THE ORIGIN STORY
Everyone loves a good “origins” story – the box office certainly knows that superhero origin stories are among the most popular genres of all time. Well, I don’t shoot webs from my hands, or turn green when I get angry, so I will keep it brief – but just in case, get your popcorn ready. When I first started out in my pursuit of institutionalized education, I wanted to be a doctor. I had always been fascinated by how the scientific world functioned, the laws of physics, and chemistry, and how they impacted our biology and more accurately, our physiology. This was compounded by the fact that both my grandfathers were doctors, and my father, was a constant investigator into the natural world. They no doubt influenced me, both in experience, and in genetics. However, I also was passionately creative at a very early age.
I have my grandmother to thank for this, who is supremely gifted in clothing design, water-colors, collage…anything you can imagine. She too influenced me both in experience, and in genetics. And so I grew up having competing interests that “duked it out” upstairs in my brain for years. This was a blessing, and this was a curse. I pursued a pre-med degree at Bowdoin College, in Brunswick, Maine early on, but my semester course loads typically involved 3/4 science, and 1/4 art. My love of art and design officially threw a techni-colored wrench in all of that during my second year as a polar bear. I started taking more art classes, and a physics class, and began deviating from the pre-med curriculum. Almost by accident I was suddenly in Florence, Italy studying architecture in the middle of my junior year, and well, you can probably understand where the first idea of becoming an architect was planted.
Becoming an architect has been the best decision I have ever made. It is the perfect occupational blend of the rational brain, and the creative mind. Each day I have the opportunity to explore new science, and new technology; advancements in physics, thermodynamics, hydrology, seismology, geology, material science…the list goes on and on. And each day I get to create, design, muse, and express on a grand scale…bigger than the canvases and sculptures of my younger days…and with other people’s money. I believe that where your livelihood meets your passion, life begins. And here I am.
Some of my best clients are doctors, and in a way, I probably will never let go of that origin story, as I design medical offices and surgical centers for them. Recent studies have found that architecture, more specifically smart design, and applications of technology, have enabled architects to play the role of healer in how they design care centers. Given my interests, my respect of doctors and what they do every day, and the pride I have for my grandfather’s legacies as doctors themselves, I have to say that I love the idea. I love the idea that my pursuit to bring great convenience, inspiration, and efficiency to peoples lives can also ease their burden and help them heal.
Without getting too deep into the economics of the design of hospitals, surgical centers, treatment facilities, and medical offices let’s create a backdrop to our discussion: A trifecta of equally contributing interests dictate how these structures are built: 1.) Management, 2.) Provider (Doctor), and 3.) Patient. While these players may have different motivations for their achievement, each have similar perspectives on how to achieve success.
Management would typically view healthcare success as whether the business is profitable. This includes efficiencies in Patient care that allows more Patients to be seen in a given period of time, and thus increase profitability in that period. This also includes infrastructural improvements such as energy efficiency, quick paybacks on construction loans, and incentives to improve on ratings such as the Medicare Quality Score, that assigns federal compensation.
The Providers, or Doctors (which may be part of management in some cases), view success largely as a measure of the quality of care they can provide. Historically, this has been defined by the rate of healing that a doctor can provide. Unfortunately, Provider agendas have shifted in some areas. Quality of care doesn’t necessarily mean the ability to heal anymore, but rather, the ability to diagnose accurately, treat, and discharge, with guidelines on symptom management.
The Patient, the one purchasing this care, measures success according to the quality of care that is provided, but includes an important component: the rate of successful and lasting healing. Patients are no longer satisfied with treatment, pain management, disease management etc. They want facilities that make them better permanently, and give them comfort during that process. And in the world of uber-competitive medical services, that is something Management has started to pay attention to. The better the experience for the Patient, the greater the level of comfort and convenience and the higher the probability of lasting healing. And in turn, the higher the demand for that healing service, and the more successful the facility. One may think that has very little to do with the built environment and more to do with the quality of the Providers, and advancements in medical science and technology. Well, these issues and the built environ are not mutually exclusive. They go hand in hand. Successful hospitals around the world are turning to smart healthcare architecture to revolutionize Patient care.
One example of this, is that medicine is changing to internet-based information exchange, empowering patients at an unprecedented rate. Doctors are learning they are no longer the gatekeepers of information, and they must not only keep an open mind, but even go as far as encouraging, and creating an environment of transparency, and collaboration with the patient. This has had profound impacts on how care centers are constructed. Hospitals are learning that promoting patient care involves enabling patients to conduct their own medical research, to self-educate, and to be a part of a medical support community which includes their providers. Imagine actually discussing an “assigned reading” in a library cafe in a hospital with a doctor who can access that very article online on a screen embedded in that cafe table? Well, it’s already happening. And architects have been at the forefront of designing and implementing this phenomenon.
