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SECURITY

HOSPITALITY

CAN THEY CO-EXIST?

Presented to:

Lisa Semidey & Madison Stevens, Summer 2016 Design Fellows, IU Health Design & Construction Managed by: BT Stuck, Mgr. Human Experience Design Strategy, IU Health Design & Construction


Introduction

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TABLE OF

CONTENTS SECURITY & HOSPITALITY | Summer 2016

4

Emergency Department

70 5

09 Behavioral Health

42 Acknowledgments


Who We Are & Why It Matters


Who we are & Why we’re here Design & Construction Fellows, Summer 2016 Lisa Semidey and Madison Stevens are graduate students studying Design Thinking and Leadership at the Herron School of Art and Design at IUPUI. Design Thinking is a people-centered approach to innovative and collaborative problem solving. During our 12 week fellowship, we adopted the perspective of IU Health patients and staff to better understand the relationship between hospitality and security. We focused our research in two areas at IU Health Methodist that exemplify the challenge of trying to balance hospitality and security:

Lisa Semidey

ƒƒ Behavioral Health Adult Psychiatric Unit, C8 ƒƒ Emergency Department, Entry and Fast Track Area We gained a deeper understanding of the contextual reality surrounding people’s experiences in these areas, and how the environment can influence that experience. We discovered pain points, synthesized insights, and have included recommendations that the Design & Construction team can take into considerations to positively impact the patient experience in future projects. We acknowledge that we are offering the recommendations in this document from an outsider perspective. We are conscious that we may not know all the details that pertain directly to either Behavioral Health or the Emergency Department, but we believe that our fresh eyes perspective could be helpful to consider and balance against your deep contextual knowledge. SECURITY & HOSPITALITY | Summer 2016

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9

Madison Stevens


Influencing Perception

IU HEALTH STRIVES TO PROVIDE

WHY SECURITY & HOSPITALITY MATTER

It is important to acknowledge the community that is served by IU Health in order to better define the offerings for them. The community that IU Health Methodist serves consists primarily of downtown Indianapolis and parts of the Near North side. The main demographic that is served consists of African American and Hispanic populations. In our research, we were able to understand some underlying factors that influence the public’s perception of security and hospitality:

1 A safe & secure place to care for our patients

A welcoming space for all

Even though we understand this, the public’s perception is that they are mutually exclusive. The real goal in creating a space and an experience is in finding the adequate balance of both. We are cognizant that each service area requires different manifestations, but if the goal of finding the adequate balance is kept in mind during the development phase, a more preferred state can be achieved. SECURITY & HOSPITALITY | Summer 2016

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life establish how they interpret and perceive measures of security. Previous encounters with security could include but are not limited to the airport (TSA), schools, sporting events, prisons and hospitals.

2

Race & Demographics Different ethnic cultures, ages and income brackets

3

Context Perceptions can vary greatly depending on the relevant context where

Some might question if these concepts are mutually exclusive. What we found during our research in both Behavioral Health and the Emergency Department is that,

NO, They are not mutually exclusive.

Previous Experience Any previous experiences patient’s have in their

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have differing interpretations and perceptions of security. For example, K9 units are not perceived favorably by African Americans for historical reasons.

security is used. Rural needs for security are vastly different from the needs of an urban downtown context. Same goes for Behavioral Health units and the Emergency Department.

Social Climate Current world events and polarizing opinions also deeply influence people’s perceptions and desires for security. When patients were asked about their perceptions of security, more than half of them began their statements with “With how things are these days…”

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Adding Value to Perception While looking at people’s perception of security, we began to understand that added hospitality could improve upon a feeling of security. Inversely, adding security measures to hospitality could detract from the feeling of hospitality. The most appropriate measure of security and hospitality needs to be implemented and evaluated on a context by context basis, always striving for an appropriate balance of both.

H

S

S H


WHY BEHAVIORAL HEALTH MATTERS

Behavioral Health Adult Psychiatric Unit, C8

Emergency Department, Entry and Fast Track Area

While completing our initial research we found that words commonly associated with Mental Health are negative in nature. Stigma, illness, crazy, loony bin, psych ward… these words usually present themselves as barriers for those seeking and needing mental health care. Since these fears and stigmas are strongest when first entering, we focused our research on the spaces that affect people’s first impression of C8. There is a need for high security considerations in the space design for the patient’s safety, but how does this affect stigmas and the perception of hospitality?

In recent meetings related to the planning and development of the AHC, a conflict in opinion arose in terms of the need for security and the ability to make people feel welcome. Are these goals mutually exclusive? Since there is a need for both, is it possible to blend both goals without compromising?

Why it matters

How might the design of the behavioral health entry enhance first impressions and mitigate stigmas for patients and visitors?

SECURITY & HOSPITALITY | Summer 2016

Understanding these barriers is important in shaping the experience of patients and families that need mental health/behavioral health care. The understanding we’re looking to gather can not only reshape or re-design the space, but can also work towards lessening perceived stigmas associated with Behavioral Health Facilities and improve the patient/family experience.

WHY THE EMERGENCY DEPARTMENT MATTERS

Why it matters

How might we humanize security measures within the emergency department to meet patient and staff needs while still providing a welcoming experience?

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It is important to understand what the population that the AHC will serve thinks about security based on their current experience with the Methodist ED. In understanding what their fears, priorities, perceptions, and opinions are related to security, IU Health will be able to design the AHC ED responding to these insights. We will also look at their opinions and understanding of hospitality in order to present relevant recommendations to balance both. By doing so we hope to leverage both security and hospitality to meet the needs of patients and staff. Although this research focuses on how to address security and hospitality within the Emergency Department, we understand the findings could be transferable to other departments, facilities, and potentially other industries.


