Blog | 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.