By Randy Keiser
Healthcare facilities are designed to support state-of-the-art medicine and technology, and over the last decade or so, we've seen a growing trend to make sure the environment alsoconnects with the patients, visitors and staff.
There are a few factors driving the trend - like the fact that now, under the Affordable Care Act, hospitals receive reimbursements based on their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score. The HCAHPS survey, given to patients after they've been discharged, includes 32 questions about patients' perceptions of their hospital experience. The survey asks about the hospital environment, the level of care from nurses and doctors and patients' ratings of the hospital, among other things.
With hospitals under increased pressure to go beyond providing excellent care, improving patient satisfaction has become a major goal of hospitals across the country. Let's explore some of the changes we've seen implemented.
Just as medicine has progressively moved toward "evidence-based medicine," where clinical choices are informed by research, healthcare design teams - builders, architects and engineers - are increasingly moving toward "evidence-based design."
More than 600 studies link aspects of hospitals' built environment to staff stress and effectiveness, patient safety, patient and family stress and healing, and improved overall healthcare quality and cost, according to research conducted by Roger Ulrich and Craig Zimring. The built environment provides a setting for human activity - and often influences our mood and behavior. Incorporating evidence-based design into a hospital's built environment allows us to create a facility that not only allows physicians and staff to provide exceptional care, but to do so in a setting that fuels satisfaction.
I've worked with a number of architects who incorporate the natural environment into their plans, including HGA Architects and Engineers, who designed a replacement hospital for the Owensboro Health Regional Hospital in Kentucky. HGA discovered that patients and staff were looking for an outside space to find respite and connect with nature, which has been proven to reduce stress. So HGA delivered by designing an interior courtyard.
It's common for hospitals to incorporate natural light into their designs, as it's proven to speed the healing process and shorten patients' length of stay. It's not just the light coming in that's important; the ability for patients to see out is also essential. All-glass exteriors, like the one we built for The James Cancer Hospital and Solove Research Institute at The Ohio State University's Wexner Medical Center, give patients a positive distraction and allow them to connect with and feel attached to nature - even from their beds. And because light is the main factor influencing our natural circadian rhythms - which turn on or off the genes that control our internal clocks - all-glass exteriors can improve patients' sleep cycles.
Hospitals are no longer reimbursed for unplanned patient readmissions 30 days after discharging a patient. To keep readmission rates down many healthcare design teams have incorporated evidence-based finishes that improve patient care and safety.
For example, new, more sophisticated beds track the weight of patient beds. If it falls to zero, which is a sign that a patient may have fallen out, it alerts the nurse. And, to eliminate slips and falls, many hospitals have opted for less slippery floors in patient rooms and bathrooms. Other common evidence-based designs include finishes that absorb sound and curtains and light fixtures that kill infection.
Many design teams take evidence-based design a step further by incorporating feedback from the hospital's staff, patients and community.
Patient Experience Workshops
I've had the pleasure of working with Kurt Spiering, vice president of HGA's Milwaukee office, on a number of projects, including the construction of Owensboro Health Regional Hospital. For three months during the preconstruction phase of the project, Spiering and his team conducted workshops with staff, physicians and community members, exploring the ideal patient experience to help them formulate a vision for the patient-focused facility.
According to Spiering, there are two core elements to the process: lean design and experience design. Lean design focuses on delivering value to the customer. In healthcare design, there are internal customers, the staff, and external customers, the patients. By listening to what they have to say you're able to determine what is important to them and what brings them value. Spiering and his team take this information and look at the built environment to help create opportunities for those experiences to take place, which is where experience design comes in.
"We place the client at the center of the design process. By approaching each project through their eyes, we're able to understand the needs and standards for success," Spiering said. "We go through a patient experience process for all of our clients, where we actually go out in the field and talk to customers. We ask what has delighted staff and patients about the way care is delivered and what has disappointed them or failed them in the process. Their feedback starts to live and breathe in actionable items that we can then put together to address how the care can be delivered to meet the needs of patients and staff. We customize the design of each space to achieve the desired experiences that we learned early on in the process."
While holding these workshops for the Owensboro replacement hospital, Spiering and his team learned that mothers with newborns in the NICU wanted to take their babies, who may only have a few days to live, outside to experience the world and feel the sunlight. So, we built a deck with rocking chairs near the NICU. HGA also learned that patients didn't like seeing the medical equipment as they entered their room, so they designed the rooms so that the medical gases and devices were placed on the front wall. The team also designed the family areas to include Internet access and a small worktable, giving families a space to work on their laptops and send updates to loved ones.
There's a lot of energy behind the movement to make sure hospitals offer a welcoming environment and great patient experience. It's up to the architect, engineer and builder to work together to create just that. Not only does this approach provide better patient outcomes - healthier people - it also reduces the cost of care.
As National Healthcare Director for Turner Construction, Randy Keiser oversees all of Turner's healthcare construction throughout the United States. Based in Nashville, Tenn., he has 35 years of experience building complex medical facilities totaling more than 10 million square feet.