The business case for better buildings

Healthcare Financial Management, Nov, 2004 by Leonard L. Berry, Derek Parker, Russell C. Coile, Jr., D. Kirk Hamilton, David D. O'Neill, Blair L. Sadler

"We shape our buildings, and afterwards our buildings shape us."--Winston Churchill, in a speech to Britain's House of Commons on October 28, 1943

AT A GLANCE

Beginning in 2000, a research collaborative of progressive healthcare organizations came together with The Center for Health Design to evaluate the impact of their new buildings on patient outcomes. Those organizations are now engaged in three-year programs of evaluation, using comparative research instruments and outcome measures. Their experiences are synthesized here in a composite 300-bed "Fable Hospital" to present evidence in support of the business case for better buildings as a key component of better, safer, and less wasteful health care.

Dozens of studies have reported health benefits associated with medical facilities' design features, such as natural lighting, views of nature, and artwork. Researchers have shown that healthcare buildings, equipment, furnishings, displays, signs, colors, art, landscape, and other sensory stimuli have a disproportionate impact on customers' overall evaluation of the service provided in those facilities. However, most healthcare facilities have yet to incorporate the fruits of this research.

There is a significant case for building better healthcare facilities--a case that includes financial benefits. It is possible to quantify those benefits by examining the financial results achieved by progressive healthcare organizations that have built or renovated facilities. For purposes of this article, a better building' is considered one that facilitates physical, mental, and social well being and productive behavior in its occupants. In addition, through measured superior performance, better buildings improve the organization's financial results.

Evidence-Based Design

Evidence-based design offers a methodology for scientific scrutiny and testing of building design benefits in health care. To help accelerate the movement of such design into the mainstream, The Center for Health Design has embarked on a multiyear research effort, called the Pebble Project, in partnership with various healthcare organizations committed to improving the patient care environment. This article is based in part on those findings.

Evidence-based design considers three categories of benefits: stress reduction, safety, and ecological health. Although the accompanying exhibits illustrate that beneficial financial results can be found in all three categories, this article focuses on the cost benefits of improved safety as having the greatest impact on the bottom line.

Enhancing Patient Safety with Better Building Design

A better building is a safer building. Just as a healthcare facility can be designed to moderate stress, so can it be designed to enhance patient safety. Safety-related building improvements include improved air filtration systems, better separation of "clean" and "dirty" areas on patient floors, transportation modalities that separate patients from potentially infectious materials and wastes, standardization and consistency of layout, and glare-free lighting. Three of the most promising facility design investments to enhance patient safety are readily available hand-hygiene stations, single occupancy patient rooms, and acuity-adaptable patient rooms.

Case studies and other research have highlighted the following in support of such investments:

* Nosocomial infections affect nearly 10 percent of hospitalized patients, lengthening hospital stays, increasing morbidity and mortality, and raising costs. Proper hand hygiene of caregivers is considered the single most effective and practical means of reducing nosocomial infections, yet adherence to recommended handcleaning practices remains low.

* Alcohol hand rubs are recommended over soap and water except when hands are visibly soiled. Positioning alcohol rub dispensers near the patient bed in the sight line of caregivers should improve compliance.

* Nosocomial infections can be a result of germs of room mates who share the same bathroom, making single-occupancy patient rooms a significant facilities design decision from a safety standpoint. At Bronson Methodist Hospital, Kalamazoo, Mich., replacement of the existing facility with a building containing 348 single bed rooms contributed to a reduction in the nosocomial infection rate (infections per 1,000 patient days) by 10.1 percent in the two years following the move.

* Patient transfers have not only cost but also safety implications, as medication errors are more likely when patients are transferred from one care team to another. Single rooms eliminate the need to transfer patients to a different room because of roommate incompatibility.

* Acuity adaptable rooms--standardized rooms designed with the space, dimensions, and features to accommodate a wide variety of patient conditions, needs, equipment, and staffing during changing stages of illness and recovery also reduce the need to transfer patients to different rooms.

* At Methodist Hospital in Indianapolis, use of a redesigned, acuity-adaptable 56-bed cardiac critical care unit eliminated nearly all patient moves, contributing to decreases in both patient falls and medication errors. Upon evaluating the indices of patient falls and medication errors per 1,000 patient days in the three years after the redesign, Methodist found that the fall index decreased from 6 to 2, and the medication error index decreased from 10 to 3.