| The Human Factor |
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IIDA and AIA leaders promote healthcare facilities that focus on patients, rather than technology and equipment.
By David Whitemyer
It should go without saying that
hospital designs always
keep the patient in mind.
But around the world, an
aging fleet of stoic post-
World War II and '70s era
hospitals point to the
fact that, historically,
healthcare facilities have
been designed to accommodate
medical equipment
and building
mechanics - not people.
Fortunately, in a recent
paradigm shift, consideration
of the human factor in
healing environments has
changed the way hospitals
are planned. Interior
designers and architects
have embraced the concept
of patient-centered
care, a term coined in the
latter part of the 20th
century. What used to be
sterile, bland, clinical environments
are morphing
into warm, welcoming,
user-friendly spaces.
In a study published by
The Commonwealth Fund,
a New York-based foundation
that supports health
systems, the quality of the physical environment was
noted as "one of the most
important factors contributing
to patient-centered
care." Consequently, a
boom in hospital construction
- one that is
expected to reach $20 billion
a year by 2010 - is
fostering the replacement
of facilities that treat
healthcare as an assembly
line process with those
that provide patients a
sense of safety, comfort
and dignity. That evolution
is not only on track, but
now seen as a design
imperative.
THE PROOF IS IN
THE PUDDING
Following on the heels of
evidence-based medicine,
interior designers and
architects are incorporating
evidence-based design
- supported by studies, as well as pre- and post-occupancy
evaluations -
into the planning of
healthcare facilities.
A mounting body of
data shows design features
that respect patients,
are inviting and comforting,
and encourage family
involvement result in
improved patient outcomes.
In 2004, research
teams from Texas A&M
University and Georgia
Institute of Technology
unveiled a watershed
report, "The Role of the
Physical Environment in
the Hospital of the 21st
Century," detailing the
combined work of more
than 600 studies and
thousands of scientific
articles. Among the myriad
findings was evidence that
daylight helps reduce hospital
stays, single-patient
rooms reduce infection rates and way-finding
systems increase patient
satisfaction.
Champions of the
cause are now promoting
the evidence and working
to convince hospital
boards of the healing and
financial benefits of
patient-centered facilities.
Planetree, a Derby, Conn.-
based nonprofit healthcare
organization, advocates a
philosophy that encourages
healing through
patient empowerment. It
emphasizes the importance
of Interior Design
and architecture in the
healing process, and has
set up a designation program
that currently
includes 97 U.S. hospitals.
Surveys completed
in the early '90s showed
patients of Planetree hospitals
had higher satisfaction
rates than those of
non-designated facilities.
Other stalwart advocates
for improving
patient care through
well-designed environments
include the Picker
Institute, the Institute for
Family-Centered Care
and the Center for Health
Design (CHD). In 2000,
CHD launched the Pebble
Project, which measures
hospital performance and
aims to spread the word
about "healthcare organizations
whose facility design has made a difference
in the quality of care."
A SOOTHING STAY
A major move toward
patient-centered care is the
increased number of singlepatient
rooms, says Peter
Bardwell, FAIA, President
of The American Institute
of Architects' Academy
of Architecture for Health
and Principal at Columbus,
Ohio-based Bardwell +
Associates. In fact, The
Guidelines for Design and
Construction of Health
Care Facilities, a bible of
sorts for hospital designers,
was revised within the
last two years to recommend
single-bed rooms
as the minimum standard
in certain types of healthcare facilities.
These new single-patient
rooms often feature
home-like aesthetics,
with fine bed linens and
custom cabinetry, while
also accommodating
state-of-the-art hospital
technologies. For example,
manufacturers have
created traditionallooking
bed headboards
that hide medical gas outlets.
In addition, designers
can draw from a huge
market of materials and
products to create a soothing
appearance that is also
easily cleaned.
