Long before healthcare reform ever pressed the need to rethink the way patient rooms are designed, NXT Health and executive director Salley Whitman recognized that the complexity of healthcare had resulted in a lack of innovation in our care environments.

Launched in 2006 with a contract from the U.S. Department of Defense to design a patient room of the future, NXT Health, a nonprofit design group, got to work. The effort evolved into what today is Patient Room 2020, a futuristic model of what inpatient care six years from now might look like—sort of.

The project isn’t necessarily prescriptive or intended for wholesale adoption. Rather, it’s been dubbed a “proving ground,” where concepts can be translated to design, put into practice, and then researched to help shape future adaptations.

When Patient Room 2020 was revealed in summer 2013, covered extensively in trade and consumer media alike, its inherently modern aesthetic and white walls were the source of much debate in the healthcare design world, where a warmer, more hospitality-inspired aesthetic had become the norm. But the concepts NXT Health set out to prove—design approaches that support patient and staff safety, engagement and empowerment in care process, quality of care, and efficiencies in work processes—were revered.

A 400-square-foot physical model of the prototype has since been built in New York, showcasing, in particular, a keen focus on technology and providing a demonstration space for an approach that truly advances the inpatient environment.

Whitman spoke with Healthcare Design about the response Patient Room 2020 has received since its launch, why the patient room continues to hold so much weight for the healthcare industry overall, and what’s next for the constantly evolving model.


Healthcare Design: It’s been more than a year now since NXT Health’s Patient Room 2020 project made its debut. Share with readers what the ongoing mission of NXT Health is and, particularly, where Patient Room 2020 fits into that larger vision.

Salley Whitman, NXT Health

Salley Whitman: Our ongoing mission at NXT is to foster creativity to improve healthcare. The Patient Room 2020 serves as an ultimate vision of supporting this type of creative design through to the completion of a full prototype for testing. While all future projects may not be this large scale, we look forward to supporting other great designers and their creative efforts to improve healthcare.


When renderings of Patient Room 2020, an arguably stark and very modern space, were first published, reactions from the healthcare design industry were immediate and ran the gamut—some loved it, some hated it. Were you expecting that?

One of my favorite quotes is by Ivan Illich: “If you want to change society, you have to tell an alternative story.” In my opinion, that is one of the most impactful things we accomplished with Patient Room 2020. There was definitely an intention to be provocative, and we fully expected dissent along with excitement. It achieved the purpose of getting people’s attention in this very noisy world. Now that we have your attention, let’s do something different to solve the problem.


In a time when healthcare is largely focused on shifting care into communities and creating accessible outpatient care models, why is there such a continued focus on the acute care patient room, as well? What role does it serve in the future of healthcare?

I don’t think that there should be a focus on one versus the other. The focus needs to be on the entire continuum of care, and better yet, on the health of the whole person. We were not making a statement with Patient Room 2020 that only inpatient care matters, rather that it shouldn’t be forgotten as we turn toward redesigning the outpatient setting. As the inevitable and positive shift toward outpatient happens, we will still have a need for acute care services in the hospital setting. If by some unfortunate circumstance you end up as an inpatient, that experience should still be of the highest quality and empowering to the individual and their family members.


For providers, the patient room is a critical space tied very closely to outcomes and, subsequently, the bottom line. How were things like patient satisfaction, medical errors/infection control, and operations considered when creating Patient Room 2020?

All three of those were part of the five main design drivers for the Patient Room 2020, along with technology integration and improved quality. Every aspect of the design includes potential solutions to the issues surrounding these outcomes. Some of those include the handwashing reminder lights at the entry sink, UV lighting to clean in-room equipment, integrated safety lifts and rails, and a “patient companion unit” to allow full control over the environment for the patient.


You’ve since built out the space in New York and have referred to it as a proving ground, where the design can be continually developed. How has the process progressed?

We have been so fortunate to have many different groups come into the space and provide their feedback. Two of the groups that we’re most excited about are patients and nurses. Last fall, we had a focus group with Planetree’s Patient and Family Advisory Council (PFAC) and got some great comments about things that work well and things that could be improved. In the spring, we conducted an innovation workshop with a group of nurses from a New York area hospital who had some fantastic questions and ideas to move some concepts forward.


What are some examples of feedback you heard?

