The Center for Health Design Blog

Equipment Noise Raises Interesting Issues

Lola Fritz at Peace Health in Oregon recently shared an observation about noise on our Pebble Project listserv that was very interesting. She wrote:

I was recently sitting in one of our new private rooms [at Sacred Heart Medical Center in River Bend], with carpet in the halls, acoustic ceiling tiles, thick glass windows, talking to friends [one of whom was a patient].

How ironic that we make our physical building as quiet as possible and some of the medical equipment is still really annoying — or maybe more annoying because it is now more noticeable?

Good point, Lola. It is time that equipment manufacturers became aware of not only how noisy their products are, but also if they are ergonomically friendly (i.e., easy to use), not to mention what they look like.

Several years ago, I toured a VIP patient unit in a major hospital in Houston. The rooms had beautiful materials, finishes, lighting, and furniture. And hanging over the patient bed was a big old ugly computer monitor that looked like it belonged in a factory.

Granted, this was an upscale unit, so the contrast was a little more stark, but you get what I’m saying. Our Environmental Standards Council has been wrestling with this issue for several years, toying with the idea of establishing a design competition for equipment manufacturers, which would definitely raise the profile of this issue. But change will only really happen if customers like Lola demand something different.

EBD is Not a ‘Lavish Perk’

The debate continues on the merits of Evidence-based Design (EBD). The Wall St. Journal is jumping in with a blog post by one of its writers in response to an article written by Laura Landro in her “Informed Patient” column in today’s Journal.

The WSJ blogger says that EBD is a largely unproved “perk” that doesn’t make sense in this economic climate. However, what he doesn’t understand is that EBD is a process of making design decisions based on credible research that results in improved outcomes. If creating a facility that helps improve both the staff and patient experience results in shorter patient stays, reduced staff turnovers, and other clinical and operational improvements, it will actually save money.

What’s more annual operating expenses far outweigh annual capital budgets, so the investment in better building design is a good one. We know this, because we’ve made the business case using actual real data. (FYI, An updated white paper outlining the business case is being published soon — we’ll be posting it on our website for free download as well as a 10-minute webcast summary.)

I’m glad, though, that people are writing and blogging about EBD. We need to continue the conversation so that, one day, everyone understands exactly what it is and what it is not.

Sacred Heart Critics Say Building is Too Opulent

An article in last Sunday’s Register-Guard about Sacred Heart Medical Center at RiverBend, whose new hospital just opened, criticizes it for being too opulent when healthcare is a “scarce commodity for hundreds of thousands of Oregonians.”

And while it is true that about 18% of the population in Lane County where Sacred Heart is located are without health insurance, spending a few less dollars on a new hospital building is not going to solve that problem. Patients will also not pay more for care because the hospital built a new building. According to one expert in the article, mostly when healthcare costs go up it is because of increases in the cost of professional time, professional services, and new technology.

What’s more, because Sacred Heart (who is part of The Center’s Pebble Project research initiative) incorporated many evidence-based design concepts into its new building, it may actually save money over the 50-year lifespan of the facility. Those savings could be spent on improving care for all patients — including those who don’t have medical insurance.

I can understand, though, how an ordinary citizen who is struggling to pay for his or her medical insurance sees this big, new, beautiful building, can’t help but feel that it will eventually come out of his or her pocket. But that’s just not how the money flows in healthcare.

As for opulence, we’ve been saying for years that good design doesn’t have to cost more. You just have to think about it differently. Those who planned and designed Sacred Heart clearly did that, and they probably did spend a little more in the process. But their investment will pay off for patients, staff, and the community at large for many years to come.

What do you think?

Evidence-Based Design Issues

The American Society for Hospital Engineering (ASHE) of the American Hospital Association (AHA) recently published a guidance statement on evidence-based design (EBD).

This statement reflects concerns among ASHE board members and staff about potential misrepresentation of EBD and is meant to provide guidance to its members who are involved in the project development process.

While many of the points brought up in this statement are valid, there are others that need some clarification and further discussion. I’d like to start a discussion about it on this blog so we can all come to a better understanding of how we can, in our different roles, contribute to the design of safer and better hospitals.

EBD is an evolving concept and as more projects following an EBD process near completion, we are reaching a better understanding of many different issues. Some of points of concern that have been brought up in the ASHE statement are still being discussed in the field of evidence based medicine (which has been around for a long time). Building on an evidence based medicine tutorial developed by librarians at Duke University and University of North Carolina, I’d like to clarify some of the points raised in the ASHE statement and invite further discussion.

Opponents:
EBD is “old hat.” Architects and designers have been using research to guide their decisions for a long time. The label is new.

Proponents:
The new focus on EBD “formalizes” that “old hat” process and filters the literature so that decisions are made based on “strong” evidence.

Opponents:
EBD is “cook book design.” It suggests that decisions are based solely on the evidence, downplaying experience and imagination.

Proponents:
EBD should be one part of the process. Design decisions must be based on many different things — the individual architect/firm’s experience, site specific and organization specific issues, and, when available, good evidence.

Opponents:
EBD is the mindless application of general studies conducted in different types of healthcare settings and different populations to a specific building design project.

Proponents:
A key step in the EBD process is to critically analyze the evidence and decide whether or not the information and results are applicable to your project.

Opponents:
Often there is no randomized controlled trial or “gold standard” in the literature to address a particular design problem

Proponents:
The design team might consider the “evidence pyramid” and look for the next best level of evidence. Architects and designers need to understand that there may be no good evidence to support every design decision.

Opponents:
There is often great difficulty in getting access to the evidence and in conducting effective searches to identify the best evidence.

Proponents:
Resource librarians can help identify the best resources and teach design professionals effective searching skills.

What do you think? Let us know!