Co-Diagnosis Workshop

Posted by Liz Kramer May 20, 2020


Creating the spaces and services to treat complex medical issues safely is an interdisciplinary problem. Physicians, nurses, architects, designers, and others are all part of the process. During the weekend of February 22, an interdisciplinary group of Sam Fox School students and hospital stakeholders came together to imagine spaces for some of the most complicated medical patients in the system: those co-diagnosed with a medical condition and a behavioral health diagnosis. 

Professor of practice Valerie Greer and lecturer Donna Ware led a cohort of 16 graduate and undergraduate students in developing design proposals for an innovative hospital unit. 

For patients with underlying behavorial issues such as major depression, severe anxiety, schizophrenia, or bipolar personality disorder, a medical diagnosis that requires a hospital stay, such as a severe infection, can be taxing on their mental health, and outright dangerous. BJC HealthCare is considering the renovation of an existing unit of patient rooms at Barnes-Jewish Hospital in St. Louis’ Central West End in order to pilot the concept of a “safe unit” for these co-diagnosed patients. The workshop was intended to help expose the scope of the challenge, and expand the potential ideas that could be pursued.

Building on Relationships and Expertise  

The impetus for the workshop was rooted in relationships Greer first developed five years ago. While participating in a patient room design study through the School’s Center for Health Research & Design and advising Sam Fox School graduate student Emily Johnson (MSAAD16) on an independent study, Greer became familiar with BJC HealthCare and the challenges of designing patient rooms. Specifically, she observed interactions between patients and clinicians firsthand in an oncology unit at Barnes-Jewish Hospital and the Siteman Cancer Center. 

Greer’s interest in developing spaces for behavioral health treatment also influenced a 2016 graduate options studio she taught, which focused on the creation of healing environments for veterans suffering from post-traumatic stress disorder (PTSD). Understanding how military training changes the way people interact with the built environment, and how to both navigate and design for those mental shifts, is essential to creating spaces that work for veterans transitioning back to civilian life. Students utilized imaginative empathy to understand veteran perspectives, experiences, and challenges, informing their designs of healing and recovery environments. *For more about this studio, see Greer’s article for the AIA here

When Ware, who’s the executive director of planning and design for BJC HealthCare, approached Greer about an opportunity to collaborate with students on a first-time pilot for a floor for co-diagnosed patients, Greer jumped at the opportunity. Ware, who is teaching a graduate architecture special topics course called Introduction to Designing Healthcare Environments, is particularly interested in helping students to understand the complexity of healthcare design. 

 “When you’re doing more general building typologies, there are building codes and life safety codes, but this multiplies when you get into healthcare,” Ware said. “Healthcare buildings come with additional regulations, codes, and guidelines, making them very complex to design. On top of the spaces where healthcare is provided, there are public spaces, lab spaces, dining spaces, and administrative offices, so you have to understand many different building types.” The workshop provided an opportunity to explore those complexities, and get students excited about healthcare design. 

Understanding through Immersion

Because the School organized the workshop experience as a one-credit, weekend-long master class, a wide range of student were able to participate, including both graduate and undergraduate students, and students from the College of Art as well as the College of Architecture. There was so much enthusiasm for the workshop that the waitlist had to be cut off due to demand. 

In preparation for the workshop, students read Charlotte Perkins Gilman’s 1892 essay “The Yellow Wallpaper,” which addresses women’s mental health issues related to post-partum depression. They also watched John Huston’s 1946 documentary Let There Be Light, which focused on the psychological wounds of war, and the 1975 film version of One Flew Over the Cuckoo’s Nest, set in a mental hospital. 

The first day of the workshop focused on learning from those who work in these spaces every day. Students spent most of Friday at Barnes-Jewish Hospital, where they heard from a series of experts including Angelleen Peters-Lewis, the hospital’s chief nursing officer; Johnson, now a medical design consultant at Perkins + Will in Atlanta; and Virginia Panke, principal and senior medical planner at HOK, who is leading the national rewrite of behavioral health design guidelines. These presentations provided students with local and national context for the design challenge, and also familiarized them with the language used in the field. 

Students also visited three units in the hospital: the psychiatric unit, the medical unit, and the floor slated to be renovated as the new co-diagnosis unit. This gave the students the chance to see program elements and design considerations in each space. For instance, they saw first-hand the setup of the common space—and lack of art—in the psychiatric unit, and the round-the-clock sitters for patients with behavioral health conditions who are located in a medical unit. 

Throughout their visit, they had the opportunity to talk to nurses, doctors, and other clinical staff about the challenges in their spaces. “One of the highlights of the workshop was getting to be on-site at the hospital and touring their facilities,” said Josephine Hsu, MArch20. “It was a cool experience to walk through these different parts of the hospital.” 

Thinking Big and Small

This grounding prepared students to dive into the workshop’s primary design challenge: creating their concepts in small teams. 

In a typical healthcare approach to such design, the top considerations relate to compliance and regulatory requirements that protect patient and clinician well-being. But unencumbered by those considerations or budgetary constraints, the students were free to think big and brought a fresh perspective, proposing ideas for environments and experiences that were sensitive to both staff and patient needs. 

“The students thought at a small scale, like industrial design and fashion design, and at a really large scale, literally going beyond the building,” Greer said.   

For example, one team proposed a nurse’s station with a slanted edge, creating a more approachable and blended space that could be adorned with a planter or artwork. 

Another team created a cantilevered walking track that bridged out beyond the floor to create an outdoor, communal space for patients to gather and engage. 

While some of these ideas might be too grand for the hospital to implement, they provide valuable new visions of what could be. 

“The teams really came together in a short period of time, and they did an incredible job,” Ware said. “They had some really interesting ideas that pushed the boundaries.” 

A Sam Fox School Experience

This workshop brought together students from across the Sam Fox School, providing opportunities for them to collaborate and use their range of disciplinary experience to generate innovative ideas. Two of the art students who participated in the workshop created a concept for customizable uniforms, broadening the design solutions beyond just the architecture to encompass the complete experience for patients and staff.   

This interdisciplinary interaction was also a highlight for students. “My team had two architecture students and two communication design students,” Hsu said. “Working together was really neat because we got to see different approaches to design. The communication design students were concerned with different parts of the deliverables, and putting together a project with them made the whole project more comprehensive.” 

Next Steps

In the future, the BJC team plans to exhibit the student work in a gallery at the hospital, and work with stakeholders at the hospital to use the students’ ideas as a jumping off point for generating a concept that they could pursue. While this next step is delayed due to the COVID-19 pandemic, participating students have been inspired to further explore healthcare design. 

“I’m doing a topic related to healthcare design for my Degree Project,” Hsu said. “I had originally planned to go to med school to become a doctor or a surgeon. I never really let go of my interest in medicine, and this comes back full circle.” 

Ware was really pleased that the students were so interested in healthcare design. “When I was going through school, this wasn’t viewed as a field you purposefully went into. I didn’t have healthcare projects as studio options, and to hear students are genuinely interested in learning more about this field is really critical.”

Nurse's station concept from Coterie team presentation.

Renderings from Breath team presentation.

Uniforms concept from Coterie team presentation.