Jessica Helfand | Essays

Code (PMS) Blue

A bout with a nasty flu sent me to the hospital for a chest x-ray last week, which, beyond the x-ray itself, involved nearly six hours spent alone in a small waiting room. As a working mother of two small children, it is rare that I spend any time alone, so the irony of this brief exercise in imposed isolation was not lost on me. Shelter magazines, long expired, did little to appease my boredom, and so, as my fever pitched and my delirium increased, I was left to ponder things like life and death (my own) and, of course, design — which in the case of the examination room in which I now found myself, evidenced itself in the paucity of anything even remotely resembling design.

I have had several hospital experiences over the past decade, and each has impressed upon me the scarcity of good design in the interest of public health. When my first child was born, I spent the early post-partum hours in a typical recovery room, with other new mothers. Exhausted and semi-conscious, my peripheral awareness of a sort of beige abyss was occasionally punctuated by explosions of extreme color. Later, I realized I'd been sharing my room with an Indian woman, whose aunties — clad in colorful saris — had drifted in and out of the room while I was slowly regaining consciousness. But this was nothing compared to the visual excess I experienced a day later, when I was moved to The Christie Brinkley Room: yes, the supermodel's birth experience at this particular hospital had been so positive, that she'd sent her decorator to re-do one of the rooms on the maternity ward, complete with ceiling frescoes, chintz curtains and a host of matching upholstery variations.

Several years later, I spent 33 days in an intensive care unit of a major metropolitan hospital with my mother who was, at the time, fighting for her life. I emerged from this vigil a little more conscious, and certainly more appreciative, of the heroic efforts of medical professionals and the technologies that serve them. But a part of me — the part that survived Christie Brinkley and sat waiting for those x-ray results last week — was surprised, even shocked at the lack of organization, the complete absence of a kind of coordinated visual context for such activity.

Hospital rooms are architectural oddities: they're all function with no form. To the extent that, in matters of critical care, timing is everything, why should it matter? Then again, why shouldn't it?

On a very basic level, hospitals are partial to monochromatic colors, which is itself hardly cause for alarm. But what can be said about the randomness of equipment, its placement, its relationship to the physician, to the patient, to the space itself? In my temporary confinement last week, I counted no less than nineteen different pieces of equipment, each serving its own designated purpose yet with no apparent regard for the other eighteen components sharing its six-by-six foot cell. From the electrocardiogram machine to the latex glove dispensers to the hanging stethoscopes to the signage, it was a study in visual chaos.

It is not hospital beautification that concerns me, but rather, the randomness with which the hospital examination room, as a microcosm of the hospital itself, seems destined to treat its patients. And as hospitals grow technologically, this problem repeats itself interminably. Computers are manufactured by different suppliers and rarely, it seems, based on any kind of consensus-based visual vocabulary. Simply put, this means that a physician entering a hospital room might be faced with as many as half a dozen different monitors, each displaying critical information in what is, effectively, a host of different languages. Blood pressure. Blood oxygen. Heart rate. Body temperature. The list is a lengthy one, and yet not only does each monitor read differently, each piece of hardware is configured differently, making for a series of visual displays that are, by their very nature, exceedingly complex. To the degree that design can simplify, or at least clarify, this seems like a no-brainer: where are the design teams working with hospital suppliers and administrators? Maybe they're out there, but from my brief encounters with hospitals, I've yet to see evidence suggesting design has a role of any such consequence in a hospital setting.

In closing, a disclaimer: I am not now nor have I ever been a medical professional. My comments are those of an occasional patient, a discriminating consumer, and a visual critic. It occurs to me that human beings have an uncanny ability to adjust to pretty much anything, even (and especially) poor design conditions. Moreover, the human psyche possesses a remarkable ability to overcome such conditions, as I noted only yesterday while I watched my son — the same child who spent his newborn hours surrounded by chintz — playing a video game in a local theatre lobby. He'd never played it, yet rose to the challenge with an innate sense of timing and button-pushing that resulted in serious bonus points. How did he know what to do, where to look, when to click? "Mommy," he replied with no shortage of exasperation, "I know video games." I suppose this is how doctors must feel when they enter a room with eighteen different monitors: after all, they know medicine, and besides, there is nothing in the Hippocratic oath that requires them to know design.

Designers, on the other hand, have no such oath. And frankly, no such excuse.

