Recently, I’ve become very interested in hospital and clinic architecture; specifically, I’m interested in how seemingly unrelated factors, such as the intensity of illumination, background noise levels, and door handle composition, can significantly affect patients’ outcomes.
The image above, from http://www.newlondonarchitecture.org, is of the Evelina Children’s Hospital in the borough of Lambeth. It’s beautiful, open, and bright; mind-blowingly, it’s part of the NHS, so it’s not for profit. The building is by Hopkins architects, and it was paid for in large part (£50 million!) by the Guy’s and St. Thomas’ charities. I want to work in this building. See more images here.
Architecture affects outcomes. According to Lorenz (2007), “environments that are designed to be supportive assist patients in coping with the stresses induced by illness and hospitalization.” Lorenz mentions the work of Smith and Helmuth (2006), who found a set of factors strongly affecting outcome; these include a psychologically supportive environment, patients’ sense of control, social support, positive distractions, and reduced negative distractions.
In the same paper, Lorenz notes that “…studies all found that the view from the window and the amount of light significantly affected [length of stay] and mortality in the patient populations studied.” She also notes positives such as reduction of nosocomial infection in hospitals with single-patient rooms as opposed to open floor plans, a reduction in the likelihood of falling when in a single-patient room, and improvements in privacy compliance.
One of the really interesting findings, though, was that many patients disagreed with their family members’ subjective ratings, at a rate of nearly 50% of responses; the patients actually preferred settings other than single-patient rooms, apparently because of the reduction of isolation that other, more communal settings provide!
Interestingly, Lorenz suggests that room-type will be determined by the particular needs of the respective patient population, and this can be expected to change as technology and patient needs evolve. One needs only to consider the impact of HMO’s reduced reimbursement for obstetrics inpatients in the late nineties upon the proliferation of “birthing suites.” Of course, when the HMOs were forced to reinstate longer lengths of stay, the birthing suites became less efficient. Oh, well…things change. Tech changes. Legislation changes. Payment changes.
This is why “open building” will be important. More on this in a moment.
One of the real challenges you will face when considering the adoption of a major project is the reality of time; that is, you need to consider that the mission, means, and support for that project will shift. Relevant to hospital or clinic design is the consideration of change in the prevailing philosophy of health care; does the medical model, as outlined by Mechanic (2006) and others, reliably preface what the model of health care delivery will be in twenty years? How about fifty? One hundred?
There’s simply no way to know the answer to this question.
I suppose one might look at the stock evaluations for firms that design and build a lot of hospitals, or perhaps of private hospitals and clinics, if available. Even these types of elections, however egalitarian, complex, and good at predicting political victors, are of little use.
It’s interesting to me, then, to consider open building. Don’t forget that prevailing ideas fall out of favor…and remember that much of what you’re building will be emptied and repurposed within ten years. Even if your department stays in place for twenty years, that’s probably half or less of the planned lifespan of the building. If you want to cut expenses for your hospital, start doing it right now. As long as open building doesn’t significantly increase your expenditures, there’s no reason not to plan for significant changes before building.
Points to consider in your future clinic or hospital (or office, for that matter!):
-Natural ventilation, which changes room air at a greater rate than mechanical systems (Escombe, et al. PLOS Med 4.2, 309-317.)
-Sunlight has been proposed as one means of non-chemical disinfection of inside environments (Hobday (1997) Sunlight therapy and solar architecture. Medical History 42, 455-472.)
-Statistics show that approximately 10 percent of patients gained an infection during hospital stay in 1955; recommendations of the study already noted the burden this would place on the “scarce” nursing staff (Hughes, J. (2000) Medical History 44: 21-56.) What is the rate today? Where do we want it to be in five or ten years?
Lorenz, S. (2007). The potential of the patient room to promote healing and well-being in patients and nurses. Holistic Nursing Practice 21.5: 263-277
Mechanic, D. The truth about health care. New Brunswick, NJ: Rutgers University Press, 2006.