Libby Laguta, CHID, EDAC

Wednesday, 16 September 2020 15:05

From Crucible to Phoenix

The hospital that we knew in 2019 is no longer there.  Hospitals are in a crucial state of being remolded.  I believe that the phoenix that will result is a hybrid model of care, highly specialized, with nothing but positive attributes for patients.

Everything we knew to be true about the healthcare experience has transformed into a environment of cost containment and competitive care.  Just using PPE purchasing as an example, we no longer tolerate price gauging and shortages.  Communities have chipped in and taken up the mantle of what needs to be provided to insure hospitals have the products they need.  We have re-invented resourcefulness and have leaped years into the future of telemedicine success.  We are now at ease with electronic interactions with physicians and nurses.  All age groups have embraced the speed at which we can talk to our physicians through electronic interface.  It saves time and money.  

To be sure, there will be much to accomplish with renewed infection control mechanisms.  Air flow and a fresh appreciation of the power of the outdoors has eclipsed inoperable windows of tightly sealed hospitals of yesteryear.  Cleaning, disinfection, and sanitation have taken on new meaning in day to day discussions of the average American in all work environments.  Ultraviolet filtration and overall education of what kills germs is now a household topic of concern.

The key word is efficiency.  What would have taken ten or more years to achieve has happened in seven months of intensity.  I am of the belief that we will be glad the Pandemic sped up the process.  The platform for care in the United States will move forward with less redundancy, separating functions into a retail marketplace of services.  The future will address individual service centers of care, with highly acute recovery centers separate from the "big house" of the hospital proper.  We have already seen free-standing emergency departments, and we will see more of these.  Singular buildings with children's services separate from adult care are already abundant.  Now we will reap the benefits of known infection control measures and plan for specific environments of care for cancer and compromised people.  There will be more sensitivity to specialized care platforms.

We are a great country and we have proven that time and time again.  The phoenix is rising from this crucible of change as it always does here in the United States and the term, "made in America" will be the key to many successes, not just in healthcare.

  

I am old enough to remember hospital solariums.  These were outdoor spaces on each wing to afford the patient fresh air and sunshine.  What happened to this idea of opening up the interior to the exterior environment?  We talk about biophilia as if it is a new term.  

As the Pandemic continues, we have learned that air flow is a pertinent factor in the transfer of droplets and virus contagion.  Perhaps we should return to our roots of yesteryear where fresh air was the solution to recovery from disease.  What if the windows at the end of hospital corridors were operable and allowed a breeze to flow through?  What if a patient room had a door out to a walking path on a green roof?  I would be that person who got up each morning to take a walk without the dings or sound of equipment alarms, but simply the sound of chirping birds and the smell of  tea olives.  That would improve my mind and body and I would heal faster.

In life plan communities/senior living environments, the limited walking paths are extremely condensed.  What if we could extend these paths further into outdoor living rooms with pause points for resting.  I would like to see paths wide enough to accommodate physical distancing.  I have a friend who has an incredibly old and tall oak tree in her backyard which has become a family art sculpture.  As her children outgrew shoes, each discarded pair was nailed to the tree, creating a topic of conversation to all who visit and sit in the yard.  This is a tremendous twist to the "Giving Tree" concept.  This would be a wonderful activity for a senior community, ever evolving and changing with time.

I believe that great good will come out of this time of change.  We are just beginning to see how to give patients and residents safe and "natural" settings to recover from disease, surgery, and behavioral complications. Let's make a giant leap into the future and return to what we know to be true:  green is good for what ails us.

Monday, 20 July 2020 20:08

Architecture for Health

If I've learned nothing else from this Pandemic, I know now that whatever we design has a bearing on health.  

Cue Gomer Pile saying, "Surprise, Surprise, Surprise!"  I have always believed that designing for hospitals and healthcare has an impact on the patients' success in illness recovery.  Today, it is not limited to spaces dedicated to healthcare.  As I review plans and one-way directions through spaces to limit unecessary physical contact, I see a familiar practice applied to a new frontier; the office.  We have a social responsibility to lessen viral exposure in our workplaces and businesses as well as ANY and ALL public spaces.  

Defining areas of office collaboration with flooring and color definition is sort of like defining the red line in surgery areas.  The lines are suddenly blurred between healthcare and workplace design.  We are hesitant to go to emergency rooms for fear of exposing ourselves to Covid, but we are also leary of going back to the office for the same reason.  Both scenarios have learned to deal with the transfer of infection in a new way.  Efficacy of old cleaning, sanitation and disinfection methods have been examined and new protocols have been developed.  

The furnishings industry has worked quickly to produce new solutions to effectively separate desks in the office and seating in waiting areas.  Time will tell how new aerosol cleaning methods affect upholstery and finishes long-term. This will influence new product development in a way that we have definitely seen in healthcare but now has washed into the office and public sectors. 

Designers in all industries have more research to do in the creation of effective solutions to projects.  I think we all are designing architecture for health.

