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Designing with Empathy: Humanizing Narratives for Inspired Healthcare

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Designing with Empathy: Humanizing Narratives for Inspired Healthcare Case Study Health Environments Research &DesignJournal 2016, Vol. 9(2) 130-146 Designing With Empathy: ª The Author(s) 2015 Reprints and permission: sagepub.com/journalsPermissions.nav Humanizing Narratives DOI: 10.1177/1937586715592633 for Inspired Healthcare herd.sagepub.com Experiences Candy Carmel-Gilfilen, MArch1, and Margaret Portillo, PhD1 Abstract Objective: Designers can and should play a critical role in shaping a holistic healthcare experience by creating empathetic design solutions that foster a culture of care for patients, families, and staff. Using narrative inquiry as a design tool, this case study shares strategies for promoting empathy. Back- ground: Designing for patient-centered care infuses empathy into the creative process. Narrative inquiry offers a methodology to think about and create empathetic design that enhances awareness, responsiveness, and accountability. Methods: This article shares discoveries from a studio on empathetic design within an outpatient cancer care center. The studio engaged students in narrative techniques throughout the design process by incorporating aural, visual, and written storytelling. Benchmarking, observations, and interviews were merged with data drawn from scholarly evidence- based design literature reviews. Results: Using an empathy-focused design process not only moti- vated students to be more engaged in the project but facilitated the generation of fresh and original ideas. Design solutions were innovative and impactful in supporting the whole person. Similarities as well as differences defined empathetic cancer care across projects and embodied concepts of design empowerment, design for the whole person, and design for healing. Conclusions: By becoming more conscious of empathy, those who create healthcare environments can better connect holistically to the user to take an experiential approach to design. Explicitly developing a mind-set that raises empathy to the forefront of the design process offers a breakthrough in design thinking that bridges the gap between what might be defined as ‘‘good design’’ and patient-centered care. Keywords academic research, case study, ambulatory care center, cancer center, evidence-based design, interior design, patient-centered care, qualitative research, design methodology Purpose Empathetic design, by definition, is life affirming. By centering on patients, engaged family mem- 1 University of Florida, Gainesville, FL, USA bers, and caregivers, empathetic design contributes Corresponding Author: to a holistic culture of care. We argue that narrative Candy Carmel-Gilfilen, MArch, University of Florida, 334 inquiry—giving insight into the thoughts, feelings, Architecture Building, Gainesville, FL 32611, USA. and experiences of others—can and should inform Email: [email protected] Carmel-Gilfilen and Portillo 131 the design process and brings design solutions into in a body cast wills himself to be at his daughter’s close alignment with the physical, emotional, wedding scheduled a few days later. A man spends spiritual, and interpersonal needs of patients and 3 hr in a waiting room. A new mother in a neonatal caregivers. Design, guided by personal narratives, intensive care unit wonders when she will be able offers a myriad of opportunities to inspire the to take her daughter home. A doctor reflects on healthcare experience. being cancer free for 7 years. The viewing audi- ence of Empathy sees the thoughts and feelings We argue that narrative inquiry—giving of patients, family members, and caregivers. insight into the thoughts, feelings, and Patients become more than ‘‘end users.’’ They are experiences of others—can and should mothers, fathers, sons, husbands, or wives. They inform the design process and brings are single, married, or divorced. Their stories design solutions into close alignment with involve receiving life-altering diagnosis, tolerating the physical, emotional, spiritual, and the prosaic frustrations of testing and receiving interpersonal needs of patients and treatment, and experiencing a moment of happi- caregivers. ness or feelings of relief. As the inner worlds of the patients, family This article shares a new way of designing members, and caregivers build to a crescendo, empathetically for the whole person using narra- empathy ends with a single question, ‘‘If you tive inquiry. This approach offers a unique vehi- could stand in someone else’s shoes ... Hear cle to heighten compassion for people that can what they hear. See what they see. Feel what they be grounded in evidence-based design (EBD) feel. Would you treat them differently?’’ principles, thus linking the subjective personal Clearly the answer is yes and ‘‘empathy takes experience with objective ways of knowing. This on a new dimension in a hospital, where there is case study focuses on designing an outpatient the push and pull of health and sickness, and cancer care center using a narrative methodology where giving and receiving care happens every within a senior-level design studio. Within this day’’ (Cleveland Clinic, 2014). Designers and context, narrative inquiry became a vehicle for design educators play a critical role in creating students to explore multiple dimensions of empa- empathetic healthcare environments. Empathy: thetic design from patient, family, and staff per- Exploring Human Connection inspired us and spectives. This process involved exploring end reinforced the power of narratives to capture user experiences through three modes of story- human experience in ways that could be particu- telling (i.e., verbal, written, and visual) to inspire larly useful for designing interior spaces (Dohr & design thinking. Original narratives, told in first Portillo, 2011; Portillo, 2000). person, situated the members of the design jury The project profiled in this article began with a within the ambulatory cancer care experience. design charrette2 where students viewed Empa- The award-winning results of this experience, thy: Exploring Human Connection and then were we argue, invite a new design process, one that asked to consider the following questions: ‘‘If you integrates narrative inquiry with EBD. could know what patients and staff were seeing, thinking, and feeling, would you design their spaces differently?’’ Students had a 48-hr period Background and Context to explore responses to these questions by reflect- Cleveland Clinic’s1 YouTube 4.32-min video ing on ways healthcare influences specific patient Empathy: Exploring Human Connection has gen- or caregiver needs. Students were asked to pres- erated wide attention beyond the healthcare indus- ent their ideas through the words and images of try since its release on February 27, 2013, and has a story. Ideas from the charrette, shared with been viewed over 2 million times. A montage fea- healthcare and design specialists, showed imagi- turing over two dozen fleeting profiles captures a nation. Far from seeming forced, the students’ range of hospital experiences through deeply per- first attempt at design storytelling seemed ener- sonal and impactful vignettes. An accident victim gizing. The narrative structure not only allowed 132 Health Environments Research & Design Journal 9(2) students to enter into the world of patients, family a tool for inspiring creative ideas during the members, and caregivers but also helped them design process, but during the midpoint and final conceptualize the experience of moving through project reviews each team shared their designs space, paralleling the narrative unfolding of a using first-person voice-overs narrating the story’s beginning, middle, and end point. This experiences with the space as corresponding temporal focus encouraged the active consider- images of the design appeared to the design jury. ation of movement through space in ways that Narratives offered a new way to communicate seemed to support patient-centered design. design ideas. Design storytelling engaged the out- side specialists who responded to the student The narrative structure not only work. The end goal of the narrative was not to allowed students to enter into the world write publishable but rather authentic stories rein- of patients, family members, and forced by EBD literature. Again the ‘‘first-per- caregivers but also helped them son’’ narrative humanized the design and conceptualize the experience of moving seemed to motivate the student teams and through space, paralleling the narrative heighten empathy in ways that led to sensitively unfolding of a story’s beginning, middle, designed, patient-centered spaces. and end point. This temporal focus encouraged the active consideration of movement through space in ways that Empathetic Design seemed to support patient-centered Empathy is well established as a critical charac- design. teristic for healthcare providers (Holloway & The creation of reality-based narratives Freshwater, 2007) but is a habit of mind that also necessitated secondary research and information should be established as a critical trait for the gathering throughout the course of the project. To designer. Tim Brown, affiliated with IDEO,3 collect story content, students talked with former defines design thinking as involving empathy, cancer survivors, family members, and caregivers integrative thinking, optimism, experimentalism, and engaged with cancer patients and other mem- and collaboration. According to Brown (2008), bers of the community in a local arts-in-medicine ‘‘By taking a ‘people first’ approach, design thin- program. Visiting cancer care
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