Behavioral BH Health


Research Methods We mostly conducted interviews and observations of daily activities. Through these we were able to understand thoughts and were also able to pick up on behaviors or space usage that might not be articulated in speech. We also brought in some tools (empathy chart, pro-cons list and image sets) that the staff could interact with in their break room. We were trying to understand what elements they thought showed a sense of hospitality. We also used the tools we left in the staff room with the visitors to understand their perception as well. We did not engage with patients directly because we didn’t want to compromise their care, and their knowledge may be more limited. The RNs and staff that are constantly working the floor are able to give us more insightful comments and observations in terms of the space itself. The visitors were key in helping us understand that first impression/stigma component of our research.

Research Overview We completed three research visits to the C8 unit. In our first visit we got a unit overview and a chance to speak with RNs and Technicians. Our second visit allowed us to observe a group therapy session with patients and speak further with some staff (RNs, unit secretary and therapist). Our third visit gave us the opportunity to observe a visiting hour and speak to visitors to gain an understanding of how they perceived and used the C8 facilities.

BEHAVIORAL HEALTH OVERVIEW

14 Interviews Conducted:

7 5 2

C8 staff members

C8 visitors Content experts: ƒƒ Deb Fabert MSN, RN BC Director Clinical Operations, Behavioral Health Services, over 15 years of clinical management experience ƒƒ Julie Sexton Experience Design Strategist, Design & Construction, oversees design and FFE for two Behavioral Health units

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17 17


RESEARCH TOOLS

What was your

first impressio

n of C8?

THINK

HEAR SEE

FEEL

Methods & Tools: ƒƒ Interview ƒƒ Observation ƒƒ Empathy Chart ƒƒ Image Comparison ƒƒ Pro / Con Worksheet

SAY

ts: Wan

(Nice

ve) to ha

:

Cons Pros:

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ave)

l to h

entia

s: (Ess

Need

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PHONES

WAITING ROOM

CURRENT C8 FLOOR PLAN

Reconsidering Adjacencies

WORK ROOM

GYM

NURSE STATION

During our research in C8, observations and staff interviews started hinting at the need to reconsider how spaces are distributed on the floor taking into consideration their use and impact on patients and staff. Although recommendations specific to the locations will be shown in the following pages, these are a few key spaces to think of when designing new Behavioral Health Facilities:

ISOLATION ISOLATION ROOM ROOM N.S. LOW STIM. ROOM

MILIEU ISOLATION ISOLATION ROOM ROOM

2. The Nurse Station, Work Room, and possibly Security need to be integrated to provide coordinated care.

2 WORK ROOM

WAITING ROOM

PHONES

Current

WAITING ROOM

NURSE STATION

GYM

ISOLATION ISOLATION ROOM ROOM NURSE STATION LOW STIM. ROOM

MILIEU

1 GYM

WORK ROOM + NURSE STATION + SECURITY

ISOLATION ISOLATION ROOM ROOM

5

N.S. ISOLATION ISOLATION ROOM ROOM

4

ISOLATION ROOM

LOW STIM. ROOM

5. Separating the Isolation Rooms from the Low Stimulation area allows for easier use of these facilities without disturbing the use of the Low Stimulation Area.

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3. The Gym and Low Stimulation rooms get little use because they require staff supervision, and at times, it is not possible. Moving these spaces within the sight line of the Nurse Station can allow patients more freedom to use these currently underutilized spaces. 4. Repositioning the phones further away from the main door, while still being close to the main Nurse Station, will lower the emotional intensity experienced when first entering the unit.

PHONES

MILIEU ISOLATION ROOM

1. Consider the Waiting Room as a space where visitors might spend more time than thought. It should provide ample and comfortable space and amenities.

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Re-configured


FINDINGS

Insight Development After completing our research we began to analyze and synthesize the data to understand the pain points that are occurring and why. We utilized post-its and a white board to make sense of the data pain points. We discovered that the best way to categorize these pain points was by the area or environment in which they occur. On the following pages you’ll see the nine areas broken down, the pain points that came directly from the stakeholders, the insights we synthesized, and finally our brief recommendations.

and synthesize lyzed d in a n a to.. . are

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that

g drive the eneration o f...

PAIN POINTS

INSIGHTS

RECOMMENDATIONS

Each bullet represents the voice of the stakeholders: patients, staff and visitors. Also includes our observations

By analyzing and synthesizing the pain points, we came to these insights

We then brainstormed ideas and recommendations in response to the insights we found

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SPACE OUTSIDE OF C8 WITHIN HOSPITAL

PAIN POINTS ƒƒ Moving patients from secure holding can be unsettling for patients, exposed pipes, through basement, feels like they are hiding the patient ƒƒ Secure holding in the Emergency Department is like a fish tank ƒƒ Had to wait to use bathroom until they left, need one closer to the unit for visitors ƒƒ Long dark hallway to get to elevators was creepy, bad, like going to the dungeons ƒƒ Elevator is slow and creepy, sets the wrong tone

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INSIGHTS ƒƒ Perception is affected the moment you step into the facility

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RECOMMENDATIONS ƒƒ Include visitor bathrooms in waiting area or area that is not locked like the in unit facilities area ƒƒ More prominent signage welcoming to unit ƒƒ Improve lighting in corridor leading up to unit (Natural light is ideal, but if not, brighter) ƒƒ Have main desk people escort first time visitors to unit to ease tension ƒƒ Camouflage or integrate Back of House (BOH) elements (pipes, electrical cables, air ducts) to create a more approachable look for Secure Holding patients being transported internally through the hospital

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VESTIBULE

PAIN POINTS ƒƒ Closed lobby is too small, claustrophobic ƒƒ Waiting area feels like afterthought, feels depressing, closed off, no TV, no magazines, etc. ƒƒ Went to the basement coffee shop to wait rather than sitting in waiting area ƒƒ Waiting area could be more inviting, more like a jail now ƒƒ Less sign redundancy, too many signs ƒƒ Waiting area can be highly emotional for visitors (before and after, saying hello and goodbye to patients) no tissues in area ƒƒ Need for additional seating in waiting area for visitors (Observed visitors using table as seating) ƒƒ Don’t like sitting in front of elevator, more space and something else to look at ƒƒ Visitors came early, expected to wait in typical waiting room, disappointed, not what they expected

