Building a new facility is usually the biggest capital investment a chief executive officer and board of trustees will ever make. Hospitals will spend more than $12 billion this year on new construction and, by 2010, spending on new hospital construction it is expected to increase to $16 billion to $20 billion annually. With so much at stake, the time is right for hospital leaders to spend a little more money to not just build a new hospital, but a better hospital-one that will actually save significant dollars in the long run. (See 2004 Design Awards feature in the Awards and Honors section of this website.)
It is well-documented and widely known that hospital buildings are too often dangerous and stressful places for patients, families and staff. According to the Institute of Medicine, medical errors and hospital-acquired infections are among the leading causes of death, each killing more Americans than AIDS, breast cancer or automobile accidents. Payers, employers, governments, accrediting bodies and consumers are placing increasing pressure on hospitals to become safe and effective places.
Just as healthcare is increasingly moving towards "evidence-based medicine," there has been an explosion of "evidence-based design"-rigorous research studies linking the physical environment of hospitals to clinical and satisfaction outcomes for patients and staff. More than 600 published evidence-based design studies have been identified by the Center for Health Design, a not-for-profit research and advocacy organization whose mission is to transform healthcare settings into healing environments that improve outcomes. These studies are summarized in a report just published by the center that was funded by the Robert Wood Johnson Foundation. In the report, authors Roger Ulrich of Texas A&M University and Craig Zimring of the Georgia Institute of Technology conclude that "the scientific literature is confirming that conventional ways that hospitals are designed contribute to stress and danger, or more positively, that this level of risk is unnecessary: Improved physical settings can be an important tool in making hospitals safer, more healing, and better places to work."
Based on this research, there are several design innovations that every hospital involved in a building project should implement:
* Build larger single-bed rooms and reduce hospital-induced nosocomial infections while including spaces for patient, family and staff activities and in-room procedures.
* Make rooms adaptable by standardizing shape, size and headwalls, thus reducing unnecessary, costly and dangerous patient transfers.
* Include double-door bathroom access, reducing patient falls and staff injuries.
* Install hand hygiene dispensers in each patient room to reduce staff-to-patient transmission of pathogens.
* Provide positive distractions through art, restful views and access to nature, thus relieving unnecessary stress and improving patient satisfaction. There are several others.
But, in the current healthcare economic environment with capital so difficult to obtain, you might ask: Are these good ideas affordable? Is there a business case for building better hospitals? The answer is yes. Based on published evidence and the experience of pioneering organizations using evidence-based design to construct new facilities, six individuals affiliated with the Center for Health Design (CEOs, architects, a business professor and a futurist) analyzed the data and designed a hypothetical "Fable Hospital." It is a fable because it has not yet been built, but it could be at any time by someone-starting tomorrow.
The Fable Hospital is a 300-bed replacement hospital costing $240 million-the average cost of building a conventional hospital today. At Fable, a courageous CEO decides to include all the proven design innovations mentioned above and others proven to work. After detailed analysis, he concludes it will require a modest one-time cost. However, to his surprise, the analysis also shows significant operating cost savings and revenue increases in the first year alone (coming from a reduction in patient falls, fewer patient transfers and reduced drug costs, as well as a measurable increase in market share). Most of these savings recur year after year, making it a superb long-term investment.
Armed with this evidence, the CEO and the board of trustees decide to proceed and convert the Fable idea into reality. To do so, they:
* Formally incorporate evidence-based design into their vision of the project.
* Select an architect who is fully conversant in the latest design research.
* Hire researchers and advisers who develop easily usable instruments to measure the impact of their decisions and publish their results.
As CEOs, we have an extraordinary opportunity and a serious responsibility to truly build better hospitals-ones that actually facilitate physical, mental and social well-being and productive behavior in their occupants. In addition, through measured superior performance we can actually improve our organizations' financial results.
The bottom line is that most hospital boards and executive leaders have only one or two opportunities in their professional lives to create a permanent legacy that can transform their organizations and their communities. Building a better hospital is an opportunity that should not and must not be wasted. The evidence for making an investment in facility excellence can no longer be ignored. And the lesson for all healthcare organizations is clear: Provide a built environment that is welcoming to patients, measurably improves their quality of life, and supports families and employees-or suffer the economic consequences in an increasingly competitive and demanding economic environment.
Blair L. Sadler is president and CEO of Children?s Hospital and Health Center, San Diego, and is a member of the board of the Center for Health Design, Concord, Calif.