Case study – co-design best practice
A co-design team of dedicated patient and staff reps worked with ArtCare for a year, creating an environment that is calm and full of light. The project, entirely funded by the hospital’s charity –the Stars Appeal, focussed as much on the quality of the environment and patient flow through the unit, as providing the best possible diagnostic equipment. The new Breast Unit, officially opened at the end of March 2017, has all services in a dedicated space. It’s hard to imagine that previously patients had to move from department to department for scans and examinations.
Sensitivity is the key quality of the new environment. Scenes from nature surround the main waiting area with seating arranged in clusters, helping people feel comfortable to wait in dressing gowns, while maintaining privacy and dignity. Wherever possible, focal points are integrated into the building – floor-to-ceiling printed DigiClad™ panels of bluebell woods, ceiling tiles, bespoke window film and signage so that the art, design and clinical function are seamless.
A connection with the outside world was important to the co-design team, who wanted the space to feel grounding, yet reflective. The theme of ‘the World Outside’ was chosen with different rooms reflecting varied locations such as coast, river, field, park, garden and forest. Many of outpatient reps described how spending time in natural surroundings was both soothing and reassuring – the tides still come and go, the sun rises every day. This sense of surety and calm is reflected inside the unit and the gender neutral theme recognises that men are also diagnosed with breast cancer.
All the treatment and consulting rooms use colour and bespoke artworks to create a sense of calm and ease anxiety, but this is most noticeable in the Rose Room – where breast prosthesis are fitted following mastectomy. The inspiration for this feminine space was the early 20th Century boutiques of Lady Duff Gordon, who created an area in each of her salons called the Rose Room, where women could freely discuss their needs for intimate clothes. Echoing this, the Rose Room is an intimate room where expert staff can really put women at ease, to enable them to talk about how treatment has altered their bodies and provide personalised care that gives women the support they want.
Co-design can be a tricky process to manage, pulling together individual’s contributions into a coherent, workable design that is delivered, on budget and on time. Taking part in the process has been very meaningful for patients, while staff gained the opportunity to champion the quality of care they wanted to deliver, which the previous building could not support. Vanessa Hawking (patient rep) sums up the results of this approach, “…this unit represents a move in the right direction to provide an empathetic and understanding environment that is largely absent overall in the NHS. It marks out Salisbury as a pioneering hospital, certainly in Wiltshire. This is a huge step forward particularly in these uncertain times of funding in the NHS.”
The Breast Unit is proof that co-design does create environments that truly meet the needs of those using the space. To better understand the process you can read the personal experiences of some of those involved below.
Photos used on this page courtesy of Altro Ltd, except Sue King glass and patient journey map below
Vanessa Hawkins – patient rep
“I have always had a problem coming into a hospital, indeed anywhere medical. The old unit had the feeling that it had been tacked on to the hospital at a time when numbers were considerably lower than they are today. As a patient you don’t feel you are thought about or considered as you sit in Medical Surgical Outpatients with so many other people going to different departments. Surroundings for me were pivotal to my treatment and when you are facing a hideous diagnosis, a pale yellow empty blank room with a curtain and a couple of chairs isn’t going to help matters.
What was a revelation was that there was this opportunity to improve this and that I was going to be part of that. I have to say that if the project had come along 2 years earlier, I wouldn’t have coped with confronting memories of the diagnosis day and thereafter. I have felt very privileged to be part of the design team, making a difference. It’s not that often when you happen to be in the right place at the right time, but I was and I have found the whole process fulfilling and enjoyable. Penny guided us expertly through the minefield and has always been open to suggestion.
I think the new unit will be a comforting hug around those of us who will visit it and the lengths that ArtCare have gone to listen to our experiences and hopes for the new Unit is fantastic. We can only be grateful that this opportunity came along when it did and to ease the anxiety and fear of those diagnostically will be immense.”
Sue King – artist
“I’m very proud to be contributing a small part to the new Breast Unit at Salisbury Hospital by designing and making a bespoke piece of glass artwork for one of the consulting rooms. I have a personal link, as my best friend of 30yrs, Nicky Duvall was treated here over a few years, but sadly died in March. Nicky was a true life force and spent the year before she died raising an amazing £10K for the centre. She wanted to thank all the wonderful nurses who’d treated and cared for her, so she organised a fabulous Abba Tribute night at Salisbury Playhouse, which was a sell out and certainly a night to remember! Nicky worked so hard on this event to ensure it was a success, all this whilst undergoing her own chemotherapy treatment.
Inspired by Nicky, I also made and sold lots of pink glass stars for the Stars Appeal, which seemed so apt! I raised about £1000 for the appeal and so therefore also made contact with the team through this.