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INSIGHTS ƒƒ Need a better waiting area. Not thought of as a waiting area currently, but it is used this way. (Visiting hour only allows two visitors per patient, this limit is often exceeded causing visitors to wait outside)

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RECOMMENDATIONS ƒƒ Use of softer lighting, comforting smells (Warm cookies…), holiday decor and music to create a warm ambiance ƒƒ Sound proofing or distancing the waiting area from nurse station/milieu ƒƒ Provide a mirror and tissues for visitors ƒƒ Including comfortable seating and more of it. (Currently use table as seating when more than 2 people are present) ƒƒ Include welcoming message in the space (Welcome to the Methodist Behavioral Health) ƒƒ Create a larger space with windows that face outward for natural light ƒƒ Transition Unit Secretary to new Waiting area ƒƒ Include staff pictures with names/bios in waiting area (Daily rotation? Like Starbucks) ƒƒ Design a Waiting area as a half-in-half-out to avoid door being left open for extended time or overcrowding hall inside unit ƒƒ Create a Staff Only entrance for use when transporting carts or equipment to maintain main door closed as much as possible to avoid escape ƒƒ Re-design signage to be more official, less redundant and use less fearful messaging (IE: multiple paper signs posted, High Escape Risk) ƒƒ Provide amenities for visitors: TV, Magazines, Water, coffee, refreshments

“It is fairly common for patients to have more than two visitors come for visiting. However, the treatment team rarely allows more than two visitors on the unit at the same time — meaning the visitors most often have to take turns coming in and out.” — Rachel Hoffman, Manager of Clinical Group Programming

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MAIN ENTRY

PAIN POINTS ƒƒ Main Door Area sometimes remains open for longer or is crowded ƒƒ Patients can get worked up in phone area ƒƒ Main door/ phones can be emotionally charged- proximity to point of entry is a challenge

INSIGHTS ƒƒ Main entry can be an emotionally charged area that influences the first impression (loved ones coming and going, telephones are too close to the door)

RECOMMENDATIONS ƒƒ Design a Waiting area that is half-in/half-out to avoid the door being left open for extended time or overcrowding hall inside unit ƒƒ Relocate or place phones away from entry door, still close to the nursing station for call transfers etc.

STAFF SPACES Staffing

PAIN POINTS

INSIGHTS

RECOMMENDATIONS

ƒƒ Sometimes it takes security too long to respond to calls ƒƒ If operating with limited staff can be harder on the rest of the staff, might limit efficacy

ƒƒ Increased staff availability (medical and safety) will increase safety and better care within unit

ƒƒ Establishing a C8-only call system for faster, dedicated responses ƒƒ Keep staff in mind when designing space. If a space requires staff supervision (low stim, exercise room) consider relocating space to maximize space use or have additional staff available for supervision ƒƒ Having security staff within the unit or closer to the unit can cut down on safety distress calls

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PHONES

WAITING ROOM

Divided to Integrated Workspace

WORK ROOM WAITING ROOM

WORK ROOM + NURSE STATION + SECURITY GYM

NURSE STATION GYM

STAFF SPACES

PHONES

Physical Space

PAIN POINTS ƒƒ Blind-spot in visibility from nurses station to milieu ƒƒ Nurses station feels crowded ƒƒ Nurses station gets crowded by carts and W.O.Ws ƒƒ Segmented work area limits communication between the staff, limits coordinated care

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MILIEU

INSIGHTS

ƒƒ Design a space that allows for and facilitates coordinated care while still keeping staff comfort in mind

MILIEU RECOMMENDATIONS

ƒƒ Design a larger, shared workspace that facilitates conversation between staff ƒƒ Limit private areas/Personal work spaces and encourage flex space use ƒƒ Provide staff with an inviting and comfortable break room to encourage relaxation during shift when needed and when possible ƒƒ Staff should be able to have high visibility of patient common areas CART/ SUN ROO ƒƒ Planned location and equipment STAFF placement ONLY on OUTSID ENTRANCE floor to avoid crowding main spaces (front of ACCES Nurse St., main hallways)

+++++++ +++++++ +++++++ +++++++

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STAFF SPACES

GROUP THERAPY AREA

Protocol

PAIN POINTS ƒƒ Not many people look over handbook, but this is most relied on to convey information ƒƒ Staff not consistently following protocolschoosing ease over correct practice ƒƒ Inconsistency between weekend and week protocols, make visitors question rules ƒƒ There isn’t a standard welcome practice or routine

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INSIGHTS ƒƒ Create purpose driven protocols with patient safety and care in mind

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RECOMMENDATIONS ƒƒ Re-design patient handbook for quick access to info, and use by patient families (many reask questions that are already addressed in there) ƒƒ Have staff co-create protocols to encourage adherence ƒƒ Nurses and Techs trained in Unit Secretary role/responsibilities for standardization over weekend visiting hours ƒƒ Having staff meeting to have everyone be on the same page ƒƒ Create a standard welcoming protocol: ƒƒ Say patient name ƒƒ Handshake ƒƒ Q&A session ƒƒ Water, coffee, refreshments

PAIN POINTS ƒƒ White-boards don’t clean easily on wall, prefer actual board ƒƒ Chairs in therapy room wobbled based on inconsistent bottom caps ƒƒ Alarm and panic buttons need to be closer to door exit points ƒƒ Code-blue alarm system placement on the center of the white board wall could cause a false alarm

INSIGHTS ƒƒ Design the space with the end use in mind

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RECOMMENDATIONS ƒƒ Use large, actual white-board that also cleans easily ƒƒ Consistent planning and implementation of alarm system throughout the unit ƒƒ Place the panic button near the exit of the room ƒƒ Place the code blue near the panic button (both should be out of the way and in the same area to avoid accidental set offs during regular use of the space)


