The possibility that the Ebola virus might find its way into the United States raises urgent questions about how well the interior design of our hospitals minimizes risks and promotes healing.
Michael Kimmelman’s article (“In Redesigned Room, Hospital Patients May Feel Better Already,”August 21, 2014)highlighted the critical intersection of design, healthcare, and science that is becoming architecture’s new frontier.
As someone who has dedicated her career to research on and architectural design of hospitals environments, I’m glad to see these disciplines aligning to the benefit of patients, professionals, and our healthcare industry. But while great strides are being made toward understanding how good architecture can contribute to the healing process, there are significant challenges to designing hospitals that are as healthy as they could or should be.
First, hard research on environmental design’s impact on healthcare is still in its infancy. For example, as Mr. Rabner (the CEO of the University Medical Center of Princeton) noted in Kimmelman’s article, antibacterial floors sound like a great idea—but to justify their cost, architects and others in the design process need to document their efficacy. As the article stated, that kind of research is difficult because of the need for control group studies. More research must be done; there are less than 3,000 peer-reviewed studies that can link design to outcomes. Michael Graves is unfortunately correct when he says that few architects have expert understanding of medicine and research methodology. As a discipline, evidence-driven healthcare architecture is still in its infancy.
Second, the architectural design process for hospitals often asks the wrong questions and measures the wrong factors. Architects are taught to listen to the client’s needs and design a space that incorporates their requests while maintaining their safety from natural disasters—all within the budget and time they have requested. Architects are not taught to measure and design to health, patient, or staff-related outcomes.
Third, our design paradigm is to do less harm rather than to promote health. Instead of asking what would maximize patient benefits, the architectural process tries to minimize potential risk and cost. Since hospitals are relatively large and infrequent projects for most designers, industry standards change slowly. As a general rule, architects lack the professional culture or mechanisms to share practical lessons on hospital design. The industry operates on anecdotal evidence without any clearinghouse for longitudinal data on the outcomes of various designs.
Fourth, it takes a village; stakeholder integration throughout the design process is critical to success. As Rabner points out in the article, only teams can advance the transformative changes required practice and operations. This integration must take a collaborative methodological approach to design. The current model for most design projects is primarily driven by time and budget. At the end of the article, Ms. Covin notes that, “No one is preventing idiotic design.”She’s right. The airline industry has the NTSB to investigate crashes and disseminate lessons learned, so that over time airline travel has become progressively safer. But there is no post-occupancy data correlating hospital designs to health outcomes. If the healthcare industry wants to design healthier hospitals, we’re going to have to invest in the learning curve.
The September 2013 issue of the Journal of Patient Safety published a study by Dr. John James that concluding that American hospitals are responsible for over 400,000 preventable deaths every year. To put that into perspective, one in every 140 admissions will die a preventable death in the United States. Is it conceivable that we’d accept over 4,000 deaths a week for school children or hotel guests? Why do we accept it in hospitals? People go in to get well. If this were happening in school or on public transportation, it would be considered a national crisis.
Many of these deaths could be prevented with better design that increased safety, promoted heath, and facilitated best practices. The physical space is an essential factor in the healing process. We need healthcare environments that live up to their name: they should be places where we cultivate health and provide care. To do that, hospital design must follow through on the revolution that has just begun. Given the pace at which that new hospitals are built, it will take decades until hospital design is a truly evidence-driven discipline. But the threat of infectious diseases and the declining efficacy of antibiotics means that a scientific approach to environmental design in healthcare cannot start soon enough.