Patient satisfaction
aside, Bardwell says
catalysts for single-patient
rooms include improved
infection control, adherence to patient privacy requirements
and sophisticated
portable equipment. "One
fundamental premise of
patient-centered care is
inverting the relationship
between patient and hospital,"
he says. Rather than
moving patients from the
bedroom to numerous
diagnostic, treatment and
lab areas, hospitals are
decentralizing and bringing
these things to the
patient, thanks in part to
the advent of portable
technologies.
"Transporting patients
takes up an inordinate
amount of staff time,"
Bardwell says. It also
increases contact with people
and, thereby, hospitalacquired
infection. "You're saving time and being
safer with single-patient
rooms," he says.
Also adding to the safety
of the patient is a movement
toward same-handed
rooms rather than mirrored
rooms. Mirrored
rooms, like in a hotel, are
designed efficiently around
a core of plumbing and
ventilation systems. Samehanded
rooms are oriented
such that equipment, outlets
and furnishings are
always located at the same
point around a patient bed.
"When seconds count,"
says Bardwell, "hospital
staff needs to know where
everything is." According
to a 1999 report by the
Washington, D.C.-based
Institute of Medicine, somewhere between
44,000 and 98,000 people
die each year because of
medical errors. Samesided
rooms help reduce
those errors.
Designers and architects
are also becoming
aware of the connection
between nature and healing
such that, where possible,
they incorporate patient
rooms with windows overlooking
green spaces, water
or other natural settings.
Even simulated nature
views seem to have a profound
impact on patients.
A 2003 study observing
blood donors in a waiting
room found blood pressure
levels and pulse to be lower
when a wall-mounted television
displayed nature images instead of typical
television programs.
BE OUR GUEST
One of the most noticeable
features in a patient-centered
room isn't for the
patient at all, but for his or
her guests. The single
backbreaking chair
wedged into a corner has
been replaced with a large
"family zone" that
includes comfortable seating
and flooring, a pullout
sofa and often a desk.
For overnight visitors, it's
a welcome retreat.
"The patient includes
the whole family," says
Linda Gabel, IIDA,
AAHID, Columbus, Ohio-based
Senior Associate
at NBBJ and IIDA's
Healthcare Forum Advisor.
"We need to design for
and treat the patient
holistically. We need to
accommodate the family
to reduce stress." Indeed,
studies have shown that
anxiety can suppress the
body's immune system,
lengthening the healing process or increasing the
possibility of infection. "If
the family is stressed,
then the patient will be
stressed worrying about
their family," Gabel says.
Apart from patient
rooms, newer healthcare
facilities have taken on the
air of four-star hotels.
Gabel points to NBBJ's
307,000-square-foot
Southwest Washington
Medical Center in
Vancouver, Wash., completed
in 2006. The lobby
houses a flower shop, café,
resource center, Internetready
plug-and-play kiosks
and pharmacy, and there's
a large fireplace and stagelike
space for musical performances
and holiday
events. "And instead of a
sea of sofas," Gabel says, "we've designed seating to
accommodate smaller
family gatherings."
Gabel also notes the
logistical hardship of having
a loved one hospitalized.
"You have to take time
off of work, but you still
have to get work done," she
says. As a result, wireless
Internet access and workspaces
are featured in
many lobbies to make visiting
more convenient.
Of course, in addition
to accommodating visitors,
there's a positive
marketing aspect to these
design changes. Offering
numerous amenities in a
healthcare setting
attracts families who
must select a hospital.
"Consumers now come
with high expectations of what they want in their
hospital," says Laurie
Waggener, IIDA, AAHID,
Vice President at Dallas-based
design firm HKS.
They're not just looking for
quality care. "They're looking
for information, service
and hope," she says. And
quality design can help
hospitals provide those.
HUMAN-CENTERED DESIGN
Patients and visitors
notwithstanding, there'd
be no hospitals without
staff. "[Interior designers
and architects must] consider
the whole package,"
Waggener says. "Taking
care of the patient means
taking care of the caregiver."
She should know.
Before becoming an interior
designer, Waggener spent
14 years as a Registered
Respiratory Therapist and
Technical Director of
Critical Care at Our Lady of
the Lake Regional Medical
Center in Baton Rouge, La.
