Good design is increasingly critical to good healthcare

If the healthcare sector routinely exists at the center of multiple, sometimes opposing forces, today it is being pulled in more—and more complex—directions than ever before, all of which have some influence on the design of medical facilities.

Let’s start with the obvious—the economy. If the healthcare sector did not experience the kind of cataclysmic downturn suffered by other sectors, it’s only because profitability margins in healthcare have been trending downward for years, even as the cost of medical care to the patient continues to rise. The demand for state of the art healthcare and healthcare facilities is increasing as the Baby Boomer generation ages, yet the available capital funds necessary to build and renovate have been significantly curtailed by a loss of investment income. Uncertainty around President Obama’s healthcare reform act, which is being contested in the Supreme Court as I write this, makes long term planning difficult. And by the way, the patient at the center of all this is an increasingly sophisticated consumer, so the competition among healthcare providers to attract and retain the best medical professionals, and provide the best care in the best facilities, is fierce.

Northwest Community Hospital South Pavilion, Arlington Heights, IL, designed by Cannon Design; Photography by Christopher Barrett

Adding to the complexity is the broader role of healthcare facilities in our built environment. “These projects are so large, touch so much of the urban fabric, involve so many people, and are so expensive, that they must be treated as the major civic structures they are,” says Randy Guillot, Design Principal at Cannon Design in Chicago. Gone are the days when creating healthcare environments involved little more than designing to code. “The quality of design in these buildings is really high,” notes Guillot, “and talented designers are bringing the latest design tools to bear, not just on the design, but on the functional areas as well.

All this makes the role of the healthcare architect and interior designer more challenging—and more critical—than ever before.

What is the design response to the many social, economic, political, demographic, and technological trends tugging at the healthcare sector? “The value proposition is better, faster, cheaper,” says Jeffrey Stouffer, Principal at HKS Architects in Dallas. The “faster” part increasingly is being addressed with lean project delivery, a risk/reward equation whereby owner, developer (third party developers, once an anomaly, are increasingly common in the healthcare sector), architect, and contractor all share the responsibility for cutting out waste in the design process and delivering the most operationally efficient facility possible—a better, more functional facility.

“The premise is that if you do it better, it will also be cheaper,” Stouffer adds.

Some examples of “better” design in healthcare, he says, include improved functional adjacencies for ideal operational flow and improved delivery of care in a reduced amount of space, shorter foot travel distances for caregivers on the job, a reduction in supply waste, and the introduction of sustainability measures that reduce long term operational costs.

Integris Health, Edmond, OK, designed by HKS; Photography by Blake Marvin

Ultimate flexibility is also key to long term operational efficiency, so the universal patient room, which is scalable and adapts to alternate uses, is increasingly favored in the design of acute care facilities. Otherwise, patient rooms are designed to accommodate family members around the clock as much as patients, and in some cases—especially in pediatrics—family members are encouraged to take an active role in the care of the patient. This provides psychological benefits for the patient, but also reduces strain on the nursing staff.

Maintenance is another huge factor of operational efficiency, and should inform the intelligent selection of materials and finishes. “We need to do more with less so we need to be looking at life cycle costs of materials and not just first costs,” says Guillot. “Flooring is a great example. Maintenance can quickly eclipse the first cost of a material if not chosen wisely.”

There is also growing documentation of the benefits of evidence-based design in healthcare, thus moving the concept out of the realm of the theoretical and into the realm of best practice benchmarking. Key findings on the environmental aspects of healthcare design indicate that daylighting, exposure to nature, strategic use of color, inclusion of artwork, and individual control of the patient environment all contribute to more positive patient outcomes. “We have been doing all of these things intuitively,” says Stouffer, “but we are starting to gain quantitative evidence that they provide true benefits.”

Among environmental factors, acoustics has become an area of particular concern. For example, “We have so many hard surfaces to keep the facility easy to maintain and as a result, have noisy environments impacting caregiver ability to concentrate on tasks and the patients’ ability to rest and heal,” says Guillot. Cannon Design is currently involved in a research study on the impact of acoustics on patient outcomes.

Both Guillot and Stouffer note that healthcare is shifting more and more toward an ambulatory care model. “Healthcare at home is on the horizon,” says Stouffer, since modern technology increasingly allows for remote diagnosis and treatment. And Guillot points to a new trend around a “retail” approach to healthcare, where services are available in retail settings away from the traditional hospital, clinic, or medical office building. “What does this mean for design?” he wonders. “How do you extend the brand of a provider into a new setting?”

In any case, gone are the days when only the rare architect or interior designer actually chose to specialize in healthcare design. “There is a vitality in healthcare design at the present time,” says Guillot. “Healthcare has moved into the general mainstream, and it is likely to stay there. Hospitals and other healthcare related projects are now judged in the same terms as all great architectural projects. They are expected to bring forth the same level of craft, innovation, and most importantly—intellectual and creative ideas.”

Even Starchitects like Frank Gehry have gotten into the act… http://www.architectmagazine.com/healthcare-projects/lou-ruvo-center-for-brain-health.aspx

Interesting Fact: According to Jeff Stouffer, the cost of information technology in an acute care facility has now surpassed the cost of the medical technology housed therein.