With patient-focused care a top priority for healthcare providers, many organizations are realizing the value of asking patients, families, and visitors to play a role in design. These populations are some of the most important users of a healthcare facility and have emotional insights into the patient experience that can help drive meaningful design decisions. But first, designers need to learn how to capture that feedback.

Fortunately, there are several ways to gather this kind of information, ranging from passive approaches, like observation and shadowing, to more active ones, such as conducting interviews and facilitating focus groups. These methods can be broken down into three categories of participation: watch, listen, and engage.

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Observation and shadowing

Observation entails both watching and listening without being an active participant. It can be as simple as walking around with a notebook and camera, or sitting in a specific spot at a certain time of the day and counting how many people walk by.

Begin with a list of objectives and a floor plan for note-taking. For studying nurses’ station configurations, an objective may be to record how long a nurse is at the station between patients and in what position, standing or sitting. The floor plan may be used to track the circulation through the nurses’ station.

Another goal of this observation study could be recording the number of non-nursing staff using the nurses’ station. This may inform what kind of workstation types to provide.

When observing, it’s important to remember there’s no “good” or “bad.” Observation is not about critique, but about learning, understanding what people do, and seeing how they interact with their current environment and others around them. These findings can be used later to help support design decisions, such as circulation paths, adjacencies, and activities that occur in certain spaces.

Using observation to understand how a facility or department functions also helps with space planning, especially when it’s done early in the design process. A recent observation study at a New York City medical center found that while the waiting areas had access to natural light, were well furnished, and included TVs, few people used them. Instead, they lingered near the nurses’ stations because they didn’t want to miss anything or be forgotten. After learning this, the design team decided to locate future waiting rooms in areas with dedicated staff or with close visual and acoustic proximity to the nurses.

Observation can also be useful in addressing specific design problems. For example, if the task is to design a new information desk for a hospital lobby, a designer may choose to watch the activity at the current desk: How many people approach it in a given amount of time? What kind of questions do they ask? How long does the average visitor remain there? Does the staff have what they need to guide visitors?

The answers to these types of questions can be used to inform the new desk’s size, shape, and components. If you observe that elderly patients or visitors are leaning on a transaction-height desk, consider changing the design to allow for a lowered portion with a chair in that area. Also, don’t forget to observe staff interactions. If staff must stand up each time they need to hand something to the visitor, a work surface with a shorter depth might be considered.

Shadowing a clinician can give further insight to shape clinical space design to better serve patients and visitors. On a recent shadowing experience at an academic medical center in an urban setting, the designer noted that it was difficult for patients and families to circulate the corridors during rounds because of large groups of residents congregating with their attending physician. In the new hospital, the design team addressed this problem by creating dedicated alcoves off the corridor for groups to use for quick discussions.

Focus groups

A focus group typically consists of a team of designers or program specialists convening anywhere from four to 20 people (including former and current patients, their families, and visitors) in a room for a few hours to ask them about their experiences at a facility. Questions can touch on a variety of matters: Was the staff attentive? How comfortable were you? Did you have enough entertainment during wait times?

The group should include a cross-sectional study of the population and be kept to a small size so that all voices can be heard equally. If you have a large number of participants, consider breaking up into smaller discussions and reconvening at the end to share findings.

A focus group should have some structure, but also flow as naturally as possible to allow participants to share their views on topics that matter to them. There can be some direct interview-style questions, but allowing patients and families to express themselves in a comfortable environment is important in getting honest feedback.

Since it can be difficult for participants to talk about personal experiences in a group setting, try setting up a hypothetical scenario. Here, the designer can invent a patient and symptoms, and then ask the group to walk through the patient’s journey from home to discharge. This allows the designer to better understand the emotional experience of the patient journey and create a spatial response that’s sensitive to patient and family needs.

Prototyping and mock-ups

The most active and direct method of getting feedback from patients and families is by immersing them in the environment or design problem. A designer studying furniture replacements for a labor, delivery, and recovery unit can bring mock-up pieces to a functioning unit and have patients and families test them. In many situations, patients enjoy the distraction and appreciate sharing their opinions.

Although it’s common to ask clinicians to perform workflow scenarios, it’s much less common—but equally valuable—to enlist patients and their families to do the same. When engaging patients or families in mock-up and prototype review, have scenarios planned out. Patients may also feel more comfortable if clinicians are on hand to act alongside them.

For example, in a patient room, the designer could ask a family member to go through the scenario of getting ready to go to bed. This simple task can pose many issues: Where is the bathroom (if not in the room)? Is there ample storage for personal belongings? Can the sofa be easily converted to a bed? Where are the pillows? How does the guest turn off the lights, but leave enough on for a night-light?

A designer should address all these elements when designing a patient room, and getting patient and family feedback can be the best way to ensure the layout works as intended.


Once these insights are collected, it’s the job of the architect or designer to evaluate, distill, synthesize, and interpret the information in a way that helps shape the patient experience. Since interior design can be very subjective, the research should serve only as a framework for starting.

Organize findings by pri
oritizing comments and observations that are repetitive and not one-off cases. Remember that patients and families may offer feedback on things they think they want or need. However, design professionals should focus on why they need them rather than only on what they need.

For example, during a pediatric focus group, a parent suggested using the color lavender. When asked why, she explained that it was a calming color. To the designer, the most important part of that conversation shouldn’t be the specific color, but the idea that the patient desired calming colors in a healthcare setting.

By taking the time to gather feedback— whether by watching, listening, or engaging— designers can better understand whom they’re designing for and why, leading to more conscientious, patient-focused design solutions.

Andrea S. Hsu

Andrea S. Hsu, IIDA, is an associate at NBBJ New York. She can be reached at ahsu@nbbj.com.