A Cure for the Common Hospital?
Healthcare doesn’t need to feel “institutional.” Insights from hospitality, tech, and workplace design can improve the patient experience.
by Anthony Treu
After a long history of mediocre designs that have given hospitals and medical facilities a reputation as uncomfortable places to be avoided and feared, healthcare providers need creativity more than ever.
There is reason to be encouraged. More architecture firms are designing healthcare facilities with a focus on uplifting design. But we must remain vigilant against false success. Organizations increasingly look to data for answers, yet it is far too easy to misread diluted metrics as true indicators of successful outcomes.
At healthcare conferences and in trade publications, designers and their clients are saturated with esoteric jargon. It is displayed in many alluring forms—colorful travel routes charting a nurse’s typical walk-a-thon, psychometric maps of observation angles, research papers that sample patients’ subjective tastes for lighting solutions. These exhibits often rely upon the legitimacy of other professions to authenticate our own. Evidence-based design and lean methodologies — two legitimate practices — have been co-opted from the medical and manufacturing sectors with reckless enthusiasm. Too easily, these approaches can be distorted into junk science.
It is important that these potentially powerful tools support, rather than replace, the work of genuine creativity. We must not rely upon shiny objects as a substitute for true innovation and design improvements. Instead, we should focus on making meaningful contributions to the institutions we serve, and in turn, the clinicians and patients they host.
To find design solutions for our healthcare clients, we often draw upon innovative ideas in other fields.
One of the benefits of working within a multidisciplinary design firm is the ability to deploy new ideas that have been developed and tested in other markets. At SOM, the breadth of our work is one of our greatest strengths: at any given time, teams within our firm may be designing a corporate office, a tech headquarters, a university research facility, a data center, and a luxury hotel. We have the ability to gather and translate insights from these projects into transformative opportunities for the healthcare sector.
Creative collisions: lessons from the research lab
To find design solutions for our healthcare clients, we often draw upon innovative ideas in other fields. For instance, SOM has long been fascinated by the famous Bell Labs facility in Murray Hill, New Jersey. By encouraging the kind of chance encounters that can lead to new discoveries, the building’s design is credited with contributing to an era of rapid innovation for the storied company. In our project for the Mount Sinai Hess Center for Science and Medicine, we sought to achieve a similar result: by linking amenity and lounge spaces across all floors, the design encourages the kind of intellectual “collisions” that foster innovative work. These kinds of spaces not only promote collaboration, they also become enticing features that help to recruit and retain top talent.
While hospitals and clinics don’t host the same kinds of scientific invention, we know that clinicians benefit from in-person collaboration and the opportunity to connect during their busy shifts. By breaking down the physical divisions between departments, we can allow medical educators, residents, and supporting clinicians to teach and learn in more open and cooperative environments.
With this approach in mind, we responded to the unique demands of the New National Cancer Institute in Cairo, a major new academic medical center scheduled to open in 2019. Instead of providing typical, separate spaces for various activities (remote charting stations, physician dictation, staff amenities, and education), we designed centralized collaboration hubs within each nursing unit to support the teaching hospital’s academic mission. These hubs feature a collection of multi-purpose rooms — some meant for private conversation, others designed for hosting larger discussions between residents and educators. The goal, as at Bell Labs, was to encourage as many opportunities as possible for people to connect, and thereby to allow inspired ideas to circulate and grow. We hope that this approach will benefit the students, clinicians, and ultimately the patients of this critical cancer treatment facility.
Learning from hospitality design
Comparisons between hospital and hotel rooms abound, and both our hospitality and interior design groups have been focused on transforming outdated prototypes. In hospitals as well as hotels, for instance, the size and configuration of the bathroom plays an enormous role, helping to determine both the building module and the efficiency and complexion of the room itself. We have learned how to optimize the size of the bathroom, while turning this previously cloistered space into an opportunity to enhance the quality of the room.
We applied this approach when designing the patient rooms for Almaty International Medical Center, in Kazakhstan. Hospital accessibility clearances have dramatically increased the size of the patient bathroom, imposing a greater footprint and reducing the usable area of the patient room. Building on our experience in hotel design, we discovered that we could not only reduce bathroom areas, and therefore cost, but also solve several clinical concerns — notably, a targeted reduction in patient falls and clinician workplace injuries. We achieved all of these goals while creating a larger usable area for patients and their families.
Following the hospitality model, we “dissolved” the fourth wall of the toilet room and replaced it with a fully openable glass sliding wall. This allows the toilet room to be much smaller in the closed position, creating a more efficient room module while opening to provide more space when accessibility clearances are required. This kind of discovery serves clinicians’ needs while improving the patient experience.
Updating the workspace
Workplace solutions, as well, are undergoing a continual revolution. Gone are the days of rigid, closed offices, but the seas of “collaborative” open-plan workspaces are also disappearing. Our interior design team has been at the forefront of a more focused, productive workplace strategy. We’ve advocated for balancing private space and group spaces. At the same time, we’ve observed a broader erosion of the boundaries between work and home. Contemporary workers are most comfortable in environments that incorporate the palette and layout of more relaxed residential and hospitality settings. By disrupting the mentality that work is a place of pressure, these spaces encourage the modern worker to be productive in a calm, but focused environment.
In a recent design for a New York-area outpatient center, we applied lessons from workplace design to a clinical setting. Seeking to benefit both patients and clinicians, we designed two environments to truly make these user groups comfortable.
Our first move was the most ambitious: we created two-sided exam rooms, where patients enter from one side and providers from another. This created an “off-stage” circulation zone for the clinicians, allowing them to move between patient rooms without disruptions, and to speak freely in a private, professional setting. We then sought to remove barriers to collaboration. Private offices were replaced with semi-private work cubicles, giving physicians space for private work, but also promoting interactions within the larger patient care team.
The two-sided exam room also created opportunities to improve the patient environment. Without clinicians and support staff circulating in the public space, we could design this zone with fewer stringent clinical demands. Taking cues from residential and hospitality interiors, we replaced many elements that would typically feel institutional. For instance, we avoided creating a large, common waiting room. Instead of a transactional reception desk facing an impersonal group of chairs, we created a concierge area where patients and guests are directed to several decentralized seating clusters. Arranged along a corridor with abundant natural light, and portioned in small groups, the seating areas simulate the scale and configuration of a more intimate, residential setting.
Seizing opportunities for change
In an era of endless data, it’s easy to be misled by hard metrics and alluring language. But we must not be seduced into thinking that data alone will revolutionize healthcare. Design is the creative engine that fuels imaginative new solutions — and by examining successful solutions in other building types, we can identify opportunities for progress in the healthcare sector. It’s possible to transform medical facilities, and people’s perception of them, but the change must be driven by true innovation.
Anthony Treu is an associate director based at SOM’s New York office.
Read more perspectives from our design leaders:
Research shows the benefits of human-centered design.medium.com
Why government should advocate for good design.medium.com