The internet is also relied upon heavily for the transmittal of information. Patient care has moved beyond the convention of telephone medicine, and into the realm of virtual medicine where nurses & doctors & patients are connecting in real-time to discuss care. This virtual access to well-being doesn’t follow a 9-5 schedule either. 24-hour access to medical records & doctors notes, scheduling, billing, registration, and education materials to local (patient kiosks & WI-FI) and remote sources (personal laptops, desktops, smart-phones) of access are being integrated presently in healthcare facilities. Connective furniture is arriving where patients can plug in their smartphones to access the internet, or to charge. But the greatest leaps in this area, is in the larger-scale modalities from which this experience is delivered.
One example of such a modal system, can be found at the Kaiserslanern Military Community Medical Center in Germany, which serves soldiers returning from the Middle East. Instead of a T.V. playing soap operas or stale news, the entire wall opposite the bed has an interactive video screen. Patients will be able to look at photos of family members, stream Netflix, surf the web, & skype with family & friends. They will also be able to see schedules for doctor’s visits, call up staff bios, and hold video chats with teams of physicians.
These advances of empowerment, efficiency, and entertainment using the internet are transforming the medical industry and the design of their buildings overnight.
DESIGN YOUR BUILDING TO ENHANCE HEALING
It has long been understood that architecture has a profound effect on an inhabitants well-being. Feng-shui, a Chinese philosophical approach to arranging an encompassing environment in harmony, explored this notion. Certainly, well thought out buildings generate efficiencies, conveniences, and comforts, that bring mental and physical well-being and relief. However there is a more to it than that. A lot more.
Color, shape, layout, and technological accoutrements of a standard hospital room have a direct effect on health. If one examines the status quo – the standard twin-bedded configuration of a recovery room – one sees a very negative healing environment. Twin-bedded configurations encourage the spread of infection, make sleeping difficult, make family visits awkward, and sensitive medical information difficult to convey privately. But Management sees this as due to the cost of construction per room, and the ability to “double-book” rooms for double the revenue right? Single-rooms are just too costly right? Wrong. There is a sweeping shift to private rooms because the single room not only improves care & reduces the chance of cross-infection, but it will also saves money. How is this possible? Occupancy rates are higher with single rooms than with double rooms because of age and gender compatibility issues. While a double room layout might get a 70% occupancy rate, a single-room layout might get a 95% occupancy rate because of this flexibility. So it makes sense from a Management standpoint, but also a Provider and Patient standpoint as well.
Perhaps even more important than technology implementation, and preventing cross-infection with single-rooms, is the focus on encouraging natural light, building quiet rooms, and allowing patients to connect to nature. Studies have proven that such a design agenda can reduce delirium, pain, and anxiety. Yes. Rooms with these design focuses are not only comfortable, they’re therapeutic. One such study was conducted in 2005, by a team at the University of Pittsburgh Medical Center. They studied the effect of sunlight on the recovery of patients who just had a spinal injury. In the study, it was found that sunlight reduced both pain, and the need for analgesic medication. Dozens of other studies have reached similar conclusions on patient exposure to nature, art, classical music, colored walls, the presence of family members, and natural light.
Smart healthcare architects put themselves in the role of Patient. In Bangor, Maine, at Eastern Maine Medical Center, the patient rooms are double-occupancy, but to be fair were designed to encourage connections to the natural landscape of the adjacent Penobscot River, and to facilitate an abundance of natural light. And yet, they fell short in their design. There intent was real, but they didn’t think things through. The windows are too high for bed-ridden patients to see out to the river. Instead, they just start out into the sky. There also is not enough glazing to produce the amount of natural light intended. My grandmother has told me that my grandfather was most disappointed about this fact saying “The windows are for the doctors & the nurses and not for the patients.” As an architect, you always put yourself in the place of the inhabitant. If you lack the capacity to do that, you are in the wrong field. And as someone looking for an architect, do your research on client side of things. Check and see if their projects really thought about the user experience.
ARCHITECT AS ANTICIPATOR
In closing, the architect must have a spyglass aimed at the horizon. Frank Lloyd Wright once said “Every great architect, is – necessarily – a great poet. He must be a great original interpreter of his time, his day, his age.” I would take it one step further, to be a great architect, in Maine, in New England, in America, in the world…you must be a bit like Nostradamus and be a great anticipator of the future. You must understand future trends in society, technology, and art, and design accordingly. There is no greater need for that prophetic perspective than in healthcare design.
Why? Well, healthcare is evolving faster than almost any other sector, maybe second only to Elon Musk’s ambitious agenda to supply everyone with a solar-powered car, and a shuttle to mars. Architects need to be well-versed in current and future advancements in general societal technology, medical technology, and trends in patient care. This spans a wide range; from interactive media to digital medical simulation to web-based doctor/patient interactions to robotics (something to be discussed in a later blog). How these systems and technologies function, interrelate, and evolve to accommodate their iterations is paramount in care centers giving the best care possible in that instance in time, and staying profitable. It is one of the greatest stages for making a lasting difference in our society as a whole. And that’s an approach that benefits Management, Provider, Patient, Architect – and everyone else.