David Duff, senior vice president and director of China healthcare at VOA Associates Inc. (Chicago), compared Chinese and U.S. healthcare practices and design at The 3rd Summit Forum of Chinese and Overseas Hospital Architects, part of the 15th Hospital Build and Infrastructure China Exhibition and Congress held June 21 to 23 in Nanjing, China.

Considering U.S. design practices, Duff focused on flexibility and reconsideration of non-hospital-based care delivery. For example, changes are likely to come with increasing incidence of environmental cancers and altering disease patterns, he said, with modular designs becoming increasingly popular in the U.S. Duff reported that between 40 and 50 percent of all surgeries in the U.S. are in outpatient centers.

With deference to the existing Chinese healthcare system, Duff made suggestions for improvements by comparing Chinese and U.S. characteristics in terms of performance, physician training and team building, and nursing services.

Care delivery infrastructure

  • All healthcare is delivered through hospitals in China. Private physician offices and outpatient care settings don’t currently exist.
  • Whereas far more patients are seen by independent physicians than by hospital personnel in the U.S., there are far fewer primary care physicians in China to serve as entry points to the system. Most Chinese physicians are specialists. The challenge is to develop patient flow processes for screening and moving them to appropriate hospital locations.


  • Intensive care units in the Chinese model, which are ward-based, may be better for patient outcomes than U.S. private rooms. Patients are easier for clinicians to observe and typically unaware of their surroundings.
  • Exam rooms are 20 percent larger in China than in the U.S.

Physician training and care team building

  • Current training practices for physicians focus on the individual and are similar to U.S. training 20 or 30 years ago.
  • In the U.S., training focuses on the physician as a member of the care team.

Nursing services

  • The nurse/patient ratio in China is low—about one per 10,000 patients vs. 98 per 10,000 in the U.S.
  • Nurses are undercompensated compared to U.S. nurses, who are fairly well compensated.
  • Training for the nursing profession is far less rigorous in China than in the U.S.
  • Chinese nurses have less effect on patient care as compared to U.S. nurses, who have a major impact on patient care.
  • Nurses in Chinese hospitals are not part of the care team; In the U.S., they are an essential team member.
  • There is a high turnover of nurses in China vs. a low turnover in the U.S.

In conclusion, the challenge for China is to include clinicians, specialists, staff, patients, and families in the design process, said Duff, adding, “We are so close to doing much better.”

Charlene Marietti is executive director of editorial initiatives for Vendome Healthcare Media, publisher of Healthcare Design. She can be reached at cmarietti@vendomegrp.com.

For more Healthcare Design coverage of the The 3rd Summit Forum of Chinese and Overseas Hospital Architects, part of the 15th Hospital Build and Infrastructure China Exhibition and Congress, see "Three Ways To Cut Building Costs In The Design Process."