Waggener combines
her direct experiences
with what she has learned
on HKS' Healthcare
Research Specialist Team
to incorporate the simple
comforts that can be
delivered to caregivers
through appropriate lighting,
flooring materials and
acoustics. "Consider the
amount of time nurses
spend standing and walking,"
she says. The turnover
rate for registered nurses
is a staggering 20 percent,
so it behooves designers
to accommodate them.
Waggener notes that a
lot of investigation is also
going into "backstage"
spaces, such as nurses
stations, efficient supply
storage areas, staff
lounges and meeting
areas. "We're trying to make
those spaces more efficient
and decentralized so
the caregiver is more connected
to the patient, and
so the caregiver also has a
place to rest," she says.
Standard hospitals tend
to locate core elements
such as elevators and mechanical shafts in the
center of floors. At the new
JELD WEN Tower of St.
Charles Redmond Medical
Center in Redmond, Ore.,
architects from Seattle-based
Callison proposed
moving those elements to
the ends of the building,
opening up the space for
maximum nursing flexibility,
storage and sightlines.
Janet Faulkner, AIA,
LEED AP, Principal at
Callison, says the firm
faced many challenges in
making that work with
codes, but the hospital
staff greatly appreciates it.
Faulkner, a leader in
Callison's Healthcare
Design Studio, says, "We
keep the design teams
focused on all of the people
who use the space."
In fact, Faulkner says
the term "patient-centered"
shouldn't even be used.
"We should be saying
'human-centered,'" she
says. "We should not be
forsaking the needs of
others to meet the needs
of one." The ideal approach
to hospital design considers
everyone: patients, nurses
and doctors, as much as
housekeeping and food
service staff. "Designing
spaces that keep the care
teams energized and adept
is the best thing we can do
to create patient-centered
care," Faulkner says.
| STRAIGHT FROM THE SOURCE |
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Heather Peach |
Numbers and ROI are worth their
weight in gold, but sometimes what
can't be quantified is even more
valuable. Oftentimes, caregivers -
those most directly involved with
patients - are the best judges of a
space's success.
In 2004, Massachusetts General
Hospital in Boston opened its new
Yawkey Center for Outpatient Care,
which houses the Pediatric
Hematology-Oncology unit. Heather
Peach, a Child Life
Specialist in that unit,
describes the clinic
where the unit formerly
resided as a plain environment
with a small
waiting room that lacked
staff office space. "For
patients, we had a bay
with rows of beds, and
hardly any windows,"
she says.
The new facility, however,
features individual
rooms - complete with
video games for children,
healing wall murals and
computers for physicians
- and a large, colorful,
child-friendly waiting
space, among other
patient-focused amenities.
"Kids walk in and
feel safe here. They
know the space is for
them," Peach says.
Designed by Cambridge Seven
Associates, Perkins+Will and Steffian
Bradley Associates, the Yawkey building
was created with patients in mind,
from its sun-washed corridors and
warm finishes to its logical configuration
and rooftop healing garden.
Peach understands she's not providing
care just to the patients. "We
need to treat their whole family -
their support system," she says. And
in that, she says, the building succeeds. Peach also appreciates how the
space has improved caregiving, such
as locating nurses stations directly
across from patient rooms.
A 2007 post-occupancy evaluation,
published by Architectural
Record, lists many of the building's
positive attributes, including the ease
of way-finding and the quietness of
the clinical interior space. The evaluation
shows that staff satisfaction is also
impressive, to which Peach can attest.
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For more information on
patient-centered care, visit
these Web sites:
IIDA's Knowledge Center
http://knowledgecenter.iida.org
AIA Academy of Architecture for Health
www.aia.org/aah_default
American Academy of Healthcare Interior Designers
www.aahid.org
Picker Institute
www.pickerinstitute.org
Planetree
www.planetree.org
The Center for Health Design
www.healthdesign.org
The Institute for Family-Centered Care
www.familycenteredcare.org
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