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The closing decade of the 20th
century saw an amazing transformation in the environmental quality of
healthcare facilities nationwide. These changes can be compared
historically with the influence of Florence Nightingale, whose observations
some 150 years ago left a lasting impression in patient-care settings.
Three forces converged in recent years to result in
dramatic improvements in design that one can see in just about every new
healthcare structure across the country. Understanding each of these
factors dependently, however, will not completely explain what has driven
the change. The shift must be viewed within the larger context of the
nation’s emphasis on continuous quality improvement, which has also fueled
U.S. economic prosperity during the past decade.
In today’s most effective healthcare settings, once can
see the convergence of the influence of business, technology and the
humanities on the overall nature of the organizations. When we view
healthcare buildings as artifacts of a given culture, it’s easier to see how
these forces are at work. Every organization has a culture that frames
all of its values and decisions. In this regard, a healthcare facility
is a tangible, living testimony to the organizations’ benefits and
priorities.
Business. Improved performance has been a
constant theme in our market-based economy. During this past decade,
the more successful healthcare organizations have made financial decisions
by viewing their buildings and related improvements as investments rather
than costs. With a return-on-investment mentality, they were
able to deploy innovative and effective design strategies that have paid
dividends in increased market share, improved satisfaction ratings, improved
staff performance and retention, and enhanced community relations.
Technology. The acquisition and application of
medical technologies that support evidence-based medical practices have also
been a theme of the past decade. The more successful healthcare
organizations have learned to employ the facility environment as one of the
care-changing technologies just as much as a new magnetic resonance imaging
unit or the recruitment of a new medical specialty practice.
A critical mass of scientific research has now
demonstrated to even the most staunch skeptics that the quality of the
physical environment can have a profound influence on improving therapeutic
outcomes. The creative and intelligent translation of this knowledge
into effective “environmental technology” is one of the important medical
breakthroughs of the past decade. Examples of these successful
translations can be seen in the new generation of pediatric hospitals,
intensive care units, women’s centers and imaging departments.
Humanities. Leading healthcare practitioners
have always known that the best practices are those that effectively blend
the art and science of medicine. More healthcare organizations have given
tangible recognition to the human element of medical practice – true
patient-focused care – by integrating the humanities within all of their
programs and facilities.
Of course this is not a new idea. It’s an
idea as old as the origins of the modern hospital from 5,000 years ago.
Today, clinical research has proved that an active
involvement and relationship with the arts can have measurable therapeutic
benefits. Consequently, we have seen a growing prevalence of arts
performance spaces, three-dimensional and experiential artwork
installations, and improved access to nature – including more sensitivity to
views of the outdoors and access to therapeutic gardens.
The best examples of healthcare design in the past decade
are those that have been influenced by the tenets of continuous quality
improvements by also intelligently integrate key principles of business,
technology and the humanities into the human experience. In such
examples, one can see the balance in the art and science of medical practice
as well as the balance in the art and science of design. As we look as
these projects and seek a common environmental theme, it’s easy to see – or,
more accurately, experience – the resolved tension between the arts and
sciences that can best be described as a life-enhancing environment.
However, such an environment cannot be created as an
episodic event just by the mere convergence of certain influences. A
truly life-enhancing environment is, in fact, an artifact of an
organizational culture that shows respect for human dignity. This
isn’t something that can be achieved by merely drafting a mission statement.
Rather, it’s an intentional, ongoing process in which all of the
participants regularly evaluate their work and feed this knowledge back into
the process for improved performance.
With these lessons learned in the closing years of the
past century, what should we strive for in the current one?
Certainly we will continue to need modern, efficient, patient-friendly
healthcare facilities. However, increasingly it will no longer be
necessary to go to the hospital, clinic or physician’s office for most
routine medical services. The most frequently used healthcare venue
might very well become our living rooms. Outpatient and
home-based care will dominate. The hospital of the future will look
more like today’s banks – where a central facility handles complex services
and administration while the more routine transactions take place at
convenient branches.
Customer convenience, comfort and satisfaction will
become the vital signs of the healthy provider organization in the next ten
years. Providers that successfully design their organizations with
consumer-sensitive experiences in mind, within the overall context of the
continuous quality improvement programs, will rapidly become the industry
leaders. Wayne Ruga is a Loeb Fellow at Harvard University and a Cambridge, Mass.-based architect specializing in healthcare facilities.
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