-By By Carrie Rich

"Designing for Health" is a monthly, Web-exclusive series from healthcare interior design leaders at Perkins+Will that focuses on the issues, trends, challenges, and research involved in crafting today's healing environments. This month's topic:

Evidence-Based Hospital Design Forum

By Carrie Rich

Earlier this year, Georgetown University hosted the first ever, daylong academic Evidence-Based Hospital Design Forum. The multidisciplinary attendee list consisted of hospital administrators, clinicians, policy experts, design professionals, academic researchers, and students. This face-to-face learning experience bridged gaps between the design and healthcare industries by jointly studying best practices of evidence-based hospital design. The multidisciplinary engagement of leaders in overlapping healthcare professions sparked the beginnings of an ongoing conversation.

We know from reports published by the Institute of Medicine, To Err Is Human: Building A Safer Health System and Crossing the Quality Chasm: A New Health System for the 21st Century, that opportunities to improve the quality of healthcare delivery lie in improved design of healthcare delivery systems. Yet, it is rare to find politically appointed leaders who actively support design of the built environment as a method of achieving systemic reform and enhanced healthcare quality. The Forum keynote speaker was Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality (AHRQ), United States Department of Health and Human Services (HHS), and a member of the 2008 Top 100 Most Influential People in Healthcare published annually by Modern Healthcare. Her skill in translating healthcare policies into language relating to evidence-based facility design helped administrative attendees navigate the design landscape, adding to the sense of intellectual excitement and energy that characterized the Forum atmosphere.

Hospital administrators and clinicians came to the Forum with the intention of seeing the built environment through a different lens, which was intrinsic to the learning nature of the event. Attendee Patrick Walters, executive vice president of strategic planning and system development for Inova Health System of Northern Virginia reflected: “The Evidence-Based Hospital Design Forum was an exceptional program that provided intensive coverage of the evidence-based support for the critical design features that are being included in healthcare facility plans today. The program was particularly timely and relevant for me as a senior executive at a large health system with responsibility for significant new and replacement facilities that will serve our community for many years to come. The broad-based overview provided me immediately relevant information that will certainly support high-level assessment and review of the project designs we are currently completing.”      

Many healthcare administrators previously had not conceptualized the built environment as a feature of quality healthcare. Gary Filerman, PhD, MS, MA, professor of health systems administration at Georgetown University and the Forum moderator, connected healthcare facility design to quality from the Forum’s outset. “A decade ago,” he noted, “the Institute of Medicine focused attention on the great gap between what we know and what we do relative to quality of care. Since then, we have clarified the dimensions of the gap and identified strategies to reduce it. One key is effective translation between those who generate evidence and those who use it (or should). The Forum was an outstanding demonstration of translation and was particularly exciting because of the mix of perspectives it brought to the table.”

Several expert speakers were selected to address key questions about the role of the built environment in healthcare. Kirk Hamilton, FAIA, FACHA, editor of the Health Environments Research and Design Journal and an associate professor and faculty fellow, Center for Health Systems and Design at the Texas A&M College of Architecture, outlined the relationship between facility design and measurable organizational performance. Eileen Malone, RN, MSN, MS, CEO Emeritus of DeWitt Army Community Hospital and Partner of Mercury Healthcare Consulting, built on Hamilton’s explanation, identifying specific design processes around which hospitals are coalescing based on institutional interests. She also outlined a rich body of resources of the most up-to-date research developed for healthcare executives.  

Robin Guenther, FAIA, LEED® AP, principal, Perkins+Will, mapped institutional interests pertaining to sustainable healthcare architecture in leading organizations. Jack Cochran, MD, FACS, executive director of The Permanente Federation, spoke about the integration of information technology in the built environment. Cochran’s presentation segued with the presentation of Alan Hedge, PhD, director, Human Factors and Ergonomics Laboratory, Cornell University, who presented on the future of health information technology and how ergonomic developments might impact facility design and/or use. Bruce Komiske, MHA, Children’s Memorial Hospital, presented yet another distinct aspect of evidence based design: how to use design as a tool for fundraising. As an administrative leader, Komiske presented a case study of how he successfully engaged his local community and hospital board members as partners in fundraising for construction projects. Two vendors were asked to partner in the event, providing generous support in the form of speakers for topics pre-selected by hospital administrators.  Kerrie Cardon, RN, AIA, represented Herman Miller and spoke about workforce patterns designed with the caregiver in mind, while Humanscale sponsored Hedge. 

The Forum was chaired by Gary Filerman, PhD, MS, MA of Georgetown University.  He collaborated directly with Tama Duffy Day, MA, FASID, LEED AP, principal at Perkins+Will, in planning the event in conjunction with a planning committee of Health Systems Administration students. 

By the end of the Forum, attendees communicated strengthened understanding of the application of evidence-based design that concurrently stimulated networking among professionals with common interests and varied perspectives. Forum attendees represented a fraction of healthcare leaders working collaboratively to design quality-driven healing environments based on data. Little by little, they are changing the blueprint of the medical world.

The Forum marks the beginning of an ongoing partnership, and plans for a second forum are underway. Forum presentations are available online by visiting
http://perkinswill.com/news/default.aspx.


Carrie Rich, MS is an adjunct faculty member of Health Systems Administration at Georgetown University and a Healthcare Specialist at Perkins+Will.  She can be reached at Carrie.Rich@Perkinswill.com

Sources:
1. Advisory Board, The.  “Hospital-architect collaboration in the downturn.”  Horizon Scan.  20 May 2009.

2. Campbell, Carol Ann.  “Health Outcomes Driving New Hospital Design.”  New York Times.  19 May 2009.

3. Commonwealth Fund, The.  “In Focus: Health Care Leaders Seek to Create Healing Environments for Patients, Staff, and the Broader Community.”  May/June 2009.


Past installments of "Designing for Health" include (click on title to access the full article):
• Designing the Ideal Space
• The Importance of Family in Patient Rehabilitation
• Maximizing the Impact of Art in Architecture
• The Benefits of Healthcare Learning Environments
• Making Hospitals More Hospitable for Children and Their Families