Summary Report on New Women s Hospital Consultation

Summary Report on New Women s Hospital Consultation The Province of Manitoba, in partnership with the Winnipeg Regional Health Authority, has begun planning construction of a new Women s Hospital at the Health Sciences Centre in Winnipeg. As a first step, the partners initiated a public consultation process (facilitated by Blue Sky Planners & Consultants) to gather input from Manitobans on the design of the new hospital. The January 2008 public consultation was designed to gather meaningful input from as broad a range of stakeholders as possible, using several different modalities. Four public consultation meetings were held in locations throughout Winnipeg. An additional consultation meeting was organized by The Women s Health Clinic in Winnipeg. Approximately 100 people participated in the consultation meetings. Community members were also able to provide input through a webbased survey, a phone line or in writing. Input was gathered from 133 participants through these modalities. Staff members at the current Women s Hospital conducted focus group discussions and individual interviews with current patients and their family members. Phone interviews were held with patients who had recently been discharged from the hospital. Sixty-three people participated in these interviews and group discussions. Staff members also reviewed findings from the hospital s Patient Lived Experience Survey, conducted April Sept. 2007. Additionally, community health programs and community-based organizations were invited to facilitate small group discussions with clients. Input was gathered from 21 of these organizations. To support comparison and analysis of participants responses, the same three questions were used in each modality. Participants were asked to draw upon their own direct experience and provide recommendations about how the hospital environment can be designed to facilitate the delivery of the best possible health care and to support the needs of patients and their families. Information gathered through each consultation method was collated and analyzed, noting consistent themes. Summary of key findings Consultation participants responses were strikingly consistent across modalities and across questions. When participants were asked what aspects of the building or environment at women s hospitals helped to meet their needs, the features and qualities most frequently identified were: a welcoming, calming, restful and homelike environment (in all modalities); accommodations and other resources for partners and other support people (in all modalities except phone); and support for a range of birthing options (in public meetings, from communitybased organizations; and in web responses). When asked what aspects made it difficult to meet their needs, the features and qualities most frequently identified were: a rundown, institutional or sterile environment (in all modalities); inadequate accommodations and resources for partners and other support people (in all modalities); inequities between the accommodations and amenities provided to women having high-risk births and women having low-risk births (in all modalities; and inadequate parking (in all modalities except phone). When participants were asked how to design a hospital that meets the needs of the women it serves, the features and qualities most frequently identified were: patient rooms that are comfortable, homey, of adequate size and, wherever possible, single (in all modalities); the provision of accommodations and amenities to women having high-risk births that are comparable to those available to women having low-risk births (in all modalities); adequate accommodations and

resources for partners and other support people (in all modalities except phone); support for a range of birth options (in all modalities except phone) and adequate parking (in all modalities except phone). It should be noted that participants responses referred most frequently to maternity and obstetrics services. This is not surprising, because, for many people, these are the primary or only services they have used at a women s hospital. In their responses, participants drew upon their own experiences and the information and ideas they shared can make a valuable contribution to all aspects of planning the new Women s Hospital. What helps meet patients needs? Participants were asked what they liked about the building or environment at the Women s Hospital or other hospitals where they had used women s services. Participants appreciated hospitals that have interior environments that are welcoming, calming, restful and home-like. They described interiors that are bright and spacious, with warm colours, decorative touches such as plants, artwork and wall borders, and access to telephones and television. They appreciated the natural light and views provided by windows and preferred to have medical equipment stored (until needed). Having their own room was important to many participants. Single patient rooms provide privacy (important to both patients and their visitors), reduce stress and make it easier to rest. For similar reasons, many preferred to have a bathroom and/or shower in their rooms. Participants liked rooms that were spacious enough to comfortably accommodate the patient, their family and other support people and visitors, along with medical personnel and equipment. This is particularly important when, for example, a patient uses a wheelchair or relies on family members to help them negotiate language differences. Many participants emphasized the need to design rooms and provide furnishings and resources that meet the needs of patients partners and support people. In particular, participants valued having a comfortable place for these people to sleep in their rooms and other practical supports, such as food services and adequate visiting areas. Participants also appreciated having on-site or near-site access to a range of medical and other relevant services, supports and resources. For example, at the current Women s Hospital, patients have easy access to a broad range of specialists, services and other medical supports, including essential services for patients in distress. Participants commented extensively on their experiences in obstetrics. As noted above, participants valued facilities that were designed to accommodate their family and other support people, particularly throughout the birthing experience. Participants also valued facilities that were equipped to support a range of birthing options. This includes spacious rooms, places to exercise or walk, and equipment such as squatting bars, mirrors, labor tubs and birthing balls. Many participants singled out the LDRP area at the current Women s Hospital and the lowrisk birthing area at the St. Boniface General Hospital for praise. These areas are designed with many of the features and qualities that (as above) participants identified as desirable. They offer patients private, home-like rooms equipped to support a range of birthing options. The rooms are spacious enough and furnished to comfortably accommodate patients, their family and support people, along with medical personnel and equipment. What gets in the way of meeting patients needs? 2 of 5

