Healthcare design is complex and is based on new medical technologies and architecture. In the past, patients have longer hospital stay as compared to today. Leading healthcare practitioners and architectural firms highlighted the need for better implementation of new technologies and an effective approach to design for better patient outcomes and well-being.
Evidence-Based and Experience-Based Design
Evidence-based design as a concept originated in the 1970s with basic research methods. In 1978, the Planetree model was established. Planetree is a non-profit organization that aims to demystify the healthcare experience and create a more personalized, humanized environment that focuses on healing and nurturing the mind, body, and spirit. Planetree designation is the only program of its kind emphasizing patient-person-centered care based on evidence and standards that is putting the needs of the individual first. Patient-centered care has a direct relationship between the built environment, its materials, and the physical well-being of the individuals in healthcare facilities. An evidence-based designer, along with an informed client, makes decisions based on the best information available from research, project evaluations, and from evidence gathered from the operations of client. EBD should result in demonstrated improvements in the organization's utilization of resources. EBD implicates better designs and safer facilities.
Experience-based design is a method of designing better experiences for patients, carers, and staff. The approach captures the experiences of those involved in healthcare services. It involves looking at the care journey and, in addition, the emotional journey people experience when they come into contact with a particular pathway or part of the service. The staff works together with patients and carers to first understand these experiences and then to improve them. Experience also plays a valuable role in facility design.
Many of today's healthcare facilities were constructed at least 50 years ago, and a growing number have outlived their useful lives. Despite renovations and renewals, they often fall short of providing an appropriate care setting. Clinicians and staff develop a mixture of compromises and workarounds simply to make things function. Evidence-based design principles are often absent from new healthcare facilities, perhaps because of a lack of awareness of the principles or because implementing them may fall foul of short-term and short-sighted budgetary decisions. In planning a new healthcare facility in 2008, the executive team at Vancouver Island Health Authority decided to adopt the evidence-based design approach. Most of the medical facilities built in the past were not designed for today's technology.
Involving patients in service improvement and listening and responding to what they say has played a key part in the redesign of healthcare processes over the past five years and more. Patients and users have attended stakeholder events, participated in discovery interviews, completed surveys, mapped healthcare processes, and even designed new hospitals with healthcare staff. However, to date, efforts have not necessarily focused on the patient's experience, beyond asking what was good and what was not. Questions were not asked to find out details of what the experience was or should be like ('experience' being different from 'attitudes') and the information was then systematically used to co-design services with patients. Knowledge of the experience, held only by the patient, is unique and precious. In this paper, attention is drawn to the burgeoning discipline of the design sciences and experience-based design, in which the traditional view of the user as a passive recipient of a product or service has begun to give way to the new view of users as integral to the improvement and innovation process. Evidence-based and experience-based designs play an important role in today's medical facility design.
Ambulatory Surgery Center
The regulatory climate in which an ambulatory surgery center (ASC) must operate is complex. Seemingly contradictory regulations at the federal, state, and local levels can be resolved by using the 'greatest requirement' approach to facilitate flexibility in the long-term use of an ASC. A well-designed ASC should be profitable, flexible, and attractive to both surgeons and patients. The development team must keep the ultimate goal in mind: a high-performance facility with maximum efficiency, high patient satisfaction, and minimal staff turnover, resulting in lower operating costs and correspondingly higher profit potential. Planning a new facility can be accomplished most effectively through a series of ordered steps for decision-making. The ultimate success of an ASC will lie in its ability to meet both initial expectations and longer-term demands for operational flexibility and financial integrity. Careful planning and patient needs and staff productivity needs to be considered.
Continued demand for ASC facilities. Technological advancement has allowed a growing range of procedures to be performed safely on an outpatient basis (unfortunately, however, Medicare has been slow to recognize these advances and assure that its beneficiaries have access to them). Faster-acting and more effective anesthetics and less invasive techniques such as arthroscopy have driven this outpatient migration. Procedures that only a few years ago required major incisions, long-acting anesthetics, and extended convalescence can now be performed through closed techniques utilizing short-acting anesthetics, and with minimal recovery time. As medical innovation continues to advance, more and more procedures will be able to be performed safely in the outpatient setting.
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Ambulatory surgical centers are scrambling to develop better quality measures for their care. With more surgeries now performed in outpatient settings than in hospitals, ambulatory surgery centers have few ways to demonstrate the quality of care they can offer patients.
In the past, I had a fractured right wrist and had to be taken to an old hospital which was the nearest center to where I live. Upon arriving at the hospital, the emergency room was located in the middle of the center and the corridors were narrow and overcrowded, which was very inconvenient and caused a delay in my operation. The medical staff at this surgical facility were not prepared with regards to experience and equipment and caused a delay with my operation which was supposed to be same-day surgery and had to be operated on the next day. Because of the negative experience with this center, it took five months for me to recover.
After three years, the center was renovated and the emergency room was accessible and was no longer located in the middle of the building. The center had a wide parking space, the corridors were wider and no longer overcrowded. The medical staff is well-experienced and state-of-the-art equipment was provided. Access to the surgery and outpatient department was very convenient. When compared to my past recovery, If the center was designed the way it should be in the past, it would have only taken a month for me to recover. Technology and facility design are valuable for patient outcomes.
