By John Cooper, AIA, ACHA

It’s no secret that the healthcare industry has experienced major changes over the past few years. Hospitals and integrated delivery systems serve more patients in less time and sometimes with less staff than ever before. We have added countless rooms of technologies. Then we added new processes to support them, starting with billing. And oh how our billing processes have changed! And all the while, our human resources and staffing needs have altered. We communicate and market ourselves differently. Many times, we think of ourselves differently.
And yet, the spaces in which all these developments happen have not changed, or at least not nearly as substantially or as quickly as the changes in our industry have occurred. So how is this working? In many cases, it’s not.

Healing Our Healing Spaces
We want healthcare spaces to inspire healing, discovery, service and endurance. But we find ourselves in a situation where we have outgrown our spaces. They are confining us, and not just in room size. It is true that our formats and our environments are dated. However, our technologies and standards of care are not. As a result, in many cases, we are limited by our settings.

For instance, the average hospital system is technologically 10 to 20 years behind the local Wal-Mart. When a checker scans your purchased item, the scanner immediately notifies the distribution center of the purchase and puts a replacement item on a truck. On the other hand, when checking into a hospital, a patient typically waits in a room and uses a pencil to fill out a sheet of paper on a clipboard. The appropriate data elements are then transcribed and inputted by an employee. The patient again waits and sometimes is sent to a new area to experience this same clipboard and charting system again. Hours later, collected information is still not processed or aggregated. And this is just the check-in procedure.

Situations like this are multiplied and compounded across systems everyday. Often these are not technology issues, but rather space or process issues. We have long possessed the technology to easily apply an updated and streamlined approach. It simply needs to be architected.

Discovering Dream Space
Many hospitals have realized that their environments and their processes are not up to standard. And after all, isn’t the experience we create a big part of the offering we deliver? Consumers have more choice than ever before so healthcare systems must rise to the occasion in order to be competitive.

Hospitals are finding that streamlined spaces and approaches help them to do just that. They build consumer confidence and trust. They create recruiting and retention means for employees. They deliver more efficient systems and methods that directly impact the bottom line.

Architects see this trend happening. As consumers, we are glad it is. We would always choose systems and experiences that are updated and integrated. We would choose that for ourselves, our families and our communities. Leaders should consider the following essential principles when designing or redesigning a new healthcare environment:

• Consider Your Brand. Your brand is your promise. Your space should reflect that promise. Does your facility accurately communicate what the hospital is and what that means to patients, to employees and to families? Does your lobby say this also? Your message should reinforce your brand, which will support, enhance and fulfill the perception of your business. Some hospitals offer the promise of a healing, hometown environment, designed with comfortable family rooms with “simulated” fireplaces and kitchens where staff or loved ones baked cookies.
• Consider Your Plan. Align the design of your space with the goals of your business plan. Consider not only where you are, but also where you want to go and grow. Form a real estate strategy, and keep your short- and long-term goals in mind. If you have aspirations to offer more surgeries, create space for that. Consider what is new and upcoming in technology. This is understandably a tricky venture. After all, in the old days, technology was just a telephone jack. But now we have the ability and opportunity to create hospital campuses with technologies ranging from wide-band Internet access to robotic surgery.
• Consider Your Customers. Entering any foreign setting is stressful, and for most consumers, a healthcare facility and its language is definitely foreign and can be overwhelming. When stress levels are up, outcomes are down. Evidence-based design has been proven and is true. Healing architecture saves lives. So modern hospitals are doing everything they can to create a healing environment with comfortable seating, landscaped areas, family rooms and accommodations, stocked bookshelves, coffee houses and the list goes on.
• Consider Your Culture. Employees are a hospital’s biggest investment and most important asset. In addition, employees, especially nurses, cite their working environment as the No. 1 reason that they make an employment change. With so many current recruiting and retention issues, healthcare systems are creating facilities to foster and complement their employee culture. To achieve this, facilitate a visioning process. Bring representatives from a variety of groups around a table to hear their critical elements and aspects. Through this, we have found that designing areas of “safe harbor” or “purging” can be incredibly meaningful to an overworked, overstressed nurse. You would be surprised how simple changes can make big changes in employee satisfaction. And when employees are happy and comfortable, patients experience the difference. These simple investments of thought and planning are an immeasurable investment.

Conclusion
The bottom line is there is a lot to consider. So where do you start? Begin with your organization’s leaders. Then bring in outside expertise, individuals who know industry movement and cycles of cause and effect. Discuss what you need, and then discover what has been proven to work. Bring in an industry architect who knows the needs, requirements and restrictions of healthcare. All the while, bring people around the table who are forward thinking. And bring these people in early. Early involvement means smart planning. Changing plans mid-course is always less effective and always more expensive.

Improvement starts with vision and ends with people. Remember this when you are making your improvements to address inevitable change. Also remember that change can be good for people, for processes and for profit. So do not fight it, benefit from it.


John Cooper, AIA, ACHA, is principal-in-charge and director of the healthcare studio at Morris Architects, Houston, Texas; (713) 622-1180; E-mail: john.cooper@morrisarchitects.com.