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Better Care Through HCIT 101: Part 6 - The Children Are Our Future

August 27, 2009
by Joe Bormel
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We walked into the Children's Hospital and Clinic. We were told where to go and when to be there:
“Just come in the main entrance, turn left at the McQueuen/Hardy sign, straight past the Seymour-Thomas Nephropaleontology Center, right at the Hoddes Chickeldorf Dobbs Imaging Center, then simply go to the end of the hall with the double glass doors. Just before those doors, turn left again and you'll find us, the Van Ders Neurocardiopedics Pavillion."
Really?

Better Care Through HCIT 101: Part 6 - The Children Are Our Future
Culturally adopted vision, values, and continuous improvement require continued focus

Everyone is familiar with the challenge of finding one's way through a hospital. Wayfinding often takes the form of clear signage and guiding lines on the floor and walls. It reflects a true patient-centered facility design. The picture above comes from a pre-eminent children's hospital in Delaware that I recently visited with my family. My initial healthcare access challenges are covered in my Relativity and Relativity post. This was a routine follow-up visit, and all was well on this visit.

The hospital and clinic are gorgeous and clean. More importantly, of course, is that the staff was highly talented, professional and attentive. Per my post, the care is objectively the best that's available within a several hundred mile radius of home.

I was reminded of a few lessons from this experience:

1) What we call things and how we find them is so instrumental. It's ease to lose focus on that.

2) Visioning is not enough. Clearly, from the picture above, the wayfinding design was well thought out and executed. Of course, I'd prefer that the Blue Module above had a background color of blue rather than green, but let's give them credit for getting it right in two out of three signs shown. The fourth and fifth signs, not shown, completely lost the vision. They had those McQueuen/Hardy/Seymour/Thomas/Hoddes/Chickenldorf names (fictitious examples) and the same, non-informational background color. Putting in a systematic process to maintain the vision through all relevant projects is important. That's what was clearly missing.

3) It's not about us [the care provider]. It's about the patient and their care. Using names of people we want to memorialize is fine, but not for something critical to our patients like wayfinding.

4) There's always room for improvement; often those ideas come from visitors, customers, patients and their families, employees, etc. I did clearly communicate my concern about the wayfinding to our physician. I will follow that up with a second email containing a link to this post and it's comments.

5) The standards for children's hospitals need to be higher than that for adult hospitals. Aside from being a recognized, vulnerable population, children are less cognitively and experientially developed. Their parents and caretakers have additional burdens, physically and emotionally, compared to adults presenting for self-care. It's not my intent to be proposing a "shame" strategy, common to what's often done to adult and children's hospitals and clinics. This hospital is a strong, positive exemplar. In my work, I've been to and toured easily a dozen children's hospitals within the last 2 years. This hospital is clearly in the top decile. Part of what got them there and keeps them there is attention to detail. There are more details in a children's hospital.

I'll report back to let you know whether this hospital is improving, or whether its existing, high value investments (as evidenced in this text and the photo) is devolving. Continuous improvement and a culturally adopted vision are critical components of our institutions.
 

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Comments

Anthony , Thanks for your comment and your parallel experience.

This hospital/clinic generally has terrific wayfinding, clearly incorporating Turtles, Giraffes, and other kid-friendly themes. I think that's why their inconsistency stood out like such a sore thumb. Perhaps the lesson here is that all humans can allow emotions such as sentimentality to cloud rational thinking. We need to work with others and discourage group-think to arrive at requirements.

Thanks Joe for reminding of us that there are many, many pieces to getting it right in the hospitalso much more than the usual "high quality care". A little thing like signage can be the one memory family members/customers walk away with (if they don't get lost!) And it can totally color their experience/memoryno matter how great the care they received. Sure, naming opportunities are great revenue sources but make the right signs for the users. The little things are just as important sometimes as the big ones. Good to remember, all around.

Jack,
I can always count on you to get me out of the ditches and start looking at the larger system.

Probably like many people, once I've chosen my healthcare provider, I lost interest in those providers that I didn't choose. That behavior does lead to a lack of dependability in healthcare facilities in general.

Are you making a case for the role of the collaborative organizations like GPOs (group-purchasing organizations) and IHI (institute for healthcare improvement) who are focused on the bigger system and standards across the board? If so, you're pretty persuasive.

Daphne, Your comment crystalizes how I felt. Thank you. Writing that post felt a little odd since signs should be a small thing. In this case, they were incongruous to the rest of the extremely positive experience.

Last year, concurrent with this post, I reached out to several executives at the hospital involved. After all, this was easily remedied with a splash of color, without dishonoring or doing away with their honorarium. As of nearly one year later, the signage is completely unchanged. Bigger fish to fry or lack of attention to details?

Joe,
I do agree with Daphne about "many, many pieces." But I think what we need here is clarification.

The standards need to be higher across the board. As you very well stated in an earlier post, the decision-making process from hospital to hospital varies too greatly. There is no meaningful standardization to give guidance to patients about treatment alternatives. The whole process is too subjective.

What good does it do to have an easy path to your destination in a healthcare facility, if the path to treatment is, too often, predictably undependable?

Jack

I think you're making an important point Joe, and not getting caught up in something inconsequential. As stated, it doesn't matter how great the care is IF YOU CAN'T FIND IT.

Right away, I can think of a parallel in magazine production and journalism. It doesn't matter how many high-level sources one has interviewed, how expertly one has weaved those interview together into the magnificent tapestry that a great story can become, IF the editors allow the art director to run amok and set the story in yellow font on a white background in eight point type.

Your point is important. This can be such a quick and easy fix for a hospital, while removing a huge amount of stress and frustration from patients. Great post.

Joe Bormel

Healthcare IT Consutant

Joe Bormel

@jbormel

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