Upper LobbyArchitectural design for improved health care delivery
Upper LobbyArchitectural design for improved health care delivery
Can architectural design impact healthcare delivery?
A 1984 study published in Science changed the way architects design healthcare spaces. View through a window may influence recovery from surgery demonstrated that post-operative patients assigned to a room with a window view of a nature setting had shorter hospital stays, took fewer analgesics and received fewer negative evaluative comments in nurses’ notes. This marked the advent of Evidence-Based Design (EBD), now standard practice in health facility design. Analogous to how physicians utilize evidence in making decisions about individual patient care, architects now base their decisions about the built environment on research to achieve the best possible outcomes. This represents a major shift from basing design decisions solely on tradition or opinion.
EBD research has demonstrated that design interventions can impact patient outcomes by decreasing iatrogenic infections, medical errors, and length of hospitalization. There is a business case to be made with ongoing operating savings when the market share impact of EBD interventions is realized. Benefits to clinicians have been documented with respect to improved satisfaction, communication, and teamwork. Studies confirm behavioural and psychological benefits of nursing unit design concerning the delivery of patient care- specifically in reduced walking time, better utilization and satisfaction. Within the critical care setting, physical and visual accessibilities can affect patient outcomes in severely ill patients, who may experience higher mortality rates when assigned to rooms not easily visible from the central nursing station. What is the model for architects and clinicians to work together towards a common goal of evidence-based practice?
How might we re-envision the hospital going forward?
Despite this shift towards an evidence-based practice, healthcare architecture has remained similar for decades. Hospital activist Dr. Leland Kaiser stated that “The hospital is a human invention and as such can be reinvented any time.” Although the hospital is meant to be a place of recovery, healthcare has not always been designed with the needs of the patient in mind. Hospitalization can often result in complications unrelated to the problem that caused admission, followed by an irreversible decline in functional status and quality of life. Certain aspects of hospital design can contribute to this decline. Although there is no therapeutic value to bed rest, patient rooms still remain focused around the bed. How can we re-envision design so that the bed is not the focal point of care, shifting the focus to encourage early patient mobility?
Design guidelines now set minimum standards for single-patient hospital rooms given evidence for improved privacy, infection control, and quality of care. However, design must find a balance between privacy and easy physical and visual accessibilities. Research has demonstrated that certain room layouts are more conducive to clinician interactions and therefore improved communication and teamwork. We should begin to question whether a one-size-fits-all model for the hospital room is adequate for all patients.
It may be time to disrupt our current design thinking and reinvent best practice trends. Architects are considering ways for hospital corridors to transition towards dynamic areas of physical therapy, multidisciplinary rounding, and family discussions. How we design and utilize circulation space is changing. The “on-stage/off-stage” model, inspired by Disney, allows guests to enjoy their stay at the theme park and never run across workers doing maintenance or characters without their costumes. This concept is now seen in newer hospitals where the design separates public and staff circulation paths. While medicine has moved towards the patient as the advocate of their own healthcare, with clinicians providing expertise to aid in their decision-making, design is moving to provide a separation. Should the built environment separate clinicians from patients when the clinical model is trying to promote physician-patient interaction?
Can we leverage architectural design to solve healthcare challenges?
Despite the inclusion of clinicians into the design and construction process through workshops and participation in full-scale mock-up spaces, there still remains some disconnect between the initial vision of those who design the hospital and final clinical use of the space. An example of the architecture-medicine disconnect can be seen with the examination room configuration. Medical students are taught to examine patients from the right-hand side of the body, enabling comfortable measurement of various anatomical landmarks. Nevertheless, physicians frequently enter spaces with layouts that do not permit this right-sided access, as architects are generally unaware of this convention. Designers can walk the halls and talk to clinicians, but it can be challenging to learn the intricacies of a particular profession and its details of practice. Opportunities are still lacking for designers to shadow clinicians, allowing a deeper understanding of healthcare delivery.
The hybrid dochitect model represents a way to find common ground between clinicians and architects- a first step in bridging this gap. This provides a unique opportunity for architects to experience the world of medicine from a perspective that is typically hidden and allows physicians to understand how design can create a context for participation. Hybrid professionals can provide integrated solutions which cross disciplines in new ways. By applying design-thinking to medicine, multidisciplinary approaches for solving current healthcare challenges can be developed.
Anderson, MD, M.Arch, is a licensed architect (Order of Architects of Quebec,
Royal Architectural Institute of Canada Member) and a physician trained in
Internal Medicine (Columbia University Medical Center/New York-Presbyterian
Hospital). Dr. Anderson is a past recipient of the AIA Arthur Tuttle Jr.
Graduate Fellowship in Health Facility Planning and Design, the Tradewell
Fellowship in healthcare design awarded by WHR Architects in Houston, Texas and
the immediate Past Chair of the Society of Critical Care Medicine’s ICU Design
Committee. As a "dochitect", Dr. Anderson combines educational and
professional experience in both medicine and architecture, in order to truly
understand the patient, visitor and clinical staff experience within the
healthcare environment. She has worked on hospital design projects within the
United States, Canada and Australia, specializing in medical planning of
inpatient units, specifically intensive care environments. Dr. Anderson is
currently a Medical Planner at Stantec Architecture in New York City.