Māngere Integrated Community Health

We want to create facilities that reduce barriers for us and increase our power in relationships. Here are our ideas about how a healthcare or other service facility could be designed. We want to create facilities that reduce barriers for us and increase our power in relationships. This is consistent with taking ownership of our health alongside health professionals.

The relationship between the community as patients and whānau and health and other professionals will shape and validate building design and environmental standards. The starting point for the development of specifications for building or enhancement of Māngere health and wellness facilities is the Community Statement of Aspirations for Health and Wellness in Māngere.

Four specifications that help us meet our needs

We drew up these specifications to show how our aspirations can be translated into building and facilities design requirements. The specifications can be worked on from a technical perspective while remaining in line with our aspirations.

We developed the specifications for four areas:

Community Statement of Aspirations for Health and Wellness in Māngere

Summary

Full Version [PDF]

Initial Encounter

Initial encounter

Acknowledging identity

The first encounter in the healthcare relationship occurs by phone, text, letter, email or in person. The way this is done communicates acknowledgement and respect, or not. The cultures who contributed to the Māngere community statement have a strong relationships approach. This generally focuses on identity and the need to acknowledge the cultural dimension of identity. The physical environment plays a part in this. It must acknowledge ‘me and mine.’ Light, music, sound, smell and colour send messages of acknowledgement of people and their whānau.

Effective design invites entry. It draws you in. Good design provides a base upon which support can be built. The result of good design is a feeling of being ‘at home.’ People feel more comfortable and in that context supported about what needs to happen next, i.e. the development of the relationship.

The Relationships Approach

Where the staff are placed

The second issue is where the staff are placed in the general space and whether they can engage with patients and whānau when they arrive.

It is difficult to begin relationship of working together when one person is behind a large reception desk. Therefore the desk needs to go. It needs to be replaced by open space in which the parties can begin to engage each other in ways that are relevant and personal.

This sort of relationship needs staff who have greeting and engagement with people as a key focus of their role.

This is very different from reception staff, who currently greet people while answering the phone, taking payments and working on the computer.

In other words, the point of developing relationships gets lost in all the other tasks.

A greeter to welcome and engage with people

There needs to be a person who assists the movement from engagement to relationship development. This will lead eventually to the business at hand.

The cultural elements of this process are critical. The person is a greeter but a greeter with a difference. The greeter would have a hand-held scheduler and some database information on patients so he or she knows something about the person who has arrived at the centre before the initial greeting. In the greeting he or she creates the effect in the visitor that they are known here.

Through this personalised approach they develop the sense that this is a place that patients and whānau connect to. The cultural elements of this process are critical. Through the use of technology, the greeter can connect the visitor immediately with an appointment or slot them into a list if they are coming without a prior appointment.

The point of the initial encounter is to lead seamlessly to relevant and active relationship development. So the encounter must be able to encourage several different activities.

Not a waiting room

The space where the person is welcomed will set the scene for their whole experience. These are some of the things to consider when planning this space:

  • Different activity needs to be able to be undertaken in the space. The furniture arrangement therefore needs to be flexible.
  • Segregated activity would need to be provided (where there is a need for a degree of privacy that is different from more active areas).
  • For very sick people who need to wait, there also needs to be provision for quiet gathering.
  • The space overall needs to be active in feel, not passive. It must be interactive around information and education.
  • There must be appropriate toilet and washing facilities available.

This implies a different naming of the space. ‘Waiting room’ is probably the most impassive label that could be given to this space, given the intent of MICH for people to own their health and work together to create wellness. Therefore as a term it needs to go. The name of the space should focus on a ‘doing health-related things’ concept.

Examples of things to do that could be provided

  • Videos on health topics (not commercial videos)
  • Computers and other resources on issues concerning our health and the health of our whānau and community
  • Surveys and questionnaires to inform and educate online
  • Information on community and health services in Māngere

There should also be an electronic facility where a person can update details on their record.

Engagement and Relationship Development

Engagement and relationship development

At this point, health professionals address the person’s reason for their visit to the medical centre (unless the person has come simply for the purpose of information or education and has no need to talk with other staff).

Therefore at the right time the greeter would escort the person from the ‘doing health things’ space to the room where they will do their work with whoever they have come to see. The idea is that this is a work room that becomes their space for the duration of the visit. Everything that needs to happen to them would take place in this room and the staff would move in and out as needed. In other words the patient wouldn’t be shunted around the medical centre if they needed the services of several different staff during any one visit. Instead they would stay in the one place and staff would come to them.

Designing spaces for working together

The working together space needs to support (in design terms) a working together relationship. As this may include whānau it needs to include:

  • sufficient room to accommodate the person and whānau
  • en-suite facilities that are appropriate for community needs
  • work areas at equal levels to facilitate the development and operation of equal working relationships.

A ‘working together room’ could look like the image to the right:

  • There would be no desk
  • Instead there would be a coffee table with chairs around it
  • There would be a bed for examinations – one that can be raised or lowered
  • There would be a computer screen that is able to be seen by the patient and whānau (wireless keyboard and screen on the wall may be practical options here)

Working Together

Working together

The space belongs to the patient and whānau

As a person’s needs are met in one place, the space in effect belongs to the patient and whānau not the doctor or health professional. This means the working together aspect of the visit can focus more on the interpersonal and group dynamics of the relationship between the patient and their whānau and the different health professionals. This relationship develops during the visit.

The range of health professionals would come and go during the visit either individually or in groups as appropriate. If related services are nearby, e.g. the pharmacist, there is no reason that they could not also come to a ‘working together room’ as one of the health professionals working with the patient and whānau during a visit. This would make a visit to the healthcare centre much less stressful for whānau with small children, disabled people and elderly members, for example. In this way the segmentation of the visit would be removed and the focus would shift from the professional to the patient and whānau.

What will it all mean for patients and whānau?

The look and feel of these ‘working together rooms’ should communicate engagement and cooperative working together. They should engender and encourage feelings of sharing, listening and safety through colour, light, music, sound and smell.

We have not covered logistical details of this here. Details of the relationships dynamics would also need to be worked through with health professionals and patients and whānau. MICH has a workstream that is focused on reviewing and developing the way agencies’ internal systems and processes can operate in support of community aspirations for health and wellness.

Disengagement and Departure

Disengagement and departure

Each professional disengages from the patient and whānau during the visit as their role ends. The last person to arrive is the greeter. His or her role is to wrap up the whole experience and to escort the patient and whānau out to the place where everything began. Through the hand-held device that they use in their work, the greeter would have the patient’s payment details listed. Their job would be to confirm these with the patient and whānau, and to offer advice if there are any changes or there is a problem with payment.

In the ‘doing health things’ space there would be a number of kiosks where people can pay for the visit (similar to kiosks in a parking building). The greeter would advise on how to use these if needed and offer any further information relating to the visit or any other matters.

At this point the greeter would farewell the patient and whānau.

For more information about designing facilities please contact us.