The Planetree PFAC helped us understand a lot more about what a patient needs at the bedside. They loved the concept of the patient companion unit [a touchscreen tablet integrated into an overbed table] but felt that it could be optimized with more room for storage, trash, and food trays while using the electronic side. They also talked about the need to have some type of pull-down seat, either off the bed or on the wall, for physicians to sit down at the bedside and discuss their care plan. The nurses are a wealth of good ideas, but some key ones include helpful apps on the caregiver dashboard, smart flooring that senses movement, and sensors on the bathroom doors that trigger a notification in the hallway that the bathroom is in use.


Let’s talk about a feature that’s been a source of debate: the aesthetic. Some argued that patients prefer homelike environments and that this particular approach doesn’t support patients on an emotional level. What was the reasoning behind the look and feel of the space? Has feedback influenced any reconsideration?

As David Ruthven, lead designer of Patient Room 2020, has described, the key reason for using the white color was to create a space that was “unapologetically healthcare.” The white serves as a better tool for color rendition, leaving the option to use lighting to color the space based on one’s preference. It also allows people to see what needs to be cleaned rather than covering up dirt with patterns and colors. Lastly, it was meant to be a neutral palette in which others could develop and grow their own ideas. We never intended the Patient Room 2020 proj
ect to be prescriptive.


Patient Room 2020 is also largely focused on the role technology can and will play in care delivery. What message would you send providers and designers in terms of planning spaces today to support the technology that’s either here or just around the corner?

I would say first and foremost: streamline. Make sure you’ve taken the time to ask the question, “Is this really necessary or is it redundant to something we already have?” Ask your clients to push back on their technology vendors and encourage them to request the least amount of hardware to accomplish the best result. In addition, healthcare providers need to insist on interoperability with existing systems. Of course, the built environment also needs to be flexible and adaptable, but I worry that the focus on this misses the larger issue of being overwhelmed instead of supported by technology.


What is your ultimate goal for Patient Room 2020?

In supporting the development and construction of the Patient Room 2020 prototype, it was never our goal for the full concept to have widespread adoption. There are too many hypotheses within the design that need to be tested and further developed. However, we do believe that there are some concepts in the room that are ready to be adopted in the real healthcare setting and we’re excited to see that happen over the next few years.


What are some of those concepts that are ready for adoption?

The patient bathroom design (including sliding doors, sink, and shower system) could be easily adopted and used in different configurations and acuity levels of inpatient rooms. Along this same line, the caregiver entry sink area is a product that could be used in a healthcare setting now. The design team may need to do some more work on the lighting cues and electronic dashboard concepts, but those could evolve over time.


How will the model continue to be developed? Do you anticipate future iterations, and what might they look like or what newly identified needs might they answer?

We are very excited about a few updates that we’re making to the Patient Room 2020 prototype this fall, including a new intelligent flooring system. We can't say a lot about it yet, but stay tuned for more information in the coming months. It’s hard to predict what future iterations may evolve from this project. I think we’re most excited about working with new designers and industry partners in the coming years to develop concepts that aren’t even on the radar yet. That’s where the real creativity happens—connecting great minds with real problems that need solving in healthcare. The possibilities are infinite.

Jennifer Kovacs Silvis is executive editor of Healthcare Design. She can be reached at jsilvis@vendomegrp.com

To read more from Healthcare Design's patient room special report, see the following:

  • Stakes Are High For Patient Room Design: The patient room is home away from home and, increasingly, where all the action happens—providing countless reasons to makes sure the design is right. This in-depth look at the state of patient room design today is the first installment in Healthcare Design’s special report on the patient room.
  • Unit Design Is Secret To Successful Patient Room: The effectiveness of any patient room design requires an equally effective unit design that supports efficient, functional, and safe operations and care delivery. Designers weigh in on best practices for inpatient unit design in this installment of Healthcare Design’s special report on the patient room.
  • Crystal Ball—Looking Into The Future Of Patient Room DesignSee a sneak peek of patient room projects on design boards today and details on how healthcare designers are reimagining this all-important space, the third installment in Healthcare Design's special report on the patient room
  • Calling For Backup In The Patient RoomEvidence-based design has shaped the modern patient room in a number of ways, but there are still plenty of places where designers would like to have more research available to support design decisions. Read how research might shape future designs in this installment of Healthcare Design's special report on the patient room.