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Better Space, Better Health
A massive change in health care is occurring as hospitals reinvent themselves to cater to the medical needs of aging baby boomers. Hospitals are building new facilities that deliver clinical excellence, improve patient safety, and accommodate patient- and family-focused care. They are moving to a private room model. And they’re considering facility design as a way to help brand themselves as the preferred hospitals in their markets.
One strategic tool that some hospitals are using is data-driven, evidence-based design. Evidence-based design looks at ways facility design can improve patient outcomes and operational performance.
Lakeland Regional Health System, a nonprofit, community-owned health care system, has embraced evidence-based design and used it as a major focus in the design of a new 118-room inpatient replacement tower on its St. Joseph, Mich., campus. Lakeland had two major objectives: to create a truly community-focused facility — one that is seen as the hospital of choice in the region — and to design environments based on the latest evidence-based design research, to improve outcomes and to raise patient, staff, physician and visitor satisfaction.
In the traditional programming phase, administrators and medical staff outline facility goals. These are often expressed in such items as number of beds, the size of the emergency department, types of medical specialties to accommodate, size of surgical suites, types of procedure rooms, size of patient rooms, and equipment needs. It is a functional list of physical and practice requirements in a new medical facility.
Evidence-based design adds an overlay of results-oriented objectives specified by the hospital. These objectives might be to reduce medical errors, increase staff satisfaction, reduce noise levels, minimize patient transfers, improve patient privacy or increase patient satisfaction.
Lakeland and the design team identified 53 metrics vital to the goal of creating the hospital of choice for its community. Data and statistics were gathered on Lakeland’s existing performance in these areas — and they will continue to be gathered until the new pavilion is finished. Once the facility is operational, performance data will be compared with the old facility’s data to evaluate the success of evidence-based design.
Hospitals look to improve patient, visitor, physician and staff satisfaction, as well as patient safety and clinical outcomes. These were key goals for Lakeland as well. But Lakeland believed that using evidence-based design would give it the opportunity to go beyond what other hospitals achieve, giving the hospital a competitive advantage in the community.
The design of patient rooms was seen as a critical factor in achieving patient safety and satisfaction. All rooms will be private, reflecting a nationwide trend. (The Facilities Guidelines Institute, in conjunction with the AIA/Academy of Architecture for Health, issued new standards last month that call for all future patient facilities to be designed with private rooms.) Studies have shown that private rooms can decrease infection rates by up to 45 percent and can produce a significant increase in patient satisfaction.
The new rooms will be 305 square feet, an increase of 140 percent compared to the space that a patient has in the current double-patient configuration (total of 220 square feet). Rooms also will receive more natural light, have operable windows, overlook natural settings, provide easier access to room controls, and include amenities such as shelves for cards and flowers, moveable chairs, and tables. Space in the family zone will increase by 170 percent and include a sleep sofa for overnight stays. In addition, the new tower will include family retreat areas with fireplaces, lounges and kitchenettes.
As part of the design process, a full-scale concept patient room was built, with all equipment (non-operable) and furniture. Staff, physicians, community members and former patients were asked for feedback. Many adjustments were suggested. For example, feedback led to rethinking and relocating lighting and lighting controls. Lighting controls that are highly used by staff were located by the entry door, with night lights on the bottom and overall room lights on the top. In addition, moving a task lighting fixture 6 inches made a significant difference for the patient. The level of control that patients have over their room, such as lighting, temperature, window treatments and call buttons, is a considerable factor in patient satisfaction.
Impact on Staff
The nursing population is aging, with the average nurse’s age close to 50. Studies have shown that nurses on average walk between 3 and 6 miles a day tending to patients and getting supplies. The design reduces average travel distance from the nurse’s station to the furthest patient room from 84 feet to 33 feet, a reduction of 255 percent. The percentage of staff work area per bed will be increased by 148 percent, equipment storage areas will increase by 149 percent, and access to medications and supplies will be more convenient. The new facility will also contain a staff retreat area, separate from staff lounges, where staff can catch some quiet time, recharge and enjoy scenic views.
A centralized distribution system, serviced by its own materials elevator within the core, will be used for all supplies, dietary needs and equipment, avoiding use of patient or visitor elevators. One additional design change locates patient and visitor elevators at opposite ends of each floor. The goal is to improve patient privacy, reduce infections and alleviate congestion.
Evidence-based design requires commitment. The hospital should identify an individual to champion the effort, both during the project process and afterwards, to help collect information. Time should be built into the schedule for research activities such as focus groups, surveys and measurements and documentation of existing facilities. At the end of the process, the additional time and effort pays off in better results, efficiencies that save money and time, and a documented return on the investment.
Evidence-based design is an effective tool in more than just health care design. It works for areas like higher education, which aims to improve learning, and in research, to improve discovery. The process allows administrators and users to understand and express priorities — what is really important from an outcome and capital investment point of view — and provides a way to track the success of their decisions and the designs.
Design Effectiveness Measured, Monitored
Lakeland Regional Health System is undergoing an examination.
— Mike Lobash, executive editor
Measurements of success
Here is a sampling of the metrics Lakeland Regional Health System is using to determine how well its new patient pavilion performs:
Monte Hoover, AIA, and Robert Schoeck, AIA, are principals with BSA LifeStructures Inc., an architecture and engineering firm with offices in Indianapolis and Chicago.