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Case Study

Designing With Empathy: Humanizing Narratives for Inspired Healthcare 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-

bers, and caregivers, empathetic design contributes

to a holistic culture of care. We argue that narrative

inquiry—giving insight into the thoughts, feelings,

and experiences of others—can and should inform

1 University of Florida, Gainesville, FL, USA

Corresponding Author:

Candy Carmel-Gilfilen, MArch, University of Florida, 334

Architecture Building, Gainesville, FL 32611, USA.

Email: [email protected]

Health Environments Research & Design Journal

2016, Vol. 9(2) 130-146 ª The Author(s) 2015

Reprints and permission: sagepub.com/journalsPermissions.nav

DOI: 10.1177/1937586715592633 herd.sagepub.com

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the design process and brings design solutions into

close alignment with the physical, emotional,

spiritual, and interpersonal needs of patients and

caregivers. Design, guided by personal narratives,

offers a myriad of opportunities to inspire the

healthcare experience.

We argue that narrative inquiry—giving

insight into the thoughts, feelings, and

experiences of others—can and should

inform the design process and brings

design solutions into close alignment with

the physical, emotional, spiritual, and

interpersonal needs of patients and

caregivers.

This article shares a new way of designing

empathetically for the whole person using narra-

tive inquiry. This approach offers a unique vehi-

cle to heighten compassion for people that can

be grounded in evidence-based design (EBD)

principles, thus linking the subjective personal

experience with objective ways of knowing. This

case study focuses on designing an outpatient

cancer care center using a narrative methodology

within a senior-level design studio. Within this

context, narrative inquiry became a vehicle for

students to explore multiple dimensions of empa-

thetic design from patient, family, and staff per-

spectives. This process involved exploring end

user experiences through three modes of story-

telling (i.e., verbal, written, and visual) to inspire

design thinking. Original narratives, told in first

person, situated the members of the design jury

within the ambulatory cancer care experience.

The award-winning results of this experience,

we argue, invite a new design process, one that

integrates narrative inquiry with EBD.

Background and Context

Cleveland Clinic’s1 YouTube 4.32-min video

Empathy: Exploring Human Connection has gen-

erated wide attention beyond the healthcare indus-

try since its release on February 27, 2013, and has

been viewed over 2 million times. A montage fea-

turing over two dozen fleeting profiles captures a

range of hospital experiences through deeply per-

sonal and impactful vignettes. An accident victim

in a body cast wills himself to be at his daughter’s

wedding scheduled a few days later. A man spends

3 hr in a waiting room. A new mother in a neonatal

intensive care unit wonders when she will be able

to take her daughter home. A doctor reflects on

being cancer free for 7 years. The viewing audi-

ence of Empathy sees the thoughts and feelings

of patients, family members, and caregivers.

Patients become more than ‘‘end users.’’ They are

mothers, fathers, sons, husbands, or wives. They

are single, married, or divorced. Their stories

involve receiving life-altering diagnosis, tolerating

the prosaic frustrations of testing and receiving

treatment, and experiencing a moment of happi-

ness or feelings of relief.

As the inner worlds of the patients, family

members, and caregivers build to a crescendo,

empathy ends with a single question, ‘‘If you

could stand in someone else’s shoes . . . Hear what they hear. See what they see. Feel what they

feel. Would you treat them differently?’’

Clearly the answer is yes and ‘‘empathy takes

on a new dimension in a hospital, where there is

the push and pull of health and sickness, and

where giving and receiving care happens every

day’’ (Cleveland Clinic, 2014). Designers and

design educators play a critical role in creating

empathetic healthcare environments. Empathy:

Exploring Human Connection inspired us and

reinforced the power of narratives to capture

human experience in ways that could be particu-

larly useful for designing interior spaces (Dohr &

Portillo, 2011; Portillo, 2000).

The project profiled in this article began with a

design charrette2 where students viewed Empa-

thy: Exploring Human Connection and then were

asked to consider the following questions: ‘‘If you

could know what patients and staff were seeing,

thinking, and feeling, would you design their

spaces differently?’’ Students had a 48-hr period

to explore responses to these questions by reflect-

ing on ways healthcare influences specific patient

or caregiver needs. Students were asked to pres-

ent their ideas through the words and images of

a story. Ideas from the charrette, shared with

healthcare and design specialists, showed imagi-

nation. Far from seeming forced, the students’

first attempt at design storytelling seemed ener-

gizing. The narrative structure not only allowed

Carmel-Gilfilen and Portillo 131

students to enter into the world of patients, family

members, and caregivers but also helped them

conceptualize the experience of moving through

space, paralleling the narrative unfolding of a

story’s beginning, middle, and end point. This

temporal focus encouraged the active consider-

ation of movement through space in ways that

seemed to support patient-centered design.

The narrative structure not only

allowed students to enter into the world

of patients, family members, and

caregivers but also helped them

conceptualize the experience of moving

through space, paralleling the narrative

unfolding of a story’s beginning, middle,

and end point. This temporal focus

encouraged the active consideration of

movement through space in ways that

seemed to support patient-centered

design.

The creation of reality-based narratives

necessitated secondary research and information

gathering throughout the course of the project. To

collect story content, students talked with former

cancer survivors, family members, and caregivers

and engaged with cancer patients and other mem-

bers of the community in a local arts-in-medicine

program. Visiting cancer care centers and other

related healthcare facilities led to a better aware-

ness of precedents and generated fresh insights.

Another indispensable source of material (and

potential for story content) came from students

gaining a working knowledge of related scholarly