Healthcare architects are building hospitals with the patients in mind, and the results are remarkable
At some point in the last 10 years or so, the professionals who design and build healthcare facilities decided to pay attention to the physical, emotional and psychological needs of patients.
One of the famous stories involves noted architect and designer Michael Graves, who was hospitalized in 2003 after contracting a rare, debilitating virus.
As the story goes, the wheelchair-confined Graves was recuperating in a rehabilitation center in New Jersey and became dumbfounded over the room that had become his home – particularly the functionality of wheelchairs, light switches, shelving, window blinds and shower stalls (such as where they place the support bar).
“The wheelchair arms are too high to slide under the sink,” he recalls thinking. “The shelves are so deep I can’t reach anything toward the back. There are only two drawers within my reach. The window blinds are too high and on the wrong side.”
And, he said. “I’m not even talking about how ugly it is.”
Perhaps it was Graves’ high profile, but the architecture and design community began to pay attention. So have the media. Earlier this month, The New York Times ran an article, “In Redesigned Room, Hospital Patients May Feel Better Already.”
“In many ways, this is the central argument in architecture today, with a new generation more attuned to issues of social responsibility and public welfare,” wrote Times reporter Michael Kimmelman. “The discussion has posed a larger, fundamental question about the role of architects, and to what extent they can or should be held responsible for how buildings work.”
Kimmelman reported that in a test case at the University Medical Center of Princeton, in Plainsboro, N.J., patients were relocated from the old hospital wing into new rooms that were larger, brighter, airier and more comfortable. Those patients rated the food and nursing care higher than patients in the old rooms did, although the meals and care were the same. They also asked for 30 percent less pain medication. And they tended to recover faster, with shorter hospital stays.
But why did it take a century for designers to realize some of these issues?
Actually, Louisville architect Steve Wiser says Humana was on the cutting edge of these issues 30 years ago. When Humana built and owned hospitals, Wiser was a staff architect who, even then, challenged manufacturers to come up with softer, warmer, residential-type materials that would withstand the rough treatment they got in healthcare environments.
“Often, domestic surfaces would break down under the intense solvents necessary to keep the environments antiseptic,” he says. “We worked with manufacturers to develop vinyl surfaces that resembled the warmth of wood.”
As director of healthcare design at JRA Architects, Wiser says he has implemented more than $2 billion worth of health care projects in his career. And he’s seeing a number of ways in which the philosophy is shifting in healthcare design, away from arrangements meant to support the organizational needs of the staff and toward the emotional needs of the patients.
A lot of it has to do with natural light, pastel colors, organic images (plants and flowers) and warmer materials. But a lot of it also has to do with logically functioning elements. Like safety.
“The No. 1 issue in healthcare design is patient safety,” Wiser told me. “You wouldn’t believe how many patients get injured in the hospital, by falling. It has become almost a crisis situation.”
So Wiser designs today’s hospital rooms to minimize patient footsteps. Like moving patient restrooms to the foot of the bed, where they’re closer and more accessible. In Wiser’s hospitals, patients don’t have to maneuver around the bed and make their way to the restroom over by the door or in the corner by the window.
Wiser also has driven the move to installing bariatric lifts over each bed in each room (such as at the University of Kentucky Hospital in Lexington, which he’s upgrading) to move especially weak or vulnerable patients from the bed to a wheelchair or gurney – or just to allow nurses to make the bed.
By the way, in Wiser’s world patient needs vs. staff needs is not a zero sum game. For example, moving the restrooms away from the door allows staffs a more unimpeded view of the patient from the hallway. And reconfiguring the floors from a single central nursing station to a number of scattered satellite stations gives the nurses fewer footsteps and responsibility for fewer patient rooms, which allows them more personalized interaction and the ability to respond more quickly to patient calls.
However, benefits notwithstanding, the architect acknowledges he’s always confronting resistance to change — a “we’ve always done it that way” mentality.
So he’s a big believer in talking to the staff before he puts pencil and ruler to drafting table, or whatever architects use in today’s digital world.
“I want to hear their needs and priorities and how they’d respond to certain changes,” he says. “Changing their culture is a huge hurdle, so I hold dozens of meetings with the staff, to gently bring them along – but also to get their input.”
He’s also a huge believer in “visualizing expectations,” so he shows the staff what its new world will look and feel like, whether through tours of similar facilities he’s built, or 3-D digital graphics he’s produced on the computer, or actual mock-up rooms he’s had the contractor build on the site.
“We always did full-scale mock-up rooms, even in the ’80s at Humana,” he says. “In fact, the Humana Building on Fifth and Main included a studio for creating these mock-ups when it was built in 1985.”
If culture shock is one big impediment to innovation, it’s no surprise that the other big impediment is cost. You don’t get bariatric lifts at Walmart. Building a state-of-the-art facility with extra plumbing and all private rooms, like Wiser is doing right now for Hardin Memorial Hospital in Elizabethtown, is not cheap. We all know about healthcare economics these days.
“These are complicated, expensive constructions,” he said. “It’s not uncommon to spend $200-$300 a square foot for a hospital – that’s three times the cost of building a house.” The E-town project is budgeted at $20 million.
“But there are ways to design, manufacture and build lean, with minimal waste,” he says. Besides, the efficiencies that today’s design can help hospitals recoup the costs with a relatively reasonable ROI.
And isn’t there something to be said for a happier, more comfortable patient who takes fewer meds, recovers more quickly and reduces hospital stays? Or at least, for a patient who doesn’t fall down and sue the hospital for millions?