The Center for Health Design Blog

Can Hospital Buildings Heal?

I read the statement today, “hospital buildings can heal,” and something about it struck me as wrong. “Hospital buildings can heal” implies that there are no other factors in healing, such as treatment methods, physician expertise, or caregiver support.

My computer dictionary defines “heal” as 1. to make a person or injury healthy or whole 2. to be repaired or restored naturally, for example, by the formation of scar tissue 3. to repair or rectify something that causes discord and animosity 4. to get rid of a wrong, evil, or painful affliction.

In the context of what we are talking about here, the #1 definition makes the most sense. So, can hospital buildings make a person or injury healthy or whole? Of course not. But we do know that the design of the physical environment can positively affect patient and staff outcomes, thereby improving the quality and safety of healthcare delivery.

Hospital buildings cannot heal, but they can affect the healing process. We are way past the place where they were just viewed as bricks and mortar to house what goes on within. Florence Nightingale was one of the first in healthcare to recognize this. Hospital buildings are part of an integrated system of people, technology, and culture that delivers care and helps people to heal.

Healing Environment or Healthy Environment?

I was looking at the brochure for the CleanMed conference today, which is next month in Pittsburgh. The tag line for the conference this year is “Creating Healing Environments.”

I find it interesting that the conference organizers have used the term “healing environments” to describe environmentally sustainable practices for healthcare. Our definition of healing environments (developed by healthcare designer Jain Malkin more than 10 years ago) is:

“A healing environment is a physical setting that supports patients and families through stress imposed by illness, hospitalization, medical visits, recovery, and sometimes, bereavement.”

Wouldn’t it make more sense to call an environmentally responsible environment a “healthy environment”? Do sustainable practices actually foster healing or health? I guess you could say that sustainable practices can help reduce stress for patients, families, and staff, but a healing environment is much more than just an environmentally responsible one.

In fact, design interventions to create healing environments can be linked to the Institute of Medicine’s six specific aims for improvement that were outlined in its 2001 report: safe, effective, patient-centered, timely, efficient, and equitable. I would argue that environmental sustainability belongs in the “efficient” and “safe” categories.

Using “creating healing environments” to describe the CleanMed conference muddies the waters for those who are trying to understand the concept. Clearly, it is much bigger than just sustainability and hopefully this will be explained by the presentors at the conference.

News Flash: Healthcare Building Boom Slowing Down

Did we really think this would go on forever? The latest stats coming out of Modern Healthcare’s annual Construction & Design survey, as well as data from the American Society for Healthcare Engineering and Reed Construction Data/RSMeans indicate that the industry is still in a “major construction mode,” but that a slowdown is expected after 2010.

Is this news to any of us? Construction booms come and go, but the reality is that in healthcare, the factors affecting the need for new or renovated facilities are not going away in the near future. These include obsolete/aging facilities, technological advancements that affect how care is delivered, and the aging of the baby boom generation.

Urban sprawl and as well as the reverse in some areas, where new condos, town homes, apartments are attracting empty nesters back to the city, are also creating a demand for new healthcare services and facilities.

The pace of building is not going to continue at the growth rates of the past few years, but there is still plenty of building going on. Modern Healthcare reports that 2,561 projects were started last year with a projected cost of $38.4 billion and 3,920 projects were in the design phase with a projected cost of $72.2 billion. True, these numbers are slightly lower than the same measures in 2006, which is why some experts are raising the caution flag — as they should.

Quality, safety, environmental responsibility are “social movements” that are sweeping across healthcare — and we are far from solving all the problems. As long as we continue to make the case that facility design can contribute to improvements in each of these areas, the need for new construction will not diminish. Maybe slow down, but not diminish.

Who Really Pays for Medical Errors?

As we all know, medical errors cost the health system billions of dollars a year. Patient safety advocates have long sought to demonstrate that if healthcare organizations invest in safer practices and systems, they will reap financial returns in the form of reduced malpractice costs and other expenses. Our part of that conversation has been to demonstrate that the design of the physical environment also impacts those practices and systems.

But, as reported by the Commonwealth Fund, Harvard University researcher Michelle M. Mello, Ph.D., J.D., and her colleagues believe that hospitals may lack the financial incentives needed to improve safety. In their article, “Who Pays for Medical Errors? An Analysis of Adverse Event Costs, the Medical Liability System, and Incentives for Patient Safety Improvement” (Journal of Empirical Legal Studies), they found that most of the costs resulting from medical errors are actually shifted to outside parties–often to payers like Medicare.

Mello and colleagues compared the costs associated with adverse events that were absorbed by hospitals, including malpractice insurance premiums and extra inpatient care they were unable to recoup, against costs that were passed along to other payers. On average, the hospitals they studied externalized 78 percent of the costs of all injuries and 70 percent of the costs of negligent injuries.

According to the authors, changes in provider payment policy and legal reforms to allow more injured parties to pursue compensation could bolster incentives for hospitals to improve safety. This is good news, but I’d venture to guess that improving safety is in the top three priorities of most hospitals — it makes good business sense for reasons other than who ultimately pays for negligent injuries. Who would want to come to a hospital if it had a lousy safety record? Besides, it’s not morally or socially responsible.

Investing in safety improvement is not an option, it is an imperative. And design of the physical environment is an important piece of the puzzle that makes practices and systems work.