There are a lot of people who make a great healthcare experience happen. Nurses are the eyes and ears, the workhorse and the expert, and the heart and soul of the healthcare industry.

People know this; ask anyone with a healthcare experience of any kind – on the patient or medical staff side – about who makes the wheels turn in the healthcare environment, who spends the most face-time with patients and can answer medical questions and can connect doctors and other medical staff with patients and family members, and they’ll tell you their nurse does all of the above.
“Nurses as Leaders in Healthcare Design: A Resource for Nurses and Interprofessional Partners” is a joint venture by Herman Miller and the Nursing Institute for Healthcare Design (NIHD).
The book marks a time in healthcare design when nurses are contributing invaluable assets to the planning and design of healthcare facilities. Nurses are becoming more closely integrated into the design process, and the genesis of this new book lies in the need for a resource that helps “leaders tap into one of the most underutilized resources in the planning and design of clinical environments: the nurses.”
The book, co-authored by more than 20 nurse and design professionals, was conceived in late November 2013, took just nine short months to write, and was released to the public in 2015. In it, the contributors dive into a wide range of topics, all approached with the uniting thread of the nurse’s perspective.
“It’s truly the product of a collaboration between entities that neither entity could accomplish alone,” says Kathy Okland, RN, MPH, NA,EDAC, a senior healthcare consultant, past president of NIHD, and nurse. Ms. Okland co-edited the book alongside Jaynelle Stichler, professor emerita at San Diego State University, research consultant for Sharp Metro Campus, and co-editor of HERD Journal. “We wanted to create something meaningful – not only a toolkit for many audiences, but also a curriculum that people can learn and work from.”
After establishing a set of design principles of which to work from, the authors provide readers with a historical overview – a chronology – of the nurse’s domain. While this is true, formally involving nurses in the design conversation is an emerging discipline.
“It’s amazing how much nurses have played a role in shaping the healthcare industry over time,” said Ms. Okland.
Then, the book works its way through a group of key influencers – areas of healthcare design that can vastly improve when considered through the lens of nursing expertise. At the top of that list is a full chapter on innovation, titled “Nurse Led Innovation in Healthcare Design.”

Perhaps the most cited and well publicized of these new design philosophies is the focus on Labor, Delivery, Recovery and Postpartum (LDRP) facilities. Trends like softer colors and more residential themes in the healthcare setting all started in LDRP. But, the adjustments go deeper than that.
“It was a nurse that first said that these things functions – labor, delivery postpartum care and recovery for returning home – should all be occurring in one inclusive space if we really want to provide holistic care. It can be jarring for patients to shift from room to room during their care experience, and nurses saw that. This wasn’t the architect who imagined this. It’s the nurse at the bedside.”
Where the book really proves its worth is when it tackles less publicized, more practical areas of concern. The authors devote a full chapter to designing for the tools nurses need to do their jobs, including operations planning techniques. For example, supplies account for 30% of an operational budget, but Ms. Okland notes a lack of research on how best to accommodate those supplies so that nurses and other medical staff can best do their jobs.
The new book highlights the lack of end user involvement, surveying and research in healthcare design projects – and shows its audience the benefits of doing so, as well as how to solve the problem.
Ms. Okland attributes the failure of the healthcare design field to involve their projects’ end users – both patients and medical and admin staff – in the design process, to the complexity and limitations of the spaces being created. Focus groups of end users are becoming more popular, but the healthcare design field still suffers from an absence of pre- and post-occupancy surveys in healthcare design projects.
“There are significant health, safety and potential of exposure risks all along the way. And many individuals feel they need to control the design planning in a way that often excludes valuable input because it can complicate the planning process and prolong it.
“But we find that involving end users early-on reduces change orders down the road, just as it does in other markets.”
Using end user input and measuring ROI through post-occupancy surveying seems like common sense, but it’s not a given in healthcare design. Despite health organizations spending billions of dollars on new facilities, many of them major capital expenses with high-end quality level, the evidence and the research aren’t currently available to support design.
To address this concern, the new book dedicates an entire chapter to the nursing influence on post-occupancy evaluations.
“Turnover at the executive level is at the highest it’s ever been, so continuity is a big issue. Every project begins with guiding principles. You need to sit down and define, philosophically and practically, what needs to be non-negotiable. And then, you need to keep coming back to those non-negotiables over and over. There has to be a strong, well established design intent.”
There’s a lot of progress still to be made in developing an inclusive planning and design atmosphere in healthcare design, but Herman Miller’s new book is a great starting point.
“Nurses are at the center of care,” says Ms. Okland. “We are the only constant in the care-giving experience. We need to provide the climate and conditions in our field to give people like this a voice in the design process, and to continue adding to research and evidence-based practices.”
The new book is available for free through the Herman Miller website – just click the link, fill out the form, and they’ll pop one in the mail for you. We encourage you to do so!