Healthcare reform is debated all over the news these days. How to deliver equitable care in a more cost-efficient system that is safe, effective, and timely is the preponderance of many in our nation's capital. It is no easy feat, but for those of us who think about improvement in this industry on a daily basis, it is pretty clear where some of the inefficiencies that impact quality of care lie. They are imbedded in the misalignment of form and function. Those of us who design the built environment do so by evaluating functions like systems operations, organizational flow, health outcomes, staff effectiveness, and building efficiencies. Our dilemma is that not all healthcare institutions can take on a major redesign of their form to support, or in some cases drive, improved functions. Those institutions that can, struggle with the economic impact of these decisions so change is incremental. Incremental change takes precious time to fully test a conceptual design intervention's hypothesized outcomes, so we move slowly to improve a system that needs more efficiency now. The lesson to get there faster has been a longtime coming, but is quite simple once understood. There is resistance to change if it is not justified in a quantifiable way. The most effective argument for our industry has been to tie each and every economic decision to the universal goal of improvement for the human condition by recording its positive return on the investment. We call this the “Business Case” in “Evidence-Based Design.”

In a true evidence-based approach one should first look at the catalysts in our industry and see how they might help our struggle to improve. “Efficient, Effective, Equitable, Safe, Timely, Patient-Centered was the mantra from the Institute of Medicine in 1999 when it sent out its plea for improved quality of care in our nation's healthcare facilities. Ten years later how have we responded?
Dublin Methodist Hospital, Dublin, Ohio

Photo by Brad Feinknopf


Dublin Methodist Hospital, Dublin, Ohio


We responded with extreme focus on patient needs, and rightfully so because much needed to be done. Collectively we focused on improving the environment in which a patient receives care in order for it to become more conducive to their wellbeing. The pendulum swung so far to that end that most of our innovative design interventions focused quite specifically on the patient room and not much beyond it unless a piece of equipment drove the change. The focus of this issue of HEALTHCARE DESIGN sheds light on our next frontier and that is the needs of the caregiver and all that supports their ability to deliver “Efficient, Effective, Equitable, Safe, Timely, Patient-Centered care.

There are many drivers moving us toward a greater emphasis on better clinical workplace performance. There is more data from our evidence-based projects; a stronger link to the understanding of how sustainable environments support greater productivity; growing acceptance of LEAN principles borrowed from manufacturing that can be adopted into a more electronically intelligent healthcare work environment; and an aging workforce with a shortage of new recruits. All of these factors will cause a shift in design thinking driven by the necessary operational shifts that will need to occur.

It is our hope, at The Center for Health Design, that interdisciplinary design teams will focus on more efficient care delivery models and take a solid evidence-based approach to their redesigns. By carefully documenting their successes and failures in an evidence-based “Business Case,” we will all move quickly toward embracing more efficient caregiver work environments. Remember, there is resistance to change if it is not justified in a quantifiable way. Thank you to all who are focused on this new frontier of designing a more efficient care model. HD

Rosalyn Cama, FASID, EDAC, is Board Chair for The Center for Health Design. Her book, Evidence-Based Healthcare Design is available through John Wiley & Sons. The Center for Health Design is located in Concord, California.

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Healthcare Design 2009 November;9(11):12