SHARED SPACES Patient Related

PAIN POINTS ƒƒ Some patients can’t read clocks, want to know the time ƒƒ Patients have to ask for books, yet there are books sitting out (unnecessary limitation, cumbersome) ƒƒ Need more activities for patients (customization for different personalities) ƒƒ Patients need more to do when not in groups / weekend

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INSIGHTS ƒƒ The space needs to support creating a sense of normalcy for patients by providing certain freedoms and choice as much as possible

SHARED SPACES Visitor Related

RECOMMENDATIONS ƒƒ Have patients take a “Get to Know You” survey to find likes and interests to cater activities ƒƒ Provide the illusion of choice, even if all options are pre-determined ƒƒ Limit unnecessary restrictions (For example: “Must ask for books…”) in order to increase opportunity for patient choice ƒƒ Incorporate digital clocks to allow for patients to use and orient themselves. Also, possibly provide calendar ƒƒ Incorporate lights that use dimmers in order to provide patients with more control on light intensity in public areas. Currently lights are either on or off depending on patient requests.

PAIN POINTS

INSIGHTS

RECOMMENDATIONS

ƒƒ Chairs are not comfortable for long term use ƒƒ Sometimes shared space has a lack of privacy for visitors to have private conversation with patients ƒƒ Furniture arrangement in milieu forced certain visitors into sitting in hallways / moving heavy furniture from other areas ƒƒ Space can get loud when there are lots of patients / visitors

ƒƒ Visitor time in C8 is brief but valuable, provide conditions that allow visitors to take advantage of their time there

ƒƒ Design milieu with more options for privacy for visitors and patients ƒƒ Bigger milieu space to accommodate for high number of visitors and patients

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UNDER-UTILIZED SPACES PAIN POINTS ƒƒ Low stimulation area isn’t used as much, feels like dead space ƒƒ Limited use of certain spaces based on staff availability (exercise)

PATIENT ROOMS

PAIN POINTS ƒƒ Need monitors / cameras in every room (security) ƒƒ Inconsistent door monitor and system use (bathroom door yes, room door, no) ƒƒ Continually press button for shower, no control over temperature, annoying to press ƒƒ Chairs and mattresses can be uncomfortable for long-term use

INSIGHTS ƒƒ Lack of consistent safety and comfort measures will have a negative impact on patients

INSIGHTS ƒƒ Consider space adjacencies to work with protocols to allow maximum patient use

RECOMMENDATIONS ƒƒ Low stimulation area should be built separately from seclusion ƒƒ Incorporate the exercise area in the high stimulation area so patients don’t need to ask to use, already under close observation ƒƒ Yoga class or mats as an option in the high stimulation area

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RECOMMENDATIONS ƒƒ All patient rooms must use security camera system ƒƒ Chairs and mattresses should be selected based on comfort before all else ƒƒ All patient rooms to be single patient rooms ƒƒ Choose shower technology that gives patients the ease to take hot showers in a safe way, non-cumbersome buttons


GENERAL C8 CONSIDERATIONS FFE Considerations

Leverage Real Nature for Healing

PAIN POINTS PAIN POINTS

INSIGHTS

RECOMMENDATIONS

ƒƒ Patients still find ways of banging head on corners and edges ƒƒ Flooring is showing signs of wear (heavy furniture, traffic, carts) ƒƒ Blue color scheme when lights were low added to the dreary / gloom feeling ƒƒ Don’t like lights, need to be less bright, possibly more control

ƒƒ FFE should consider the following human factors: daily use, wear and tear, maintenance, replacement cost, etc. ƒƒ Be conscientious of design choices that are great in theory but are different in application

ƒƒ Consider how the elements work together (ie: heavy chairs = scratched floors) ƒƒ Use Light dimmers instead of. on/off switch ƒƒ Consider using lighter trim / flooring to hide wear imperfections easier ƒƒ Utilize a warm color palette to create a homey, welcoming feeling

Messaging

The connection to nature needs to be real and first-hand to have a stronger healing effect.*

ƒƒ No Access to Outside / Exterior Space / Sunlight / Fresh Air

INSIGHTS ƒƒ Connection to nature needs to be real and first hand to have a stronger healing effect

RECOMMENDATIONS

PAIN POINTS ƒƒ Nature art may be too cliché like motivational poster, insensitive to how patient feels ƒƒ Paper signs on door seem flimsy / contain fearful messaging

INSIGHTS

RECOMMENDATIONS

ƒƒ Need to intentionally balance clear messaging with a more hospitable tone

ƒƒ Fewer signage that is more official and use of standard, not piecemeal ƒƒ Incorporate abstract art ƒƒ Create templates for signs needed immediately ƒƒ Have patients create art and hang in shared areas ƒƒ Tweak the language used in signage (more friendly)

ƒƒ Create an outdoor space, garden, park, visitor area, accessible to patients when supervised ƒƒ Design a unit adjacent to a sun room if exterior space is not available option ƒƒ Allow certain windows to open (maybe high up, out of reach) ƒƒ Have a “nature” simulation room, plays sounds from nature, maybe textures of nature (sand, wood, grass floor, etc.) ƒƒ Bring in non-harmful, sustainable plants into the high stimulation area (gardening as a patient activity) *Statement supported by the following research: Ulrich, Roger S., Evidence Based Environmental Design for Improving Medical Outcomes, presented at Healing by Design – Building for Health Care in the 21st Century conference in 2013.

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BEHAVIORAL HEALTH INSIGHTS SUMMARY ƒƒVisitor time in C8 is brief but valuable, provide conditions that allow visitors to take advantage of their time there

ƒƒPerception is affected the moment you step into the facility ƒƒNeed a better waiting area. Not thought of as a waiting area currently, but it is used this way. (Visiting hour only allows two visitors per patient, this limit is often exceeded causing visitors to wait outside)

ƒƒConsider space adjacencies to work with protocols to allow maximum patient use ƒƒLack of consistent safety and comfort measures will have a negative impact on patients

ƒƒMain entry can be an emotionally charged area that influences the first impression (loved ones coming and going, telephones are too close to the door)

ƒƒFFE should consider the following human factors: daily use, wear and tear, maintenance, replacement cost, etc.

