Transforming the Healthcare Setting
The Search for Evidence
What impact does hospital environment have on the patient experience? How does a building's design affect the productivity and satisfaction of healthcare workers? Can a healthcare organization compete effectively without a facility that connects physical environment to a long list of positive outcomes for both patients and workers?
Questions like these abound today as healthcare groups across the United States invest billions of dollars in upgrading the healthcare infrastructure. The best of them approach building new or remodeling an outmoded facility as a golden opportunity to plan and construct something that provides answers for transforming the healthcare setting.
Architects and planners who specialize in healthcare facilities and other decision makers have an important role here, too, challenging the status quo with designs that do more than house medical services.
They respond to modern healthcare's demand that buildings improve patient satisfaction and reduce medical errors. The physical environment must help keep healthcare workers effective, fulfilled, and on the payroll. Finally, hospitals today must have the capacity to manage the pace of changing technology and compete in a tough marketplace.
Search the evidence
The search for evidence in how to meet these expectations begins by going inside healthcare. Which is what architect and professor Raymond Matulionis of the University of Wisconsin Department of Engineering Professional Development-Healthcare Facility Planning Component did when researching the topic for an upcoming workshop.
He understands, as most designers do, that planners and architects cannot dispense with intuition and creativity when working on a project. It is critical to research facility use from many perspectives.
Matulionis, who did his doctoral research on human response to the physical environment, surveyed professionals managing executive or operational healthcare decisions. He talked to people who provide or oversee patient care, and others who advocate for the patients themselves. He found that ideas from these “insiders” and facility users in general give dimension to the issue and inform the efforts of those who plan and design hospitals.
Create an expectation
Anne Klawiter, President and CEO of Southwest Health Center in Platteville, Wisconsin, recalls that a vision session with community leaders was the key to successful development of the regional hospital and medical center that changed the healthcare landscape of southwestern Wisconsin when it opened in 2005. Her organization's experience shows how important it is now to take the pulse of the market when planning new hospital construction.
Klawiter explains the visioning process helped validate a number of design ideas already under consideration. “It also gave people an opportunity to feel involved in what we were proposing. By the time we opened, that fact made a huge difference in acceptance of the new facility.”
During the visioning session, Klawiter and planners from Marshall Erdman & Associates heard cautions about over building. “People said we don't have a Cadillac dealership in Platteville, let's not get carried away,”
Klawiter says. “They agreed about having a quality, state–of–the–art hospital, but wanted it physically to reflect the values of this rural community. We did a good job, right down to the color of the exterior brick.”
Many interior design elements in the new hospital and attached clinic were a response to the cramped, chaotic environment of the old downtown hospital it replaced. The new Southwest Health has all private in–patient rooms and a division of public/private corridors that streamlines the confidential movement of patients between services. Two large patient reception areas in the front lobby support a program change that has staff members escorting patients from reception to exam or procedure rooms. Klawiter notes there was resistance to this at first from staff members. “Now they are the biggest proponents of the process. It provides an interlude that puts everyone at ease.”
Throughout the planning and design, Klawiter insisted the new facility be patient friendly and contribute to effective staff recruitment. Both issues drove what she anticipated would be selling points for Southwest Health, necessary to stay competitive and quality–driven in the regional market.
Other design decisions also factored in. Siting the building visibly on rising ground, creating an inviting approach, using lots of natural light inside, and adding a garden outside—these aspects of the built environment help create an expectation that Klawiter says gives people confidence about the care they receive. “We see the results with positive Press Ganey scores in patient satisfaction and our ability to recruit physicians, nurses, and pharmacy professionals more successfully than others in the area.”
Satisfy nurses, satisfy patients
Hospital executives know they need a high–caliber facility to recruit top talent. Joseph Howell, RN, Oncology Nurse Coordinator for the lung cancer program at University of Wisconsin–Paul P. Carbone Comprehensive Cancer Center in Madison, Wisconsin, says nurses understand that when a facility works for them, it works for patients, too.
“Nurses derive satisfaction from the way patients respond to them and to the environment,” Howell notes. “We serve both well when we design hospitals that meet the needs of nursing professionals.”
Howell considers a truly functional patient room a primary goal of modern healthcare design. Planning rooms bigger than 10–feet square may be a luxury if budgets are tight. But spacious or not, he suggests patient rooms work best when designers think first about what goes in the rooms, from equipment and fixtures that must function smoothly to the people who will occupy or work in it.
Architects designing hospital space should collaborate closely with the engineers designing the equipment that fills the space, Howell argues. “It would make a huge difference in how hospital spaces serve both patients and nurses.”
Space outside private patient rooms is another area critical to a better environment for healthcare workers and patients. Patient lounges out of traffic, for example, where patients can go in street clothes and feel a sense of normalcy, socialize with others, or host visitors. It introduces a change of scene that Howell feels does play a role in healing.
Nurses also need adequate space away where they can keep things or take a real break from the care environment, a place they do not share with physicians or other workers. “This is an important element left out of many hospital designs,” Howell says. “Yet it's important recognition of nurses' professional standing and critical for people who spend 12 hours or longer at a stretch on the job.”
To recognize where healing happens
Martha (Meg) Gaines walks into a hospital or clinic with one question on her mind: Can healing happen here? She asks it for herself as a cancer survivor and for patients and families she helps as a noted patient advocate.
Founder and Director of the Center for Patient Partnership at the University of Wisconsin–Madison Law School, Gaines holds strong views on the importance of place for people who are ill or dying. “We need to change the way we think about the patient experience, about how a hospital functions and feels,” she says. “Glaring lights and slick linoleum ratchet up everyone's terror. We need comforting environments that promote healing.”
Gaines draws a distinction between healing and curing as a way to define how the built environment affects people. “Not everyone can be cured, but everyone can be healed,” she says. “Healing has to do with believing that the things which can be done for us in a healthcare setting are being done. We sense that people care and, by extension, the place that inspires them to care must have healing qualities, too.”
From experience and professional observation, Gaines identifies things like openness, natural light, textural elements, inviting clusters of chairs in waiting or treatment rooms, and the option to interact with others or be private as among the design decisions she feels contribute to healing in modern hospitals and clinics. She also suggests such decisions not be left solely to the doctors who often lead healthcare organizations.
“The need for creativity at the highest levels heightens the designer's importance,” Gaines says. “Facility planners still have to persuade, but the more they research and understand the needs of the people who use the space, the better case they make for a design with humanity.”
Designing better hospitals
Intuition might tell most planners and architects by now to incorporate natural light, safe floor coverings, same–handed rooms, lifts, patient controls, acoustic ceiling tiles, space for families, outdoor gardens, and other components in a new hospital design. It also might tell them these components only scratch the surface. Healthcare facility planning and design is a complex field that challenges talented professionals constantly to rethink their approach and maintain close involvement with the evolution of healthcare needs and environments.
Learn more about EPD's healthcare planning and design courses by contacting Ray Matulionis at 608-263-3372. For details on registration, call 800-462-0876 or view our Architectual Planning and Design Courses.
Written by Mary Maher
This article is based upon work supported by the University of Wisconsin–Madison Department of Engineering Professional Development. It is for general information and distribution. It is not intended to provide specific solutions or advice for specific circumstances, which should be sought from appropriate professionals.