Changing Health Care Design: How informed design drives health care facilities

by Jonathan McGaha | April 30, 2015 12:00 am

Not many people enjoy having to visit or spend time in hospitals. Yet, hospitals often are a part of life for many people. So, how does the design of a hospital or health care facility affect the patients inside it? Can the building’s design really change the way patients feel while there, and even shorten the length of their stay? Based on the ideas of evidence-based design (EBD), the answer is yes. And in recent years, EBD has been increasingly used in the design of hospitals and health care facilities.

According to The Center for Health Design[1] (CHD), Concord, Calif., evidence-based design is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes. The center’s mission is to transform health care environments for a healthier, safer world through design research, education and advocacy. As a nonprofit organization of passionate health care designers and professionals, it is dedicated to engaging and supporting professionals and organizations in the health care and design industry to improve the quality of health care facilities and create new environments for healthy aging.

“Just as the medical community has increasingly moved toward ‘evidence-based medicine,’ where clinical choices are informed by research, the health care community is increasingly moving toward ‘evidence-based design’ where decisions about the physical environment are based on credible research and organizations are evaluating their results and sharing them with the industry to keep adding to the knowledge base,” says Donna Deckard, BSN, MPA, EDAC, director of strategic projects at CHD.

Since 1993, when CHD began as a team with a vision for creating health care facilities that promote healthier environments for patients and staff, changes to health care facilities range from daylighting and access to nature to single-bed patient rooms and thoughtful design details that can reduce falls and infections. “These changes are not only commonplace-they’re creating a positive change,” says Debra Levin, EDAC, president and CEO, CHD. “Today CHD is a diverse community of architects, interior designers, health care executives, health care professionals, researchers, product manufacturers, educators and students are all committed to optimizing health care facilities. “Health care design is changing for the better and we only see this trend gaining momentum.”

 

The EBD Process

There are some key ways that EBD adds value to any project delivery process. According to Ellen Taylor, AIA, MBA, EDAC, director of research at CHD, the EBD process addresses the key strategic goals and challenges of the health care provider by developing measurable concepts about how design strategies target clinical, environmental and safety outcomes. “An important first step is to conduct a literature review and use relevant research to educate the project team and guide the development of the design strategies linked to achieving better outcomes,” Deckard adds. “Finally, once a project is completed, research is finalized, outcomes are gathered and evaluated, and results shared to add to the body of knowledge in the industry.”

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The eight steps to EBD are:

• Define evidence-based goals and objectives.
• Find sources for relevant evidence.
• Critically interpret relevant evidence.
• Create and innovate evidence-based design concepts.
• Develop a hypothesis.
• Collect baseline performance measures.
• Monitor implementation of design and construction.
• Measure post-occupancy performance results.

“A large and growing body of evidence attests to the fact that the physical environment impacts patient and staff stress, safety and satisfaction, as well as staff effectiveness and quality of care provided in hospitals and other health care settings,” says Taylor. “Basing health care facility planning and design decisions on this evidence to achieve the best possible outcomes is what evidence-based design is all about.”

“Overall, the introduction of evidence-based thinking serves to make decision-making that is based on achieving positive outcomes for patients, caregivers and families,” says Jocelyn M. Stroupe, CHD, EDAC, IIDA, ASID, principal, director of health care interiors, CannonDesign[3], Chicago. “Design recommendations need to be based on improving outcomes, particularly as the cost of health care continues to rise.”

Yen Ong, AIA, NCARB, LEED AP BD+C, partner at 5G Studio Collaborative[4], Dallas, says recent improvements in health care architecture has benefitted greatly from empirical data derived from EBD research, which has assisted owners, operators and designers in learning new ways of doing things that result in better care delivery. In asking how one synthesizes these findings into a coherent architectural thought and design without creating a building that can be perceived as being overly methodical, Ong says that health care architecture can begin with the questions of human experiences that are evaluated through the lens of EBD.

 

Putting EBD to Work

When starting a project using EBD, Stroupe says they conduct an outcomes-based visioning session that identifies specific measurable goals for the project. “These relate to operational and financial outcomes that serve to define the overall approach to planning and design,” she explains. “By establishing such goals, all decisions can be framed within the context of achieving measurable success, rather than based solely on personal opinion or past practices.”

“Any design process ideally begins with some concepts that would improve some aspect of the facility or patient experience, or the safety of the patient and staff,” adds Robert F. Sharrow, AIA, ACHA, EDAC, vice president and principal at Albert Kahn Associates Inc.[5], Detroit. “The goal is to create some feedback on whether the evidence after the project’s completed, supports the design hypothesis.”

For example, when it comes to research on private rooms, Sharrow says that while they are more costly to build and operate, there are many more benefits, such as fewer infections, increased patient satisfaction, which results in reduced hospital stays and reduced overall cost. According to Sharrow, Albert Kahn hasn’t designed and built a semi-private room in more than 12 years, with every project having 100 percent private rooms. They’ve also redesigned the bathrooms in rooms to increase patient safety by using a different type of grab bar and putting one on each side of the toilet, allowing staff to get on both sides of the patient. “The evidence we’ve collected has shown about a 50 percent reduction in patient falls in the use of these bathrooms,” he notes.

