Applicable design example: hospitals!

Because MRSA and C. diff are increasingly problematic in hospitals (and hospital equipment has been said to be badly designed):

British designers have come together to give the grim and functional hospital ward a much-needed revamp, and in doing so, they have thrown out the clunky old bedside cabinets, the tired mattresses and dubious-looking commodes and replaced them with more futuristic versions.

The makeover has been prompted not by aesthetic shame, but by medical prudence.

Design! The Guardian report continues:

“There are huge issues with superbugs in hospitals, but it’s likely that if we can make the environment easier to clean, we will go a long way to improving the situation. A lot of hospital furniture has nooks and crannies that are repositories for bugs, so the challenge was to design those out,” said David Kester, head of the Design Council.

How the glorious people at the Design Council did it:

Design teams were despatched to hospitals to look over wards and talk to doctors and nurses about how curtains, bedside cabinets, commodes and other ward furniture were used. The Council then called on designers to come up with smooth, cheap and simple alternatives.

In: Hospital Description

A completely unfiltered, no holds barred description of hospitals from Aaron Swartz’s blog (it was published waaaaaay back in 2006):

Were the large sign reading “Hospital” to go missing, one might easily mistake the facility as one for torture: men whose clothes have been replaced by dreary gowns slowly wander the halls in dreary stupor, their battered faces making them appear as if they have been badly beaten. They are not permitted to escape.

Brutal, yes.  Worth the read, yes.

Hospitals looking like hotels

Freakonomics:

Amenities such as good food, attentive staff, and pleasant surroundings may play an important role in hospital demand. We use a marketing survey to measure amenities at hospitals in greater Los Angeles and analyze the choice behavior of Medicare pneumonia patients in this market. We find that the mean valuation of amenities is positive and substantial. From the patient perspective, hospital quality therefore embodies amenities as well as clinical quality. We also find that a one-standard-deviation increase in amenities raises a hospital’s demand by 38.4 percent on average, whereas demand is substantially less responsive to clinical quality as measured by pneumonia mortality. These findings imply that hospitals may have an incentive to compete in amenities, with potentially important implications for welfare.

“Hospitals as Hotels” a working paper by RAND‘s Dana Goldman and John A. Romley

Show them the money

The hope is that this credit crunch is a short-term pain.  No one knows, of course.  Anything longer than what experts consider short-term may ignite a perfect storm with massive consequences to the health care industry.

From The New York Times:

Tight credit is adding to a financial challenge that some hospitals are already facing, as greater numbers of patients are unable to afford the rising out-of-pocket portions of their medical bills or lack insurance altogether. Many hospitals say they are already seeing an increase in their bad debt — money they bill patients for but cannot collect.

And that problem could get worse, as people worry first about paying their mortgages and credit card bills before dealing with their medical bills, said Gary Taylor, a hospital analyst at Citi Investment Research. “We’re worrying about collection rates falling,” he said.

Unfair criticism, the uninsured, and health care realities

The University of Chicago Medical Center is drawing criticism over a “strategy to steer poor and uninsured patients with less serious injuries to other facilities to focus on treating the most challenging cases,” especially from the non-profit sheriff Senator Chuck Grassley according to the Chicago Tribune.

Meanwhile, newly appointed Grady Memorial Hospital CEO Michael Young took a swipe at Atlanta-area hospitals saying “I think the other hospitals need to do a gut check on their missions, and see if they’re doing their fair share,” at a recent news conference reported by The Atlanta Journal-Constitution.

We all know hospitals that fulfill their non-profit missions daily; and we all know hospitals that could improve.  Our health care system presents difficulties in treating patients who are not properly insured.  Non-profit or not, hospitals need to keep their doors open.  Whether it is a new strategy to treat uninsured patients outside of the emergency department or a plea to other leaders to help carry the load, hospitals are increasingly pursuing new efforts to sustain themselves.

The realty is that most hospitals try to limit the number of uninsured patients they care for—it’s happening in every metropolitan area throughout the United States.  Some try harder than others.  Some are more transparent in their efforts than the rest.