ƒƒIncreased staff availability (medical and safety) will increase safety and better care within unit

ƒƒBe conscientious of design choices that are great in theory but are different in application

ƒƒDesign a space that allows for and facilitates coordinated care while still keeping staff comfort in mind

ƒƒNeed to intentionally balance clear messaging with a more hospitable tone

ƒƒCreate purpose driven protocols with patient safety and care in mind

ƒƒConnection to nature needs to be real and first hand to have a stronger healing effect

ƒƒDesign the space with the end use in mind ƒƒThe space needs to support creating a sense of normalcy for patients by providing certain freedoms and choice as much as possible

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Emergency ED Department


EMERGENCY DEPARTMENT OVERVIEW Research Overview

ED PATIENT JOURNEY

For our research in the Methodist Emergency Department we conducted interviews with patients, staff, and the general public. We began our research by interviewing Joe Anderson, Director of Protective Services, and Beth Newton Watson, Director of Chaplaincy Services. These preliminary interviews gave us a basic understanding of the safety considerations and hospitality considerations currently in place at Methodist.

Critical Remains in Trauma Room

if

44 Responses Received:

21

patient surveys

10 9 4

public surveys

Research Methods We then conducted interviews with staff and patients in the Fast Track area of the Emergency Department. We created a Typeform Survey to more easily capture patient responses, that we filled out during the interviews. During this first visit we interviewed three staff members, and conducted 11 patient survey interviews. The following day we returned and interviewed four staff members and ten more patients. We also conducted interviews at the Indianapolis Transit Center and spoke with individuals within the target population to better understand their perception of safety and hospitality. Along with this, we created a cultural probe to be distributed by the PFAC organizations. Over the course of three weeks, we were able to conduct 40 interviews, and collected data from a wide spectrum of the current and targeted demographic.

Ambulance Trauma Bay Room

Parking

ED Main Entrance

Not Critical

Patient Check-In

Lobby Triage

Waiting Room

(Metal Detector)

staff interviews

The journey map below illustrates the patient’s journey through the Emergency Department. The top line shows an ambulance arrival, the middle line shows the typical patient journey beginning with parking, and the bottom, blue line shows the staff interactions that occur at each touch point. The journey map allows us to understand where and when pain points occur and the stakeholders that are engaged during that time.

Fast-Track Room

Other Discharge Service Area (If needed)

PFAC responses • Parking Attendant

ƒƒ Arnett ƒƒ Bedford ƒƒ Health Plans ƒƒ Tipton

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• Contract Security Guard

• Patient Check-In Staff • Guest Relations

• Triage RN

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• Patient Check-In Staff • Guest Relations • Volunteer

• Tech. • Other Staff • RN • NP • Registration • Support Staff


FINDINGS

PREVIOUS EXPERIENCE

Insight Development Similarly to Behavioral Health, we analyzed and synthesize the data to understand the pain points that are occurring and why. We categorized these pain points by the source of the perspective. Each section will utilize the icons (seen on the right) to indicate which perspective is being used to identify the pain points, insights and recommendations. Many of the pain points are quotes collected from our patient survey and staff interviews.

PATIENT PERSPECTIVE

STAFF PERSPECTIVE

Main Finding When asked in the Emergency Department Which is more important to you, to feel safe or to feel welcomed? Why? An overwhelming amount of patients said security. Patients visiting the Emergency Department are looking to get taken care of, and place a high value on their security. They want to make sure they get taken care of without having to think about any other negative experiences while there.

Safe. I always think safety first. I want to know that where I'm going everything is going to be ok. Say hello to me later. Equal, definitely need to feel safe, if you’re not welcome then don't feel safe because they don't have your best interest.

Welcome. If I'm not welcome I wouldn't be somewhere where safety mattered. Welcome first, safety second

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Safe. You're always welcome in the hospital. You want to be safe, make sure there are no crazy people here with guns. Only person with a gun should be security.

7

21

BOTH

SECURITY

PAIN POINTS

INSIGHTS

ƒƒ Knowing what to expect gives patients a sense of calm ƒƒ Go to schools and see police, expect to see them at hospitals too ƒƒ See security everyday in my environment, so it doesn’t bother me here. It’s Indianapolis, trash city ƒƒ Security doesn’t matter, if a person wants to do something they will. Security won’t stop them. I don’t call cops for anything, I rely on myself ƒƒ Anecdote from experience on maternity floor: “When in maternity with my pregnant daughter, security kicked us out after visiting hours were over. That was shitty. Maternity was better in the past, now it sucks, everyone there was rude, didn’t know they were the grandparents of the child being born. Forced to leave the premises and 45mins later the child was born. Missed the birth! If anything would have happened to my daughter, I would have sued since I couldn’t be there to support my daughter.”

ƒƒ Previous experiences dictate perception and expectations ƒƒ High intensity and emotional experiences elicit a stronger evaluation of the provider, creating a lasting impression (high stakes to make positive 1st impression)

RECOMMENDATIONS ƒƒ Ask about previous experience at hospital to help understand what the patient values for current experience

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VALUE OF METAL DETECTOR

PAIN POINTS ƒƒ Knowing everyone inside has the same thing (nothing actually) makes me feel safer ƒƒ Makes me feel safe to know no one has a gun in here (metal detector) ƒƒ Nice to have security and know no one has a gun, but security can contradict the idea of we are here to help ƒƒ Sometimes the people in here look crazy but you know they went through the metal detector and you’re safe

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INSIGHTS ƒƒ Universally the metal detector is understood and accepted, but the process needs to be sensitive to patient’s time and condition

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RECOMMENDATIONS ƒƒ Re-design of space that allows for better patient flow. Brings them into the building and then takes them through the metal detector to reduce bottlenecks at the entrance ƒƒ Scripting security personnel at metal detector with welcome message and guidance for metal detector procedures ƒƒ Use of new/latest metal detectors technology to reduce the time and intrusiveness (stadium box) ƒƒ Use of multiple metal detectors at the entrance ƒƒ Wand process implementation for ambulance patients being brought in to ensure staff safety


