Re-Inventing Our Healthcare Facilities For the Future.

I recently served as volunteer in a small rural Texas hospital between San Antonio and Houston. I was amazed — not by the technology or the quality of the facility ?(because there wasn’t much in the way of new technology, and the facility was a lot older than me.) But the place was safe, and well maintained. And the personnel were knowledgeable, compassionate, and attentive to their patient’s needs, providing high quality care to every patient in their facility. It was an amazing experience that changed my thinking how to plan our healthcare environments for the future. ?

I quickly realized that in that one, 33 bed, small town hospital, which is similar to hundreds of other rural hospitals across the US, the clinicians’ and nurses demonstrated a knowledge about their patients that wasn’t solely based on information gathered through their medical records, or as a result of the technology that was available to them. ?The engaged staff knew where patients lived, worked, farmed, or ranched. They knew who their families were, and they took time to engage - meeting the the patients family and friends and most of all they were on a first name basis with all the members of the patient’s family. I also observed how the care-giver teams collaborated together in developing their hospitalization, and discharge plans for each patient, and how they intentionally explored the various social determinants of health and evaluate how each may be impacting their patients conditions.

During my time in the hospital, I had the opportunity to witness the personal nature of health care, up close and as a volunteer. The experience provided me with a very different perspective on how we can start re-thinking the hospital built environment - focusing more on ways to support memorable experiences and interaction between the patient, their family members, and the nurses, doctors and staff who were so engaged and committed with getting to know their patient's and family members history. This approach may be the norm but today, more than ever, we as planners and architects seem to be obsessed with how best to integrate technologies into the built environment vs how to make patients feel better through creating human environments that promote wellness and foster the type of interaction and care giving I witnessed during my visit.

By no means does my statement above lessen the importance of understanding and planning for life saving technologies when we plan or design a new hospital. We all recognize that technology has changed the hospital industry. ?For example, when I began my carrier planning healthcare facilities, technology infrastructure represented approximately 2% of?a new buildings budget. Today that number is closer to 30% and climbing.

In fact, the adoption of new technology in the healthcare space is changing nurses, doctors, and staff’s daily routines in ways that force hospital planners and building designers to ?re-invent how we design and build health and wellness facilities and even entire medical campuses. While technology has been widely embraced in medical research and laboratory buildings for decades, it’s only recently been fully integrated into the design and construction of medical facilities. And as healthcare providers try to increase efficiency without sacrificing the quality of care, patients do benefit from spaces designed and constructed around their safety, medical need, and new state of the art technologies, but we must also remain diligent in creating environments that promote people and their social and wellness needs making sure our hospitals of the future support the personal interactions that develop during a patients stay, and address the need for a memorable positive experience for both the patients and family members , as well as the nurses and doctors that care for them.

How Can We Make Our Hospitals and Medical Campus’s More Human? The goal starts with better access. We need to start by keeping the hospital from being surrounded by a sea of parking. The experience of visiting a hospital can be challenging. By creating more inviting - "human" surrounding's we can help lessen the fear, or uncertainty, that many of us experience when we visit a hospital.

Also, re-thinking how we incorporate ad-hoc technology infrastructure is the 2nd goal. Fast changing technology requirements are creating a disconnect in how the built environment is planned . When it comes to designing spaces for care delivery, new technology requirements can create longer travel distances, and result in crowded patient rooms, poor visibility, and changes to building infrastructure that impacts adjacencies, hallway widths and wall spaces to name only a few design challenges that design teams are having to deal with today. ?

Of course, patients’ safety always comes first but how about comfort, and focusing on how we make our hospitals more human? A concept we call “Building for life”.

The design of hospitals has always been centered around function vs the overall patient experience. And with technology literally taking over the hospital box, taking up large amounts of square footage, now dedicated to technology rather than patient comfort, aesthetics,? and or convenance of staff and patient alike, it may be time for many of us who plan, design, and build hospitals to all spend a few days in hospitals experiencing the personal attention and care that patients receive and how we can plan and design spaces that support that interaction.

We also have to recognize that their is always increased pressure to achieve profitability. And that there are growing concerns about limited staffing resources which cause healthcare providers to explore leaner building floorplans with more of an emphasis on enabling technology to help supplement the "human factor . But that integration of technology into the built environment should not come at the high price of compromising patient comfort or the human connection they crave.

I think we all recognize the crucial role Technology in our hospitals plays today. But we must also recognize the importance of ?how people ?feel when they visit those hospitals. After all our hospitals are social anchors in our communities, big or small. The big idea here is to make sure our health care facilities always favor the "human care" factor, which means addressing, scale, socialization, easy of access, and patient and family member, and care giver comfort. This big idea starts?with reinventing what a medical campus should look like, and then how rethinking the “smart box” we call a hospital can help make peoples lives better.

