Redesigning Healthcare: To Hotel or Not to Hotel?

What represents healthcare innovation?

Oscar Health Insurance is a startup based in New York trying to bring innovation to the health insurance experience. It provides a web-based experience, free telemedicine visits and checkups, and cash incentives to members for preventive health measures like getting a flu shot and exercising using wearables. Business Insider recently described a new clinic, opened by the startup called the Oscar Center, created in partnership with Mount Sinai Hospital. The title reads:

“Take a look inside the doctor’s office of the future, created by a $2 billion startup that’s shaking up healthcare”

How much has Oscar really changed the healthcare paradigm with this new clinic?

The clinic has aesthetic innovations. It is definitely beautiful and minimalist with modern furniture and hardwood floors. The elevator doors say “Be Well”, and bright bold text in the window of the community space, which provides members with free classes for expectant mothers or for yoga, reads: “Let the healing begin”. Individuals sign in with an iPad, and sit in a waiting area “stocked with free juices, bottled water and Kind bars.” This is the first prototype of the clinic for the company, which has received millions of dollars in venture funding and was recently valued at $2.7 billion.

The clinic resembles that of many other mainstream clinics in terms of personnel, employing a staff physician, medical assistant, and nurse practitioner, and in terms of architecture, with exam rooms, consultation rooms, and a laboratory for tests and vaccines. It does seem to have some novelty in that it apparently employs both a behavioral health specialist and mental health specialist. Curiously, it also provides something that they call an “insurance room” in the lobby, which “contains a phone that connects to Oscar’s sales team so you can sign up for Oscar insurance during open enrollment, ask billing questions, or ask questions about your plan.” (The insurance room sounds like a virtual version of an outpatient clinic front desk to me!).

The impact of this clinic design on outcomes has yet to be determined, but I am skeptical of whether it really has the capacity to “transform” care when its structure seems so similar to the current healthcare delivery system. It reminds me of a trend described in an article from the New York Times titled “Is This a Hospital or a Hotel”?

You should take the entire “Hospital or Hotel Quiz”; it is remarkably hard to distinguish between the two.

http://www.nytimes.com/interactive/2014/sunday-review/hotel-hospital-quiz.html?_r=0

The bottom line is that hospitals are creating facilities and amenities similar to those of the hotel industry to attract customers and improve market share. Although these investments do attract more patients, the impact on quality of care and outcomes is unclear.

Contrast this approach with a totally different one from the Sinai Health System in Toronto, which has issued a ban on breakfast in bed. That’s right, a ban on breakfast in bed, the opposite of a hotel!

Samir Sinha, the director of geriatrics at Sinai, asks a very important question for a delivery system:

“Are we the Mount Sinai Hotel, or are we the Mount Sinai Hospital?”

How is the “breakfast in bed” ban implemented at Mount Sinai?

Seniors are encouraged to sit up in a chair for meals, and to attend lunch and dinner in a common room with other patients. This leads to greater opportunities for mobility, since they have to leave their room to get to the meal, and for social interaction, since patients can engage in conversation with one another. As Sinha describes:

“We know that bed rest can promote dysfunction…If none of us actually eat breakfast, lunch and dinner in bed on a regular basis, why should we do that in the hospital?”

The ban is part of a larger care improvement strategy called Acute Care for Elders (ACE), which has implemented additional innovations, including: “clustering frail seniors on one ward, handing out no-slip socks, lowering beds to decrease falls and empowering geriatric-emergency-management nurses at the front door of the hospital”.

What is the result of this strategy? It has lead to quicker discharges of patients over the age of 65 and saved the hospital more than $6.7-million in 2014. This model is apparently being replicated at scale through a national care collaborative supported by the Canadian Frailty Network and the Canadian Foundation for Healthcare Improvement (CFHI).

This is an example of an innovation that is truly “low tech”, but nonetheless effective.

As a designer, it’s not as though I am opposed to the creation of beautiful healthcare facilities and amenities, but it’s my belief that changing the actual paradigm of care delivery will likely lead to the most transformative solutions that improve outcomes and reduce costs.

Perhaps “not to hotel” should be the new trend.

I tweet and blog about design, healthcare, and innovation as “Doctor as Designer”. Click here for information about creative commons licensing. My disclosures are here.