SPEED OF SERVICE

PAIN POINTS ƒƒ Sometimes security is too intrusive. If you’re really sick, you just want to get in fast, not get held up ƒƒ I hoped that I didn’t set the metal detector off, I was in pain and didn’t want to go back through

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INSIGHTS ƒƒ Need for more accommodating space and faster process for metal detector entrance

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RECOMMENDATIONS ƒƒ Establish wand process for patients that are in pain or unable to walk ƒƒ Re-design of space that allows for better patient flow. Brings them into the building and then takes them through the metal detector to reduce bottlenecks at the entrance ƒƒ Use of new/latest metal detectors technology to reduce the time and intrusiveness (stadium box) ƒƒ Use of multiple metal detectors at the entrance

INTRUSIVENESS

PAIN POINTS ƒƒ I want to be safe, but I don’t want to see it ƒƒ Mostly don’t notice but usually feel more fear because you know it’s a high target area when you can see security. Catch 22. Have to know they are there, but not in the way. ƒƒ Expect security to be courteous not overruling or overbearing ƒƒ Sometimes security is too intrusive. If you’re really sick, you just want to get in fast, not get held up

INSIGHTS ƒƒ Security should be present but not get in the way of receiving care

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RECOMMENDATIONS ƒƒ Scripting security personnel at metal detector with welcome message and guidance for metal detector procedures. ƒƒ Use of new/latest metal detectors technology to reduce the time and intrusiveness (stadium box) ƒƒ Use of multiple metal detectors at the entrance ƒƒ Wand process implementation for ambulance patients being brought in to ensure staff safety


SOURCE OF FEAR

PAIN POINTS ƒƒ Fear is not only associated with terrorists, but also with normal everyday people ƒƒ “Especially these days…”* ƒƒ “This day and age…”* ƒƒ “Especially now…”* ƒƒ “Nowadays…”*

INSIGHTS

RECOMMENDATIONS

ƒƒ Current Global / Social Climate change is a big driver for why people value and desire security

ƒƒ Patient Recommendation: Expect the Staff not just security to be vetted, screened, background check to avoid internal threat (use of working knowledge to plan an attack) ƒƒ Security placed outside of the building so that patients and visitors know that it is protected before they enter ƒƒ Subdivisions in the patient waiting area, less exposed to others if they choose to be

*We conducted our interviews the same week as the Orlando shooting. This may have affected the responses.

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HOSPITALITY IMPROVES SECURITY

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ƒƒ Welcome is priority. If I’m somewhere where I don’t feel welcomed then I wouldn’t be in a place where safety mattered. ƒƒ If I don’t feel welcome then I won’t feel safe, Don’t want to feel exposed

H S

SECURITY DOESN’T IMPROVE HOSPITALITY

HOSPITALITY IMPROVES THE FEELING OF SECURITY

PAIN POINTS

INSIGHTS ƒƒ Hospitality not only improves care, but can improve the perception of safety for some ƒƒ Hospitality can improve security but overwhelming security can crush the feeling of hospitality

RECOMMENDATIONS ƒƒ Patient Recommendation: Would be nice if they had complimentary drinks or food, especially for the kids, something for them to color ƒƒ Subdivisions in the patient waiting area, less exposed to others if they choose to be ƒƒ Greet as a person first: ƒƒ Hi, How are you? ƒƒ Nice to meet you, welcome ƒƒ Shake hand, wave ƒƒ Small gestures ƒƒ Create an Empathy Phrase Packet for staff and security to use, practice humanization

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STAFF ENGAGEMENT PAIN POINTS Regarding Hospital Staff: ƒƒ Would like and appreciate “genuine engagement” to feel welcome ƒƒ Patients want to receive a “hello,” when they walk in ƒƒ Patients want to hear their language when being taken care of (2 cases of Spanish speaking) ƒƒ Would like to be asked if I need anything, no one asked Regarding Security Staff: ƒƒ Having guards is important, having alert guards is more important ƒƒ Don’t like to see security eating behind the counter ƒƒ Security now is more rude, especially at night ƒƒ Don’t like it when they glare at you like you might be a criminal

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STAFF DISBELIEF INSIGHTS

RECOMMENDATIONS

PAIN POINTS

INSIGHTS

RECOMMENDATIONS

ƒƒ The public perceives that performing your job well is being genuinely engaged ƒƒ Be aware of shifting demographics and be prepared to meet their needs (ESL) ƒƒ For ESL patients they highly value and appreciate speaking their native language directly with the provider ƒƒ Increases comfort ƒƒ Opportunity to show care over tech ƒƒ Decreases anxiety over language being an added challenge to receive proper care ƒƒ Practice genuine engagement: ƒƒ View as a person first, patient second ƒƒ Have true empathy ƒƒ Extra effort to understanding all needs, including latent needs ƒƒ Be present, dedicate attention

ƒƒ Hire for / Train Welcome / Front of House Staff in multiple languages to assist with ESL patients ƒƒ Train all staff to greet in the patient’s language even if just to explain that a translator will be coming ƒƒ Greet as a person first: ƒƒ Hi, How are you? ƒƒ Nice to meet you, welcome ƒƒ Shake hand, wave ƒƒ Small gestures ƒƒ Create an Empathy Phrase Packet for staff and security to use, practice humanization

ƒƒ NP treated me like she didn’t believe I was sick ƒƒ Lady at parking was rude, didn’t believe I was going to be seen, finally let us park close by, acted like we wanted free parking, not nice ƒƒ Don’t like coming, too time-consuming, don’t get the results you’re looking for, waste of time, unneeded bill ƒƒ Every time I come I get told nothing is wrong but still get the bill, try not to come, only came today because work told me to

ƒƒ Patients need to feel validated in order to have a positive experience ƒƒ Need to balance expectations with reality; validation is correlated to positive experience

