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Technology’s Impact Revolutionizes Hospital Design
by Beth Leibson
The latest trends in healthcare design read just like a word-processing manual: Add new and ever-changing technology; delete multi-patient rooms; and search for “institutional feel” and replace with “hospitality.” When you’re done, of course, change the font color to green.
If only hospitals were as capable of acrobatics as the latest laptop.
“Trend is actually too light a word for healthcare,” says Debbie Breunig, RN, MBA, Vice President—Healthcare Market at KI furniture company. “It takes a long time for a change to get support within the healthcare environment,” she explains, noting the tremendous number of rules and regulations. “So I prefer the term ‘direction’.” |
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Private rooms give patients more control, as we see in the AtlantiCare Regional Medical Center. |
Technology demands change
In the healthcare arena, technology comes in two basic flavors: administrative technology and new diagnostic/treatment equipment.
Advances in medical devices can wreak havoc on a floor plan. “Whenever a hospital gets a new PET Positron Emission Tomography] (PET) or CT [Computed Tomography] scanner, it triggers major renovations in the imaging department,” says Haley C. Driscoll, IIDA, Associate at the Philadelphia office of design firm, Francis Cauffman.
The PETscan, for instance, is becoming the standard of care in diagnostic oncology and many healthcare facilities have several PETscan machines. The machinery itself takes up an entire room and is far from “plug-and-play,” requiring tremendous power and radiation safeguards. And remember, this is only one piece of equipment.
Similarly, changes in administrative technology reverberate throughout an entire healthcare facility. “It can put an entire project into a state of paralysis,” says Driscoll. “One hospital project I am working on is transferring from a paper-only system to electronic record-keeping. But they haven’t decided whether they are going with notebooks that the nurses will carry; PCs on wheels; bedside PCs in each patient room; or a docking station at the nurse’s station—or some combination of these approaches.”
The most appropriate approach depends on the particular facility involved and touches on issues of infection control (moving a device from patient room to patient room also can transport microorganisms) as well as HVAC and electrical requirements and operating procedures. “Healthcare designers juggle a lot of balls,” jokes Driscoll.
Nurses’ stations, too, are changing. “We used to build for the long haul, especially with nurses’ stations,” says Driscoll. “But we can’t do that anymore.” For instance, in one hospital, Driscoll is considering using systems furniture rather than custom millwork. The shelves might not match the exact size of current forms. But there is an important advantage. “It will make it much easier to reconfigure as systems and technology needs change,” she says.
To add to the complexity, she mentions, technology changes about every two years. So a ‘final decision’ is anything but that. And any design must have built-in flexibility.
Patients go solo
Private patient rooms have become the industry standard in the United States for a variety of reasons, many related to the rise of evidence-based design research in healthcare (see Evidence-Based Design: Why the Controversy? by Patty Looker, www.mcmorrowreport.com/hfm/articles/ebd.asp). Private patient rooms reduce the rate of hospital-acquired infections, simplify patient care and management, and provide greater therapeutic benefits for patients than the older multi-patient rooms.
“Private patient rooms give patients more control over their environment. They can pick the lighting level (including the amount of daylighting), the noise level, and sometimes even the temperature,” says Driscoll. Because private rooms lower the noise level, patients sleep better and experience lower blood pressure, quicker wound healing, and lower rates of re-hospitalization, according to research by the Center for Health Design in Concord, Calif. Indeed, notes a study by the Center, private patient rooms are probably the single most effective strategy for alleviating excessive noise levels in healthcare facilities.
Private rooms also can provide more privacy, per the Health Insurance Portability and Accessibility Act (HIPAA) of 1996. “It’s great when patients don’t have to worry about having a roommate overhear a diagnosis or discussion, or see an awkward physical examination,” says Driscoll.
They can also facilitate family involvement in patient care and decision-making. “It helps patients to have their family visit and sometimes stay the night,” says Kristen DelGandio, Senior Interior Designer at Wilmot Sanz of Gaithersburg, Md. “Private rooms make that easier on family members.” Not surprisingly, the Center for Health Design has found that private patient rooms increase overall patient satisfaction.
In addition, private patient rooms improve working conditions for hospital staff, according to the Center for Health Design. High noise levels increase perceived work pressure, stress, and annoyance; contribute to emotional burnout and exhaustion; and can potentially impede communication among staff members. Private patient rooms, conversely, lower staff stress and burnout and, perhaps most important, improve employee retention.
Accent on hospitality
Healthcare facilities are also evolving from facilities that exude “institution” to places that seem more friendly and hospitable. “We have to meet the clinical requirements,” says Driscoll. “But we want to take the scary edge off the facility,” she adds.
Part of the change stems from the increased number of healthcare options available to patients. “We live in an age of consumerism,” says Breunig. “We want to spend our time in a facility that we like.” As a result, hospitals are changing. “Healthcare facilities are moving away from being sterile, institutional environments to those that nurture and comfort their patients and visitors,” Breunig adds. “Because patients can sometimes pick their facilities, they pick places that seem safer and friendlier.”
Friendly does not mean overly fancy, explains Driscoll. In fact, most healthcare facilities, she adds, use fewer hard woods and more plastic laminates, to enhance infection control. There are fewer curlicues and a crisper esthetic to give microorganisms fewer places to hide.
In AtlantiCare Regional Medical Center’s (ARMC) new seven-story patient tower in Atlantic City, N.J., for instance, the emphasis on hospitality is evident. “ARMC physicians and staff designed the patient tower to include the latest diagnostic and treatment technology in an environment that focuses on patient privacy, safety and comfort,” said Driscoll. “To affect that type of environment, we sought to create a residential aesthetic, one that evokes the comforts of home.”
Hospitality often encompasses access to natural lighting, which offers its own benefits to patients according to the Center for Health Design. Access to natural light can reduce pain; improve patient sleep; lower patient stress and depression. In some cases, it can even shorten hospital stay. Almost invariably, a hospitality focus improves overall patient satisfaction.
And the hospitality focus is not bad for hospital staff, either. An emphasis on hospitality can lower staff stress levels and enhance staff satisfaction, notes research from the Center for Health Design—and that can reduce burnout and turnover.
Healthcare goes green
“I suppose designing for green could be a trend,” says DelGandio. “But I don’t think it’s going to disappear. I think we’re going to keep thinking that way for a long time.”
But going green can be a hard sell, sometimes, asserts DelGandio. “A lot of healthcare facilities worry about the initial costs, without thinking about the payback later on.” But change is coming, albeit slower than some hope.
“We are always thinking about how we can reduce, reuse, recycle,” says Breunig, focusing on product development. “Finishes have to look like a spa or hotel, but be able to withstand guerilla warfare,” in terms of nonstop cleaning and disinfecting, she adds.
In addition to product selection, designers are thinking about maximizing natural light. They are using more motion detectors and adding smaller bedside lamps, giving patients more choices than total darkness or complete over-bed illumination. “That saves on energy use and gives patients more control over their space,” says Driscoll.
“We also design in places for recycling,” says Driscoll. “We just finished a facility in Wilkes Barre, Pennsylvania, where we put recycling bins in every nurse’s station.” But it’s not just for hospital staff. “We find that everyone—including patients and their families—are tuned into recycling. Family members are happy to walk down the hall to put a soda can in a recycling bin.”
It is an exciting—and challenging—time for healthcare design, with so many changes afoot. But with a little bit of work, the hospitals of the future will be more technologically advanced, hospitality focused, and environmentally friendly. |