Nicky, like me, was an interior designer and had lots of ideas and influences that she wanted to bring into the centre, but sadly was not able to see it completed. She was quite determined that somehow some of my glass could be installed, as she so believed in me, my best advocate! I am so thrilled, and deeply honoured to be creating some glass, and I will certainly be thinking of Nicky whilst I make it in my studio. Nicky always inspired and supported me in what I do and so I hope, in some small way, creating a bespoke piece of colourful glass will bring some inspiration and uplifting ambience for the patients and staff who use the room.”
Sonnya Dabill – Breast nurse
During my 32 year nursing career I used to feel it wasn’t the building, but the high standard of care that goes on within it that is so important. I now realise how therapeutic an enhanced environment can be for patients’ wellbeing and how it can support their care.
Our old office was small, hot and airless. We provided a lymphodema clinic in there twice a week and patients were often in wheelchairs or with family, so were often uncomfortable in a stuffy room. If delivering bad news patients had to walk out when feeling upset into a busy outpatient clinic. Also, when patients had to go from department to department, to dress and undress during scans and examinations, it just exacerbated their anxiety and they often felt lost.
Being part of the design team I felt privileged to work with our patients who we knew well, as we had cared for them during breast cancer treatment. One patient had moved to the area and we gleaned from her experience at her previous hospital where they had a dedicated breast unit. I felt at ease to express my thoughts during the design team meetings and to say if a design was not appropriate. I think perhaps we should have got more elderly patients involved as the majority of our patients are over the age of 50, with many aged 60+. The Unit will also accommodate a few men (yearly this can be up to 5) so it would have been good to get their views too.
I feel the design decisions made used ideas and involved compromise to meet all the group needs. I appreciate the communication skills used by Penny to meet the diverse group of patients and staff all with opinions on what they would like the new Unit to be like and to discuss on request! I really felt it was a team effort. The chosen designs will hopefully be liked by, and enhance, all patients’ experience of using the service, as they are not too bold or contemporary. They give a sense of luxury and they are worth the high spec the Unit can provide. I feel privileged to have been involved in the project as this Unit will be a legacy. In years to come I will remember the fundraising events I attended, often great fun, a patient popping in with a cheque from their birthday where they asked for no presents but money for the unit and now to see this huge community effort put into bricks and mortar with beautiful internal furnishings.
I hope that the environment the patient walks into makes them feel safe. The Unit will be a place to breathe when they feel anxious. I hope it will give breast patients the Unit they deserve. For staff, it will be a light, airy environment to work in and a place where we can be more productive and provide more clinics alongside each other. The space will be private, with fewer interruptions unlike our old rooms that were in the centre of a busy corridor.”
Penny Calvert – ArtCare
“My challenge – how do you take a wide group of people with varying and sometimes polar demands and bring them through the process together? How can you create ‘wow’ that lasts and still delivers the function that clinical staff need, all on a fixed budget? For me this is the most exciting and memorable part of a project and happens through co-designing, by having the opportunity to give patients and staff a meaningful and real role in designing spaces by developing the ground work for the project directly with them.
We looked at the patient experience, the patient journey, and consulted extensively to map out the whole process practically, but also emotionally. We used online scrapbooks as a tool to get people thinking – how do you feel, what makes you relaxed. This mapping the patient journey gave us information on where and why a patient is seen and looked at the time spent in each room. It also focused on what thoughts and feelings happen during this time and meant we were able to prioritise the rooms where anxiety is highest, where focal points were essential for distraction. We also looked at frequency of use, which was really important when the budget is finite and you can’t throw money at everything. Now feedback from staff, that a super busy clinic was not stressful and seemed more like a spa lounge than a hospital waiting room, speaks volumes about improving the patient experience compared to the original map we’d captured.
Co-design fosters insight and empathy, which is translated into design elements throughout the building. One example of this is the use of humour. Each themed room has a door sign that incorporates a bird of that area and those include blue tits and boobies. Our research showed that humour is not inappropriate; in fact,it helps people get through.
This project continues the lessons learnt from the children’s unit and the ArtCare projects that followed it. Time and co-design are what makes a space unique and relevant to the service being delivered. The solid involvement of the staff is what ensures the building still looks as good in 5 years time and onwards. Seeing tears of pride in the eyes of one of the co-design team members, was evidence itself of the benefits of this co-design approach. This is ROBUST design and at the core of ArtCare’s aims for healthcare environment design. This opportunity of working together and therefore knowing the ground work is solid is what makes it easier to see past the hurdles and get to the end result – a wonderful example of a clinical service delivered in a soothing space without compromising function, all thanks to the incredible support of local people donating to the Stars Appeal.“