Tuesday, 02 February 2021 19:11

A Tumultuous Time

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I am glad that 2020 is behind us and we can look forward to Covid resolution in 2021.  As I examine the toll the virus has taken on hospitals, I realize that many fiscal as well as physical changes are necessary moving forward.  I believe that future hospital design will feature a dynamic tension between infection prevention and flexibility.  Hospital bed counts for overnight stays will be the sole purpose of the main hospital building for the foreseeable future.  We will protect our vulnerable populations by further isolating care for seniors, heart patients, diabetics, emergency patients and children.  We have already seen this movement towards free-standing specialty clinics and this concept will continue to grow.  We call it the "hub and spoke" model.  The hub being the main hospital with the spokes formed with individual specialty services.

As planners and designers, we will become proficient in the needs for each population and assist owners in rebranding these facilities.  We will select materials not only based on durability, but also review the finish or fabric's ability to stop the growth of microbes.  Careful considersation as to the properties of materials will require research and a proven track record for success.  Healthcare organizations will depend on our knowledge and foresight to recommend the best possible design selections for the budget.  These organizations are in a critical balance between addressing the need for separating patient populations, making the most of outpatient options, and in the end, making money to offset the costs of the pandemic.  Historically, outpatient business has been a lucrative venture for healthcare owners.  This will be even more important in the coming years.

Our expertise in planning and our experience in mitigating the transfer of infection through our designs will be paramount to our clients. We have never seen such importance placed on our knowledge as we perceive it now..  Take the baton and be sensitive to revamping the delivery of healthcare.  Architects, designers and engineers need to understand that we are shaping the future of healthcare with careful consideration to patient groups. It is a tumultuous time in healthcare, but perhaps a positive leap forward in the evolution of healthcare design.

Monday, 20 July 2020 20:08

Architecture for Health

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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, 21 May 2020 23:41

What We Know Now

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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.

ScreenHunter 519 Apr 22 1614

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."

 

ScreenHunter 521 Apr 22 1615

 

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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ScreenHunter 522 Apr 22 1616

 

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.
Friday, 19 April 2019 19:09

Modularity in Healthcare

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ScreenHunter 525 Apr 22 1617

 

As the over 65 population ages, the demand for healthcare expands. Owners and operators of hospitals are struggling to keep up. Medical office buildings are in short supply in many areas of the US and as a result, modular buildings are becoming a quick and easy solution.

I remember when modular workstations were a new idea in office furnishings. It was a much-needed solution to the lack of space and the rising costs of leasing. I liken this to the need for affordable and fast options for medical office space. Suburban sites and convenient access to major hospital brands close to home dictate a need for modularity.

Just like the hospital staff designs protocols and standards of care, I believe standards for the physical modularity of the space are needed. By this I mean prefabricated parts and pieces assembled on site to meet a particular building size and configuration.

As communities grow, constituents demand access to care within the limits of their geographical area. The scale of the facility is based on how many patients are seen and processed. It may sounds like a factory, but truthfully, it is reality to think in terms of numbers and shear accessibility. Deficiencies in service areas can be addressed by telehealth. If a modular building location begins to see the need for a service such as orthopedics or rheumatology that is not currently offered, then a remote team is utilized by a telehealth platform.

Just as modular workstations provide more efficient square footage for planning people in a work space, prefabricated buildings afford more people access to healthcare within their day to day domains. This is quicker for the patient and by spending less than the cost of brick and mortar, hospitals and owners save on the physical building cost.

Thursday, 21 February 2019 18:21

Early Feedback Brings Project Success

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ScreenHunter 528 Apr 22 1618

The effective design process includes visioning sessions, focus groups, and mock-ups. All is relevant to providing the most patient-focused design solutions. However, some interior architectural design firms simply blow through the design process utilizing the typical FGI Guidelines and seemingly provide a decent result. Or do they?

The proof is in the post-occupancy evaluation. Did the patients' path of travel intersect with the staff at key steps in the process or were there shortcuts in the cycle of care? The staff needs to understand the patient's path and buy into it. Otherwise, they ignore the space design and adjust the signage to meet their needs thereby changing the patient's course of travel. I know this from experience.

