Designing Better Patient Care
VIDEO (Coming Soon)
The hospital built today must anticipate the inevitable and dramatic transformations in the delivery of health care that will happen over the next several decades. What should the hospital’s physical environment look like in order to prevent obsolescence given the rapid change in medical services and patient care modalities? The answers will require interdisciplinary cooperation. This panel will bring together experts to present new models for the hospital of tomorrow.
In the new era of health care, a dramatic physical transformation is sweeping through hospital planning. Led by teams of health care administrators, planners, designers and architects, and backed by research, the latest generation of buildings for 24-hour patient care encompass environments that elevate safety and well-being for patients, according to panelists at the University of Miami Global Business Forum, held Jan. 12–14, 2011.
Panelists (L-R) David Birnbach, Professor, Miller
Panelists participating in the session titled “The Hospital of Tomorrow: Physical Design for a New Era,” say that statistically, physicians, nurses and even patients fall short in the simplest aspects of care, such as hand washing and preventing falls. What’s more, facility cultures lack accountability, and even such basics as noise reduction are contributing to the disintegration of care.
“Historically we have designed hospitals around the staff, around the physicians, around departments,” said Frank Sacco, president and CEO of Memorial Healthcare System. “We forgot to design hospitals around the patients. That’s where I think we need to look: at the patients and their families.”
In fact, updated hospital designs can improve care outcomes. For example, reorganizing a room so that sinks and soap are at the entryway would likely encourage more frequent hand washing. Lack of hand washing contributes to 100,000 deaths each year, according to John J. Greisch, president and CEO of the medical technology company Hill-Rom. Yet studies show that the most hygienic practices occur as little as one out of three times, said Craig Zimring, an environmental psychologist and professor of architecture at the Georgia Institute of Technology.
“That’s ridiculous,” Zimring said. “Architects need to be part of setting those goals. We need to do design research the same way we do clinical medical research.”
Another architectural enhancement, said Zimring, is the move from semi-private rooms to private rooms. He cited research showing that when ICU patients slept alone in their rooms, infections fell by 50 percent, patient stays were 10 percent shorter, hand washing became more common, and cleaning after each patient was more thorough.
“We know solutions to some of problems presented here,” said Zimring, noting that 1 in 7 patients are harmed in U.S. hospitals. “We cannot accept a health care system where this is everyday practice.”
The move to private rooms cuts down on another major problem: noise. Not only do moans of pain and loud conversations between hospital staff directly affect patients, but they also indirectly contribute to compromised care. Noise in on-call rooms diminishes the benefit of rest for medical residents; one study found that residents who slept in on-call rooms across from labor and delivery wards had no benefit at all, said physician David Birnbach, a professor at UM’s Miller School of Medicine and the associate dean and director of UM/Jackson Memorial Hospital Center for Patient Safety.
“You’ll hear it again and again,” Birnbach said. “We need a multidisciplinary approach. We need to practice evidence-based design.”
Unnecessary noise, panelists said, can be eliminated by sealing doors with materials that can be scrubbed and sanitized.
More broadly, hospital architecture must incorporate the ever-evolving technologies that can prevent accidents and save lives, said Greisch. For instance, to reduce the number of weak patients who slip and fall in their rooms, hospital beds can incorporate devices that alert nurses’ stations when side rails have been lowered.
“The question we should be asking is, How can we leverage technology with medical devices to provide more safety and better care?” Greisch said.
For example, hospitals now have access to machines that monitor compliance with hand-washing policies, and those machines can be built into room design. Other technology can monitor vital signs and deliver critical data to caregivers. Electronic medical records and their use also need to be incorporated into hospital design.
“It all exists,” Greisch said of the technology. “We need to get people together to make the fundamental implementations.”
Yes, people — because unless a hospital’s culture embraces the practices it preaches, even a design overhaul won’t improve patient care, said Tom Tulloch, a corporate vice president of construction at Baptist Health South Florida. Tulloch noted that regardless of the plans an organization puts on paper, the overall sentiment among administrators and medical staff will determine day-to-day operations.
“Culture eats strategy’s lunch,” he said. “Culture makes a big difference in every organization. We have to keep those principles in mind. We have very smart people and it’s exciting. But we must never lose sight of why we’re there: for the patient.”