The Takeaway

Does Better Design Make for Better Health?

Mary Dee Hacker, Robin Orr, and James Theimer at Zócalo

Comfortable furniture, soft lighting, art, and gardens aren’t usually the stuff of hospitals.

“There’s a new generation of hospitals and clinics on the rise,” said Dana Dubbs, a health care journalist and owner of Dana Dubbs Communications. “They’re often compared to hotels.”

Healthcare providers, administrators, architects and designers are embracing the idea that health care design helps patients heal. In an event sponsored by the California HealthCare Foundation, Dubbs joined Childrens Hospital Los Angeles vice president for patient care services and chief nursing officer Mary Dee Hacker, healthcare consultant Robin Orr, and architect James Theimer to find out what hospitals are doing differently, what makes for good design, and how it helps patients and staff.

Far from Florence Nightingale

As Hacker explained, hospitals haven’t always been about healing. “Forty years ago the purpose of a hospital was to cure disease,” she said. “Over time we began to look at the fact that health is more than just physiology and biology.” The noise, clutter, and bleakness of old hospital rooms can inhibit healing, family visits, and make it harder for patients to go back home knowing what to do. “The old Florence Nightingale ward rooms are inadequate to create a healing environment,” Hacker said.

Zócalo audience at the Petersen Automotive MuseumBut research into the notion of healthy design is relatively new. Orr, a member of the board of the Center for Health Design, noted that the center starting to bring together architects, planners, providers, and administrators in 1994 to think about the issue.”What we remember of the hospital is from when we had our tonsils out, and it’s a dark, scary place,” Orr said. “We began to use words like healing and patient-centered and people thought, ‘Whoa, you must be from California.’”

As Hacker and Theimer agreed, for years architects and nurses didn’t talk about what patients needed. “You find their expectations are artificially low,” Theimer said of patients. “You say, ‘What would you like if you could have anything?’ And they say, ‘I’d love if they closed the door to the exam room.’” Theimer added that architects “have to create rules that raise expectations.”

Concrete changes

As the executive sponsor through the planning and design of a new 317-bed, $600 million tower at the Childrens Hospital Los Angeles, Hacker explained some components the hospital used to create healthy design. The most immediately visible one is the hospital’s playground. “That is what children do – play,” she said. “As you pull onto the campus the first thing a child will see is a playground.” The playground not only serves children of all abilities, but supports the child’s recovery and reminds “that someday this child will be healthy and happy again,” she said. The tower will also include easy-to-clean rooms, and a new cafeteria, moved from the basement to an upper floor with full windows and outdoor seating.

Hacker’s hospital also took something of a gamble after focus groups with parents suggested that children shouldn’t always be in private rooms, though that’s what research in the health care design field suggests. Children, she noted, “are only in rooms alone if they’re sleeping or if they’ve misbehaved.” When parents expressed reluctance to leave kids in single rooms, Hacker’s team decided to build 80 percent private rooms and 20 percent semi-private, and to monitor what works. Of course, as Orr noted, for grown-ups, single rooms still are ideal. “It was terrible having a roommate,” she said of her hospital experience. “One of my roommates died in the middle of the night. The other one was having lots of problems breathing and making all sorts of noises. I could not sleep.”

Theimer’s firm took inspiration from outside the world of health care to create a rural health clinic that also served as a community center. The clinic featured a restaurant and café, conference rooms, and event space. “It was wellness design instead of health design,” he said. “We want to create spaces that promote health as opposed to treat sickness.” It’s what Orr called the “hospital without walls,” which transforms hospitals into places of learning, interaction, and community. Part of what’s making that possible, Hacker emphasized, is the consumer. “My mother never questioned her doctor,” she said. “I tend to be an interactive client.”

For hospitals still waiting for the funds to remodel, Orr noted in Q&A, there are some quick fixes that could be made by watching operations, or simply using common sense. “If the shelf is in the wrong place, so patients can’t see the flowers, we moved the shelves,” she said.

Space for staff

Guests at the receptionSome hospitals, Orr noted, manage patient satisfaction but forget about staff. “You’ll see the beautiful lobby, all marble, and then you go behind the scenes,” she said, “and the kinds of environments they’re in were dreadful, bleak.” Research shows, she said, that staff do better in environments where they feel they have more control – they require places to go for quiet. “Where’s their playground?” she asked.

Hacker agreed. “Our current environment is horrible. We’ve got a bathroom, a locker room, and a couch in the same space,” she said. The new design she discussed includes large and beautiful staff lounges, along with quiet rooms to accommodate a staff that spans generations. “I don’t want to hear about their party last night, and they don’t want to hear about my grandchildren,” she said.

Theimer added that the staff, too, can have low expectations when it comes to natural lighting and white walls. “They’re used to being in the center of the buildings, in dark spaces with artificial lighting,” he said. As for the paint, he noted, “Why do buildings have to be white? Because that’s antiseptic, that’s what we learned? Now, color is a good thing, and I hope that’s not just a trend,” he said. He also uses rubber flooring which makes it easier for staff that stands and move all day.

Culture changes

But as the panelists noted, design isn’t everything. When it comes to creating better atmospheres for sleep – though materials and private rooms go a long way – a hospital’s culture has to change as well. “We might talk a little softer,” Orr said, adding, “Hospital cultures are so powerful… they can shoot you down so fast.” The cultural change should happen at the same time as the design change, Orr noted. And as Hacker said, “The work is never done. The architects may leave, the contractors may leave, and yet the culture change is an ongoing process.”

Hacker noted that her hospital is creating best practices and guiding principles for creating a healthy environment – including reducing noise – just as they would for treating disease. Such follow-up is also crucial to making sure the changes work. While Hacker emphasized the importance of following up with health outcomes and patient satisfaction, Theimer suggested that architects visit their old projects. “When we get into commercial or institutional architecture, it’s not as passionate. For some of the people, it’s, ‘I gotta get this built and I have this much money,’” he said.

What’s green, what’s good

Robin Orr chats with a guest at the receptionStill, there isn’t always a consensus on what makes good design, or where to find it. Theimer noted that it requires clients to have a certain experimental mindset of “wanting to do something more.”

“You go and talk about a building, and people have to think, ‘I’ve been somewhere I really liked,’ and they couldn’t think of a clinic they really liked,” he said, referring to one of his past projects. Theimer asked his clients instead to think about schools, libraries, and homes. He transformed what was to be a 4,000-square-foot dental office expansion into a 12,000-square-foot full remodel that boasted a community feel and green architecture. Once pushed, Theimer noted, the clients were asking his firm, “How green can we be? Are we green enough?”

But even if how green to go and how to make good design is unclear, Theimer noted, one thing is obvious. As he put it, “I would tell you that marble floors in a lobby doesn’t make good design. In fact, don’t use marble.”

Watch the video here.
See more photos here.
Read five experts discussing healthy design at hospitals and beyond here.
Read In The Green Room Q&As with Dana Dubbs, Mary Dee Hacker, Robin Orr and James Theimer.

*Photos by Aaron Salcido.

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