Global Shifts, Large And Small
In May, I had the opportunity to speak at the 14th China Hospital Construction Forum, which was held during the Hospital Build & Infrastructure China Exhibition & Congress in Nanjing, just a few hours outside of Shanghai. While there, I also met the next generation of healthcare architects at Southeast University, visited an architectural firm with 3,000 employees, toured a newer traditional Chinese hospital, attended many beautifully and lovingly prepared traditional Chinese dinners, and ate a lot of noodles.
My first impression was amazement at how much had changed since I’d last visited in 2010. Although the United States was deep in a recession at the time, China was in the midst of a building boom. During that first trip, I spent three weeks traveling the country and noticed every major city I visited had signs of new construction. Fast forward to 2013, and the building in China continues to boom but has now extended from the major cities outward for many miles, connecting what were tertiary cities together into huge metropolises. In terms of healthcare, in 2012, the Chinese government developed a five-year plan to build 20,000 hospitals and healthcare facilities. I was told that there are 3,000 hospital projects currently in progress, one of which is planned to have 10,000 beds. Either number is significant, especially as we see so many of our hospitals here in America either merging or closing their doors and it looks like that trend will continue for some time.
There’s a deep desire in China to have access to resources and to absorb knowledge swiftly. The Chinese know they have a significant opportunity to affect generations to come with the projects they’re currently building. The challenge is that there’s little time to problem solve and innovate, given how quickly these projects are being constructed—literally 24 hours a day, seven days a week. How do you maximize innovation as the walls are being built around you?
In the 24 years that I’ve been at The Center for Health Design, the progress in every aspect of our industry here in the U.S. has been dramatic yet developed over time with much trial and error. Because of the pent-up demand in China and the migration of its citizens from rural to urban settings, the speed of design and construction of medical structures is happening at breakneck speeds. It’s obvious that the time needed to progress through their own learning curve is a luxury that the Chinese don’t have. Within the decade, the next generation of healthcare architecture in China will be complete.
The tour I had of a three-year-old traditional Chinese hospital was enlightening. In many ways, it brought home for me how much progress we’ve made here. Two and a half decades ago, we struggled with many of the same issues that the Chinese are facing today. Single patient rooms were not the industry standard, the availability of healthcare furniture and products was a fraction of what it is now, there was no easily accessible formal body of research, no community of support, and the idea of patient-centered anything was discussed by few. However, some progress in China has been made. There are many research-supported design interventions relating to sound and natural light. In the hospital I visited, all patient spaces faced east to take advantage of natural morning light. All the patient rooms had open ventilation for fresh air, and families played a significant part in the patient’s care and dietary needs.
Nonetheless, it was still jarring to see three patients to a room, having fought so long here in the U.S. for single-patient rooms to reduce the chance of medical errors and the spread of infection from patient to patient. But looking at the pressures facing our healthcare system and the move towards more distributed care here in the U.S., it also forced me to think about the long-term financial viability of our healthcare system. We face so many challenges, and change is inevitable.
Knowing this, what lessons on economy-of-scale can we learn from China that may answer some of our own complex questions? Though our cultures are very different, both our countries are facing similar challenges when it comes to an aging population: parents who no longer live near their offspring, diminishing resources, and an understaffed workforce. Solutions are needed that will address these challenges and help us to create a clear vision of what an appropriate healthcare continuum looks like. Looking at healthcare through a global lens gives us a much larger set of potential solutions. Paying attention to what other countries are doing to provide quality healthcare at reasonable costs might lead to solutions here in the U.S. that we might not try otherwise. Site visits around the world are costly, but publications like this one and conferences like the Healthcare Design Conference, where attendees come from around the world, are perfect ways to broaden horizons, as we work to develop a healthcare system that will provide quality care to our citizens for decades to come.
Debra Levin, EDAC, is president and CEO of The Center for Health Design. She can be reached at email@example.com.