Ambulating to Recovery
Over the next decade and beyond, healthcare cost reduction will be a critical focus area for provider organizations. When considering the physical design of care environments, an immediate impulse in relation to cost reduction is to economize on space—and many of us are already witnessing that dialogue in the post-recession healthcare market.
The resulting vision of the new-generation healthcare setting is one that is smaller, and employs extreme measures to audit space needs.
Cost of care delivery is highest in acute-care settings and is a primary focus of contemporary debate; however, there is a way to reduce costs in acute care space design without compromising on space need audit measures.
My clinician colleagues have, time and again, explained to me how getting a patient up and ambulating is a faster way to recovery. I am assuming that this is true for most patients, if not all. Reduced LOS will directly translate to savings, which can be shared among the providers in a shared savings or a bundled payment model.
Can the physical design play a role in promoting ambulation? In addition to verbal encouragements to the patient to be mobile, are there design interventions that could potentially be effective? Perhaps yes.
One idea (that we have entertained in intellectual discussions but not implemented in practice) pertains to the view from the patient bed. If the best view from a patient room is provided from the patient chair and not from the bed, could that possibly encourage a patient to spend more time in the chair?
Another interesting idea originated from one of our clients, which was about serving the food on a dining table and not on the bed. Such a step could ensure greater mobility in applicable cases.
Interventions can also be targeted outside the patient room; for instance, incorporating porches and making hallways more ambulation-friendly by providing the appropriate support and furniture. Perhaps, the best view from a unit should be from one or more proximally located lounge areas—to offer the more socially active patients a chance to interact and ambulate.
Of course, pros and cons of these concepts (including operational and cultural implications) need to be examined through robust studies before implementation.
If these (and other) concepts promoting ambulation prove successful, they could address the need for cost reduction through reduced LOS in a way that optimizes the use of available evidence on healing environments. More important, however, it will create care settings that will look and feel drastically different.
For the patient, the difference could be between perceptions of getting squeezed out as opposed to walking out of an acute care facility.