Safety Versus Aesthetics
Safety of patients and medical personnel is a hot button of concern among healthcare institutions. Patient falls, infection control, medication errors, and errors made during patient hand-offs are just a few of the areas of focus. Particular attention is being paid to ways that design can better support a safe patient-care environment. The fact is that safety has always been at the forefront of effective hospital design. The differences today are improved knowledge bases (medical knowledge and data supporting evidence-based design) and technologic advancements. Other affecting factors include increased obesity rates and the potential for major disasters, both of which demand appropriate responses. The 2006 Guidelines for Design and Construction of Health Care Facilities, published by The American Institute of Architects, and safety standards set by the Joint Commission on Accreditation of Health Care Organizations (JCAHO) address the issue of patient safety more than have previous guidelines and standards.
Patient safety in a hospital setting can actually be empowered and strengthened through aesthetic and operationally efficient design. An environment promoting patient safety does not have to be devoid of color and comforting healing elements of design. Through creative design, both safety measures and aesthetics can be incorporated cost effectively.
Designing for Safety
When St. Anthony Central Hospital in Denver made the decision to build a new 300-bed replacement hospital, safety was at the top of its list of needs for its facility's design.
“Like thousands of hospitals across America, St. Anthony Central makes the safety of our patients a top priority,” says George Zara, CEO, St. Anthony Hospitals. “We are blessed with the opportunity that few other hospitals ever get—the chance to create a new campus, from the ground up, with a design that is driven by clinical care and patient safety considerations.”
St. Anthony Central is scheduled to relocate to its new 900,000-square-foot, phase-one facility in early 2009. The facility is planned to incorporate the latest in patient safety equipment and systems. According to research findings published in 2004 and compiled from a study conducted by members of the Department of Medicine at Washington University School of Medicine, a significant percentage of patient falls occur while patients are moving between the toilet and the bed. To reduce the opportunities for falls, the new St. Anthony Central facility will include grab bars, rails, and outboard toilets in its patient room designs (figure 1). Advanced ventilation systems will protect air quality and help guard against infection. State-of-the-art information systems and other technology will decrease the risk for errors in medication administration and other treatments.
The floor plan for St. Anthony Central Hospital in Denver indicates various measures that will be taken for patient and medical personnel safety. Rendering by Earl Swensson Associates, Inc.
Rooms will be laid out around a central core with a centralized nurses' station proximate to the patient rooms and substations close to bedside without violating the patient's need for privacy. Additionally, lift systems built into patient rooms will assist in patient transfers for increased safety for both the patient and caregivers.
“What's more exciting,” says Zara, “is that the very design of the hospital will enable a higher level of safety. The configuration and use of space will shape more effective workflows for nurses and doctors. The way that patient care areas relate to one another will enhance communication between caregivers and speed of treatment. Direct line-of-sight from nurses' stations to patient beds will support constant connectivity. Separate caregiver and family zones within patient rooms will promote order and calm during the delivery of care. The facility's physical design not only will reflect our culture of patient safety, it will empower it.”
Aesthetics Promote Healing
A broad concept, safety not only means preventing patients from falling or injuring themselves, but it also embraces the grander issue of wellness. Everyone is interested in safety, but healthcare is moving far beyond that. Our research shows us the importance of designing to promote healing. Hospitals should be created in a way that actually assists caregivers. If all you're doing to ensure safety is removing metal bed corners and walking obstacles, your design is missing the bigger opportunity to aid patient recovery. Aesthetics actually play a critical role in promoting healing.
Other examples around the country in which safety design considerations successfully coexist in aesthetically healing environments include Mayo Clinic Hospital in Phoenix, and St. Vincent's Hospital in Birmingham, Alabama.
The universal acuity adaptable patient rooms in Mayo Clinic Hospital in Phoenix, completed in 1998, have outboard toilets located on the patient headwall (figure 2). Another notable safety consideration in this technologically advanced facility is telemetry wiring for cardiac monitoring of patients throughout the hospital. This hospital's design infuses hospitality concepts into a safe, healing environment.
