Our generation has been witness to the transformation of a building
type. We have seen a consistent rate of change in the health care
delivery environment and its corresponding effect on facility design.
From the utilitarian “custodians of the bedridden” hospital,
predominant in the 50s and 60s, to the modular technology-driven
designs of the 70s and 80s, to current facilities that are designed to
be friendlier, safer, patient-focused.
Through it all, the only constant has been change.
Before embarking on any effort to develop a strategic plan, hospital
administrators and board members should carefully and objectively
evaluate if this is indeed in the hospital’s best interest. According
to the Center for Health Systems and Design, the following six
questions can act as a guide when trying to evaluate a course of action:
• Urgency. Is the expansion/replacement needed now to fulfill the mission or can it be deferred?
• Appropriateness. Is the proposed plan the most appropriate and sound,
and all alternatives been explored – such as partnerships with other
hospitals and satellite operations – as opposed to expanding,
replacing, or upgrading the facility in question?
• Cost of the project. Has the project been reviewed to offer the maximum value for every dollar spent?
• Financial impact. Has the operating impact of the additional volume
been accurately analyzed financially and the operating impact of doing
nothing been considered?
• Sources of funds. Have the sources of funds for the new facility been identified, and are they reasonable and defensible?
• Design impact. Has the project or strategic plan considered new and
emerging design concepts that have an effect on its business, as well
as the facility’s quality, safety, and impact on patients, families,
and staff?
Today there are many diverse factors influencing the direction of
health care facility design. Technology, regulatory requirements,
social attitudes, local demographics, reimbursement policies, market
demands, and building codes all influence the way health care
facilities are programmed, designed, and built.
The following trends have emerged as those factors most likely to
impact the design of facilities today and into the immediate future:
• Continued reorientation to outpatient services. Both medical science
and health care economics are pushing those patients once considered
inpatients into the outpatient arena.
• Rising acuity of inpatient care. This shift is hard to accurately anticipate, so flexibility must be built into the design.
• Cost effective delivery of care – return on investment. Far and away,
the largest portion of a hospital’s budget is consumed by employee
costs. Emphasis should be placed on staff and facility efficiency.
Consider organizing by service lines and streamlining throughout with
an emphasis on patient pathways.
• Integration of healing design concepts. The hospital is a place of
healing and the design concepts should support this basic assumption.
• Continued provisions for future growth and change. Technological
advancements, administrative restructuring, changes in modalities of
treatment, and unforeseen directions in the activities of healing – all
these pull on a facility’s ability to adapt and evolve.
• Patient safety in design. Design concepts that minimize errors and accidents within the hospital.
• Staff ergonomics and safety in design. Increase staff effectiveness,
reduce errors, and increase satisfaction by designing better
workplaces.
• Recognize the continued consumerization in the health care market.
Potential patients are more informed than at any time in the history of
health care. Patients are looking for convenient access, intuitive
way-finding systems, comfortable environments, and a one-stop shopping
experience that works with their schedule.
• Alliance with physicians or third-party entities. Strategies to limit
a hospital’s initial capital expenditures while enhancing the overall
return on investment need to be fully explored. Partner up with a
design team with extensive experience in health care design concepts.
The optimal building environment
Architects can, at times, find themselves in a truly unique position
with the ability to have a very real and tangible impact on people at
such an exposed moment of their lives. Seldom does one find themselves
involved with a building type that covers such extremities of the
emotional continuum from the joyous birth of a new family member to the
exhaustive emotional endurance required to persevere through a long,
and possibly, fatal disease.
The optimal building environment must address not just the medical
needs, but also the emotional, social, spiritual, and psychological
needs of all the users of the facility. At times, these needs appear to
be contradictory – a modern high tech image may instill confidence and
communicate technical competence, while a more traditional image can be
reassuringly familiar and comfortable to potential users.
The task of the design team is to find the balance that can satisfy
this broad continuum, while at the same time create buildings that are
economically viable, meet diverse goals, promote good health, and act
as an ally in the art of healing.