Participants were asked to list things they didn t like about the current Women s Hospital or another hospital where they had used women s services. Many participants felt that parking at the current Women s Hospital is inadequate. Parking is expensive, difficult to find and much of what is available is relatively far from the hospital. Parking reserved at the building for patient drop off allows less time than it ordinarily takes someone to be admitted to the hospital. Long-term parking is not available in the area. Many participants found the entrance to the current Women s Hospital unwelcoming. The front entrance doors are narrow and difficult to open and navigate. The waiting area is so small that people sometimes must stand and has no toys or play area for children. Some participants found the admitting area unfriendly and were intimidated by having to speak through a call-box and/or go through a steel door. Participants also commented on the triage area. Some had had difficulty finding triage, which is on the second floor. The triage area is small, crowded and offers little privacy to patients who are often asked to provide personal information. Participants generally characterized the interior environment of the current Women s Hospital as rundown, institutional, and sterile. Several described patient rooms as drab and depressing, with little natural light. In some rooms, patients must pay for phone and television service. Participants observed that having medical equipment out in the open makes patients rooms feel clinical. Many participants indicated that it is difficult to navigate through the hospital and the HSC complex. Hallways are narrow and cluttered and the HSC tunnel system can be confusing. Participants commented on noisy environments, reporting difficulty sleeping because of noise made by their roommates, staff activity and traffic flow on wards, the hospital call system, nearby elevators and the HVAC system. Participants also felt that shared rooms compromise privacy, rest and recovery for patients. Typically, these rooms are relatively small and feel cramped and crowded, with patients separated by no more than a curtain. Shared rooms tend to have very medical environments, with few windows or other amenities. Conversations can be overheard by anyone in the room; patients, visitors and staff must be careful not to bump into or intrude on each other; and there is no comfortable space for partners or other support people to spend the night. Noise and activity make it difficult for patients to rest. Patients in shared rooms must also share their bathrooms. Many participants were uncomfortable with shared bathrooms and showers, noting that they compromise privacy and, in the case of showers, are sometimes difficult to access. Many bathrooms are too small to accommodate IV poles, bassinets or attendants. Women who have high-risk pregnancies often must share rooms. Participants suggested that, at minimum, women with high-risk pregnancies should have access to rooms and other amenities equivalent to those typically provided to women with low-risk pregnancies, particularly because they typically have longer and more stressful hospital stays than women with low-risk pregnancies. Participants observed that many patient rooms (particularly shared rooms) are too small to comfortably accommodate patients, medical staff and equipment and visitors and difficult to negotiate with medical equipment, bassinets and wheelchairs. Participants reported that many patient rooms do not have adequate space for family members and other support people or a comfortable place for them to rest or sleep. Participants also noted that there are very few food services in or close to the Women s Hospital (virtually none at night) and that there are also no kitchenettes or snack areas in patient areas and no gift shops or convenience stores on-site to pick up basic necessities. It is difficult, for many mothers, to be physically separated from their newborn children. The NICU is located at a considerable distance from the Women s Hospital and it can be 3 of 5

