PhiloWilke Partnership explores current issues affecting how healthcare spaces are shaped.

A happy and healthy patient is every healthcare practitioner’s wish. When that patient checks in or schedules their next appointment, they want to be confident that they are receiving quality care. One small but important part of that quality care is the experience that the physical environment provides the patient. How does the patient interact with their environment? Do they feel comfortable? Have they been properly accommodated? It is these human interactions that influence the choices designers, owners, engineers, and contractors make on a daily basis. Below are some of the key issues currently affecting the design of healthcare spaces today:

  • Design for the family
  • Embrace flexibility
  • Create spaces for the aging population
  • Incorporate modern technology
  • Plan for patients of size
  • Consider the cost of convenience

PATIENT CENTRIC– Design for the family

The healthcare environment of today is no longer synonymous with institutional. The cold, dark, bland, and impersonal facilities of yesterday are being replaced with hospitality influenced, light-filled environments that are patient-centric. From the moment of arrival, the patient, as well as accompanying family members, are greeted with a warm, inviting atmosphere that is at once momentous, yet intimate. The cold ambiance of old is now replaced with the warm and familiar. Reception is immediate with staff that is dedicated to the needs of patients and visitors. Gone are the old airport-style waiting rooms with their rows of hard plastic chairs and haphazardly placed TVs. More than a place to simply pass the time, the waiting area has become a place with many faces. Here you will find carefully zoned areas that provide for a variety of seating configurations. Individuals will find high-quality seating in a variety of sizes, as well as high bench work surfaces for productivity, and quiet, contemplative zones to escape the chaos. Families will be able to sit in a group setting facing each other, while their children play in nearby in well-monitored zones designed with the child in mind.

MENTAL/ BEHAVIORAL HEALTH INTEGRATION – Embrace flexibility

Currently, there is a rise in the need for treatment of behavioral health issues in the United States. The healthcare system’s first contact with these patients is often in the Emergency Room, requiring a shift in the type of rooms provided. The patient rooms need to be multifunctional and flexible to meet the additional security measures at a moment’s notice yet still function for a typical patient. Behavioral health patient rooms are also needed in nursing units in hospitals without traditional in-patient psychiatric units. The ability to flex patient rooms into behavioral health rooms is beneficial to the hospital until beds in psychiatric facilities are available. Rooms should be positioned as close as possible to the nursing stations for constant observation, ensuring the safety of the patient. These areas should receive the same design approach as other clinical areas, utilizing the latest healing environment strategies. Gone are the days of providing the stark and cold facilities that seem to only de-humanize the spaces that most need it. Unfortunately, most current regulations do not address the many issues of providing successful behavioral health environments – however, this can be addressed by following best practices and closely working with the authorities having jurisdiction.

AGE-RELATED DESIGN – Create spaces for the aging population

The aging of the world population is one of the defining paradigms of our era. There are two major societal changes taking place worldwide – people are living longer and the global population is becoming more concentrated in cities. Between 2000 and 2015, the population over 60 increased by 68% in urban and suburban areas. In contrast, the same population in rural areas only increased by 25%.

The projections from the U.S. Census Bureau point to 2030 as a milestone year in which older people will outnumber children for the first time in history. Census Bureau data also estimates that one in every five Americans will be retirement age by that year. And beyond that, come 2035 some 78 million people will be over 65, while 76.7 million will be 18 or younger.

Design professionals and healthcare providers need to be aware of these demographic changes and respond appropriately to the needs of the elderly in the built environment. Developing a framework of design that supports the elderly’s feeling of independence, safety and well-being will be critical in the years to come. Our primary goal should be “creating environments and opportunities that enable older people to be and do what they value throughout their lives.”

The trends of aging and urbanization are clearly underway. Design professionals and healthcare providers have an important role to play in providing a healing environment for our growing senior population. A holistic approach between healthcare delivery and the built environment must be implemented to accommodate the needs that will emerge from these changes.

TECHNOLOGY/TELEHEALTH INTEGRATION – Incorporate modern technology

Technology continues to impact every aspect of our lives as well as the planning of healthcare and medical research facilities. Individuals without regular access to technology have new opportunities to interact with physicians and other providers via telehealth solutions. The prevalence of technology can provide a safer care environment where monitoring is done via a remote setting rather than directly in a unit. This approach to providing patient care is in its early stages, and currently isn’t replacing exam rooms or consultation rooms. In the future, we may see an increase in these spaces and possibly the reduction of hands-on patient exam spaces. For now, it is an excellent way to reach a population that may go without follow up appointments or other consultations.

For instance, critical care patients are monitored by a care team that may not be located directly within each unit but can provide continuous monitoring and recognize trends in a patient’s vitals. Virtual ICU’s are gaining popularity across the country as a way to extend the care of clinicians to more patients from a remote location.

It is still hard to say whether technology will make healthcare spaces smaller or even if there will be fewer of them, but it is allowing us to forecast the future more easily. In medical research laboratories, investigators are now able to rely on years and years of reputable data to create virtual experiments. This allows them to quickly adjust their protocols and eliminate setup and growth time, therefore the wet lab is indeed shrinking as more work moves to the computer away from the bench. The impact on the laboratory is impressive, as wet lab space is exceptionally costly to build and to maintain. While the need for bench space won’t go away, it will critically important to carefully balance the flexible lab needs of the future.

BARIATRICS – Plan for patients of size

The American Society of Metabolic and Bariatric Surgery (ASMBS) has recorded an increase of 42% in sleeve procedures alone in the past eight years. In 2018, the global bariatric surgery market was valued at approximately 1.9 million dollars and by 2024, has plans to grow to a generated revenue of $3.5 million. The US population continues to get larger and this has become apparent most in the healthcare industry.

We are finding more and more requests within our renovation and new construction projects for accommodations of bariatric, or patients of size, type equipment. This includes requests as small as needing larger waiting rooms to accommodate wider seating configurations or additional alcoves needed to store larger wheelchairs, to more involved requests of adding or coordinating patient body lift harnesses and tracks inpatient rooms, to assist nursing staff in caring for these patients without risk of injuring themselves. The larger equipment also has a significant impact on the size of rooms in both the inpatient and outpatient environments. Imaging and surgical rooms are also affected by the need for larger sized rooms, due to the larger equipment tables needed to accommodate patients of size.

The clinical staff isn’t the only group expressing concern within the healthcare market. Facilities groups are facing more challenges for maintaining and replacing damaged plumbing fixtures, particularly toilets, due to the weight impact increases. Almost every client we work with asks for bariatric specifications of some sort when discussing plumbing fixtures. This, along with additional supports for handrails, patient lift integration, and larger rooms and equipment, increases the construction and facility costs more every year.

COMMUNITY CLINICS – Consider the cost of convenience

We see the continued migration and proliferation of out-patient services throughout the United States, largely driven by technology. New medical technologies provide opportunities to intervene and prevent illness regardless of geographic location. For routine care as well as chronic illnesses, organizations of all sizes and types are offering solutions that were only a dream a few years ago. From traditional hospitals to drug stores to technology companies, competition and decentralization of the delivery of healthcare is providing access to more people in more ways than ever. Although it is seen by many as a fragmented approach, it is providing both more personalized and specific care to many more people across the country. Finding creative ways to contain costs will continue to be the largest challenge for healthcare providers and insurance companies.

CONCLUSION: What do we take away from these issues?

The healthcare facilities of today represent a new vision for patient care. There has been an overall shift in the way design is approached by designers putting themselves in the shoes (or gurney) of the patient and learning from their experiences. Important future considerations include mental health reform, an aging population, accommodating patients of size and technology advancements within the ever-changing healthcare design industry.