Changes in health care market affect facility design

"Quality health care" is still the general motto of the health care industry, however, the definition of "quality" is continually changing.

As a result, hospitals must look at how their facilities operate and how they are designed in order to meet the new and changing definition.

Health care dynamics

Much of the change stems from the Balanced Budget Act, which reduces federal and state funds earmarked for health care; and the Emergency Act, which requires hospitals to take all emergency cases. These two items have changed the dynamics of health care, and technology has not even been mentioned.

Hospitals continue to fight the tight labor market, shrinking revenues, health maintenance organization red tape, soaring pharmaceutical prices and constantly evolving technology.

Of all these items, technology is causing the most change. But no matter how much change occurs, quality is the intended result.

One way to ensure the quality of a facility is to utilize a dedicated architect with a team of competent engineers, interior designers and information system professionals.

It is important to have these people involved in the design phase to ensure all systems are networked and coordinated to provide better care for the patient.

New technology

As a result of improved technology and equipment, the amount of outpatient activity has increased while the need for inpatient beds has decreased. As a result, costs to patients and medical centers have been reduced.

Another way technology has helped the industry is through telemedicine, electronic records and video networks which can offer better care and can be more interactive.

This also includes networked diagnostic services, Q&A sessions, ability to access self-care guides, 24-hour ask-a-nurse service and instantaneous diagnostic tests.

Seniors are able to remotely link to electronic monitoring, computerized pharmaceutical management and desktop video monitoring, allowing elderly people to stay at home and forego in-home nursing care.

Through technology, large admitting areas can be reduced by pre-admitting and creating pre-admitting unit call centers, implementation of a system-wide scheduling system and creation of a patient liaison role.

In the emergency room, bedside registration via wireless networks, wireless physiological monitoring, wireless phones for physicians, area-wide cable imaging capabilities and filmless radiology are reducing the need for large admitting areas and allowing more privacy for the patient and improving accessibility to information for the staff.

Personal, flexible spaces

Patient rooms are starting to look more like hotel rooms. Single occupancy and family areas not only give the patient more privacy, but actually help in the healing process.

Nurse stations have also been redesigned. They still maintain visibility and confidentiality, but they are becoming more open to permit easier staff flow. A dedicated charting area for physicians and nurses allows more privacy and more efficient charting.

In this era of consumerism, hospitals are not exempt from consumer demands. The retail and service industries are acting as models of how to improve the patient-friendly appeal.

Patient rooms are being designed in pod-like clusters that allow for additions and staff accessibility. Outpatient and inpatient facilities are being designed with more flexibility in terms of the types of procedures that can take place in the same room.

Since more cases are handled at outpatient facilities, the cases hospitals treat have become more severe, and their equipment needs have become more intense.

In the near future, it is possible that some of us will never visit a hospital, but rather a heart clinic, dialysis clinic or a doctor's suite.

As technology changes, our ideas of what constitutes a hospital will change, as must the design of hospital facilities. As clinics evolve into "mini-hospitals," having an architect who has experience in the field of health care becomes imperative.

(Stephanie D. Ireland, AIA, is an architect with Ireland & Associates. Ireland compiled the above article as a synopsis of a nine-article feature from the conference of the Academy of Architects for Health.)