Competing by design: healing environments attract patients, reduce costs and help recruit staff - Innovation

Physician Executive, July-August, 2002 by Russell C. Coile, Jr.

TAKE A LOOK AT YOUR hospital or medical office.

If you think of a hospital as an antiseptic environment with harsh lighting, stiff furniture and views of acoustical tile ceilings from a drab sickbed, think again. (1) Picture a medical clinic painted in the warm colors of Tuscany, with a Renaissance-style mural of the daughters of Aesclepius on the walls and a fluffy robe for every patient.

A fresh wave of health facilities are coming that promise to reinvent the concept of a hospital and revive the spirit of "hospitality" in patient care settings. Health care architects and designers are updating and upgrading hospitals with new facilities like:

* Bronson Medical Center in Kalamazoo, Mich.

* Doernbecher Children's Hospital in Portland, Ore.

* Northwestern Memorial in Chicago, Ill.

* Woodwinds in St. Paul, Minn.

* Griffin Hospital in Stamford, Conn.

* Children's Hospital and Health Center in San Diego, Calif.

The emphasis on healing design in these new facilities is long overdue recognition that patients' surroundings affect their well-being.

Lighting the way

Health care architects, space planners, interior designers and progressive industry suppliers are developing innovative concepts for health facilities, including:

* Natural light that penetrates interiors

* Open space in atriums, walkways

* Noise reduction and elimination of overhead paging

* Patient privacy and control of their environment

* Healing gardens

* Theraputic art and sculpture

* Private (one-patient) oversized rooms

* Hidden storage of supplies and equipment

* Views of the natural environment

* "Village"-like campuses of ambulatory, inpatient facilities

* Integrated physician offices

* Environmentally friendly "green" design

* Cafes, bookstores and health-related retail shops

* Wellness, fitness and complementary medicine

* Digital and wireless telecommunications

* Internet access

The best of these new facilities are focused on evidence-based design. Like evidence-based medicine, the goal is to translate research findings on the impact of the environment on patients' physical and psychological health.

More than 125 research projects have been conducted in the U.S. and around the world testing the health care designers' palette of color, light, noise control, art, privacy, space and scale.

The goal of research in healing design is to create health facilities that reduce patient stress, utilize fewer strong medications and promote rapid recovery.

Some of these new hospitals are formally evaluating the fiscal, clinical, behavioral and health status impacts of health care design in a collaborative research model pioneered by the Boston-based Institute for Healthcare Improvement.

In the past, hospitals that experimented with radical new designs seldom knew if the new ideas actually worked. The Center for Health Design, based in Lafayette, Calif., is recruiting a consortium of hospitals that is building new health facilities utilizing principles of healing design.

These institutions are committed to research and evaluation to see how well their new facilities work in practice. They're looking at cost of operation, patient and family satisfaction, staff morale, use of resources such as pharmaceuticals, labor hours and health status outcome.

Understanding the environment

Researchers are developing a new understanding of how the environment affects patients.

Studies are testing the way in which health care surroundings interrelate with medical care, illness and patient attributes. This new field of environmental psychology is called "psychoneuroimmunology," focusing on the correlation between stress and health. (2)

The findings demonstrate that the mind, brain and nervous system can be directly influenced, positively or negatively, by sensual elements in the environment. The research surprised many designers.

Health care interiors must be stimulating, not neutral. Normal consciousness can be maintained only in a constantly changing environment. The drab interiors and unchanging artificial light typically found in many hospitals may dull the senses and be visually and emotionally stressful.

There are three primary ways in which the environment can influence patients' outcomes: (3)

1. Medical care--The environment can support or hinder caregiver actions and medical interventions, making it easier or more difficult for clinicians to do their jobs and facilitating helpful or harmful impacts. One example: carpeting reduces the stressful hubbub and noise of health care workers moving about in the patient's room.

2. Health status--The environment may strengthen or impair patients' health status and personal characteristics by alleviating or exacerbating existing conditions and patients' personal strengths. One example is that loss of sleep due to noise in the post-operative setting may prolong recovery time.

3. Causes of illness--The environment can protect patients from or expose them to causes of illness. Circulation of ultra-clean air may protect hospitalized patients from debilitating or even fatal nosocomial infections.