Posted in: Product Design, Theory + Criticism

Comments [17]

As I read this, the first visuals that came to mind - besides the old Shape magazines - are all the award winning entries in the Equipment category in I.D.'s Design Annuals. As stand-alone pieces they excite the imagination like any good sci-fi movie, specially when they are professionally photographed with dramatic shadows and lighting. You look at these things and it is impossible to not go - in the best Keanu Reeves voice - Whoah. However, in the context of an hospital... boy, do they look sterile. I guess it must be nearly impossible to transcend the uninviting, unappealing, unnerving stigma of hospitals - regardless of good or bad design. (Not that that should be an excuse, but...).

And I could definitely use, say, the latest issue of Print or Eye in the waiting room.

I thought of that while writing this — about the range of impressive product designs for specific medical uses often featured in magazines like ID — but in my experience these have yet to migrate into everyday use. (Maybe it's a testament to my own good health that my hospital visits haven't been frequent — or for that matter, serious— enough to actually witness any of these devices first-hand.) Meanwhile, my civillian experience of the typical hospital room remains rooted in messy incoherence: it's a visual no-man's-land. You'd think there'd be something between chaotic beige sprawl and sci-fi streamlining, wouldn't you?
Jessica Helfand

Your experience is certainly true for the large, general-purpose hospitals. But look around at the growing industry of special-purpose hospitals, surgery centers, cardio-speciality hospitals, and even plastic surgery centers. Often, these places are set up by wealthy specialist practicioners for select sets of clients, usually focussing on procedures people happily pay for (like bigger boobs) or which insurance companies always pay for (like angioplasty).

Very often, these places are acutely aware of architectural appeal, design, marketing and branding, and go to great lengths to make their buildings (and websites!) appealing and attractive; often more like salons than hospitals. There was a good NPR piece on this the other day.

Of course, it's not too surprising that wealthy succesful doctors may pay a lot of attention to design when they build the profitable medical practices of their dreams. Likewise, it's not surprising that the average hospital, which is probably cutting back on costs any way possible, doesn't. Jessica, I think the gulf you see between "chaotic beige sprawl" and "sci-fi streamlining" is due to exactly this.

SIX hours for a medical appointment? I'm surprised this essay isn't angrier.

Sounds like the hospital management could use some systems efficiency and customer satisfaction teams, too.


"It occurs to me that human beings have an uncanny ability to adjust to pretty much anything."

Does this mean that our occupations are disabling in some ways? If a designer cannot adjust to (or ignore) poor design conditions, is this a curse? If an aspiring writer can't help but become fixated on a grammatical error in a love letter, is this a curse? If a musician can't help but deride the technical merits of the music his child listens to, is this a curse? Is this an inability to adjust?

I guess it depends on how we handle these observations.

BTW, hope you are feeling better.

Five years ago this month I sat in a particularly ugly hospital room in Fountain Valley, California with my exhausted wife and hours-old son sleeping while the television droned on in the background, providing a source of white noise for my wife to snooze to. I'd brought a bag of magazines with me, customary practice since I've had the attention span of a gnat since childhood.

When I say particularly ugly I mean that it was the first time I'd been in a hospital room and taken a look around. Most visits to hospital rooms in the past had involved seeing loved ones in various states of disrepair and I was never in mind of examining the ergonomics of the equipment or surveying the interior decoration. This time, however, my wife's delivery of our newborn son having gone well, I was not in a tense or grief-stricken state, and I took a look around us. Ugly walls, ugly wood, ugly windows. Hmph.

Somehow, though, the glow of being around my wife and son sleeping so peacefully enveloped me. I looked to my left and noticed lettering on the sheets my wife was wrapped in spelled the word "Angelic." (The hospital's linen service was Anglelica.) I took out my black book, sketched the scene, and thought not one more minute about the hardware and hospital green on the walls around us, only the basking in the sense of warmth and belonging that surrounded the three of us.

The december issue of blueprint magazine had an interesting article about a dentist who designed his whole surgery, the architecture, layout etc. Might be of some interest to you. If you can't get a copy of the magazine I might be able to scan the article or something.
George Morgan

Seven or eight years ago, I spent a night that lasted until dawn outside the emergency room of a suburban hospital where a close relative was near death. Years later, I remember every detail of that room, especially the clunk-BANG of an automatic door that was activated every time a doctor or nurse came to give us an update (usually a bad one). Confronting mortality really does make perception almost painfully acute: I can still hear that door today.
Michael Bierut

I vote for the adaptation option. Seems that it's just plain more realistic to always be prepared to do a scan of the room you're going into and find the stuff you're looking for than to expect everyone to clean up after themselves and put everything back in its place, every time.

Maybe ask the Push Fluids people?

Interesting article. Maybe it's just me, but was it necessary to compare the Indian women's ("auntie's") saris to visual excess and Christie Brinkley's birthing room? I don't feel that it was needed to malign (albeit veiled) another's rich traditions to illustrate your point.

