“Here are all the voices of caregivers telling us what is needed at the end of life,” says Rana Sagha Zadeh, Design and Environmental Analysis. She stands before a large graph made up of sticky notes, each bearing a phrase written in black marker. Lines drawn between the stickies show relationships between the phrases, grouping them like constellations around a core concept that is itself part of a galaxy of concepts revolving around an even more encompassing idea. “Provide appetizing food,” says one sticky. “Allow pets,” says another. “Decrease light at night,” advises a third.
“We are using the content analysis method of qualitative research here,” Zadeh says. She explains that the graph is the product of her latest research project on how to design the optimal end-of-life health-care facility. A year and a half ago, she joined with Paul E. Eshelman, Design and Environmental Analysis; Judith Setla, Medical Director of the Hospice of Central New York; and Ana Krieger, Clinical Medicine, Clinical Neurology, and Clinical Genetic Medicine at Weill Cornell Medicine to carry out this research project. Their aim was to gather data from those most intimately acquainted with the needs of the dying: the health-care professionals and administrative staff who provide end-of-life services directly to patients.
Voices from the Local Health-Care Communities
The researchers partnered with four nonprofits engaged in end-of-life work in the Finger Lakes, New York area. Zadeh and her fellow researchers administered a four-page survey to 134 people connected with the facilities during the summer of 2013. They responded to a wide range of questions about the needs of dying patients and their families, as well as the needs of staff members who care for them.
Their answers yielded approximately 2,000 statements that Zadeh, her colleagues, and her students, with the help of administrative leaders from the participant organizations, sorted into categories under summary headings representing the core concepts—the overarching graphs of sticky notes. Then design students drew representational drawings of each of these main concepts. The drawings will be released to the public as part of the final translational report, which will function as a guidebook for how to build the optimal health-care facility.
“Health-care staff collaboratively presented a new model of delivering end-of-life care and highlighted who has to play what role to deliver that health care in the best way possible,” Zadeh says with satisfaction. “All these voices are summarized for others to use. They don’t have to interview 134 people themselves.”
This research is groundbreaking, Zadeh explains, because there are not many extensive guidelines for how to design for end-of-life care. In essence, policymakers and others building new facilities have been reinventing architectural and design solutions to the same problems, and following their own time-consuming process to arrive at these solutions. Sometimes they actually come up with a better answer than those before them, sometimes their solution is not as optimal. Sometimes they don’t even ask the same questions.
The Effect of Light on Nurses
The end-of-life project is just one of the health-care design projects Zadeh has been involved with since coming to Cornell in 2012. Soon after arriving she joined with Mardelle McCuskey Shepley of the College of Architecture at Texas A&M, Gary Williams of St. Joseph Regional Health Center in Bryan, Texas, and Cornell doctoral student Susan Sung Eun Chung to publish a paper that looked at the effect of daylight on nurses working long shifts in health-care facilities. The researchers found that the presence of daylight had a positive effect on nurses’ circadian rhythms, helping them stay alert and responsive.
How does this translate into building design? The staff’s need for daylight must be taken into account, Zadeh explains. Usually hospitals have deep floor plates with nursing stations typically situated in the core of the building and windows located in the surrounding patient rooms. Consequently, daylight is not readily available to the nurses. More natural lighting can be brought into the nurses’ area by designing courtyards for the buildings and by building narrower buildings, among other things—all of which increases nurses’ quality of life on the job, and thus positive outcomes for staff and patients.
Is It a Healing Design?
“Buildings and the environment have an impact on people’s quality of life,” Zadeh says. “Adverse people outcomes are ten times more costly than the initial building costs.” When investing in a new building design, she explains, designers should question whether the goals of the design are meeting the needs of the people who will be using the facility. “If it’s a hospital, is it healing? That’s as important as how much material the building is using. If return on investment is successful then not only resources are saved but it’s also a success in human outcomes.”
The researchers found that the presence of daylight had a positive effect on nurses’ circadian rhythms, helping them stay alert and responsive.
The practical application of her findings to real-life situations is what keeps Zadeh pursuing the next research project. “I’m a designer and an architect—but also a researcher,” she says. “I see myself in the wonderful role of being able to translate critical research into practice and make it accessible in day-to-day life. By documenting user experience, I can find the most pressing issues and areas with highest potential impact and come back to the university and help community members with solutions that are supported with best available evidence.”
Health Designs Innovations
To further that aim, Zadeh cofounded the Health Designs Innovations Lab (HDIL) in 2013, along with Frank Becker, professor emeritus. The HDIL is a multidisciplinary community made up of faculty, students, practitioners, and community members committed to cutting-edge research on health-care environments. “We wanted to create a center to help foster communication among different fields that contribute to improving health-care outcomes,” Zadeh says. “We know from research that to better health-care delivery, we need to break the silos and facilitate collaboration among many fields including engineering, design, medicine, nursing, and others.”
HDIL members work together, researching problems from the angles of many different players in the health-care arena. “We want to facilitate the translation of research findings into practice,” Zadeh says, “to make a difference in peoples’ lives.”