Design and Health World Health Design

Inquiry: Sustainable strategies

The global economic recession has highlighted the challenge of the ever-rising costs associated with healthcare delivery around the world. Our four experts discuss the role of design in containing costs and supporting preventative approaches to care.

Doug Wignall, AIA, LEED AP, international director
– healthcare, HDR Architecture, USA

An integral element in the debate about healthcare reform in the United States needs to focus on eliminating the inefficiencies in the way care is delivered. We believe that a significant factor in helping make healthcare more affordable – and thus more accessible to all citizens – is to contain costs, especially those related to inefficiencies in how a building facilitates the work of its users, as well as how it functions operationally.

Increasingly, research demonstrates that design can exert a powerful influence on both clinical outcomes and building performance. In fact, some gurus predict that ‘performance’ may be the next big trend in healthcare. In the US, Medicare no longer pays hospitals if they make certain kinds of medical errors, and is considering ‘value-based purchasing’ that reimburses healthcare providers based on clinical outcomes.

This new emphasis on clinical performance will inevitably impact on facility design and construction. If hospitals and doctors need to prove performance, they will be expecting their facilities to do the same. It will be imperative to demonstrate that design can reduce medical errors, infections and falls while relieving patient and caregiver stress. It is also imperative to show that design can significantly reduce operating costs by decreasing energy and water usage, lowering maintenance costs and lessening waste generation.

As we plan, programme and design advanced healthcare facilities for our clients, we have a responsibility to consider all the ways in which those facilities can help patients heal better, allow nurses and physicians to provide better care and help facilities work better and more efficiently. In the face of a rapidly changing healthcare landscape, to do anything less is unacceptable.

Greg Penoyre, partner, Penoyre & Prasad, UK
The idea that good design can be uplifting, inspiring and affect one’s morale is well established. In healthcare this means that good design can contribute to faster recovery rates and in turn bring significant cost benefits to the health system.

Most people attending health facilities would probably rather not be there and are apprehensive about what they may have to go through. By designing welcoming and accessible buildings which are easy for people to find their way around, such negative feelings can be significantly reduced. Our designs have as much glazing at entrances as possible so the visitor can see in and once inside are easy for them to find their way around.

Treatment and inpatient areas are designed to be as non-clinical as possible using colour, texture and materials to create a rich and interesting, rather than alienating, environment.

So how do such measures reduce cost to the health system? Obviously, if the healing can start before the patient reaches the door and can be enhanced by the internal environment, time spent in the healthcare facilities will be reduced, demand for bed or outpatient space will be less and facilities can be smaller. Patient self-help and empowerment will also reduce staff costs. A popular and accessible health facility will provide opportunities for health education and preventative care for whole sections of the community who might otherwise not become involved until expensive care or treatment is needed.

Good design can also provide significant benefits in flexibility and to allow for changing technical needs and care methods at minimal ongoing cost. Now more than ever we need to make buildings last longer and provide a more sustainable estate for the long term.

Frank D Kittredge Jr, vice-president/operational planner,
Clinical Solutions & Research Group HKS, US

Prior to the downturn in the economy, healthcare systems were tending toward the construction of larger, showpiece hospitals. These new facilities helped them effectively compete for patients and staff based on image and amenities – but often lacked focus on the potential for efficiency improvements. Given today’s economic climate, building is not the only factor.

More healthcare providers are focusing on operational improvements to provide value for their investment. The goal is balance. Each is looking to tune operational effectiveness and right-size square footage without sacrificing the customer experience.

As such, the owner must set future space and provider efficiency goals. They must also consider opportunities to improve operational effectiveness. Examples of operational effectiveness include developing right-sized space, increasing volume without increasing space, creating non-duplicated services across multiple sites, implementing standardisation and flexibility, and eliminating service fragmentation.

Healthcare providers are incorporating operational strategies which include using lean processes to reduce/eliminate waste, implementing just-in-time delivery models for all support services, increasing caregiver patient time by reducing travel distances, integrating smart technology into the hospital, and using bedside registration. The objective in each case is to increase throughput and efficiency.

Patient- and family-centred care will also continue to drive the healthcare industry. In addition, market competitiveness, increased patient acuity, population ageing, technology and information systems, regulations and building codes, and flexible design will be vital considerations.

Designing smart hospitals that challenge current thinking – and which are anchored in evidence-informed research – will be the new standard of efficient care in the next decade and beyond.

Alex Van Den Berg, director, Nightingale Associates, South Africa
Preventative medicine has long been recognised as a highly effective means of reducing healthcare costs. Good ‘primary healthcare’ can be a fundamental element of preventative healthcare. However, in the South African context this is often not the case, given that historical political policies have led to resource deficiencies and dramatic disparity between rich and poor, as well as between rural and urban development.

The results of this are more evident in rural areas where the primary healthcare clinic is generally the most accessible point of access to medical care.

Here the clinic is required to provide both preventative and curative treatment of infected patients, leading to potential cross-infection. Picture a waiting room where sitting next to a healthy visitor is a patient infected with a contagious disease awaiting treatment.

The most problematic issues facing the South African Health system are the prevalence of tuberculosis, HIV and malnutrition. The financial burden on the health budget, in dealing with the consequences of these conditions, is enormous.

The incidence of these conditions can be substantially mitigated through an extensive integrated health education plan supported by well-designed and sufficiently staffed primary care centres. These buildings should facilitate health workers’ optimal opportunities to educate the public regarding healthy living practices, then offering the health workers opportunities to interact with the broader community – not only those coming for medical treatment. We believe this could assist in breaking down the social stigmas associated with diseases like tuberculosis and HIV.

These community health centres or clinics require the sensitive segregation of preventative and curative treatment areas as well as the inclusion of multipurpose community spaces. The design should allow for early screening, on arrival, between healthy visitors and patients with contagious diseases such as active TB.

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