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Literature review shows impact on outcomes
You may not be an architect, but it might be time for you to start paying a little more attention to the way your hospital is designed — especially if you’re about to have a new facility built or you’re embarking on a substantial renovation.
That’s the message coming from the Concord, CA-based Center for Health Design (www.healthdesign.org), which recently commissioned an analysis of more than 600 research studies. The analysis shows a direct link between patient health and quality of care and the way a hospital is designed.
The review, conducted by Craig Zimring, PhD, professor of architecture and an environmental psychologist at the Georgia Institute of Technology in Atlanta, and Roger Ulrich, PhD, director of the Center for Health System and Design at Texas A&M University in College Station, outlines the benefits of an evidence-based approach to hospital design.
"Just as evidence-based medicine is revolutionizing health care treatment, evidence-based design is transforming the health care environment," says Zimring. "We now have at our disposal proven architectural methods for improving patient outcomes, safety, and satisfaction, as well as staff retention and service efficiency."
According to his report, evidence-based design can:
It’s important to note that evidence-based design can reduce stress, not only for patients and families, but for staff as well, Zimring explains.
"I think hospitals are very risky and stressful places for the people who work in them, but also for patients and families. We know that according to the Institute of Medicine (IOM), between 44,000 and 88,000 people die each year due to preventable errors, which is more than the number of people who die of breast cancer, automobile accidents, or AIDS. Likewise, an estimated 88,000 die due to nosocomial infections," he continues. "We also know that the IOM and the IHI [the Boston-based Institute for Healthcare Improvement] argue that one of strongest measures we can take to boost safety is to hire more nurses."
At the same time, Zimring points out, the United States is starting one of the largest hospital building booms in history. "It’s a perfect storm — aging baby boomers, people moving to the Sunbelt, and replacing all the hospitals built in the ’60s and ’70s. The prediction is that in this year there will be between $16 billion and $27 billion worth of hospitals built," he adds.
The good news, Zimring says, is that "there is a body of scientifically defensible evidence that says the physical environment can affect patient safety, stress, the ability of staff to do a good job, staff stress, and nursing turnover."
For example, the national average for nursing turnover is 20% a year, he explains. "But some facilities, like the Mayo Clinic, have 3% to 4% a year. "What’s clear is that the environment impacts outcomes — it reduces medical errors, nosocomial infection, and makes it a better place to work," Zimring observes.
The findings hold a big lesson for quality managers, he says. "The physical environment matters for quality outcomes, and the quality manager will either be working with or against that physical environment. Many hospitals, even new ones, are simply places that breed errors and infection."
On the other side of the coin, however, facilities that have invested in evidence-based design have reaped real benefits. Bronson Methodist Hospital, for example, used such an approach in the $181 million redevelopment of its hospital campus in downtown Kalamazoo, MI.
The redesign included private rooms with rooming-in accommodations for all patients; creative use of artwork, music, light, and nature to create a more pleasant and less stressful environment; shorter walking distances for patients and families with seating along the way; and touch-screen information kiosks at every main entrance.
Among the results cited in the report:
Texas A&M research indicated that such changes increase overall costs by about 5%, "but if you look at it very conservatively, you’d get it back in one year," Zimring adds. (For other examples, see box, below.)
He concedes that none of those improvements occur in a vacuum. "You need quality improvement initiatives as well, but do you want to work against the building or use it as a tool to make these things easier and more permanent?"
Remember, that what is built today will be in place for decades. "If we do it wrong now, it will haunt us for the rest of our careers or it will help us for the rest of our careers," Zimring notes. That is precisely why the quality manager should be heavily involved in the design process, he says. "Common sense and research suggest that where you get the biggest bang for your quality buck is if the system and the process design are in concert."
Zimring and Ulrich offer the following recommendations for designing your facility in a way that will support your QI efforts:
"We now have 600-plus studies that show the physical environment can be a tool in improving quality, so QI managers should be brought in very early in the design process and throughout the process," Zimring says.
"Quality managers need to know the potential of the physical environment and what the key decisions are," he adds.
[For more information, contact:
• Craig Zimring, PhD, Professor, College of Architecture, Georgia Institute of Technology, Atlanta. Phone: (404) 894-3915. E-mail: firstname.lastname@example.org.]