Trends in the design of healthcare facilities are bringing us to the edge of a completely re-imagined environment of care. This new landscape is built on the foundations of evidence-based design and patient-centered care, but it’s a quantum leap from these somewhat tired objectives on their own.

With the adoption of healthcare reform, we can expect significant requirements for greater operational efficiencies and patient outcomes.

Driven by the prospects of the Affordable Care Act, here are five ways the industry needs to change to meet the new demands for both efficiency and better care:

  1. Provide care efficiently and with a continued emphasis on raising quality. Unfortunately, traditional design models are still the subject of user group meetings, and healthcare administrators aren’t yet fully realizing that new facilities can and should support more efficient models of care and operational metrics. Healthcare design of the future must therefore be more closely aligned with performance-based criteria and objectives, coupled with the physical facility scope. It should be unacceptable to provide new facilities for existing operational models of care. 
  2. Prevent the spread of infection. Healthcare-associated infections are rampant, but they shouldn’t be. In fact, facility design—and operational redesign—can play a role in limiting or preventing the spread of infections and disease so that the hospital becomes a place where patients get better, not sicker. For example, automatic doors might be used to avoid the presence of germ-infested doorknobs, especially in bathrooms. Patient room design may be evaluated on turn-around time, including complete cleaning. Therefore, the projected cleaning times related to a new design may be integrated with other design criteria. Exam room design may include appropriate patient privacy; however, the cubical curtains can be eliminated with the use of a “privacy swing” on the entry door. 
  3. Use more sustainable energy. Building and operational efficiency, including energy independence, is no longer science fiction. While other industries have proven this, healthcare isn’t picking up the mantle for its extensive energy consumption. On average, a new building per square foot can be 28 percent more efficient than an older building per square foot through more efficient energy designs. In response, the healthcare industry is adopting systems for humidification, daylighting, insulation, advanced controls, and air distribution (such as displacement ventilation) to make buildings more energy efficient. 
  4. Build resiliency for extreme conditions. Hurricanes, tornadoes, and earthquakes have given us all great pause in how we design healthcare campus infrastructure, including access and potential off-grid performance. Preparing for scenarios of disaster should be an element of any programming and schematic design sign-off. Think about the architectural and engineering objectives that will withstand a natural disaster. Simple items such as operable windows, location of primary infrastructure, and seismic criteria should be addressed along with more complex items, such as medical gas piping to a garage, isolation gardens, hazmat courtyards, and urban redundancy for infrastructure. This design discussion should extend to the hospital board room with regard to “when is it time to renovate or relocate?” 
  5.  Create health districts. Should hospitals be competing with or embracing retail clinics’ models of care? How are other industries thinking about nutrition, wellness, and education? If emergency department visits are 80 percent due to lifestyle choice, how can we become more proactive than reactive to our health? Hospitals can lead this charge by integrating systems with other private institutions to create a broader ecosystem that promotes health. Through educational programs, health counseling, and the design and distribution of nutrition or exercise apps, the insurance industry is beginning to focus on wellness. We see non-healthcare institutions providing various forms of primary care through mall clinics or pharmacies, so the design strategy for new facilities may be focused around systems of care that are specialized or that can’t be provided through these more streamlined care models.

The environment plays a role in healing, and it’s time to go beyond simply fitting an institution’s needs into a box. We can do better.

Dennis Kaiser, AIA, NCARB, LEED AP, has 30 years of healthcare design and planning experience. He can be reached at