Design and Health World Health Design

Standpoint: Shaping the future

It’s not just better design; it’s the chance to shape a nation’s health, writes Dr Ray Pentecost. Economic turmoil and rising healthcare costs are creating new opportunities for healthcare planners and architects.

Healthcare planning and design communities worldwide are experiencing unprecedented opportunity to expand their influence beyond the confines of the built environment and into the policy realm where national priorities, agendas and strategies are shaped.

Why? Because the professionals who plan and design healthcare facilities are creating operating efficiencies and savings on a scale that can be used to underwrite new and/or expanded healthcare programming, and health system leaders with shrinking resources are taking notice.

Healthcare design research is yielding opportunities for the design community to impact areas of high cost in healthcare delivery, such as nosocomial infections, slips, trips and falls, and medical errors. It is also suggesting ways that design might impact staff safety, performance, satisfaction, and retention in competitive, global labour markets.

In the US, for example, the financial impact of staff shortages are costing billions of dollars, yet it is still unclear how to incorporate these priorities into national health agendas. Singapore, the host city for June's 6th World Congress on Design and Health, proudly demonstrated to the world at this important global forum its well-organised healthcare system. First, the focus of the health leadership in Singapore is on the health of every citizen. It is not on a medical transaction, which sometimes comes with a diminished concern about personal health and wellness, as is often the case in a supply-driven healthcare system.

Second, the creation of savings and efficiencies are harvested by those capable of redeploying them, the central health ministry. Sadly, in fragmented healthcare delivery systems the savings are often created by those who are not empowered to re-use them. Third, system overseers are committed to setting realistic limits on what is spent on the health of their nation. Financial gateways of personal accountability discourage the inappropriate and excessive utilisation of resources.

Perhaps the greatest challenge for health planners in decentralised systems is that if one doesn’t control, or at least strongly influence, the direction of the health system, like in Singapore, then realistically one is only able to choose two of the three points on the triangle in Figure 1. Having chosen two, the third becomes a derivative of those choices.

However, if planners are able to shape the healthcare system, or at least articulate a clear and compelling national agenda, then the potential exists to address all three points and tailor the system to support them. So how does this translate into an opportunity for the planning and design communities to sit at the table of healthcare system policy, strategy and design?

There are at least two ways. First, to create new programmes that emphasise health promotion or wellness, or to extend services to those unable to afford them, resources must be found. Design research that could shape healthcare facilities capable of saving billions annually in operating costs and favourably impacting healthcare staffing needs to be understood, appreciated and strongly underwritten nationally. It could unlock signifi cant, enabling resources.

Second, planners and designers must introduce a greater emphasis on salutogenic design, or design that supports healthy behaviour. Not only do these designs improve personal health, they should reduce the demand on other resources in the healthcare system at large. In one Singapore hospital signs encouraged workers to use the stairs, not take elevators, because it was good for their health. Successful salutogenic design must be driven by rigorous research.

The WCDH 2011 will be held in Boston, Massachusetts in the US, and the focus will be on ways in which the planning and design communities can engage in and help shape the national health policy debate. Focus on the health of the individual should direct the agenda. Research must empower the strategy. Results will get us an invitation to the next debate. See you in Boston!

Dr Ray Pentecost III, DrPH, AIA, ACHA, LEED AP is director of healthcare architecture for Clark Nexsen Architecture & Engineering and the 2009 national president of the American Institute of Architects – Academy of Architecture for Health

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