Healthcare's Vital Signs
Healthcare's Vital Signs
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Healthcare's Vital Signs
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The healthcare industry is experiencing some growing pains in the recessionary economy, but in the long run, healthcare is bound for great things. Building new and updating structures will benefit the future of the system.

While the healthcare industry may be experiencing some of the growing pains of a recessionary economy, long term the industry isn’t ill-fated.

Maturing baby boomers and a nursing shortage are testament to a continued demand for quality healthcare. Aging medical facilities, medical breakthroughs and technology advancements alone are enough to demand a hospital rebuilding boom. Adding the latest developments in healthcare design and the cost savings of energy efficiency to the equation begs the question: Why not build now?

“Everyone is in a holding pattern. Every CEO is concerned about making fiscally conservative decisions in today’s economic climate,” says Rick Keeler, vice president and general manager of the Burns & McDonnell Healthcare & Research Facilities Group. “Building a new hospital or renovating an existing facility will, unfortunately, never be cheaper. Healthcare is a very competitive market. Staying current with trends and technology is vital to retaining staff and attracting patients.”

Evidence-Based Design

One of the recent advancements in healthcare architecture, evidence-based design stems from evidence-based medicine as the practice of making design decisions based on research that proves a particular design yields the desired result.

Consider daylighting. A 2005 study published in Psychosomatic Medicine found post-operative spinal surgery patients who were exposed to bright natural sunlight experienced less stress and required 22 percent less pain medication than patients recovering from spinal surgery in dimly lit rooms. Related studies prove that daylighting improves staff productivity, saves energy and even accelerates recovery. This allows patients exposed to daylighting to leave the hospital 20 percent sooner than those in dimly lit rooms, a cost saver for both the hospital and the patient.

At Methodist Boerne Medical Center in Boerne, Texas, emergency room staff and patients enjoy the positive effects of daylighting with a large, frosted-glass skylight above the centrally located nurses’ station and windows that allow natural light to infiltrate treatment rooms.

“Daylight will always be better than any light fixture because it creates a positive atmosphere within a facility and saves energy during daylight hours,” says Keeler, principal architect for the Methodist Boerne Medical Center Emergency Department. “Skylights not only offer the benefits of daylighting but also solve the problem of limited real estate left for windows with all of the required equipment in a modern, technologically advanced emergency department.”

Architectural design preferences are changing with the latest in evidence-based design. In the past, popular theories supported the incorporation of semi-private patient rooms. While semi-private rooms allow for more beds, the risk for hospital-acquired infections is just too high — one in 10 patients contract nosocomial infections, adding $6.7 billion annually in 2002 dollars to U.S. healthcare costs and killing thousands, according to the Centers for Disease Control and Prevention. Because of these considerable figures, Medicare will no longer pay higher-rate hospital bills for certain hospital-acquired infections as of Oct. 1, 2008, and prohibits the hospital from billing the patient for the difference — a significant motivation for hospitals to implement proven infection control measures such as single-patient rooms.

“Since evidence-based design is still in its infancy, studies do not yet exist for all design elements,” says Keeler. “Great design can incorporate evidence-based design and meet the unique needs and goals of each organization. For me, that’s the challenge; it’s never the same.”

Blueprint for Retention

To be successful, a hospital must offer more than just adequate space to treat patients. It must also be inviting to patients and visitors as a center for leading-edge medical care in a hospitable environment. It must appeal to doctors as a pleasant environment, where they want to refer patients. It must attract and retain nurses during a nursing shortage, maintain community involvement and operate efficiently.

Through his 30 years of experience in healthcare architecture, Keeler found that an open-concept emergency department design improves operational efficiency and staff retention. At the Methodist Boerne Medical Center, he worked with the Hospital Corporation of America (HCA) to modify its standard formula for emergency department design into a more open concept.

The sunlit Methodist Boerne Emergency Department, which opened in fall 2007, revolves around a central nurses’ station with walls no higher than 4 feet, allowing nurses an unobstructed, 360-degree view of the department with optimal visibility of patient treatment areas. Often, offices and storage rooms interspersed throughout an emergency department interfere with visibility and workflow.

“Visibility is essential for managing the critical issues an emergency department staff is confronted with daily,” says Keeler, who designed a similar open-concept emergency room for Christus Santa Rosa Health Care in San Antonio.

A central nurses’ station fosters communication and, as a result, retention, which is especially important for hospitals facing the challenges of a nursing shortage. For instance, when patient-centered design first became prevalent, Keeler remodeled a cross-shaped floor plan at University Health System in San Antonio to incorporate smaller nurses’ stations at key junctures. This allows nursing staff to stay in proximity to patient rooms. While nurses traveled fewer steps to care for patients, they felt isolated, unable to socially interact with other nurses during downtime and the night shift. And when a staff member becomes ill, separated nursing stations can create staff shortages and unbalanced personnel distribution. Such scenarios contribute to decreased job satisfaction and, as a result, diminished efficiency. Four years later Keeler redesigned those floors of University Hospital, reverting each to a design revolving around a central nurses’ station.

Eco-Friendly Payback

Sustainable design can please many hospital stakeholders. For publicly owned healthcare organizations that may be required to obtain Leadership in Energy and Environmental Design (LEED®) certification, this designation promotes a positive public image by showcasing the organization’s desire to care for our planet as well as its patients.

“LEED® certification or not, sustainability is inherent in our designs,” says Keeler. “We implement the most efficient mechanical systems, the most durable materials and the most effective sustainable solutions that make sense for each facility.”

At the Brownsville Community Health Center in Brownsville, Texas, Burns & McDonnell incorporated sustainable features with direct payback into the medical facility’s design. For example, the health center has motion sensor-activated lights instead of traditional flip switches. This simple substitution saves enough energy to offset the initial cost of purchasing motion sensors with a more than 100 percent payback.

Design for the Evolving Patient

The patient population also influences how healthcare facilities are designed. The first of the baby boomers turn 65 in 2011 and 880,000 people worldwide join them in the 65-plus age range each month, according to the U.S. Census Bureau. A senior patient may experience difficulty when moving around a hospital room, so handrails are being added between the patient’s bed and bathroom door. Some floor plans are being reconfigured to shorten the distance an older patient must travel to the restroom. With a population weight shift, nurses are no longer able to assist obese patients in getting out of bed, so hospitals are incorporating additional electric bed lifts that were once reserved for patients with major orthopedic injuries.

Technologically Secure

With the U.S. investing $50 billion over the next five years in electronic information technology systems for healthcare and the emergence of electronic medical records, an accessible yet secure network infrastructure is becoming a critical need for all healthcare facilities.

“The expertise of our architects, engineers, and environmental and construction professionals merges through an integrated approach from day one, so your healthcare facility works for you,” says Keeler. “We know the pressing issues that hospitals are up against. That’s why we design with the future in mind, so you only build what you need now and leave with a master plan flexible enough to keep pace with your changing needs.”

For more information, contact Rick Keeler, 816-822-3244.

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