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Designing for Health

Designing for Health

Smart Building Teams are using 'evidence-based design' to improve healthcare

By Staff | August 11, 2010
This article first appeared in the 200302 issue of BD+C.

Of all major building projects, hospitals are unique, not just for their complexity — the vast amounts of high-tech equipment, the mountainous record-keeping systems, the maneuvering of thousands and thousands of employees, patients, and visitors, the grueling 24-hour schedule — but also because those who walk through their doors, patients and their families, are in dire need of help.

Hospitals are sacred places where life begins, where life is often made better, and where life ends. The gravity of that mission imposes a unique burden on those who design and build hospitals, a responsibility to make these institutions places where core human values are most vigorously respected.

Historically, though, hospital design too often suffered from a terminal case of bottom-line expediency: Get the job done at the lowest cost. That attitude lingers even today, as many hospital CEOs, administrators, and board members question the worth of any "improvement" that could be interpreted as extravagant or unduly risky.

Such scrupulousness, while perhaps understandable from a legal and fiduciary perspective, too often produced hospitals that were windowless, colorless, cramped, full of equipment and tubes and wires, poorly lighted, noisy, full of germs, often dirty and drab. Not very pleasant places to visit, no less in which to be confined, and terrible environments in which to work long, tiring hours, often in the dark of night.

Since the 1970s, there have been efforts to make hospitals more humane. The women's movement encouraged the establishment of birthing rooms, gynecological centers, and other specialty facilities designed to meet the unique — and, it should be noted, highly profitable — needs of female patients. The rise of HMOs and other forms of so-called "managed care," coupled with hospital closings, mergers and acquisitions, and systemwide consolidations, brought on vicious competitive battles in many healthcare markets, with hospitals vying against each other on the basis of "guest relations" concepts borrowed from the hotel industry — things like valet parking, fancy menus, and, perhaps most ignominiously, "smile training" for the staff.

Most of these "innovations" turned out to be cheap gimmicks, easily copied by even the most slow-footed competitors. And while they might have contributed marginally to the hospitality aspect of patient care, their impact on clinical outcome — how well patients did in terms of improved care — was rarely measured, and never proven.

Today's hospital administrators face a dramatically changing patient population: an explosion of elderly, more sickly patients at one end of the generation span, and a more demanding younger patient at the other.

Fortunately, the last few years have seen the rise of a new movement in healthcare. A growing number of hospital and healthcare systems, aided and abetted by a cadre of progressive architectural design firms, construction companies, academicians, consultants, and advocacy groups, are challenging the conventional wisdom of hospital design with new approaches that actually contribute to improved patient care and clinical outcome.

It's true. We're starting to see hospitals where design may actually be helping patients do better clinically — to heal more quickly, use fewer pain medications, require shorter hospital stays — all of which is backed by quantifiable data, not merely hopes and prayers. At the same time, these facilities are becoming better places in which to work, especially for their hard-pressed nursing staffs, and more humane environments for patients' families to participate in their loved ones' healing process.

In the following pages, the editors of Building Design & Construction present a Special Report on this new movement, called variously "evidence-based design" or "designing for health outcome."

We welcome your comments. Please send them to Robert Cassidy, Editor-in-Chief, Building Design & Construction:

Spring Symposium on Healthcare Design will focus on designing for the future


Date: April 23-26, 2003

Location: Loews Coronado Bay resort, Coronado, Calif.

Now in its 16th year, the spring edition of the Symposium on Healthcare Design will gather designers, care providers, healthcare executives, and facility planners/managers to discuss the latest design techniques for meeting the challenging requirements for the healthcare market. Top issues that will be addressed at the event include:

n Increasing healthcare organizations’ profitability

n Becoming HIPAA compliant

n Incorporating and implementing technology

n Creating a long term care healing environment that is financially feasible

Major themes that will be covered at the event include:

Building and defining healing environments

Although the term ‘healing environment’ has been around for some time, architects and planners are still working to create surroundings that truly heal. This track will explore new ways of defining and creating these environments.

Process, collaboration, communication

This track focuses on what it takes to create a successful design team, manage communications, expectations, and collaborate with stakeholders. Additionally, the session will cover the importance of relationship building, client education, and how to define the needs of caregivers and patients.


Learn how to future-proof a facility against the inevitable and unrelenting advancements of technology. This session will also look at the new technologies on the horizon.

Perspectives and innovations

Get a view from outside your day-to-day experiences. This track presents several perspectives on innovation and design from outside the industry that relate to healthcare facilities.

Emergency department

As the new “front door” of the facility, concerns with the most efficient and effective techniques for designing emergency departments are more prevalent each day. This track will discuss new design techniques, ways to improve the patient’s experience, and look at technology’s effect on these ever-changing facilities.

Women’s and children’s facilities

This track focuses on ways to integrate families into the healing process, discuss methods to measure the value of the facility design, and look at the future of women’s and children’s healthcare.

The patient’s experience

Focuses on methods of measuring patient satisfaction, enhancing the healing environment, increasing the quality of care, deinstitutionalizing the healing experience, and technologies to more effectively treat, educate, and track patients records. BDC


The following organizations are involved in evidence-based design for healthcare facilities:

AIA Academy of Architecture for Health

American College of Healthcare Architects

D. Kirk Hamilton, FAIA, President

Janene Dawson, Executive Director


Center for Health Design

Debra J. Levin, EVP


Coalition for Health Environments Research

Tib Tusler, FAIA, Executive Director


Center for Health Systems and Design

Texas A&M University

Roger Ulrich, PhD, Director


Institute for Healthcare Improvement

Donald M. Berwick, MD, President/CEO


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