The Mayo Clinic Hospital in Phoenix features outboard toilets in patient room headwalls. Photography by Mark Boisclair Photography, Inc.
The philosophy behind the design of St. Vincent's North Tower, completed in 2004, included creating a healing, hospitality-influenced setting while bringing staff closer to the patient. The same hospital's South Tower, which opens later this year, also brings staff closer to patients, as well as including inboard toilets on the patient room headwalls and patient lifts built into some of the headwalls. Beds will be angled toward windows for the psychological effect (figure 3).
The new South Tower at St. Vincent's Hospital in Birmingham, Alabama, features patient rooms with angled beds (A, B) and patient substations near patient rooms (C). Renderings by Earl Swensson Associates, Inc.
Natural light, textures, and color incorporated in both towers' designs serve as positive reinforcement for patients and family members, who are integral caregivers and important partners with the healthcare team in patient care. Nurses will have the benefit of natural light emitting through atriums.
“Our goal with South Tower is to create a safe and patient-friendly facility that offers cutting-edge technology with superior design,” says Curtis James, President and Chief Executive Officer, St. Vincent's Health System. “To better meet the needs of our patients and staff, satellite nursing areas are located on each patient floor. In addition, niches are strategically placed near the patient rooms so that nurses do not have to walk to a main station to document. Nurses also have the capability of accessing and responding to patient calls in these niches.”
Concurring with James, St. Vincent's Executive Vice-President and Chief Strategy Officer Nan Priest says, “Our South Tower is a shining example of how integrated design concepts can make a hospital environment safer for our patients. At the bedside, caregivers can monitor patient vitals and access state-of-the-art computer systems. This technology is used to improve overall patient care. In addition, South Tower's design incorporates natural light, which translates into a better working environment for our associates and a friendlier space for our patients and visitors.”
In the quest for safer hospitals, a safe room is mandatory. However, a building that helps doctors and nurses do their jobs, protects patients, facilitates healing, and imbues those who enter with a positive attitude—that's the definition of a healthcare center.
The growth of the for-profit hospital sector in the 1980s introduced new cost sensitivities into the design equation. These sensitivities, however, do not have to exclude patient-friendly interiors. Administrators and owners are often surprised to discover that warm and friendly environments can be created for the same cost as something that's clinical and cold. Good design doesn't have to cost more.
Embracing new design ideas—not trimming them away—has become critical, according to the 2006 Guidelines for Design and Construction of Health Care Facilities. These guidelines detail emerging connections between design and patient well-being with ways that design can:
reduce patient, family, and staff stress;
enhance the performance, productivity, and satisfaction of the staff to promote a safe environment of care; and
incorporate flexibility for technology advancements.
These points illustrate a confluence of issues coming to bear on hospital managers. First, the expensive technologies required for patient care are advancing as fast as hospitals can acquire them. New facility designers have to build flexibility into their floor plans so that new equipment and procedures can be installed without incurring unexpected construction costs later.
Second, staff turnover—especially among nurses—is not only a factor in hospital management, but also in patient care. Coupled with this is the national shortage of nurses and an aging workforce. While the provision of a safe environment for patients is critical, equally important is a focus on safety for medical personnel. Design can help retain workers by making their environment safer and more efficient, as well as making it a more aesthetically pleasing place to work.
The above considerations are not to be made simply for the sake of the design. The point is to use design to support the healing effort not just by cutting the design down to make rooms physically safer, but by using interior elements with aesthetic components to produce a much more comprehensive solution to safety. HD
Richard L. Miller, FAIA, is president of Earl Swensson Associates, Inc. (ESa), a Nashville-based architectural firm. Misty Chambers, RN, MSN, Associate AIA, is ESa's clinical operations/design specialist.