I think it's just you. Indian women regularly cover themselves neck-to-toe in hot pink, mango and turquoise, with detailed patterns on top and gold highlights, sometimes all at once. And that's before you get into the matter of how to tie the thing(two, with images: [1], [2]). Yes, there are also much simpler designs, but it's still not Jill Sander. Given Jessica's condition at the time, I'm not surprised a bunch of Indian women would recall as a mass of color.
It's a colorful culture, to the degree that many others would see as garishness. Have you ever watched a group of teenagers ambushing each other in high school hallways for Holi(results here), or been to a Garba dance in full swing? It's gorgeous, yes, but I don't think anyone has any illusions about it not being visually loud.

It was never my intention to malign anyone, and apologies if that's what you interpreted. Au contraire: my memories of those vivid colors drifting in and out of my room is one of the happier recollections of my recovery. (Hospital administrators, take note!)
Jessica Helfand

Having just spent the last three hours in the new ER of one of main teaching hospitals, I was struck by the obvious attention paid to the central layout of the space. The nurses' station was situated in the middle of the room (didn't have time to note the equipment layout) and was surrounded by all the patient 'rooms'. The place was bright, clean, sterile but not overly institutional in feel. Probably, if I had to place a feeling from the visuals, it would be more hi-tech, state-of-the-art care.

The patient 'rooms' were another story. I felt I been shuttered in a cave far apart from the bright hi-tech center from which I'd been ushered through. Things seemed randomly placed, especially the garbage can right next to the guest chair. (Of course, one could move the chair but I thought it would have made more sense to have the trash can next to sink on the other side of the room.) The best design element had to have been the sink itself. The faucet, much like in an operating suite, was controlled by equivalent pedals on the floor. But other things, to my untrained eye, seemed more randomly placed. And the design certainly made no attempts to address patient comfort.

Looking at the IDEO presentation that Ms. Helfand shared, I noted that the words 'patient comfort' never appear. Since I'm venturing in territory I have extremely limited knowledge of, is it off-base to think that the design of surgical equipment should take both the surgeon's and the patient's comfort into account?

Clearly, hospitals have come along way in many instances of making patients more comfortable. One, which has been pointed out, is the utter redesign of birthing suites in most major hospitals. These rooms are designed to look more like a room at home than a hospital room. They are large, bright and designed with the sense of making the mother-to-be and family as comfortable as possible. (Two kids later, my only complaint is the chairs that dads have to sleep on).

So, if the maternity award can do it (driven of course by competition) maybe the ER won't be too far behind.


Having spent 4 months at UCI medical center (Orange, CA) with my wife, who was a patient, I have to say that the most memorable thing was the constant beeping as alarms on the monitors went off. The nurses are able to tune them out completely. On the other hand, the patient or their family is looking at a blinking red light with the word "alarm" printed under it. The natural reaction leans towards panic. Semi-panicing patient or friend tells nurse - nurse reacts like you just told her that her scrubs make her/him look fat. Now you are on the "annoying" list, insuring that you get even less attention than you originally did.

Having spent most of my early childhood in the hospital with kidney problems I have seen my fair share of hospitals, the good the bad, and mostly the ugly. But with that out of the way, I now work at the largest healthcare design firms in the world. With over 700 employees and over 60% of our projects being those of designing hospitals i can say that i see my fair share of hospitals in my professional life.

I think before you can be critical of the design of hospitals and sometimes the lack of, you have to remember the atmosphere that surrounds healthcare, lawsuits a plenty, more regulations than you can shake a stick at, and lack of funding.

Believe it or not, there are reasons behind placement of equipment and other functions of the space. If you don't believe that there are hospitals that are attractive feel free to take a look at these images (all projects we have recently completed)[1], [2]

Just try to remember that you pay for all of these slick amenities, so when/if you complain about how much your hospital bill is it might be that herman miller office furniture all over the hospital that had something to do with it. I hope i don't come across as aggressive but with a fiancee in med school and a father in law who is a doctor, it is very difficult to hear comments that take the sacrifices that doctors give for their patients for granted.

Hope you are feeling better

The one thing I've always thought was an ignored opportunity for patient-oriented design attention is the ceiling of dentists offices and hospital rooms. As a patient, you spend a great deal of time, sometimes days at a time in severe situations, flat on your back and staring at stained acoustic tiles. Not exactly a sight that's condusive to recovery.
Nathan Skreslet

The concept already has been used in children's hospitals in the Philadelphia and Wilmington areas. Unfortunately, I am not certain the execution of that concept that I've been exposed to aids or hinders the healing process...it certainly offers some distraction from more serious matters.
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