physically and emotional stressful for mothers to have to travel the tunnels to get to their child. It is also difficult for mothers separated from their children in the on-site intermediate care nursery. A new hospital that meets the needs of women and their families Participants were asked how to design a building and environment for the new Women s Hospital that meets the needs of the women it serves and their families and other people who might be there to support them. Key recommendations are presented below: Design principles: Promote healing and reflect values appropriate to the function of a woman s hospital and that support all aspects of women s health and wellness (physical, emotional and spiritual) Reflect and support the cultural diversity of the population the hospital serves. Incorporate Universal Design principles to make building accessible to people of all abilities. Refer to Baby-Friendly Initiative and Mother-Friendly Childbirth Initiative standards. Refer to current LEED standards and the framework developed by the Canadian Coalition for Green Health Care. Draw on best design practices of other hospitals. Design different functional areas to reflect the experiences people are likely to have there, e.g., joyous space for birth, peaceful space for palliative care and healing space for recovery. Think carefully about whom patients will share space with so that, e.g., women who experience pregnancy loss do not share space or travel through birth areas. Accessing hospital services: Parking should be readily available, affordable and conveniently located. Parking for pickup and drop-off should allow adequate time to bring someone into the hospital. Enhance safety in parking and other exterior areas, as well as security within building. Main entrance to building should be welcoming, with large, accessible entryway; adequately sized, comfortable waiting area; and clear signage to guide patients through hospital. Interior environment and layout: Create a welcoming, relaxing, home-like environment, with lots of natural light, warm colours, plants, artwork and other decorative touches. Provide patients with ways to connect with nature and the outdoors, such as an atrium, access to outdoors, windows that open and/or balconies. Layout should make it easy for women to navigate the hospital and HSC complex. Hallways, doorways and elevators should allow easy passage and transportation within the hospital and HSC complex. Nursing stations should be as close as possible to patient rooms. Related services should be as close together as possible, e.g., mothers and children in nurseries on same floor and Women s Hospital as close as possible to Children s NICU. Patient areas: Lounges and visiting rooms in patient areas should be well located and equipped, comfortable, child-friendly, of adequate size and include relatively private spaces. Provide places to walk and exercise. These areas should provide natural light, plants and a view of or access to the outdoors and be equipped with support bars. Bathrooms should provide as much privacy as possible and be large enough and equipped to accommodate patients with medical or assistive equipment and basinets. Include appropriately equipped kitchen areas (accessible all hours) in patient areas. Patient rooms: Patient rooms should provide as much privacy as possible and, where feasible, patients should have single rooms with fully equipped bathrooms. 4 of 5

Patient rooms should be comfortable and home-like, with natural light and equipped with phones, television and internet access. Patient rooms should be large enough to adequately accommodate, patient (and, in the case of new mothers, baby), support people and visitors, staff and equipment. All patient rooms should be equipped to accommodate partners and/or support people, including at least one comfortable sleeping place for support person. Where possible, patients should remain in one room throughout their hospital stay. Obstetrics area Design and equip rooms and area to support a full range of birthing options and women s right to make choices throughout the birthing process. Environment should affirm that birthing is a natural process, not an illness. Provide more LDRP rooms. Wherever possible, the entire labour/deliver/recovery process should occur in one room. Rooms provided to women with high-risk pregnancies should, at minimum, provide an equivalent level of comfort, space and amenities as that provided in rooms for women with low-risk pregnancies. Obstetrics rooms and areas should be designed to support the relationship between mother and baby. Patient rooms should include items such as beds equipped for cosleeping and nursing chairs, Nurseries should be dispersed throughout obstetrics area, so that mothers are near to their babies at all times and to ensure that mothers can safely rest. Spiritual wellness: Designate space for patients spiritual care, such as a quiet space where patients, their families and support network can reflect, practice their spirituality or faith traditions and access qualified spiritual care, and an independent space for Aboriginal traditional practices. Design the hospital to support all spiritual practices. In particular, the ventilation system should enable patients to smudge in their rooms. Provide space for a broad range of medical services and supports: Provide space for a multidisciplinary, holistic range of services. Provide space for activities that support a broad range of birthing options and parenting needs, such as space for midwives, private milk-pumping areas equipped for storage, breast feeding clinics and a post-partum clinic. Enhance access and capacity for ultrasound and other pregnancy-related services and supports. Provide space for a broad range of patient services and supports: Provide a resource centre, where patients and families can access health information, education programs and peer support groups and connect with community-based resources. Creating a child- and family-friendly environment: Provide on-site childcare services to patients and child play areas in waiting and visiting areas. Accommodating patients support network: Provide accommodations on- or near site for family members of hospital patients. In addition to providing a sleeping area in patients rooms (above), this may include an on-site hospitality suite, where people can shower, rest and access food or beverages. Provide 24-hour access to nutritious food and a comfortable space to eat on-site. Provide an on-site convenience or gift store where patients and support people can purchase items such as newspapers, personal care items and gifts. Environment that supports staff: Design work space and equipment that enables staff to work together efficiently and effectively. This includes adequately sized work and storage areas; enhanced computer access; ergonomic work stations and equipment; up-to-date equipment and quiet and comfortable lounge areas. 5 of 5