Thursday, 25 June 2020 18:12

Curating a Lifestyle

Bridge The Gap: Multigenerational Workplace Success - Insperity

It is time to face our responsibility and moral obligation to end labeling and include all bodies in our design intent.  No one person likes to be labeled.  Millennials hate their label and seniors feel like their assigned nomenclature means they are automatically excluded.

It is the age of inclusion and while we are in this dialogue, let's look at all of our labels as a society.

The "us versus them" mentality doesn't work for us any longer.  We are all the same.  We all want to be valuable members of society and our communities.  Remember that those over the age of 65 will outnumber those under the age of 18 within the next ten years.  Instead of pushing our sage employees out of the workplace, they become our mentors.  We design communities to contain this group but not all people want or need to live with same age individuals.  Personal interaction  with all walks of life keeps everyone sharp and aware.

I believe the new terms is "curating a lifestyle" that speaks to living, working, shopping, playing and generally appreciating a mix of all necessities.  Now that we have all felt the impact of social isolation, let's apply that to taking care of those who need our attention.  This includes provisions of success for all.  We know what contributes to well-being: access to nature, those who support us, and supporting others.  

Are you ready to curate a lifestyle of inclusion?

 

There's a crossover occurring between all types of design; hospitality, multi-family, workplace, retail and healthcare.  The vocabulary of  "social distancing" in the workplace and "touchless" fixtures in hospitality and multi-housing are now commonplace.  But do you know the most appropriate way to conquer the new "safe" requirements in design?  

We have all experienced social distancing with lines drawn on the floor and numbers indicating how far apart to stand in the grocery line or the post office cue.  We've seen the plexiglass shields between us and the cashiers.  Restaurants are opening at half capacity and streets are being closed to allow outdoor dining options.  We're worried about going back to work in an office where employees are barely 36" apart typically.  We would rather sit outside and work at our laptops on a picnic blanket than expose ourselves to Covid in the coming months. Working from home is certainly an option and may be the first choice solution.

But whether at home, at the office, or at a food venue, biophilia is an absolute necessity in design now.  If for nothing else, for the addition of exterior spaces to relax and extend environments.  There will be a need to have "mask-off" time and the best areas to accomplish that is in a green landscape. 

I see a need for healthcare experts to join teams in all modes of design delivery.  A designer with healthcare experience can take an intense look into what the steps are to secure infection control in  hospitality, multi-family, workplace, and retail as well as healthcare.  This new position may be called a "hygiene manager" or "health maintenance officer."  

Whatever the term, the need is real.  If we truly care about our staff and our neighbors, we need to consult with those who know how to design to mitigate the risks.

 

Thursday, 21 May 2020 23:41

What We Know Now

When Covid was discovered, every hospital had predetermined protocols for the diagnosis and treatment of patients. The C Suite and department directors painstakingly developed these standards and protocols after years of input.  I listened to a webinar this week where 3 hospitals agreed that those were all negated the week that the virus hit their doors! The frontline workers have re-worked the standards and have adapted to the best and most effective ways to treat patients. Those who have the experience have set the protocols for the new normal.


I watched as photos were pinned to the webinar screen to illustrate how one hospital created a more human approach to care starting with the staff having facetime with the patient. Patients were issued Ipads and while the healthcare worker was outside the room, the patient conversed with the staff face to face through electronics. In an effort to save costs on PPE's, the staff moved ALL EQUIPMENT out of the patient room and into the adjacent corridor. All leads from the equipment to the patient were lengthened and flowed under the door to the bed. This was genius! The corridor became the patient bedside! Most work could be conducted without PPE's. There were, of course, times when the staff suited up and entered the room for hands-on care, but the patient knew who was working on them and had established a relationship with the nurse or physician. The patients felt less isolated.


Is this a contingency that hospital design might need to plan for in the future?  Possibly. What we know now is that more flexibility needs to be built into care patient environments. If a hospital system can set up beds in a parking deck to address a pandemic, then designers and architects can certainly address flexibility in the future plans for hospitals. I believe that building codes will be re-written to allow more temporary conditions to prevail, that privacy curtains will be eliminated or replaced with disposable ones, that wood arms on chairs in a patient room are no longer viable with current cleaning methods, and paints and wall finishes need to pass muster with aerosol disinfection. This is just a small portion of the changes that will come out of the last couple of months.

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Three months from now, when the Covid-19 virus is under control, what happens to hospitals and healthcare as we know it in the United States? How will hospitals fare financially? This is an unprecedented situation which has cost hospitals money and supplies.

I believe the answer to that question lies in the basic economics of how to recoup the costs of a pandemic. While we thank those brave souls on the front lines of caring for the afflicted, we need to recognize this may have caused their careers to be fundamentally changed forever. When all is said and done, will they go back to the same job as before the pandemic or will they have a new role?

Hospitals have set up beds in parking garages to address the numbers of patients. This all costs money and the implications continue to grow. Will big donors help? Will our future healthcare plans start to look more like socialized medicine? The U.S. as a whole will need to step up and support the people and systems who literally gave everything they had to keep our citizens healthy. Large philanthropic organizations need to keep this in mind and continue to give in the coming months to keep our hospitals viable and able to go back to "normal."