ƒƒ Have staff training on empathy, new process / script to respond to patients who aren’t as sick in a meaningful way ƒƒ Have NPs trained in de-escalating tactics

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NEED FOR TRANSPARENCY PAIN POINTS ƒƒ It’s just weird to have to empty your pockets and stuff, security is fine, maybe just another way of doing it? ƒƒ I think security is cool how it is, I just don’t like the intense security ƒƒ I question why there is so much security at the hospital entrance ƒƒ Thought security was odd, not used to it at the hospital, why is this here? Security officer wasn’t mean or rude, looked through my purse

INSIGHTS ƒƒ Security needs to explain their value of being there at the patient’s first encounter

RECOMMENDATIONS ƒƒ Scripting security with the value of security to address patient’s shock, complaint, or lack of understanding

FACILITY OFFERINGS

PAIN POINTS ƒƒ There isn’t a lot of parking in front of ED ƒƒ Visitors don’t like parking in garage, don’t want to pay ƒƒ No phone in the room to call loved ones

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INSIGHTS ƒƒ The demographic served by Methodist may not have funds for quintessential resources, consider absorbing these expenses to provide the best care and experience

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RECOMMENDATIONS ƒƒ Have a portable mobile phone for patients to use when needed ƒƒ Create more parking, train the parking attendant in a proper greeting procedure (first point of contact, first impression) ƒƒ Offer vouchers for the parking garage 59


SUMMARY OF PATIENT INSIGHTS

SECURITY CONCERNS

PAIN POINTS ƒƒFor ESL patients they highly value and appreciate speaking their native language directly with the provider

ƒƒPrevious experiences dictate perception and expectations ƒƒHigh intensity and emotional experiences elicit a stronger evaluation of the provider, creating lasting impression (high stakes to make positive 1st impression)

ƒƒ Increases comfort ƒƒ Opportunity to show care over tech

ƒƒMetal detector has most direct impact on patient experience, sense of calm and impression of safety. Can be cumbersome but should remain as an element of security.

ƒƒ Decreases anxiety over language being an added challenge to receive proper care ƒƒGenuine Engagement:

ƒƒNeed for more accommodating space and faster process for metal detector entrance

ƒƒ Staff security should be considered just as much as patient security

RECOMMENDATIONS ƒƒ Reassure staff that their safety is a priority, provide information on how and why they are secure

ƒƒ View as a person first, patient second ƒƒ Have true empathy

ƒƒSecurity should be present but not get in the way of receiving care

ƒƒ Extra effort to understanding all needs, including latent needs

ƒƒGlobal / Social Climate change is a big driver for why people value security

ƒƒ Be present, dedicate attention

ƒƒThe value of hospitality is that it not only improves care, but can improve the perception of safety for some

ƒƒPatients need to feel validated in order to have a positive experience

ƒƒHospitality influences safety, but not the other way around

ƒƒThere is a need for security to explain their value of being there at the patient’s first encounter

ƒƒPublic perceives that performing your job well is being genuinely engaged

ƒƒThe demographic you’re serving may not have funds for even “basic” resources, providing for even “small” expenses should be considered to provide the best care and experience

ƒƒNeed to balance expectations with reality; validation is correlated to positive experience ƒƒBe aware of shifting demographics and be prepared to meet their needs (ESL) SECURITY & HOSPITALITY | Summer 2016

ƒƒ Need more security by main entrance, not just ED ƒƒ Ensuring patient/visitor safety is not as big as a problem as is ensuring staff safety ƒƒ Heart Center had two security guards, but they would just sit at desk. Like it better when they’re walking around, alert ƒƒ Methodist ED has a reputation (Not a nice/safe place based on area)

INSIGHTS

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BEHAVIORAL CHALLENGES

PAIN POINTS ƒƒ Family dynamics can be challenging to manage in high stress situations ƒƒ Trauma patients can be aggressive because they are in pain, drugs, disoriented or experiencing withdrawal

INSIGHTS ƒƒ Need to respond appropriately to these high stress situations for overall safety (staff + patient)

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RECOMMENDATIONS ƒƒ Offer combined training with staff and security that gets repeated more often ƒƒ Emphasizing use of de-escalation techniques as primary response ƒƒ Train staff in not taking things personally


“QTIP— Quit Taking It Personally.” — Deb Fabert, Director Clinical Operations, Behavioral Health Services

PATIENT / STAFF INTERACTIONS

PAIN POINTS ƒƒ Patients may speak with at least five different staff members in the ED ƒƒ They need something to better clarify who each person is (and their function within the process) so that patients know who to disclose what kind of information to ƒƒ People will tell what’s wrong to the first person they see, don’t know to wait to speak to RN (3rd person they see) ƒƒ Staff tends to get offended by patient actions or words. Patient might be experiencing pain, withdrawal or be under the influence of drugs or alcohol and might be affected by that. ƒƒ When I needed to speak to staff you couldn’t find any. Need for people to come when you call for them ƒƒ Things can be calm one second, tense the next

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INSIGHTS ƒƒ There is a need to establish a better communicative and emotional connection between patient and service providers ƒƒ Patients need clarity on identifying service providers and understanding their role

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RECOMMENDATIONS ƒƒ Have call buttons in rooms (? Unsure if currently available) ƒƒ Have security cameras in all rooms for continued visibility ƒƒ Train staff in not taking things personally ƒƒ Have staff share a personal story/anecdote to build trust with patient


SECURITY COMPLAINTS FROM PATIENTS

PERCEPTION OF SECURITY INFLUENCED BY RACE PAIN POINTS

INSIGHTS

ƒƒ Nobody wants to be searched, 50/50, half will complain, half will be happy it’s there ƒƒ People will complain about security, staff explains it’s for their own protection ƒƒ Very few people are happy to see security, or at least very few comment positively ƒƒ Biggest complaint is that security is time consuming ƒƒ People get aggravated when they go through their purse

