This editorial appeared in Contract's October 2013 issue. To read the digital edition, click here.
I am pleased to present our annual issue focused on healthcare design, which includes the winners of the Healthcare Environment Awards (page 58), presented in conjunction with The Center for Health Design, as well as an exclusive feature on the impact of the Affordable Care Act (page 84). Even if your practice is not focused on healthcare design, I believe you will gain insight from the content of this issue. We are all seeking to learn from innovations in design, in general, as well as the implications of the evolving model of healthcare delivery.
In our profession, we usually consider design to be a positive solution. But not everyone shares that sentiment, especially when costs seem high. In a provocative opinion piece in The New York Times on September 21 titled “Is This a Hospital or a Hotel?,” staff reporter Elizabeth Rosenthal equates the increasing cost of healthcare delivery in the United States with new acute care architecture and interiors designed to be more akin to high-end hotels. While the rising cost of healthcare delivery is a significant issue that requires multi-pronged solutions, I believe Rosenthal’s pointed focus on amenities, as well as design and construction capital costs, is misdirected.
Rosenthal writes frequently about healthcare, and is authoring a series about the cost of healthcare titled “Paying Till It Hurts.” But this article in particular, which garnered more than 100 comments on The New York Times website in the first 24 hours, has generated significant discussion among design and healthcare professionals alike. In the article, Rosenthal notes that amenities such as private rooms, once considered VIP treatment, are now becoming a standard. She writes: “Some health economists worry that the luxury surroundings are adding unneeded costs to the nation’s $2.7 trillion healthcare bill. There are some medical arguments for the trend—private rooms, for example, could lower infection rates and allow patients more rest as they heal. But the main reason for the largess is marketing.”
While competitive hospital and healthcare system marketing is one factor in building newer, more patient-friendly facilities, to say that that is the main reason for the recent increase in quality of healthcare architecture and interiors is cynical and shortsighted. And it is an affront to the work of healthcare architects and designers who thoughtfully utilize evidence-based design.
I asked Rebecca Kleinbaum Sanders, a healthcare architect who is associate vice president at HGA in Minneapolis, for her reaction. “Hospitals are understanding the need to provide better patient experiences, not only to gain market share, but to treat people with respect and dignity. Many of these design decisions also stem from the new direction of healthcare focusing on wellness and keeping people healthy, not just treating the ill,” Sanders says. “Construction dollars are carefully vetted throughout the design process. Design decisions are not being made at the expense of providing great care.”
Exceptional design of healthcare interiors, we now know, can aid the healing process, improve staff efficiencies, and enable the overall delivery of quality care. I asked Rosalyn Cama, FASID, for her thoughts on the Rosenthal article as well. Cama is the president of design firm CAMA, Inc., in New Haven, Connecticut, and is the current chair of the board of directors of The Center for Health Design. “Design that impacts improved human behavior is economically sound,” Cama says. “The data collected from countless peer-reviewed studies are building the case that informed, proven design improves health outcomes. The payback for what appears to be pricey has, in a relatively short period of time, delivered the safe, timely, efficient, effective, equitable, patient-centered care needed.”
Of course, good design, even with the highest level of amenities, does not guarantee great care. The best care still requires excellent healthcare professionals working in concert. But evidence shows that design of the physical environment can, indeed, be a positive a factor.
Dallas–based healthcare designer Mindy Graves of HOK had a visceral reaction to the Rosenthal article. “When a person is hospitalized, they are in their most vulnerable state,” Graves says. “If a designer can implement interior elements to help soothe a patient and create an atmosphere that is conducive to healing, then why wouldn’t they?”
Why wouldn’t they, indeed.
John Czarnecki, Assoc. AIA, Hon. IIDA, Editor in Chief