The Center for Health Design Blog

Redefining “Evidence-Based Design”

The beauty of words, terms and phrases in any language lies in understanding that their meanings can evolve over time as dictated by cultural and societal changes. There are many definitions of “evidence-based design” currently in circulation in the healthcare design community that focus on the use of evidence and creating hypotheses in the service of patient, family, staff outcomes.

As an organization, we feel that it is time to reconcile those different interpretations, and articulate a CHD endorsed definition that captures where our industry is today. The new definition was recently drafted in a collaborative effort by a group of 15 industry experts, including CHD Board members and staff, and can be read below. We welcome your comments.

Evidence-Based Design is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes. (Source: The Center for Health Design)

Healthcare Leads the Way in Energy Efficiency

Two new studies from the American Society for Healthcare Engineering and Johnson Controls in collaboration with the International Facilities Management Association offer up some interesting information on the importance of energy efficiency to U.S. healthcare executives. On average, they plan to spend 8% of their capital budgets and 6% of their operating budgets to conserve energy in the coming year. This is more than any other business sector.

Most are improving their building management systems; installing energy efficient lighting, variable speed/frequency drives, and lighting sensors; adjusting time that heating/AC runs; and negotiating energy contracts with suppliers.

Hospitals are one of the worst energy “hogs,” so this is good news indeed — and one that experts believe is a long-term trend. And while I’d like to think that part of the motivation is because healthcare organizations want to be more environmentally responsible, most of it is due to the soaring price of energy and the need to control costs.

No matter — the important thing is that healthcare is realizing that going green is not only good for the planet, it is also good business.

P.S. If you haven’t checked out the Global Health & Safety Initiative’s new website yet, please do. This is a collaborative effort between CHD, Health Care Without Harm, Practice Green Health, and a group of health systems to collect and disseminate information on worker safety, patient safety, and environmental health and safety.

Johns Hopkins Tops U.S. News’ Annual Rankings

This week, U.S. News & World Report’s annual rankings of America’s Best Hospitals hit the newsstands. Johns Hopkins Hospital in Baltimore topped the Honor Roll list (high scores in six or more specialties), followed by Mayo Clinic in Rochester, MN, Ronald Reagan UCLA Medical Center in Los Angeles, CA; Cleveland Clinic in OH; Massachusetts General Hospital in Boston, MA (a CHD Pebble Project partner); and 14 others.

The rankings are based on several factors: 1) reputational survey (random sample of 200 physicians for each of the 16 specialties); 2) mortality index (Medicare data); and information on other care related factors (mostly from the American Hospital Association’s member survey).

I’m happy to report that two of our other Pebble Project partners also ranked in the top 10 of several specialty areas: M.D. Anderson Cancer Center in Houston (pictured below) is #1 in Cancer and #4 in Ear, Nose & Throat, and #9 in Urology; St. Luke’s Episcopal Hospital also in Houston is #7 in Heart & Heart Surgery.

As I scrolled through the list looking for Pebble Project partners, I was pleased to see many hospitals whose names I recognized as being published in Healthcare Design magazine’s annual Architectural Review issue or recipients of CHD’s annual Healthcare Environment Awards. So, although facility design is not a factor in the rankings (see my blog post from July 23, 2007), many are recognizing that excellence in medical care is related to excellence in facility design.

Rare Study of Legendary Healthcare Organization

In a book just published last month, CHD board member Leonard L. Berry and Kent D. Seltman have skillfully transformed Mayo Clinic’s elite-level performance into lessons that managers in any industry can use. Management Lessons from Mayo Clinic: Inside One of the World’s Most Admired Service Organizations (McGraw-Hill, June 2008) is the first in-depth study of this notoriously “private” organization.

Len, a Distinguished Professor of Marketing Leadership in the Mays Business School at Texas A&M University, and Kent, director of marketing at Mayo Clinic from 1992-2006, spent many months studying Mayo intensively. The book is based on their numerous personal interviews with leaders, clinicians, staff, and patients, as well as observations of hundreds of clinician-patient interactions.

It was, in fact, Len’s experience studying Mayo that led him to CHD. Having spent most of his career studying, writing, and teaching about retail service organizations, he turned to healthcare as a new challenge — serving as a Visiting Scientist at Mayo Clinic in Rochester during the 2001-2002 academic term. Upon returning to College Station, he reached out to Roger Ulrich, a professor in the Texas A&M College of Architecture and long-time CHD board member. Shortly after that, we invited Len to one of our Pebble Project meetings, where he mesmerized us with stories from his Mayo experience. Since then, he has been actively involved in our organization.

And while this book is more about understanding the management culture and systems that produce Mayo Clinic’s signature service to patients and families, it does offer some interesting insights that can be applied to facility design. In Chapter 7, “Orchestrating the Clues of Quality,” the authors write about the three types of experience clues that customers process and organize into a “set of impressions that evoke feelings.” One of these types of clues — mechanics — come from inanimate objects, such as facilities, equipment, furniture, displays, lighting, and other sensory clues.

Len and Kent’s book is a gem — must reading for every healthcare executive and anyone else who is looking to achieve service excellence in their organization!