Too often, a hospital construction project is the glorious swan song of a distinguished leader, rather than a new facility that reflects a high-performance organization through improved efficiencies and outcomes and enhanced satisfaction among patients and caregivers.
Instead of pouring millions of dollars into a building that extends the organization of the past, it may be the time to take a look at how to improve your organization-not just your bricks and mortar-for the future. The challenges of evolving technology, eroding finances, increasing competition and regulatory uncertainty suggest most healthcare organizations could benefit from planned changes to improve performance and effectiveness. A strategy is needed to respond to the changing market, and only when you have aligned your organization with that strategy does it make sense to consider building something that fulfills this mission.
Architects effect significant change in the organizations with which they work, often altering the organization's behavior, culture, performance, structure and systems. Architecture, however, should be a last resort in creating organizational change and should follow a thorough assessment of organizational performance and change implementation.
Such an assessment examines the fit between the external environment and corporate strategy, as well as the fit between strategy and organization. If there are misalignments with the environment, the strategy should be revised. If there are misalignments between the strategy and the organization, an organizational redesign is appropriate.
Not all healthcare systems operate effectively. Some have no clear system goals or roles; some compete with their own affiliates. If you can't track imaging, lab tests or supply resources within a service line, you have a deficient structure. Informal systems often bypass official organization charts to get things done.
New initiatives need new structures to be successful. Design of the work itself should be reviewed, along with the flow of information, patients, staff and supplies. Process improvement should ensure that the new building supports an efficient model.
Environmental psychologists tell us the space around us profoundly affects individuals and groups. For patients, the physical environment of a hospital has a physiological effect and plays a role in outcomes. For staff, the environment has a role in enhancing or hindering performance and social interaction. A poorly designed environment can increase stress for both patients and staff.
The Center for Health Design, a proponent of evidence-based design, is conducting a series of important and rigorous research studies called the "Pebble Project" to establish the relationship between facility design and measurable outcomes, including clinical, economic, philanthropic and satisfaction criteria. Based on preliminary data, facility changes can dramatically improve performance effectiveness and employee satisfaction. Nosocomial infection rates are down at Bronson Methodist Hospital's new facility in Kalamazoo, Mich. After two units at the Karmanos Cancer Institute in Detroit were renovated-providing better access to records, clutter-free hallways and lodging for family members-the nurse attrition rate fell 19% and patient satisfaction rose 18%.
Planetree, the pioneer of patient-centered care, incorporates organizational change in its work. Training for its care delivery model includes "unlearning" previous organizational assumptions, cultures and norms. Returning to fundamental philosophical principles of family-centered care resonates with patients, their families and a committed staff. An Illinois Planetree affiliate profoundly changed the way care was administered by pairing a culture change with facility design that is more homelike and nurturing. The philosophical commitment to involve patients in their care had an intangible cultural aspect in giving patients better access to their medical records and a tangible architectural aspect by putting a resource library in the nursing unit.
In Baltimore, Harbor Hospital's philosophy-oriented "creed" project to restate its vision of service and caring was accompanied by a construction project. The staff signed contracts with one another to achieve specific behavior changes. Renovations dramatically altered the facility's appearance, decentralizing nursing activities, supporting interdisciplinary teams and enhancing cultural interventions such as family-centered care. The result: a financial turnaround and better patient satisfaction.
Valley View Medical Center, a rural replacement hospital in Cedar City, Utah, was designed around a new organizational structure. The multimodality Diagnostic Center and Procedure Center consolidated management, staff and space. Thirty-five departments became 12 new centers and service groups. Such a change was only possible with a new facility design.
Optimizing both organizational and facility design is a powerful model. The result is coordinated interventions to improve the technical and physical environments, along with positive changes in the social and cultural aspects of the healthcare experience. Hospital design is better correlated with the redesigned organization and can result in clinical and performance improvements.
If you are anticipating major construction and spending big dollars, be sure to model your evidence-based design on the type of organization you want. A research-informed design for an organization properly aligned with its strategy will produce a building that offers measurable improvement in organizational performance.
D. Kirk Hamilton is a founding principal of Watkins Hamilton Ross Architects, Houston, and a past president of the American College of Healthcare Architects.