Trends in Health Care Design Are Driven by Changing Demographics

by Rob Davidson, AIA
H+L Architecture

I have been involved in the design of health care facilities for more than 20 years. During that time, the design change that has received the most public attention is the shift from institutional-looking spaces to patient- and family-friendly buildings - buildings that feel more like a hotel than a hospital. But that is merely the tip of the iceberg. So much more is going on - and will need to go on - in health care design to accommodate an array of developing trends in the health care industry.

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Health Care Trends

• Baby boomer demands. The aging of baby boomers anticipates a doubling of the over-65 population by 2030. Colorado is one of four states expected to lead the nation in the growth of that age group by 2007. Baby boomers demand services and access in the health care arena that their parents did not. They are more educated and are accustomed to immediate service. Examples include concierge services, on-demand videos, room service and Internet access during their stay.
• Hispanics and Asians. Growth in Hispanic and Asian populations has signified cultural shifts in health care delivery. Patients are often accompanied by their entire family when entering health care settings. To accommodate this increased familial participation, patient rooms need to be single rooms and adaptable to expand and/or contract as needed.
• Patient safety. A visit to a U.S. hospital can be dangerous and stressful for patients, families and staff members. Medical errors and hospital-acquired infections are among the leading causes of death in the United States, each killing more Americans than AIDS, breast cancer or automobile accidents.

Increased visibility between staff and patients, involving patients and families in care and standardizing room layouts so devices and medications are always in the same place can help reduce the number of medical errors. By bringing care and treatment to the patient, the number of times a patient is transported is minimized, which also reduces errors.

National Design Trends

• Evidence-based design. An exciting trend for designers across the country is a movement to provide evidence that design has an impact on patient outcomes. This evidence-based research is similar to the rigors of the clinical field, requiring measured studies of specific areas and comparing the results. Research is showing that design coupled with a shift in the model of care is producing great outcomes.
• The recently completed intensive care unit at Exempla Lutheran Medical Center has experienced a drop in its mortality rate, to a few percentage points below the national average, proving that more patients survive in that unit than in others.
• New designs have helped with increases in patient and staff satisfaction (a 30 percent increase in some cases), increased philanthropic donations, reduced medical errors, decreased infection, shorter lengths of stay and many other outcomes, which improve health care and decrease costs.
• Technology. No trend affects health care more than new technology. Facility design is becoming increasingly more flexible and adaptable to accommodate this. Technology is advancing so rapidly that even the timing of when to purchase equipment is extremely challenging to health care providers.
• For example, a CT Scan has changed over a 10-year span from four-slice to 16-slice to 64-slice with expectations of a 128-slice device very soon. Each model replaces film images with electronic 3D images, which improves detection and diagnosis of disease.
• E-Health. Electronic access to health care allows consumers to evaluate and select their care through a Web site. Pre- and post-visits to hospitals for many procedures can be coordinated via e-mail. Although the physician community may be slower to embrace the Internet because of concerns surrounding patient privacy, some doctors are willing to communicate with patients through e-mail, potentially saving office visits.
• Some local hospitals are granting patients access to their entire medical records, for a nominal fee, producing rave reviews.
• A healing environment. Providing patients with a sense of control over their environment, reducing environmental stressors such as glare and noise, and providing positive distractions such as music, art and nature - are all elements of health care environments that promote healing.
• Attention to healing environments also has great impact on staff through reduced stress and pleasing work environments, thereby increasing staff satisfaction and retention.
• Sustainable/green design. Another trend in health care is the incorporation of Leadership in Energy and Environmental Design certification goals or sustainability into the design. The concept of using non-toxic materials, recycled materials, daylight controls, reduced water consumption, exterior gardens and reduced light pollution are finding their way into new and remodeled medical facilities. The Anschutz Inpatient Pavilion and The Children's Hospital at Fitzsimons are new health care facilities in Colorado that have incorporated green design.

As an architect and a cancer survivor myself, I find great pleasure in the significant changes in health care design that have taken place over the past decade and applaud the concerted effort hospital clients have taken to improve healing environments.

H+L Architecture has provided design services to more than 25 hospitals and in 10 health care systems in five states with over $2 billion in construction costs over 42 years.

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