If the patient intuitively understands where to go and what to do, they do not need a staff member to assist them. Nurses and physicians must be on board in the planning process to show the patient how to maneuver the space. I find that as a designer, my biggest ally, source of information, and advocate is the people who work in the space. A relaxed and happy staff provides a relaxed and happy patient.

During the focus groups, the community voices "wants and needs" based on the culture of the neighborhood and geographical area. Unique idiosyncrasies surface at these sessions and the designer begins to understand and "feel" the group's needs and aspirations. This provides the background and foundation to build the design. In short, get to know what is fun and interesting to the people who will occupy the space. They will appreciate your attention to detail.

Show photos in the visioning session to get feedback. I have found that what I picture in my mind can often be totally different than what a nurse or focus group participant was conveying to me. Interpretation of thought is important and continual feedback along the design process eliminates surprises in the end result.

Finally, mock-ups of strategic areas uncover a wealth of information to discuss. Physical placement of tools and design of spacial proximity provide the 3D representation that many cannot grasp until the they see and touch the environment. Once constructed in the field, it is too late to make costly changes and concessions are made. This leads to disappointing compromises to the flow of their space and no client wants to end with less than they bargained for after waiting years for a new and technologically advanced space.

Monday, 17 December 2018 20:20

Defensive Medicine

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ScreenHunter 518 Apr 17 1752 

Back in 2015, the New York Times published an article which summarized that the physicians' best defense against litigation was to communication better with patients and families. This is still a true statement today.

Many times, I feel rushed through my appointment and rarely does a physician sit down to discuss my visit with me. The few times that I felt synergy with my caretaker included eye contact, a friendly banter, then pointed questions followed by a dialogue which ended with me having a new understanding of my medication or illness. That would be deemed a successful visit. While I was in dialogue with my physician, the assistant was busy inputting the information into the computer. All was recorded.

The days of a standard exam room equipped with an exam table, casework for storage, a computer station, a side chair, and a physician stool are passe. The educated consumer/patient now expects interaction and friendly exchanges of personal chatter followed by more serious exchanges of health status and symptom checks. A physician who gets to know his or her patients is more effective at spotting differences in health changes.

The designer can support the process of dialogue and discussion by the room design. The basics of furnishings and equipment are now supplemented by the addition of a place to sit side-by-side and review charts and visuals on a screen. In some cases, videos are available for patients to watch in the exam room to delve deeper into understanding their steps and process in care. The provision of warm wood finishes are not the only means to ease the stress of a doctor visit. The layout of the space plays an important role as well. When the entire room becomes usable and there is no separation between the physician area and the patient area, there is a sense of equality established. Adding upholstery and more comfortable seating also creates a space that speaks to a caring and interactionary environment. The patient feels empowered and welcomed. This is the future of healthcare.

Sociopetal waiting layouts were once thought to be the best. Like petals radiating from the center of a flower, designers were striving for "conversation groups" and a combination of lounge seating and chairs with a lesser footprint. The results looked similar to our living rooms at home. We implemented furnishings plans in medical office buildings with sociopetal layouts and we even planned them inside the hospital; in radiology waiting and outpatient areas.

waiting room

​Sociofugal waiting areas, on the other hand, line chairs up in rows with ganging mechanisms. The problem is that people don't like to sit next to strangers. They will leave a seat between themselves and their neighbor and will gravitate their position between a chair closest to the door to their exam room or near an outlet to re-charge their devices. While this layout seems to create the largest seating count, it also creates the most wasted amount of seats because of the habit of leaving vacant seats between patients and families.

conversational waiting area

As designers, we need to advise our clients of the pros and cons of each option and make a recommendation that is best for the stakeholders. It could be a combination of sociopetal and sociofugal arrangements in an acute care setting. It could be a total sociopetal configuration in a residential healthcare scenario, as in the lobby of an assisted living community. Another possibility is table placement between a sociopetal circle of chairs as shown above. The right answer lies in the use of available space.