry points. As a first line of defense, consider clearly identified screening areas outside the facility, which can offer automated temperature checks, smell tests, and visual tests or an in-person greeter to conduct tests and give social distancing and hygiene reminders. Amenities such as masks, hand sanitizer stands, paper towels, a trash can, and a written reminder of the facility’s rules should be available at the screening area. When experiencing high volumes of patients and visitors, proper queuing standards can be executed with stanchions that offer six-foot separation and prevent crowding at the door.

Moving inside the facility, healthcare organizations should consider offering hygienic amenities for the most frequented touchpoints, such as doors and door handles, in addition to branded signage and wayfinding outlining new safety protocols. Arm door pulls, kick plates, and foot toe pulls are some of the temporary or permanent solutions available. Wherever possible, doors should be split and marked as “in” and “out” with signage or universally understood icons to avoid cross-circulation.

Simple communications like banners or signs throughout the facility can remind users to follow the “rules of engagement” and behavioral guidelines. These guidelines should be posted in strategic, high-traffic areas like elevator lobbies or waiting rooms with information targeted to different audiences—keeping messaging simpler for pediatric areas or displayed in larger fonts for geriatric spaces.

Because of their confined nature, three areas—restrooms, elevators, and stairs—require the greatest communication about hygiene, reduced occupancy, and flow patterns. For example, restrooms need a maximum occupancy tracking system—perhaps with elbow-pushed buttons that occupants use when entering/exiting—to tell someone coming in to wait for availability. A paper towel dispenser at the exit will help users avoid contact with shared surfaces when pulling the door open, and a trash can should be placed there for easy discarding of towels. Likewise, stairwells should have clear directional signage to ensure paths of travel are defined and remind people to stay to the right when passing others. Doorways to stairs also need hand sanitizer as well as paper towel dispensers and trash cans for using door handles. Elevator signage should communicate maximum occupancy and encourage patients to use their elbows, rather than fingers, to push buttons.

Wherever possible, reminding people to wash their hands and providing directional signage to existing hand-washing infrastructure will increase the chances of creating a new behavior. Universal design principles are recommended for communicating and supporting people with diverse sensory abilities. For example, consider sharing this information in multiple ways, including written and spoken. Ensure that written communication is legible for color blind individuals and, where possible and feasible, use braille and other universal-access methods.

Repetition is key
The “rule of seven” is an old marketing adage that says a prospect needs to see or hear your marketing message at least seven times before they act. A clearly defined strategy to communicate new safety protocols with building users will significantly help shift behaviors. Healthcare facilities that embrace and create an integrated approach will help establish a new mindset that embraces safety and wellness. 

Daniel Aizenman is a senior principal at Stantec (Boulder, Colo.). He can be reached at daniel.aizenman@stantec.com. Brenda Bush-Moline is a vice president and global health sector leader at Stantec (Chicago). She can be reached at brenda.bush-moline@stantec.com.