Future Trends for Ambulatory Surgical Centers
Virtual reality becomes a critical planning tool for hospital design. In 2018, more healthcare clients will benefit from virtual reality (VR) technology as they partner with architects to imagine and design complex spaces like operating rooms. The ability to use VR goggles and headsets to visualize space in three dimensions and coordinate both the room design and placement of equipment is improving facility efficiency and safety. VR headset technology breaks through the traditional limitations of a screen to put people ‘in’ the design to experience, evaluate, and comment on everything from casework configurations to outlet quantities and furniture arrangements.
An increasing number of same-day services and procedures may be performed outside hospitals, in community locations chosen for ease of access and improved customer convenience. Established retail locations are and will become even more attractive to developers of micro-hospitals, outpatient imaging, urgent care and ambulatory surgery centers, and medical office buildings. This approach serves not only convenience-minded patients but also providers interested in growing market share. Trends that Walmart and Panera consider for their locations - demographics, quality of highway or transit access, parking - all translate to healthcare as well.
Acute care needs continue to grow. As baby boomers age, 10,000 Americans will turn 65 every day for the next 20 years, and the total demand for inpatient care will only grow. Additionally, as services are pushed to outpatient facilities, remaining inpatients will increasingly be the sickest and most acute, requiring longer stays. Maximizing the efficiency of space and movement of medical staff to serve this inpatient population, including more private rooms and fewer shared rooms, is critical to healthcare facility design. In the last two years, E4H has designed new private, room bed towers at the Heart Hospital at Baylor Plano, Eastern Maine Medical Center, and the University of Vermont Medical Center.
The ASC market is expected to grow at a 4 percent compound annual growth rate from 2017 to 2027, according to Future Market Insights. The hospital-based ASC segment is expected to hit $69.7 billion by 2027, and multispecialty ASCs are expected to dominate reaching $76.8 billion over the next decade.
Conclusion
Healthcare facility design is based on new technologies and architecture. An effective, well-designed facility, state-of-the-art technology, experienced medical staff, and management of the physical environment contribute to patient well-being or outcome, as well as medical staff efficiency and increased productivity. The facility will also meet economic, safety, and quality expectations.
References
- ASCs: A Positive Trend in Health Care. (n.d.). Retrieved August 2, 2019, from https://www.ascassociation.org/advancingsurgicalcare/aboutascs/industryoverview/apositivetrendinhealthcare
- Bate, P., & Robert, G. (2006, October). Experience-Based Design: From Redesigning the System Around the Patient to Co-Designing Services with the Patient. Retrieved August 2, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2565809/
- Dyrda, L. (n.d.). Retrieved from https://mail.beckersasc.com/asc-turnarounds-ideas-to-improve-performance/10-key-trends-for-ascs-and-outpatient-surgery-in-the-next-10-years.html
- Evidence-Based Design for Healthcare Facilities. (n.d.). Retrieved August 2, 2019, from http://docshare02.docshare.tips/files/7358/73586537.pdf
- Knight, H. (2019, April 9). 7 Trends Transforming the Ambulatory Surgery Center Industry. Retrieved August 2, 2019, from https://vertess.com/salientvalue/7-trends-transforming-the-ambulatory-surgery-center-industry/
- Lindeman, W. E. (2008, September). Design and Construction of an Ambulatory Surgery Center. Retrieved August 2, 2019, from https://www.ncbi.nlm.nih.gov/pubmed/18790100
- Modern Healthcare (2019, April 8). Accessed (2019, August 2). Retrieved August 2, 2019, from https://psv4.userapi.com/c848120/u510634745/docs/d7/98a27a934bf0/Modern_Healthcare__April_08_2019.pdf?extra=yB4kVnP4tRvAcEoUaKK73l5MpY5vZhD-EEgaj_-0BABahriy8uOIPECWA2lGIrbtgWwnPvcdP37R5bls44HxiZDe0wWWlLhdGRNVXR7dpVMPumo-s_pkRgAI8jNjGjUiIHtuyWhwNSm88ZT1
- Ramoie, P. (2015, May 05). Evidence-Based Design Thesis_PaulRamoie_2014. Retrieved August 2, 2019, from https://www.slideshare.net/PaulRamoie/evidencebased-design-thesispaulramoie2014
- Sullivan, E. (2018, January 24). Facilities Management News: 7 Healthcare Design Trends in 2018 - Health Care Facilities Coverage. Retrieved August 2, 2019, from https://www.facilitiesnet.com/site/pressreleases.aspx?id=40541
- Ulrich, R. S., Zimring, C., Zhu, X., DuBose, J., Seo, H., Choi, Y., . . . Joseph, A. (n.d.). A Review of the Research Literature on Evidence-Based Healthcare Design - Roger S. Ulrich, Craig Zimring, Xuemei Zhu, Jennifer DuBose, Hyun-Bo Seo, Young-Seon Choi, Xiaobo Quan, Anjali Joseph, 2008. Retrieved August 2, 2019, from https://journals.sagepub.com/doi/10.1177/193758670800100306
- Waldner, H., Johnson, B., & Sadler, B. (2012, December 17). Building Better Healthcare Facilities Through Evidence-Based Design: Breaking New Ground at Vancouver Island Health Authority. Retrieved August 2, 2019, from https://www.longwoods.com/content/23158
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