The Case for Human-Centered Healthcare Design
Humane hospital care is subverted by an outmoded practice: metrics based design.
Metric-based funding systems often leave some hospitals to operate on a shoestring budget, where the items that help shape a patient’s experience positively are the first to go.
Photo Courtesy of Flickr User Bill McChesney
In a short video in Harvard Medicine’s Winter 2015 issue, Dr. Mitchell Rabkin points out that the traditional doctor/patient interaction occurs on two different planes—the vertical doctor and the horizontal patient. This illustrates how the doctor is bound to fail seeing the room from the patients’ perspective. This reality is more important than you may think.
If you were confined to a hospital bed recently, you’ll recall the many, tiny details that affected your overall comfort. Details like “where the clock is on which wall?” says Rabkin. “If it’s above the patient’s head, the patient will miss it completely. At the foot of the bed, that’s a totally different and reassuring aspect.” Obscuring the clock from patients’ view deprives them of a connection with time, which can keep stress low. This is critical, as stress hinders the healing process. Even as a visitor, it’s hard to feel at ease in a hospital. When I reflect on times I’ve spent visiting family in the hospital, I remember the drab waiting rooms and fluorescent, maze-like hallways—spaces that increased my own stress level before I even saw the person I came to visit.
Rabkin’s observations illustrate a major problem with healthcare design. There’s a disconnect between those who design, plan, and furnish hospitals and the people who go there to be healed. Evidence-Based Design is a good start in reducing this divide. “EBD pairs research with the evidence that centering an environment around the patient promotes improved results—such as decreased time spent in healthcare environments, faster recuperation, and less recurrences of patients returning with similar ailments,” says northeast Ohio architect Robert Donaldson. Medicare incorporates EBD into their Hospital Value-Based Purchasing (VBP) system, which adjusts payouts based on patients’ reviews of their experiences. VBP offers healthcare facilities the opportunity to raise their bottom line through bettering the patient experience.
There is, however, a flipside to the merits of VBP that must be considered. Facilities receiving poor reviews are put in the impossible situation of having to improve service while being continually underfunded. When a hospital is operating on a shoestring budget, the first things to be sacrificed are exactly the items that help shape a patient’s experience positively. Patient rooms and staff workspaces fall into disrepair. It becomes harder to offer nurses and technical staff competitive wages. Each of these cutbacks impacts the overall quality of care that the facility can offer the patient. This catch-22 is a major fallback of metrics-based funding systems, such as the No Child Left Behind Act, whose “perverse” performance incentives are expertly dissected in this 2004 article in the NYU Law Review.
In situations where EBD and VBP function as intended, the question must still be asked: Do they go far enough? While metrics-based evidence is important, there is no substitute for healthcare providers and their designers getting closer to the human being at the center of health care. As Donaldson points out, the late Michael Graves immersed himself into healthcare facilities, examined the successes and failures of their design, and used his experiences to place the patient at the center of his designs for the remainder of his life. This familiarity with healthcare design came at a cost; he was paralyzed by a spinal infection in 2003, and would later refer to himself as a “reluctant healthcare expert.”
Graves was a first-rate architect and designer, and he is a heartwarming example of an architect leveraging his own life experiences to change the lives of others. But it shouldn’t take personal health problems to drive designers and decision-makers to understand the needs of patients. These “experts in the field” can immerse themselves today and begin to transform the facilities that are “just too depressing to even die in,” as Graves once lamented. To really see a transformation in healthcare design, concludes Donaldson, “our future design discussions need to involve patients and caregivers, observe how these individuals use spaces, and to ultimately see things such as they do. Only when we view the environment through the patient’s eyes shall we understand how to advance healthcare environments.”