ƒƒ More people are inclined to voice their complaints than to voice their appreciation, unless prompted ƒƒ When asked, more people value security, they might not have shared that with us otherwise if we had not asked ƒƒ The power of caring about others before self can sometimes be more acceptable (rather than “for your protection” might be better to say “for your child’s protection” or “for staff protection”) ƒƒ “For your own protection” sounds like “for your own good” which sounds deprecating ƒƒ “I am indestructible” mentality by many patients, Don’t think of harm happening to self, easier to imagine harm happening to others

PAIN POINTS ƒƒ Police officers might not be trusted by all based on race. African American and Hispanic males might have a different relationship/ perception than a white woman. Power, abuser vs help and safety

INSIGHTS ƒƒ Racial tensions still exist, but not enough data was collected to say how it should be addressed ƒƒ Security can be seen differently by patients of color which is one of the biggest populations served by Methodist

RECOMMENDATIONS ƒƒ “For the safety of everyone here” - not just you, not just staff ƒƒ More directly asking for positive or negative patient feedback at the end of service

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RECOMMENDATIONS ƒƒ Conduct further research, might have biased answers based on interviewers


PHYSICAL ENVIRONMENT

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NEED FOR SECURITY IN AMBULANCE AREA

PAIN POINTS

INSIGHTS

PAIN POINTS

ƒƒ Waiting room isn’t big enough to have a results waiting room ƒƒ No music in an area that could be tense with noises and alarms, could be alarming if don’t know the source ƒƒ The doors are locked, how do I get in? If stressed, could cause more frustration for visitors ƒƒ Paintings of historic figures seem old and uninviting ƒƒ Barriers around the seating area block flow ƒƒ Signs in the lobby are too close together, causes confusion on who to go to ƒƒ Check-in and triage desk is high, if a person is in a wheelchair they can’t reach or see the staff, they may try to stand up and fall

ƒƒ Design conditions that provide clarity to reduce stress and confusion in the environment

ƒƒ There is no metal detector by the ambulance entrance ƒƒ Drunk patients will come by ambulance, immediately supposed to be stripped down to a gown but it doesn’t always happen ƒƒ People that come off the ambulance aren’t being checked, EMTs don’t check for weapons, If the patient isn’t critical then they are wheeled through the back hallway to the waiting area, bypassing security

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RECOMMENDATIONS ƒƒ Having music might distract from alarms, give the patients and guests more comfort as they wait ƒƒ Have variable heights for the check-in triage desk, make it adjustable

INSIGHTS ƒƒ Security needs to be amplified by the ambulance area for staff and patient safety

RECOMMENDATIONS ƒƒ Establish protocol for wanding patients once in bed or chair


SUMMARY OF STAFF INSIGHTS ƒƒStaff security should be considered just as much as patient security

ƒƒ“For your own protection” sounds like “for your own good” which sounds deprecating

ƒƒNeed to respond appropriately to these high stress situations for overall safety (staff + patient)

ƒƒ“I am indestructible” mentality by many patients, Don’t think of harm happening to self, easier to imagine harm happening to others

ƒƒThere is a need to establish a better communicative and emotional connection between patient and service providers

ƒƒRacial tensions still exist, but not enough data was collected to say how it should be addressed

ƒƒPatients need clarity on identifying service providers and understanding their role

ƒƒSecurity can be seen differently by patients of color which is one of the biggest populations served by Methodist

ƒƒMore people are inclined to voice their complaints than to voice their appreciation, unless prompted

ƒƒDesign conditions that provide clarity to reduce stress and confusion in the environment

ƒƒWhen asked, more people value security, they might not have shared that with us otherwise if we had not asked

ƒƒSecurity needs to be amplified by the ambulance area for staff and patient safety

ƒƒThe power of caring about others before self can sometimes be more acceptable (rather than “for your protection” might be better to say “for your child’s protection” or “for staff protection”)

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OVERALL TAKEAWAYS

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1

The first impression of a space can help shape or hinder the rest of the experience.

2

People are more aware of when they don’t feel safe, than when they do.

3

Hospitality can improve security but overwhelming security can crush the feeling of hospitality and in turn detract from the feeling of safety.

4

The ability to be hospitable requires a dedicated focus to being empathetic.

5

Strategic space adjacencies can provide more patient comfort.


Acknowledgments


ACKNOWLEDGMENTS

THANKYOU

We would like to express our deepest appreciation to all those who provided us the opportunity to complete this report. A special gratitude is given to our Manager of Human Experience Design Strategy, Mr. BT Stuck, whose contribution in stimulating suggestions and encouragement helped us to conduct the research and develop insights in a meaningful way. Furthermore, we would also like to acknowledge with much appreciation the crucial role of the staff in the Adult Psychiatric Unit of C8 at Methodist Hospital. They gave us the permission to conduct all of the necessary interviews and allowed us to integrate our research tools into their workspace. We appreciate their patience and their willingness to be forthcoming in sharing their experience. We would especially like to thank Ms. Deb Fabert and Ms. Rachel Hoffman for their cooperation with coordinating the Behavioral Health portion of the project. Many thanks also go to the staff of the Emergency Department at Methodist Hospital—

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their invested time, effort, validations and candid responses allowed us to achieve our research goals. We greatly appreciate their cooperation with allowing us to interview patients which was crucial to understanding the perception of hospitality and security. We would particularly like to extend our gratitude to Mr. Aaron Wilson for coordinating our time in the Fast Track Area. We would also like to thank Rina Turpen for seamlessly integrating our research into the PFAC meeting agendas. It allowed participation from members of the community we might not have been able to reach on our own. Last but not least, we would like to thank Mr. Joe Anderson, Director of Protective Services, and Ms. Beth Newton Watson, Director of Chaplaincy Services, for their healthy debate that spurred the need for our research. We hope that our findings are meaningful to all those that we worked with, and that it will help drive future decisions when considering hospitality and security.


August 2, 2016


Security vs. Hospitality, Can They Co-Exist?