The Center for Health Design Blog

EBD is Not ‘Medical Feng Shui’

Yesterday, Maureen Larkin posted an article for HealthLeaders Media Quality Leaders e-newsletter on Emory Hospital’s new ICU titled “Medical Feng Shui.” She opened her article with these words: “We’ve all seen the designers on the home improvement networks talking about the design and flow of a home and how it can effect a person’s energy. Turns out that feng shui is a valid concept in healthcare, too. We just call it evidence-based design.”

Now perhaps Ms. Larkin thought she had come up with a compelling lead to her article, but I respectfully have to disagree with her interpretation. Comparing evidence-based design (EBD) to feng shui is like comparing apples to oranges. They may both look at how the design of the built environment affects behavior, but EBD is based on solid, scientific evidence — more than 1,500 studies and growing every day — that document the built environment’s impact on outcomes. Feng shui has no such scientific rigor behind it.

I’m not saying that there isn’t something to the ancient Chinese art of placement, but feng shui isn’t even in the same league as evidence-based design. According to researchers Roger Ulrich, Ph.D., and Craig Zimring, Ph.D., the 1,500 studies show clear links between the built environment and patient outcomes, including safety issues like infections, medical errors, falls and injuries, confidentiality and privacy, and also other outcomes such as stress, sleep, spatial orientation, pain, depression, social support, communication, length of stay, and satisfaction.

They also link building design to staff outcomes, such as stress, safety, effectiveness and efficiency, and satisfaction. In addition, there are clear financial implications to many of these outcomes, which can affect operational performance.

Ulrich and Zimring’s latest review of the evidence-based design literature (a project funded by the Robert Wood Johnson Foundation in association with the Georgia Institute of Technology and The Center for Health Design) is being published in the Spring 2008 issue of the HERD journal, which is coming out this week.

Medical Tourism — A Passing Fad or New Reality?

As reported in Modern Healthcare recently, a study conducted by the Deloitte Center for Health Solutions found that U.S. healthcare providers will lose almost $16 billion in 2008 to those seeking treatment abroad.

Granted, that’s only about 3% of total U.S. hospital revenue right now, but that figure is expected to grow to $68 billion by 2010.

Why wouldn’t you go abroad for a hernia repair if it would cost $1,800 instead of $5,400? Or get knee repair surgery for $1,400 instead of $12,000? Increasing costs of healthcare, higher deductible health plans, and increasing co-payment rates are making it a more attractive option for many. Not to mention that you can build in a little vacation time while you’re at it — that’s why it’s called medical “tourism”.

And foreign hospitals are improving their quality standards as well. Many are becoming Joint Commission accredited and hiring physicians that are trained in the U.S. Yet questions about continuity of care and liability still loom. Some feel that U.S. hospitals won’t really be affected by medical tourism unless insurers begin to cover care received abroad.

What’s more, although foreign hospital construction statistics are hard to come by, the drive to improve quality standards and increase market share has to be creating a demand for new and improved facilities. At The Center, we’ve seen increased interest from abroad in our work in the past two years.

So, while we still have a lot of work to do here right at home, the message here is, there are opportunities abroad to design safer, more supportive, and healthier hospitals abroad as well.