There are many factors involved in the recent evolution of healthcare, but one thing is for certain: Covid-19 exposed major deficiencies and sped up the need for innovation.
Many of the critical issues healthcare systems are facing today, however, have been looming since pre-pandemic times such as the aging population of the U.S., staff shortages, technology advancements, and resiliency.
Many of the lessons learned over the past two years can be carried forward into the future of healthcare design. From more efficient patient screening, patient flow, and other operational efficiencies, solutions that have reduced cost and saved time are likely to continue, as the money and time saved through these efficiencies can be put towards enhancing the patient experience.
The Patient Experience
The healthcare industry has shifted towards a consumer-driven market: today, consumers have many choices when it comes to how, when and where they receive medical care. Virtual care visits are 38 times more frequent than before the pandemic, as consumers are opting for fewer hospital visits. Improving patient outcomes and overall experience is and will remain a high priority for healthcare systems.
From the moment the patient checks in at the reception desk, and enters the exam room, the goal is for all points of engagement to combine and create a comfortable experience, leading to repeat customers, referrals, and maintained revenue.
There’s much to consider when planning the design of internal spaces that contribute to the patient experience, such as corridor length or width, room size, and nurse station placement. All of which can have effects on safety, infection control, and patient visibility. In some instances, the patient experience, and most efficient solutions are at odds, as what might be desired by the patient, such as more privacy, might be opposite of the staff’s preferred layout. For example, more privacy for the patient may result in less collaboration for nurses, less opportunity for training, difficulty in monitoring patients, and less chance of preventing falls. More privacy for patients could also result in nurses feeling more isolated and less efficient, potentially causing anxiety and burnout. These are difficult design decisions that need to be evaluated from all angles.
Staff communication and training has also evolved since the pandemic. Like other industries, we’ve all had to adjust to alternative communication and training methods, but how has this affected patient care, and what investments need to be made to ensure proper training and adequate care? Healthcare systems now rely on technology more than ever before. Investments in technology and improving IT infrastructure can be costly, but the long-term benefit of easing workforce challenges and the ability to offer user-friendly solutions to patients may be worth the investment.
Another major disruptor to the healthcare industry that has altered how care is being delivered is telemedicine. Keeping up with digital transformation will be crucial for healthcare systems to remain competitive and meet patient expectations. Virtual care may create both opportunities and threats for healthcare systems as competitors continue to grow. As the patient and doctor interaction continues to evolve, the built environment to support these spaces will change as well.
Healthcare systems will also have to consider the needs of the aging population, the shift towards prevention-based care, and what technologies are available when designing new spaces.
There are more than 46 million Americans age 65 and over, and that number is projected to double to more than 98 million by 2060. Some hospitals are renovating existing facilities to accommodate older patients, including things like custom lighting and temperature controls, improving wayfinding signage, and adding more family support spaces. Other hospitals are taking the approach of building new specialized geriatric care units dedicated to this specific population.
Hospitals are also continuing to invest in behavioral health care, by adding dedicated space into existing facilities or building entirely new facilities. In fact, 42% of facilities have behavioral healthcare projects under construction or planned over the next three years.
One of the most critical challenges the healthcare industry is facing is workforce related. Even before the pandemic, burnout had reached crisis levels with 35-54% with nurses and physicians, and 45-60% of medical students reporting symptoms of burnout. This report also projects a shortage of more than 3 million essential support staff in the next five years and a projected shortage of 140,000 physicians by 2033.
The recommendations outlined in the report touch on the critical issues of workplace culture, safety, prioritizing social connection and community, and investment in public health. Involving staff in the planning and design process of healthcare construction projects could provide the perspective needed to address some of these issues.
Design elements that can reduce stress and improve mental health could aid in staff retention. This could include more respite areas, more natural light, and exterior landscaped areas. Some health systems are going beyond cosmetic design features and offering more robust solutions like on-site housing and childcare assistance.
Safety & Security
Improving safety and security systems may also be necessary to make staff feel safe in the workplace as 44% of nurses have experienced physical violence, and 68% experienced verbal abuse during the heights of the pandemic.
Security strategies can be built into the design of new facilities and renovations. Like the patient points of engagement mentioned above, from the parking lot to the exam room, safety and security should be considered as well. This could affect stairwell placement, exterior lighting, circulation routes, cameras, panic buttons, etc.
Covid-19 has brought several design considerations to light, such as future-proofing hospitals for a mass influx of patients. This could include more modular design components to allow flexibility in the future, or upgrades to allow for isolated units. The challenge is balancing the potential need for pandemic-ready facilities with the financial resources available and determining what is most financially responsible.
During the initial planning stages and program development for healthcare projects, cost and schedule typically have a major impact on decision making. The problem we’re facing today is that healthcare design is evolving rapidly, coupled with unprecedented inflation, construction cost escalation, lack of materials, and workforce shortages, that historical cost data and prior construction projects don’t provide an accurate benchmark.
Developing budgets has become much more complicated at this early stage. Communication with stakeholders is key to fully understanding the design intent and project requirements in order to align the scope with the available funding.
It’s clear that planning, designing, and building a healthcare facility is complex. The landscape of healthcare is changing and prioritizing one design element over another seems impossible. Healthcare leaders face a great challenge but can incorporate strategies into the built environment that can create better patient outcomes and safer conditions for all.
Below is a list of design considerations that have been mentioned here, along with the relative construction cost associated with each of them.
|MEP infrastructure upgrades for future flexibility||$$$|
|On-site housing for staff||$$$|
|Custom lighting and temperature controls||$$|
|Improve infrastructure for telemedicine||$$|
|Separate entrance/exit to direct patient flow||$|
|Improve wayfinding signage||$|
|Provide more natural elements / landscaped areas||$|
|Add respite areas for staff||$|
|Improve acoustic properties / mitigate noise||$|