American College of Physicians: Internal Medicine — Doctors for Adults ®

Wednesday, June 18, 2014

Designing a better hospital

Let’s face it. A hospital is a place where nobody wants to be. By its very nature, it is somewhere scary and not too nice.

Those of us who work every day in hospitals can easily forget this fact: Those who we serve would rather be anywhere else (and so they should). Think of all the things our patients would rather be doing: enjoying a leisurely afternoon with the family, out in the shopping mall, or at a dinner party with friends. Because of this, we have to think of hospitals in slightly different terms than many other institutions.

For all the talk of patient satisfaction and improving the health care experience, hospitals will always be inherently different from hotels, restaurants, and airports, which are associated with excitement and a good time. But that doesn’t mean that we can’t put more thought into how we could make them more inviting and tolerable from a basic design perspective. As comfortable and healing as possible. That is, after all, the basic function of a hospital: to allow patients to rest and recover.

As someone who has worked in several different hospitals, all very different in terms of location and appearance, I have gained a fair idea of what a good hospital looks like, architecturally, both internally and externally. Here are some of those qualities:

1. An open lobby
The hospital entrance should be as open-plan as possible. Make use of as much natural light, greenery, water (I’ve worked in a hospital with a small waterfall in the lobby), and background music. Along the same lines, make use of an open space feeling everywhere, including on hospital floors. The more cramped and enclosed a hospital feels, the less welcoming it will be

2. Glass exterior
This is being used by new hospitals, and imparts a more modern and “futuristic” feel. The worst external designs use a lot of concrete, dull in color, and bland from the outside

3. Rethink corridors and don’t let them be too long
Traditionally hospital floors are based on a “corridor” design. Generally the longer the corridor, the more “detached” and monotonous a hospital can begin to feel. Some of the older hospitals have extremely long corridors, which was the old-style way to build hospitals. Most intensive care units do not utilize this design, and will have patient rooms distributed around a central area (more circular design). That’s for a reason: Corridors don’t promote vigilant patient care

4. Flooring
Flooring is very important to the design of any area, and an often overlooked aspect in hospitals. Think carefully about the type and color of the floors. Avoid drab and dull colors. Carpets may be also be a good idea, but are tricky because they are difficult to clean. While we can’t obviously have carpets in patient rooms, we can maximize their use elsewhere. Wooden floors also look good, and can be glossed over to make them hygienic and bleachable

5. Single-bed rooms
Multiple occupancy rooms are on the way out. Most hospitals now have two to a room, and the trend is for more isolation. We are way ahead of the curve in the United States, because most hospitals in Europe still have much larger numbers of patients per room. No doubt one day we will find it unacceptable that we have to share a room with anyone at all when we are in hospital, a place that is supposed to be hygienic and restful

6. Minimize clutter
This gets back to an open space design, but it’s very important to minimize the amount of clutter that is located in corridors and patient rooms. Equipment that is not being used should be placed in storage areas

7. Outside campus
New hospitals should only be built in places that are detached from the outside “hustle and bustle.” The problem with downtown hospitals, aside from the noise from outside, is that it’s often difficult for visitors to get there and parking can be a whole different story. Ideally hospitals should be located a bit out of town and have plenty of parking outside

8. Quiet and healing
Patients need to be able to recover in a comfortable and healing environment. One of the biggest complaints I hear when I enter a patient’s room first thing in the morning is how they couldn’t sleep—either due to noise from staff, equipment, or a noisy neighbor! It should go without saying that if we don’t let sick people rest, they cannot possibly feel better. The layout and design of the surroundings plays a large part in the sound-proof nature of the patient’s room

The above design points are common to many of the best performing hospitals and those that usually get the best ratings. Obviously it is more difficult for hospitals that are already established. They can’t just change their whole design. But as we build new hospitals, and those that are already here build new wings, we must think of these. Input is required not just from architects, but everyone involved in the hospital. The internal design of a hospital can make a massive difference to patients’ health care experience. It also makes a huge difference to how everyone who works in the hospital experiences their workday. We can never make hospitals exciting and thrilling places to be—they shouldn’t be! But while we guide patients through a tough and low time in their lives, we can at least give them the best possible environment in which to get better.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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