Another example is the use of daylighting and natural light. “It is a well-established fact that access and exposure to natural light is good for people,” says Marya Graff, LEED AP, Assoc. AIA, senior associate at CannonDesign. “It has enormous influence over both physical and emotional wellbeing. It is linked to shorter recovery times and greater productivity metrics.”

Sharrow agrees, saying there is evidence that maximizing the amount of glass in a patient’s room can improve their outcome while reducing the need for interior lighting. If the exterior wall is designed properly with high levels of glass, he says high levels of daylight can get deep into a room. This eliminates the need for artificial lighting during daytime hours, which saves on the building’s energy use throughout the year.

In Ong’s design of the Legacy ER[6] in Allen, Texas, multiple skylights were situated at strategic intersections of the circulation to form a sensible system of wayfinding. The components of workspaces were designed for peer collaboration, patient accessibility and data privacy, while patient care areas were crafted for hospitality and treatment efficacy to reduce errors in the administration of medicine. “The off-stage environment of the medical staff was well accounted for; the staff lounge and office areas were connected through a daylight-filled double-height space and were provided access to a balcony tucked under the zinc roof,” he adds. “Health care architecture will do well to care for its users by providing spaces that support intangible healing and lift their spirits.”

“Metal ceiling panels have the potential to seamlessly integrate lighting elements aiding in wayfinding,” says Randy Guillot, AIA, LEED AP, design principal, CannonDesign. “By perforating the panels you can add yet another dimension to the lighting. Perforated ceiling and wall panels backed with an acoustical treatment can also significantly cut down on ambient noise creating a more relaxing environment without sacrificing durability in a space for softer absorptive surfaces.”

At Elmhurst Memorial Hospital[7] in Elmhurst, Ill., Sharrow says the hospital is designed with balconies on each floor, adjacent to each unit with tables and chairs and potted flowers, allowing visitors to step outside and get some fresh air. They also designed rooms with a sleeping couch and a foldaway table so family can spend the night with a patient. The hospital has no visiting hours, so family and friends can come whenever a patient feels up to visitors. “We’ve designed the facility to make it comfortable for a patient’s family member to stay,” he says. “That can be very important in improving the safety and satisfaction of patients, while reducing the length of their stay.”

 

Design and Human Connections

The overall goal of EBD is to add to the body of knowledge that designers have when they are designing a health care facility, explains Sharrow. This allows designers to know they’re basing the design on credible information that will improve the health care outcomes of patients, the safety of staff, and the satisfaction levels of both patients and staff.

“Seeking to reinforce the uniqueness of the places that buildings are built in is one of the things that makes great architecture great,” says Guillot. “This connection to place is a powerful healing tool in reinforcing community and a sense that the patient is cared for by a group of people-not just impacted by a clinical environment.”

“The connections between buildings and human health are countless,” says Graff. “Many of these connections are well understood-like the importance of natural light, views and air quality. But there is much that is not so well understood-like how materials impact health, not just within the building but within the communities where they are manufactured. And how production of the energy required to operate the building impacts public health. Evidence and data exists but making the direct connection to a building project is not always easy.”

 

EBD Certification The Center for Health Design[8] (CHD) offers the Evidence-Based Design Accreditation and Certification (EDAC) program for health care planners, architects, designers, contractors and management professionals who demonstrate an understanding of applying evidence-based design to health care facilities. Launched in 2009, the program was developed with the help of more than 100 industry experts and Steelcase Health, Grand Rapids, Mich., CHD’s educational partner. Today, EDAC is an internationally recognized program that awards credentials in the United States, Canada and other countries. “The EDAC appellation is a known credential in the industry and today many health care organizations are requesting EDAC certified individuals in their request for proposals (RFPs) when selecting individuals and firms for their projects,” says Donna Deckard, BSN, MPA, EDAC, director of strategic projects at CHD. “Many schools are incorporating evidence-based design as part of their core curriculum and students are graduating with the EDAC credential.” There are currently 1,488 EDAC-certified individuals including health care executives, facility managers, contractors, engineers, project managers, clinicians, nurses, vendors, students and others. Architects and designers make up approximately 66 percent of those certified. “We also have EDAC Champion and Advocate firms who commit to having 25 percent to 30 percent of their health care teams be EDAC certified and actively incorporate EDB in their health care projects,” adds Deckard. For more information on The Center for Health Design and the EDAC program, visit www.healthdesign.org/edac[9].

 

Photo credits from top: (Indiana University Neuroscience Center of Excellence) James Steinkamp Photography; Image from EDAC Designed by 5G Studio Collaborative, Study Guide 2: Building the Evidence Base, page 34; (skylight) Photo courtesy of Albert Kahn Associates; (private room) Photo courtesy of Albert Kahn Associates; (Elmhurst Memorial Hospital exterior) Photo courtesy of Albert Kahn Associates.

Source URL: https://www.metalarchitecture.com/articles/changing-health-care-design/

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