Using Evidence-Based Design to Create the Hospital of the Future
The hospitals of tomorrow are being built today, using evidence-based design that closely follows health care history and the outcomes of earlier plans, said panelists at the University of Miami Global Business Forum, held Jan.12–14, 2011.
Moderated by UM School of Architecture Dean Elizabeth Plater-Zyberk, the panelists at “The Hospital of Tomorrow: Concepts and Lessons Learned,” session agreed that hospital design is evolving as planners better understand the factors that are making medicine more efficient, patients more comfortable and families more involved in care. Evidence-based design offers the kind of proof that comes only with experience and research, they say.
“I’m a health care architect managing change in health care for over 30 years,” said Donovan K. Smith Jr., a senior health care planner with KTH Architects. “From a health care designer’s perspective; the newest design involves dealing with those principles and fundamental truths that research now supports.”
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Jose Gelabert-Navia speaks at the 2011 GBF |
Those architectural concepts, including sustainability and collaborative spaces, are a far cry from hospital construction in the 1940s, when the Hill-Burton Act helped to turn many hospitals into physician-centered facilities. The institutions left standing from the three decades of construction that followed the act are disadvantaged by isolated spaces and other obstacles that impede the comfort and safety of patients and their families.
“[Those designs] didn’t take into consideration the dynamic,” Smith said. “Everything was static. Barriers were built that became physical that we’re still living with today.” Patient rooms of the future, Smith explains, will be spacious and open.
“We are continuing to look at things from a modular standpoint,” Smith said. “The concept of design in itself is separate and distinct from medical planning. But they can work together.”
Evidence-based design does require a steep initial investment, but the payoff comes in the form of reduced costs and increased market share. “It’s equivalent to the investment,” Smith asserted.
David M. Schwarz, president of David M. Schwarz Architects, said that’s true of his work at the Cook Children’s Medical Center in Fort Worth, Texas. The project began with a $30 million budget but grew to a staggering $300 million over the 20 years that the team has worked to combine the organization’s medical center and hospital. Over this period, occupancy rates rose to 90 percent for the combined facility, from between 40 and 60 percent when the two buildings were separate.
“The concept does not rule out traditional design,” Schwarz said. “It embraces it and takes it to another level. Steel and concrete can only span a certain distance. There are things you can pull out and make more adaptable. It’s planning from the inside out.”
To that end, his team considered very carefully the patients the hospital would be serving — children — and implemented features that would accommodate young people and their families. For example, they replaced traditionally written signs on the rooms with cartoon graphics illustrating what happens on the other side of the door, such as X-rays.
“The most distressing thing for a child is seeing all the apparatus,” explained Schwarz. “If they don’t need it, they shouldn’t see it.”
Because the center is a 24-hour facility, Schwarz incorporated a central atrium that serves as a town square, which is useful for, say, visits from Santa Claus. The cafeteria was designed to become the social area, so it’s splashed with natural light. And the hotel portion is a window-filled black-and-white wonderland that is flooded with brightly colored lights.
“We wanted the hotel portion to be welcoming and childlike without being childish,” Schwarz said.
Of course, while patients and their families are only in a hospital or medical center for a limited time, health care professionals need to work there every day. Evidence-based design also looks to enhance daily work. Jose Gelabert-Navia, a managing director of Perkins & Will and a professor at UM’s School of Architecture, stressed that a center’s design must facilitate the integration of professionals from various disciplines, and it must promote innovation and transparency in the way medicine is practiced. Many hospitals also want buildings that can meet international standards of design and that can provide specific care regardless of location.
“Clients come to us from different parts of world wanting us to design buildings that meet international standards in order to secure international accreditation,” said Gelabert-Navia, whose Hospital Universitario San Vicente de Paúl project in Colombia should be completed next year. “Folks there believed they had great human talent in terms of doctors and research, but did not have the facility. They were frustrated to watch patients go to the U.S. for treatment. So the facility was designed to retain those patients.”
Globally, there’s a focus on sustainability that includes regenerative environments, managing storm water and optimizing energy performance, said Gelabert-Navia. But that kind of forward thinking is still a work-in-progress.
“A lot of the innovation in planning is taking place beyond the regulatory environment that drives most design in the U.S.,” he said. “We find a more eager and open audience in China, the Middle East and Africa than we do in own backyard.”
