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Culture Shock At The Hospital
By Lynn Drover

For most of us, a trip to the doctor is a logistics challenge and somewhat stressful. Yet for almost half of the residents in the San Francisco Bay Area and other large population centers - which are filled with people who hail from other ethnic backgrounds or cultures -- any trip to an ordinary U.S. physician's office or medical center represents enormous culture shock.

At many facilities, an assortment of signage in different languages attempts to address some of these needs. But while merely dismal for most Americans, the style of healthcare delivery, wayfinding, and departmental organization, and even the furniture groupings and colors used in exam and patient rooms, can be offensive or downright terrifying for people of other cultures. Firmly entrenched in our "logical" Western European medical traditions, we fail to see how some of our most fundamental assumptions may offend or alienate huge numbers of people. When it comes to being welcoming and accessible to all people, we are not putting our money where our mouths are.

When I first began researching and designing interiors for acute care facilities in the San Francisco Bay Area several years ago, I spent some eye-opening time gathering information by simple observation. I was struck by what seemed to be wide cultural gaps between expectation and response of caregivers and patients.

There are large numbers of people from China, South Vietnam, Mexico, South America, the Middle East, Russia, Indonesia, Thailand, and elsewhere in the Bay Area. Many immigrants are successful, educated people who are behind much of a community's growth and welfare. Healthcare administrators and design professionals have slowly added "alternative treatment programs" and made strides in the past decade in humanizing institutional policies and spaces. But when I interviewed staff members, I found evidence of some fascinating (and only partially successful) attempts to accommodate cultural flexibility within inflexible surroundings.

• Contrary to the American norm of trying to "shield children from unpleasantness," children of other cultures are being calmly ushered into their coronary care-bound grandfather's room in quantity, forcing the unit's nurse manager to relax the visitation rules while sometimes raising the stress levels of staff members.
• In an OB-Birthing center, the traditional "candlelight dinner" for post-partum couples was dropped after it was found that for several cultures, it is more likely to be a female relative that accompanies the new mother, not the husband. Nurses scrambled to find semi-private space for the crowded and sometimes boisterous picnic feasts that accompany the celebration of a healthy birth for some Pacific Islanders.
• While on vacation in the American Southwest, I learned that, in order to attract more indigenous patients, a fairly progressive local hospital had designed a room around the cultural needs of the largest local tribe. Great idea, but unfortunately the attempt managed to offend nearly every other tribe in the Four Corners area.

Within the current noble trend to bring nature to healthcare environments, I also uncovered a few interesting divisions. While everyone seems to appreciate living greenery, sunlight, and water features, there are some issues.

• For some cultures, a single tiny, perfect plant or perfectly-oriented view window may be sufficient.
• For others, the very fact that there is a fourth wall cutting them off from the outside is uncomfortably claustrophobic.
• And for a few, "nature" means constant change and the right to customize your surroundings to suit you and your loved ones, which increases the scope of the nurses' workload.

While conducting multiple color tests and group presentations over the years, I've also learned that different cultures do not necessarily agree on which are the "appropriate" colors for particular uses.

• For many Asian cultures, our pristine, clean "hospital white" smocks may inadvertently be associated with death and traditional burial rituals.
• The color red, which Westerners often avoid because of its association with blood, can signify vitality, good luck, and many other beneficial and healing values.
• Although administrators will often automatically reject a color scheme that includes green because of associations with the American "institutional green" period, for most other cultures, green more than any other color signifies growth and hope!

In light of all this, I'd like to see us learn how to design healthcare environments not only for the insurance companies and the American With Disabilities Act, but also for the multi-cultural marketplace.

I'd also like to see broad acceptance of the idea that the incredible diversity of our country's population should be reflected throughout all our medical practices - not just alternative healing referrals, but even in the way we address or welcome a patient to and through a facility.

We need to look at what the fundamental similarities are that we can safely build on, while tweaking our approach to meet local demographics. And, while struggling with the increasing capital squeeze, how can we create cost-effective solutions that really serve the actual patients, whoever they are?

Lynn Drover is a designer with the SmithGroup in San Francisco, Calif. Her past design experience with corporate and retail clients has served to underline the importance of "knowing your client base." Contact Lynn at tel. 415.365.3461, or e-mail ldrover@sf.smithgroup.com.