The business case for healing environments
How can we use evidence-based design to reimagine an alternative to the hospital cubicle curtain?
Image courtesy of Skyline Design
Project Title: CAMAflage Evidence-Based Design Rearch & Business Case
Company: CAMA, Inc. Duration: Jan 2019 - April 2019 (4 months)
Key Project Activities: My Role: Design Researcher
Design research and synthesis Collaborators: CAMA Staff, Skyline Design staff
Brainstorming and ideation
Cost benefit analysis
Business case development
Context & Challenge
CAMA, Inc. is an architecture and design studio in New Haven, CT that has spearheaded the evidence-based design movement by creating care environments and experiences that empower wellbeing. Inspired by patients and families to design dignified healthcare experiences, CAMA recognized the need to look beyond the cubicle curtain for alternative privacy screening solutions. Beyond patient satisfaction, cubicle curtains are an important piece of the chain of transmission of hospital-acquired infections (HAI’s) raising questions of patient safety, health outcomes, and ultimately the cost to the U.S. healthcare system. Conversations with Skyline Design (a patterned glass manufacturer based in Chicago, IL) about this need in the marketplace ultimately led to a partnership and the creation of glass screens, CAMAflage, that promote dignity in care environments by providing the necessary levels of visual privacy.
While the product promised safety, functionality, and beauty, the case had to be made to convince hospitals and healthcare environments to adopt this glass alternative to cubicle curtains. I was brought on to carry out research on the evidence-based design principles that went into developing CAMAflage as well as conduct a cost analysis on the lifetime cost of the product to build out a business case. Our aims for the project were to demonstrate how the CAMAflage product improved patient outcomes, increased hospital operational efficiency, and ultimately decreased costs for the healthcare system.
Image courtesy of CAMA, Inc.
Process
Evidence-Based Design Research & IDEATION
“Evidence-based design (EBD) is the process of basing decisions about the built environment on credible research to achive the best possible outcomes. A large and growing body of evidence attests to the fact that physical environment impacts patient stress, patient and staff safety, staff effectiveness and quality of care provided in hospitals and other healthcare settings. Basing healthcare facility planning and design decisions on this evidence to achieve the best possible patient, staff and operational outcomes is what evidence-based design is all about.” - The Center for Health Design
Image courtesy of CAMA, Inc.
Image courtesy of Center for Health Design
For the research phase of the project, I carried out the following activities:
Systematic review of the literature surrounding cubicle curtains and their alternatives
Secondary research of EBD best practices and research, exploring questions such as:
What contributes to patient dignity in care environments?
How can we strike a balance between visibility of the patient while providing the illusion of privacy?
How might we enchance beauty in this clinical environment?
Once all the research was completed, the qualitative data was organized into post-it notes and the internal CAMA staff worked together to develop insights. The brainstorming and ideation session involved synthesis of the research and grouping of the data by themes with affinity maps. This sensemaking process allowed us to bring in new and experienced perspectives of the staff to understand the data and develop insights to include in the business case.
Cost Benefit Analysis
For the cost analysis portion of the project, I aimed to make the case for glass by showing how the lifetime cost (or the cost of the product over the lifetime of its use) of CAMAflage would be lower than the lifetime cost of traditional cubicle curtains. The analysis was broken down into the the following categories:
Direct costs
Fixed costs of purchasing curtains and their installation
Variable costs of laundering, replacements, staff time, and room closure
Indirect costs
Treatment of common hospital-acquire infections (MRSA, VRE, C.dificile)
Increase in patient length of stay (LOS)
Center for Medicare & Medicaid Services (CMS) penalties for hospital-acquired infections
Risk of staff falls from curtain installation
Intangible costs
Patient satisfaction scores
Hospital reputation
Beauty and aesthetics
Image courtesy of CAMA, Inc.
Business Case Development
We built out the business case as a team, and it included the following pieces:
Properties of glass as a building material
The four thematic categories from our design synthesis session:
Infection Control: Glass is easy and efficient to clean
Dignity & Privacy: Glass allows patients to be seen and heard on their terms
Safety & Visibility: Glass makes it easiers for providers to monitor patients and prevent falls
Beauty & Satisfaction: Glass lets in natural light which promotes healing and serves as a canvas for nature patterns
Cost benefit analysis of the lifetime cost of CAMAflage vs. traditional cubicle curtains
outcomes & Impact
The creation of the business case for CAMAflage not only created a justification for the product but allowed for a larger conversation about looking at new materials to reimagine clinical environments as healing spaces. The case was developed into a Continuing Education Unit (CEU) presentation given by CAMA’s President, Rosalyn Cama, in April 2019, which was extremely well-received. Additionally, the case was presented to various hospitals across the U.S. and developed into a white paper by a notable health system.