Attract Consumers By Design
Through evidence-based design, hospitals can attract both employees and consumers.
By Lisa Zamosky
With healthcare facilities under increasing pressure to remain competitive by providing exceptional patient care, state-of-the-art healing environments, and the finest medical staffs, construction and renovation projects are underway all over the country at large-university and small-town hospitals alike. Perhaps not since after World War II and the institution of the Hill-Burton Act in 1946 has hospital construction in the United States witnessed a bigger boom than today. According to the U.S. Census Bureau, between 2000 and 2005, the hospital industry spent $100 billion on the construction of new buildings or on the expansion of existing facilities, a number that represents double the amount spent on such activities in the previous five years. In addition, the investment in hospital construction over the next decade, according to the Robert Wood Johnson Foundation, is expected to register in the $200 billion range. The boom has officially begun.
The Spark That Lit The Fire
A number of factors have converged to create today's conditions in the healthcare market. The aging population and the anticipated increase in baby boomer healthcare consumption are major concerns and realities that the healthcare system needs to consider.
Aging healthcare facilities, many of which were built 50 or 60 years ago, also contribute to this boom. According to Kirk Hamilton, associate professor of architecture at Texas A&M University and founding principal emeritus of WHR Architects, facilities that were built in the ’40s and ’50s are in need of updates. “There is a collection of facilities around the country that have reached the point of obsolescence, so there is a natural need for them to be replaced.”
Adding to all of this, Hamilton says, is the certificate of need (CON) legislation of the 1970s, which was intended to curb expenditures on healthcare construction and successfully limited construction in some parts of the country. “Construction moratoriums of the ’90s created pent-up demand,” Hamilton says. As a result, when the moratoriums were lifted, the dam burst and many hospitals began to play catch-up by initiating major construction projects. “Instead of smaller projects, many got total replacement projects when the moratorium was lifted,” he says.
Evidence-Based Design
Healthcare design—and the impact it has on everything from improved patient outcomes to increased market share, greater staff retention, and reduced medical costs—is increasingly coming to light and gaining the attention of hospital administrators nationwide.
The Center for Health Design (CHD) is a leading research and advocacy organization of healthcare and design professionals. Through evidence-based research, CHD has led the charge in demonstrating the ability to improve the quality of health care with architecture and design. In 2000, the CHD initiated the Pebble Project, a national partnership involving healthcare facilities throughout the country that embrace evidence-based design. By rigorously measuring outcomes associated with facility design initiatives, these hospitals demonstrate how design aids the delivery of quality healthcare while improving financial performance at the same time. These facilities prove that a better building facilitates physical, mental, and social well-being, not only for the healthcare consumer but for the healthcare employee as well. A hospital built in accordance with evidence-based design principles should help reduce stress, improve safety, and enhance ecological health.
Reducing Stress
“What we know about hospitals is that the people who use them—the patients, families of patients, and staff—are under considerable stress. It’s hard to imagine a building in which the occupants are under more stress than in the hospital,” says Leonard Berry, PhD, professor of marketing and M.B. Zale chair in retailing and marketing leadership in the Mays Business School at Texas A&M University. For this reason, Berry suggests the pivotal question for any hospital administrator is: Does my building help moderate the stress that people enter it with, or does it make it worse? “That’s a key question today and tomorrow if you want to be running a competitive hospital.”
Patients tend to focus on the healthcare environment as a major determinant of their overall satisfaction with the services they receive. Hospitals today face tremendous pressure to attract a higher volume of patients. Creating a pleasing environment that incorporates elements such as natural light, private rooms, views of nature, artwork, and reduced noise has been shown to increase patient satisfaction and ultimately increase the number of patient admissions.
Design’s Impact on Safety
A well-designed hospital can decrease medical costs associated with common hospital errors such as patient falls and hospital-acquired infections. It also can improve outcomes and the facility's financial performance.
Bronson Methodist Hospital in Kalamazoo, Mich., a Pebble Project partner, designed its new facility with only single-occupancy rooms and found that its hospital–acquired infection rates dropped by 10 percent.
“It’s hard for anyone to argue against a safety or health issue,” Hamilton says in reference to evidence–based hospital design. “So if we’re showing that we’re reducing hospital-acquired infections or reducing falls or reducing medication error through design interventions, it’s pretty easy to make that case.”
Retaining Your Staff
At a time when nursing and other healthcare worker shortages are of great and mounting concern, the healthcare facility that incorporates evidence-based designs puts itself in a position of strength with respect to the quality of staff it can hope to attract and retain well into the future.
Hamilton cites Woodwinds Health Campus in Woodbury, Minn., a suburb of Minneapolis and another Pebble Project partner, as a great success story about overcoming staffing odds. The design of this hospital’s new facility was so effective and pleasant and the philosophy so powerful, Hamilton says, that at a time when Minnesota had a nursing shortage of about 20 percent, Woodwinds had 4,000 applicants for 400 positions. “You can’t say it doesn’t have something to do with the physical environment—the artwork, the wood, the views of nature—it all fits with what we know about how to effectively design a physical environment and is enhanced by a very positive philosophy on the part of management,” Hamilton says.
According to Roger Ulrich, PhD, Fellow, Center for Health Systems and Design as well as Beale Endowed Professor of Health Facilities Design both in the Department of Architecture and the Department of Landscape Architecture and Urban Planning at Texas A&M University, design that supports workers, such as nurses, and addresses both the physical and emotional stress inherent to their jobs can save a hospital a lot of money, not only in direct costs associated with personnel change, but also in the documented impact those changes have on outcomes and safety. “How could it be rational in even a short-term sense to not pay attention to organization and physical design measures that help to reduce fatigue, reduce stress, enable staff to perform better and spend more time actually caring for patients and less time running around wastefully fetching things or lifting and hurting themselves?” Ulrich asks. “Why deny them comfortable break areas when their jobs are so well documented to be stressful and so prone to burn-out with so many demands?”
Get Staff Input From The Start
When building a new facility, actively consulting with nurses is critical, Berry says. “No one knows better than a nurse what works and what doesn’t work. You want input from the users while you’re designing, not after.”
“I’m a true believer in the participatory planning model,” Hamilton says. “In fact, I’ve turned down projects where I don’t have an opportunity to work with the staff. For projects where there is no staff to work with because the facility is new, we have used surrogates to gain input.”
Building A Better Future
Hospital environments that are more welcoming to patients, more supportive of employees, and incorporate designs that increase safety will withstand future pressures and competition. “If you build a hospital the right way you will increase your revenue and lower your operating costs,” Berry says.