The places we live, the streets we walk, and the roofs under which we gather are containers for human experiences. But physical spaces — and the often-complicated histories they hold — also have the power to shape those experiences and the outcomes they enable.

And this notion is especially true in the world of healthcare.

The team at St. Paul’s Hospital, an acute care and applied research hospital in Saskatoon, Saskatchewan, wanted to create a more inclusive hospital environment by listening to and working with healthcare seekers (patients, families, and members of the broader community) who have historically been marginalized by the healthcare system, particularly Indigenous peoples and newcomers to Canada.

St. Paul’s wanted to understand healthcare seekers’ overall experiences, and how these experiences were informed by the hospital’s physical features and the interpersonal interactions held within its walls.

As the first meeting place between people seeking care and the hospital, St. Paul’s set out to redesign its entrance experience.

To kick-off the entrance redesign project in 2021, St. Paul’s Hospital partnered with Coeuraj. Our team worked closely with St. Paul’s staff, leadership, a patient/family partner, and key departments from the Saskatchewan Health Authority, including First Nations and Métis Health Services providers and Elders, to deliver a community-focused engagement plan rooted in the hospital’s vision to steward compassionate healthcare and ensure dignity, integrity, and respect for all. This engagement plan was the engine behind a final report of recommendations and a beautifully designed synthesis map that informed a material redesign of the hospital entryway and highlighted the need for broader changes within hospital policies, roles, responsibilities, and organizational culture.

Transformation requires an approach that is as human centered as it is rigorous.

Redesigning a space requires gathering feedback from the people who interact with it the most. Transforming the system behind the space, and its embedded attitudes, perspectives, and experiences, requires these voices to share in conversation, together.

Over a nine-month timeline, we invited over 160 participants made up of hospital staff, healthcare seekers and their families, community members, and leaders of local organizations to engage in dialogue and safely share their experiences of the hospital. We met people where they were at, which meant that we facilitated art-based exercises in community and online, set up tables in community spaces where we had delicious sandwiches and great conversations, and co-created research tools with participants. Their voices were at the centre of one-on-one interviews, surveys, focus groups, and interactive exercises. Community connection, culture, and ceremony energized this work from start to finish.

At each touch point we learned something about participant experiences and our process, and these learnings continually informed how we approached the next stages of our work. Not only would participant recommendations shape an inclusive redesign of the entrance experience, the process of getting there helped to build trust among a diverse group of people and a new kind of relationship with the hospital.

To build trust and confidence, St. Paul’s collaborated with a diverse group of community members, care providers, and other regional stakeholders to redesign not just an entryway, but a system of experiences.

Today, St. Paul’s continues to mobilize around the set of recommendations provided in the report to transform the hospital from being viewed as a “big building on the hill” and become an integrated, inclusive fixture within the community.

Outside of advancing the physical redesign of the hospital entrance, St Paul’s has begun to develop educational resources to increase staff’s understanding of the diverse communities with whom they work and the land on which they live, as well as embedding report recommendations into team accountability plans and establishing a working group to recognize key dates. These recommendations now support the hospital’s approach to care and delivery of services in a holistic way.

Report recommendations will also influence the broader Saskatchewan Health Authority’s plans in a collective commitment to address systemic problems that affect community members’ experiences when accessing healthcare.

While this work for St Paul’s Hospital and its broader network continues, this project has shown that holding space for different types of conversations is necessary if a truly collaborative process is desired and transforming a complex system is the long-term goal.

"Coeuraj supported our team to co-create a model that would collect meaningful and actionable feedback regarding the experience people have entering our hospital. This included capturing the experience of those that work in the front end of the hospital. Coeuraj was able to develop and implement appropriate means to engage employee teams and the geographic community in a productive, creative and culturally responsive manner. The recommendations from this report are already providing the guidance we need to improve the experience of health seekers!"

- Tracy Muggli, Executive Director, St. Paul's Hospital