Whether you consider what the University of Chicago Medical Center is doing is right or wrong, the problem with the criticism is this: the reason they have come under fire is because they have been transparent in their efforts.  We know about what they are doing because they have openly communicated it.  Being singled out is wrong when there’s evidence of the practice elsewhere.

Further, any investigation into whether or not UCMC is properly carrying out its mission and taking care of the necessary number of uninsured patients does nothing to solve our problem of millions of uninsured Americans and their poor access to necessary health care.

Learning from Mistakes

As the hospital construction boom and health system consolidation trend continues in the United States, Moody’s Investor Services–a credit-rating organization–may be, in a few more words, telling the industry to slow down.

Moody’s is using the ten-year anniversary of the largest collapse of a non-profit health care system in U.S. history, Allegheny Health and Research Education Foundation, to issue a report that urges current industry leaders to learn from past mistakes.

The blog PhillyInc writes, “Moody’s calls the collapse ‘a cautionary tale for today as hospitals currently face a growing number of industry-wide pressures.'”

The report asks for discussions centering around “What have we learned?”

As they say, “Those who forget history are doomed to repeat it.”

Finally, some honesty

The last month has brought news of plans for new hospitals including this one, this one, this one, this one, this one, and this one.  There are more to be sure.

Aging hospitals, demographic shifts, increasing use of technology, and the evolution of patient care have spawned the need for new buildings.

Another story of new hospital construction is particularly intriguing: “An expansion at the University of Iowa Hospitals and Clinics will result in an increase in patient costs, but officials said they don’t yet know how much.”

The case of need can be made quite easily.  Americans are consuming more health care than ever before.  Increased patient volumes are directly correlated with need for more space.

But lacking in many stories of plans for new hospital construction is the cost implications to the patient.  This at a time when the number of uninsured is high.  At a time when patients are being expected to share more equally in their health insurance costs.  At a time that heralds warnings of health care costs reaching the 20 percent mark of gross domestic product.

So at least University of Iowa officials are being honest.  State of the art health care in state of the art facilities is going to cost more.

From the article:

University Hospitals Chief Financial Officer Ken Fisher said there’s no way to tell how much patient costs will rise because the size of the project and how it will be financed have not been resolved.

Fisher said building now rather than later is a good move for the consumer. With construction costs increasing each year and favorable lending conditions, the project would be more expensive in the future.

New hospital construction is adding costs to the system.  The building boom is showing no signs of slowing.  PriceWaterhouseCoopers estimates health care costs will increase nearly 10 percent in both 2008 and 2009—and new hospital construction is partly to blame.

Is the new construction worth the surcharge added to the final bill?

It depends. Truthfully, the answer may not matter.

Hospital Design

Health Care Fine Art comments on a new look hospital in London.  There’s also a link to a post from last summer asking the question “Why No Cool Looking Hospitals?”  Read the post and the comments—there are some interesting thoughts.

One thought on why the newest of hospitals continue to utilize traditional architectural themes is the opportunity for expansion.  The boxy buildings make it easier to add floors or corridors without upsetting the design.  Medicine changes often and sometime those changes require new construction.

Anyway, hospital design is getting better.  The biggest challenge will come as we continue to update the Hill-Burton hospitals to allow, among other things (including functionality), natural light into buildings.

If it looks, feels, sounds like a hotel…it’s a hospital

A new hospital in the Henry Ford Health System has taken hotealthcare to the ultimate:

In addition to national-class clinical services, the 300-bed hospital is to offer amenities ranging from homelike private rooms with couches where relatives can sleep comfortably overnight to relaxing in-room whirlpool tubs for mothers in labor.

Wellness services include health coaches, holistic therapies and personal trainers — part of an emerging national trend to help people control or prevent chronic conditions that lead to expensive hospital stays.

But one of the hospital’s most innovative elements is its culinary program, which involves a trio of partners: prominent metro Detroit restaurateur Matt Prentice, the nationally known culinary department at Schoolcraft College in Livonia and Chef’s Garden, an elite organic farm in Ohio that sells exclusively to America’s most famous restaurants.

Here is the best part from System President and Chief Executive Officer Nancy Schlichting:

But those customer-oriented features and services won’t cost consumers more or raise health care costs.