 

Wednesday, 04 March 2020 22:01

Color in 2030

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For the first time in the history of the United States, "Boomers" will out number children by the year 2030. Those under the age of 18 will be the lesser demographic to those over 65. Should we adjust our hospital color palettes to suite this group of adults?

Accommodating the changing feature customer in healthcare environments will be tricky. I am potentially suggesting that we switch to color that the aging eyes will perceive. There are so many factors to consider; the presence of cataracts, the yellowing of color perception with dementia, and the blurred close vision of presbyopia, to name a few.

Let's see, there could be evidence to design with pops of color to signal changes in wall surfaces. There are also schools of thought to create a black, white, and grey world to make certain we appeal to all people with all conditions. Then there's the contradictory use of red in a healthcare setting. Let's use it, because this color will visually appear more muted to this crowd! More recently, there is the use of the blue color spectrum, now coupled with LED lighting. Does skin tone actually change under these lighting conditions? Perhaps we have pushed the envelope of possibilities far enough

Let's remember that no two people are alike. I may not see the same hue that you see, but I can appreciate it. I am totally sure that my color perception will never be completely gone! A space devoid of color will bore me to tears. Let's not jump the gun to delete color in the foreseeable future. Let's agree to evolve color into the best application as designers have always done and thereby appeal to all generations.

After all, the most successful spaces and those with color make terrific black and white photos.

Thursday, 05 December 2019 21:55

Emotional Intelligence in Senior Healthcare

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Yesterday evening, I attended an ACHE event entitled "The Principles and Characteristics of Emotional Intelligence in Healthcare." I enjoyed the panelists and the moderator's examples regarding heightened awareness of emotional intelligence in a healthcare setting. Sadly, not all hospitals have an "EQ" (emotional quotient) program in place. Why not? That strikes me as insanely odd.

I understand that IQ cannot be altered, but EQ can be improved over time.

How many times have you been in a situation at a medical office or outpatient facility and heard someone over the age of 65 checking in for an appointment? . . . . and how many times has the staff person talked down to the senior person? The staff needs to know that just because a senior cannot hear well or is confused by a form, they do not need to be shouted at or spoken to as if they are a child. It's as if we believe that IQ diminishes as we get older. It does not.

Every person deserves the dignity to express themselves and be heard. I quietly fired a doctor and replaced him because he disregarded what I asked and glossed over my questions without really addressing my concerns. I cancelled my next appointment and never went back. I have a new physician now. The first time I met my new physician, I explained that I need communication and answers. He is not intimidated. He takes time with me and applauds my homework and my level of detail.

It's only a matter of time before I fall into the category of being labeled as "senior." I will state my case every time the person on the other side of the (healthcare) desk does not exhibit empathy or authenticity toward me, but other people may not be so bold. It's up to the institution of healthcare to make the effort to educate their employees. What is your emotional quotient and are you improving it?

Tuesday, 08 October 2019 21:51

ED for Seniors?

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Today there are emergency departments designed especially for children. These are set up differently with specific and adjacent waiting areas. The staff are well-educated in the illnesses of children.

At the VA, there are specific mental health sectors in the ED to deal with traumatic brain injury, PTSD, and a host of illnesses that are best treated without visibility to the typical ED patients and families. Behavioral health has become synonomous with privacy and specific treatment regimes. At the very least, a standard ED department should have a mental health professional on staff at all times.

Why then, do we not provide a specialty ED for those over the age of 65? With the changing demographics of the US population and seniors predicted to out-number our children in the next 9 years, it is highly likely that senior ED's will be the norm. Seniors require medical staff with knowledge of their lifestyles and characteristic ailments. Gerontologists need to evaluate the patients and determine if they are capable of making their own medical decisions. If not, the families and caregivers need to be incorporated in treatment programs.

In her blog post, Anne-Marie Botek, listed the senior emergency room design offering:

  • Floors with more traction and less glare
  • Lighting that is gentler on elderly eyes
  • Reclining chairs and mattresses designed to lessen pressure
  • Personal rooms for patients
  • Telephones, clocks and documents with larger print
  • Blankets warmed in ovens
  • Equipment to aid in hearing/communication between patient and health professional

What if families are far away? Teleconferences with families need to be immediately available. It is possible that Dad or Grandad has chosen to hide his medical condition from his family. This is his decision, but staff are there to explain and prepare him for what lies ahead as his illness progresses. Plans need to be made for caregivers if he needs help.

The idea of self-contained "Senior Emergency Medicine Clinics" seems feasible and necessary. If this is not enacted, those 65 and over will impede the flow of the typical ED and cause the ED's to reach capacity with regularity. The solution is as simple as a re-direction of the group to a more resourceful staff at a facility built specifically for their needs.

According to the Wall Street Journal, the good news is that more than 50 geriatric emergency departments have earned the Geriatric Emergency Department Accreditation (GEDA) and 100 more ED's are in the process of accreditation.
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