Imagine checking into a four-star hotel. You arrive at your room for which you are paying $1,000 a night. You walk in. You discover you have a roommate. No one mentioned this when you were checking in. Odd. The next thing you notice is that your roommate is ill, right there in the bed next to yours. You then see that only a curtain separates you from her. As you turn to take in the rest of the terrain, you realize you must share a bathroom. One shower. One toilet.

As you settle in to your room, albeit self-consciously, the door flies open suddenly. Your roommate's family and friends burst in with minimal restraint. They are loud and inconsiderate. There are more interruptions. Others come and go with a mere tap at the door. No one responds when you call for assistance or, more often than not, someone finally responds just when you've fallen asleep. The lights are never turned off at night, and there is minimal natural daylight. Noises emanate from all around: alarms beep, overhead paging blares, loud voices intrude. The service is spotty—the help seems distracted, frustrated, and insensitive to your concerns. You have few choices about the food you eat. You find that you are not feeling so well yourself and are beginning to feel worse.

As must be obvious by now, this is the typical experience of patients admitted to our hospitals every day—even our wealthiest hospitals with outstanding reputations in science and medicine. If you were to experience the above scenario in a hotel, you might complain, refuse to pay, or even refuse to stay. But we are captives in the healthcare system when we are ill, with little or no choice. The high end of the hospitality industry has figured out exactly what makes people feel welcome, comfortable, and special, and is extremely successful at providing it. Is it any less critical to feel good and special when one is critically ill, giving birth, or having life-altering diagnostic testing?

(Ironically, some people might get well faster if they checked into a four-star hotel. After all, the risk of a hospital-acquired infection or medical error is markedly increased in our hospitals. A recent article in the New York Times [“Coming Clean,” June 6, 2005] cites a study that showed that hospital infections kill an estimated 103,000 people in the United States each year—as many as AIDS, breast cancer, and auto accidents combined.)

In addition to the stresses patients experience, today's hospitals exert extraordinary pressure on healthcare workers. I know—I speak from personal experience as a longtime healthcare provider who has assumed many roles on the care delivery front lines. The number of nurses, practitioners, and caregiving staff we will potentially lose from the workforce because of poor hospital working conditions affects us all. Healthcare workers spend countless hours in environments that can create enormous stress which, when not ameliorated, can often contribute to illness. Nurses suffer more back injuries than construction workers. Yet nurses, despite all this, are expected to be the caring profession. Lots of lip service is given in the medical profession to deploring burnout, yet we watch staff leave, one by one. Sadly, they often migrate from one institution to another, only to encounter the same problems. More energy is spent recruiting replacements than focusing on retention. It has been said that there isn't a nursing shortage; there is a shortage of nurses willing to work in today's hospitals.

Today we are in the midst of a boom of new hospital construction. Most of these projects are years away from completion. It is critical that we do not replicate hospitals of the past, either in architectural design or in organizational design.

In contrast to traditional hospital design, evidence-based design prescribes healthcare environments that are therapeutic, supportive of family involvement, conducive to staff efficiency, and restorative for workers under stress. Evidence-based design is the result of investigation conducted in more than 600 rigorous studies linking the built environment of hospitals to staff stress and effectiveness, patient safety, patient and family stress and healing, and improved overall healthcare quality and cost.

A primary concern of any institution is financial. The bottom line is that evidence-based design is good business, providing cost savings in the long run. Of equal importance is the human factor; in employing evidence-based design, we will have accomplished our original intent—to first do no harm—and prove that we are in fact building healing environments. The truth is, we pay now or pay laterand possibly risk going completely out of business later.

However, like turning a ship at sea, it can take a long time to move in a new direction. How can we address these issues while we are waiting for the hospital of the future? How many patients will suffer needlessly while we wait? How many nurses, physicians, nurse practitioners, and hospital staff will we lose to the stresses hospitals pose? How many smaller hospitals that cannot afford to rebuild will be forced to close, cutting off communities from accessible healthcare?

We are obligated to reassess the vision of our purpose, develop a new way of thinking, and adopt a new approach to problem solving. Fortunately, much of this work has already begun. Through such organizations as The Center For Health Design, Health Care Without Harm, and the Robert Wood Johnson Foundation, to name a few—and resources such as the Green Guide for Health Care—dedicated and diligent work has been going on to help guide us toward the future of healthcare design.

The inspirational saying “just do it is not yet a resounding mantra in healthcare. It must become one. We all want and need to support and retain our existing nurses and physicians now. We must reduce risk and improve outcomes for patients now. We cannot afford to wait for the hospital of the future. Let's start turning the ship now.

All nurses and physicians are urged to become educated about these issues, to become a driving force in creating a work world in which they want to work, so that their career choice will be lasting, rewarding, and healthy. And consumers of healthcare should become advocates of change in their local hospitals.

Say something. Do something. And say it and do it now. HD

Barbara Wallace Winter has provided frontline healthcare for 35 years as a nurse, nurse-midwife, manager, author, and educator. She has served in management roles, innovating and transforming the culture and organization of healthcare delivery. She has worked for such healthcare institutions as Capital Health System in Trenton, New Jersey, and Monmouth Medical Center in Long Branch, New Jersey. She is establishing herself in her new career as a healthcare design consultant and author.

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Healthcare Design 2006 May;6(3):20-21