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How Brigham & Women’s Hospital responded to the threat of COVID-19 with Senior Architect Planner, Andrew Shinn

See our interview with Andrew Shinn, Senior Architect Planner at Brigham & Women’s Hospital, one of Harvard’s largest teaching hospitals below. Andrew discussed how the Brigham prepared for CV19 and the operational changes they made to tackle these challenges.

How did Brigham & Women’s Hospital prepare for COVID-19 once it started to become apparent how serious the crisis was going to be?

We got ourselves prepared early on as we’re getting ready for a big wave, we did a lot of operational planning to figure out how many hundreds if not thousands of patients we would need to see in the city of Boston and that was coordinated effort with our system and city and government officials.

How many operational changes did you make within the hospital?

We did a lot of what amounted to temporary relocations. Our inpatient units that were set up for cardiology, and cardiovascular services, and even some orthopedic services- we almost overnight were able to turn those into an ICU level of space where we had negative pressure rooms and physicians teams ready to handle the sudden increase of patients.

What pressure was there on the hospital and the wider City of Boston at the height of the crisis?

We saw a gradual increase day by day and thankfully we were in a place of being overplanned which was a better place to be for sure. So we ended up seeing a few hundred patients here concurrently and most of those were in critical care status. The pressure was eased slightly, mostly because we were able to set up a convention centre here in Boston with a thousand beds that were able to take a lot of the acute care, not quite ICU level critical care, but they were able to take a lot of patients into that facility. That was known as Boston Hope, and that was able to help there. There was a very concerted effort to get ourselves ready.

How has the delivery of healthcare changed as a result of the crisis?

From a technology point of view, it has been absolutely amazing to see the thousands of patient visits we are able to do virtually. We were doing some virtual care before COVID, but now it’s the norm and it’s the first point of contact and then we’re starting to bring more patients back on site, which is now very important because elective surgeries and such are going to be starting again soon. On the ambulatory care front, I don’t think we’re ever going to go back to the way we were entirely. Because there are too many advantages to patients that we really don’t think we will be overlooking that. And when your vsit does happen at the hospital it may in fact be more integrated, with multiple services seeing the patient at the same time. More so then we used to. That’s a snapshot of where we are spatially.

How was wayfinding used to tackle the challenges you were facing concerning COVID-19?

One of the first things that happened with wayfinding was that we changed how staff and patients entered our facilities. We’re a big inner city urban campus and they’re quite porous, and we have a lot of entrances, so we promptly closed several entrances to patients and said these are for staff so that we can screen everybody and check for symptoms. So we have this whole attestation process we do everyday. And If you’re a patient you would also do a screening where a staffer at the door would ask you some questions and we wanted that to be reflected in our wayfinding so you would go to the right entrance rather than one you couldn’t get in. It was Monica at Purple who reached out and said “hey do you want us to update your entrances? I bet you’ve had some changes.” And she was right and we did. In a matter of minutes it appears we were able to reflect accurately where patients could come into the facility. For safety reasons there needed to be a very controlled entry point.

How do you see wayfinding playing a future role in managing the crisis?

Initially we didn’t want to be too overt with our wayfinding and that patients who were coming in were all being told quite eloquently where and how to go, stay in your car and the test will actually be done from the window of your car. Some of that has passed and we can consider some wayfinding to our remote testing site and talking with Purple further to discuss some of the other use cases that they have experienced.

What surprised you most about your use of wayfinding during the crisis?

Our wayfinding has been very helpful for our staff during this time, totally unanticipated. We have a lot of staff who are of course on the front line and having to experience a lot of issues with people sadly passing away because of COVID. We have stood up several new respite or wellness rooms throughout the facility by converting offices, just a room with a comfortable recliner and music and artwork to relax and process – or mourn. So we put these wellness rooms into our wayfinding so staff can easily find them and I’ll conclude there.

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