Better Healing from Better Hospital Design
Bright, beautiful lobbies featuring an atrium filled with local flora. Rooms with big windows and access to outdoor gardens. Dining options served up by one of the top chefs in the world.
Innovative new hospital designs have changed patients’ experiences and expectations of what a hospital should be. These sleek buildings have design features found in many high-end hotels—and they are built with the express intention not just of increasing patient satisfaction but of reducing costs and improving outcomes.
Research has shown that hospitals that feature new designs and amenities send patient satisfaction scores vaulting skyward. In fact, one study, conducted by Professor Dana Goldman and Associate Professor (Research) John A. Romley at the Schaeffer Center for Health Policy and Economics at the University of Southern California, showed that amenities are a larger factor in driving traffic to hospitals than clinical quality. As a result, amenity-rich hospitals with modern design features are attracting more patients, which is good for the hospital’s top line.
It’s clear that newly designed hospitals with hotel-like perks increase patient satisfaction and traffic. But are these newly designed hospitals having a desirable impact on value? Measuring before and after costs and outcomes shows that they can.
Hospital-acquired infections continue to plague hospitals. They occur in about 30% of patients in intensive care units (ICUs), leading to substantial illness and fatalities. When one of two McGill University hospitals in the Montreal region of Canada redesigned its ICU from shared to private rooms, the rate of bacterial infection decreased by more than 50%. The new ICU design also decreased the length of stay by 10%.
This impact was measured over five years by collecting information across three hospital databases. One database tracked each patient’s length of stay, and another tracked every patients’ infectious organism screening results upon ICU admission. The third database recorded any infections acquired from 48 hours after admission (patient likely arrived with an infection) to 48 hours after discharge (patient likely left with a hospital-acquired infection). By simply measuring infection incidence over time between a control and intervention hospital, these two facilities were able to accurately measure, using over 19,000 admissions with a 95% confidence interval, the impact of the newer hospital’s design. Thanks to the results of studies like this, private patient rooms, seen historically as a luxurious amenity, are now a standard, accepted design for reducing the transmission of infectious organisms in hospitals.
Salvocorp’s range of products are incredibly hygienic allowing them to contribute to the healing of patients. Their non-porous attribute prevents the growth of bacteria which contributes to fewer infections and their range of colours enables the implementation of colour therapy which has, in recent years, proven to assist with healing and the emotional levels of long-term patients.
Roger Ulrich, a visiting professor at Center for Healthcare Architecture at Chalmers University of Technology in Sweden, has been a thought leader in the evidence-based design movement for 30 years. In 1984, he wrote a seminal paper that significantly affected how hospitals are designed today. In “View Through A Window May Influence Recovery From Surgery,” he famously compared two sets of patients—one with “tree views” and one with “wall views.” He showed, using clinical data, that patients with tree views had “shorter postoperative hospital stays, fewer negative evaluative comments from nurses, took fewer moderate-to-strong analgesic doses, and had slightly lower scores for minor postsurgical complications.”
Today, many hospitals feature gardens of various types, and their impact on care has been studied more rigorously. One study reports that 95% of people who walk through hospital gardens report a therapeutic benefit from simply being in them. Contact with nature not only speeds patient healing, it also helps family members and hospital staff more effectively deal with the stress of providing care. And that enables them to better serve their recovering loved ones and patients.
But what if your geographic location makes having a beautiful outdoor garden impractical? That was the challenge posed to Bronson Methodist Hospital in Kalamazoo, Michigan. Because it is located in the “snow shadow” of Lake Michigan, it receives an average of 80 inches of snow each winter. So they created a giant, drum atrium “full of nature” in the middle of the hospital. The wings of the hospital radiate out from it, making it easily accessible to everyone.
When hospitals provide easy access to nature, patients, employees and family members can all enjoy the benefit it provides, including reduced stress, reduced blood pressure, reduced pain and increased pain tolerance, faster recovery times, and, simply, pleasant escape from stressful situations.
The design of environments inside clinical settings has also demonstrated positive impact on patient outcomes, particularly for children. A study by Sunitha and Santhanum Suresh showed that after surgery, children who listened to music or a story of their own choosing for 30 minutes reduced their pain score by one point on a ten-point scale, compared to the children who listened to nothing. Because children suffer more side effects of pain medication—such as trouble breathing and nausea—than adults, reducing the amount of medicine administered to kids can have a positive impact on outcomes as well as cost of care.
Shorter Hospital Stays
“Design your organization before you design your building,” wrote D. Kirk Hamilton, professor of architecture at Texas A&M University. It sums up nicely the symbiotic relationship between culture, process and architectural design.
Karolinska University Hospital in Sweden wanted to change their protocol for caring for prematurely born infants in the neonatal ICU. Before the hospital brought in their architect, the care team devised its strategy and process for providing a new care model to mothers and their premature infants.
“The staff had a good idea that coupling should be their new protocol, but it no idea what the care environment should be like to support it,” said Ulrich. The existing design of the unit didn’t allow coupling — in which mothers hold their babies against their skin as early as possible after birth — as mothers recovered in a completely different ward from the infants, and existing rooms weren’t large enough to accommodate infants, mothers, and the equipment they both needed to recover. So the architect, Peter Fröst, worked alongside the care teams to clearly understand the new strategy, goals and processes, and shared “architectural expressions” of the space with the team to ensure alignment. After the new protocols and architectural space were designed and built out, the hospital reported that length of stay was 10 days shorter for the most premature infants, morbidity rates were lower, fewer infants required ventilator assistance, and long-term mental and physical prospects were higher.
“The combined impact of protocol and space design was a ‘game-changer,’” according to Ulrich. “One of the most effective ways to impact outcomes is to design an integrated cluster of architecture changes and care process changes.”
When many people think of hospital design and its impact, they often believe it’s a superficial, touchy-feely, and subjective endeavour. But there are numerous examples throughout the world that have demonstrated—with clinical data—that design has a measurable, desirable impact on clinical outcomes and cost. These evidence-based designs have saved lives, reduced pain, improved clinical outcomes, and made less painful (and even provided some delight during) some of the most difficult moments in people’s lives.