A Sea of Parking: How about starting with rethinking how that sea of parking outside our hospitals can be reconfigured into a pedestrian centric main street or town center atmosphere were people visiting and working at the hospital have more places to create memorable positive experiences as well as meet their everyday needs on or near campus. Next how about turning our medical campuses into mixed-use “wellness villages”, where patients no longer have a view of a parking lot but of trees, parks and an active town center just like that?small town in west Texas I volunteered in. ?

Re-inviting the "Smart Box" that we call hospitals. What about that Box??What if we re-invented how patient rooms work, look and feel? Fewer than 10 years ago we made the decision to offer individual rooms almost exclusively. Although that was a great decision environmentally, the rooms keep getting smaller as technology becomes more and more integrated into every wall and corner of those rooms. This results in as much as a 20% increase to the overall square footage of new hospitals which translates to added costs. How about re-inventing the patient room into a true "family care room" with a specific section for families and staff to socialize and support the patient, and creating opportunities for families to participate in a new care model of the future, helping ease the staffing shortage - reduce square footage in other areas of the "box" and create overall more enjoyable care spaces to spend time in.

It’s definitely becoming more and more difficult to find health care staff, in many towns and cities across the nation which means the existing staff will by default be less available to each patient so if we make the room bigger and more human or inviting, with a well planned family section this could compensate for the lack of attention due to staff shortages, while improving communication and affording the patient a lot more support, and a better overall feeling that they are being well cared for.

That small hospital in Texas may have only had 33 beds but those old rooms were converted from double occupancy to single occupancy leaving large and comfortable spaces for family and friends to spend lots of time caring for the patient and helping the nurse by keeping her informed, which they were comfortable communicating with because the nurse invested the time to get to know the family. A relationship was forged that supported the patients needs. ?

In Asia and and the EU including Greece hospitals are?already allowing family members to participate in the care model which has changed the way their hospitals are planned and operated. They also have a serious lack of health care staff, just like in the US. But in Greece for example, one visiting a hospitals will see families meeting with the nurse every day, and helping staff care for their loved ones by keeping the patients company, and the nurse informed and even preparing meals, and helping care for the patient when they need to move or change. There is a real psychological aspect for the patient with this approach, which may help them get better faster, and something we may want to explore further.

The point of my example is that the "big idea" is not something new that's never been tried before. Examples of family room designs exist all over the world. And in many cases, they exist right here in our own back yard, just like that small rural hospital in Texas where I had? the opportunity to serve as a volunteer and see first hand how families can engage in patient care if enabled to do so by the staff and the a build environment that can support the concept .

And finally, when we talk about re-inventing our hospitals, one must also?consider the current state of clinical support spaces including the nurses stations which often have little to no natural light making nurses and staff feel like they are working in a basement from morning till night. How about if we ?brought natural light to the nurse stations by moving them to the ends vs the middle core of the box? After all, ?if natural daylight is good for the patient it must also be good for the staff, who spend every working day of their lives in these spaces.

Finally let’s also rethink how we address the hospital on and off stage corridors and hallways. Continuously changing technologies, including movable Cow's and other portable medical equipment used by nurses and staff on a regular basis have transformed the hallway creating, parking lot conditions and traffic jams which disorient visitors and patients looking to find their way through what is becoming a confusing maze of "portable equipment on the move".

So as we search for ways to transform our hospitals into state of the art health care facilities lets make sure we don’t transform the current “smart Box” ?into a ?harsh machine environment but rather focus on improving the human experience. Let’s focus on reinventing the Box into a building designed for Life, ?starting from when we arrive on campus and taking us all the way through the care experience inside the built environment. Let’s make sure our hospitals, both big or small look , feel, and focus on "human care" and not machine care. And lets?continue to create warm, welcoming and pleasant designs that psychologically speak to healing and the human experience in ways that meet the patients’ expectations, and helps support staff and visitors alike in our hospitals and healthcare facilities of the future.

About the Author: Chris Kay is a planner, architect, and builder of healthcare facilities for over 30 years. He helps?clients solve complex real estate problems and inspires confidence in project teams by providing?leadership in delivering large-scale healthcare and wellness real-estate development projects?across the United States. He brings a comprehensive understanding of the entire?real estate development process spanning project feasibility and strategic planning through design and construction. Chris can be reached at [email protected].?Chris is the executive director of, The Healthcare Infrastructure Research Institute. (HIR) Is a collaborative research program helping bring community leaders together with leading healthcare and life sciences professionals to address industry challenges at a national level.

HIR's Mission Is to present the latest thinking from nationally recognized experts, providing a platform that facilitates interaction and collaboration among healthcare leaders, and public- private interests focused on creating actionable programs that can help improve the delivery of cost effective, safe, and operationally efficient healthcare facilities in underserved communities across the US. to learn more about HIR visit, hirleadership.org

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