Evidence-Based Design
The correlation between design and the human psyche has been studied for decades, and evidence-based design (EBD) has become the norm in almost every type of construction. Perhaps unsurprisingly, EBD originated in healthcare architecture from a need to quantify and improve the impact physical space has on health.2 Let’s take a simple example, such as lighting, to illustrate just how significantly one aspect of a built environment impacts the human psyche.
Natural light coming through a nearby window, as opposed to fluorescent light, has proven to increase the mood of hospitalized patients, especially if they are immobile or unable to leave the room. Nurses in the same environment have also responded favorably, experiencing increased affability, less stress, and greater satisfaction. Well-lit pharmacies, surgery rooms, and exam rooms reduce medication errors and surgery interruptions. Brighter rooms give the appearance of spaciousness, reduce the frequency of elderly falls, and help regulate circadian rhythms.3 Offering an outdoor walkway, filled with sunlight and greenery, instead of a sterile, fluorescent hallway, has the ability to impact patient behavior and improve mood.3 Lighting is but a minute aspect in healthcare design, but the overall impact continues to be uncovered as we dive deeper and deeper into EBD.
EBD has become the norm in the design industry and the scope has been expanded to workspaces, public spaces, and transportation, among others; however, healthcare design, as a whole, is pushing the boundaries even further. In addition to using evidence to influence the design of healthcare facilities, the industry is now quantifying and optimizing the patient’s experience while simultaneously considering future needs.
Integrated Healthcare
Healthcare has been moving away from a traditional treatment-based approach to a more proactive philosophy that encourages prevention.4 A traditional healthcare setup—seeing a primary care provider and being referred to other services at other locations—is no longer the preferred method of operation. Newer healthcare facilities offer the integrated care model, a more streamlined process where specialists are located in the same building, work collaboratively with the patient, and manage a more holistic view of the patient’s health.4 More space is devoted to collaborative areas, rather than isolated physician offices. Furthermore, the layout is constructed in a way that reduces staff walking distance and optimizes visibility.5 A more efficient process ultimately saves time and money for both the patient and the facility. This demand for an improved process has yielded a significant rise in smaller wellness centers instead of largescale hospital and inpatient facilities.1 Ease of access and collaborative care have become the driving factor behind recent healthcare design.
The rise of prevention-based treatment has also resulted in facilities that engage in a wellness-related approach. This coincides with the rise of behavior-based solutions to treatment, such as physicians prescribing exercise bikes or encouraging patients to go outside more.6 Natural lighting, as mentioned previously, has a massive impact on the human psyche and, while physicians may encourage it in a patient’s day-to-day life, the message is reinforced by optimizing natural light in lobbies and common areas of the clinic. Exercise rooms, educational spaces, and retail areas are being implemented in a community-like environment to encourage positive lifestyle changes.
Technology
Technology is shifting how patients interact with their physicians, rendering it possible to access care from the comfort of their own home. This frees up space in the clinic for other uses.4 Technology is also integral to streamlining access to, and security of, patient records and lab results.7 Improved technology, along with reduced financial barriers to medical procedures, has altered how facilities are constructed. For example, surgeries and procedures that used to require specific inpatient settings and overnight stays can now be performed less invasively in an outpatient setting.1 Wellness programs can be monitored by practitioners through the use of apps, test results can be viewed instantly, and patients have on-demand access to resources and information.
Flexibility
With the threat of technology and legislation shifting how healthcare systems will function in the future, the need for flexibility has become one of the driving forces behind recent healthcare design. This has undoubtedly resulted in smaller footprints with a focus on efficiency, as opposed to the large-scale, inpatient projects of the past.8 Furthermore, the uncertainty of healthcare legislation has caused wariness around investing billions of dollars into large projects if healthcare codes may change by the time construction is completed. It is therefore more cost-effective to build out a space that can be modified as needed.4 This includes the use of modular partition walls, zoning spaces, and standardized exam rooms. Although the cost may be higher upfront, it allows for easier renovation should the need arise in the future.1
Case Study #1: Hoag Health Center (Newport Coast)
Located in the Newport Coast Shopping Center, this 4,000 square foot facility provides convenient access to care with ample parking, short wait times, and the capacity to treat most urgent care needs. The clinic has of an average wait time of 15 minutes with a 95% satisfaction rate, which is undoubtedly a result of their consideration of the patient’s experience.9 Not only does the facility offer quick, convenient access, but complete radiology and laboratory rooms allow patients to receive comprehensive care at a singular location. Nurse workstations and patient waiting nooks are arranged so as to facilitate the flow of traffic, providing a more streamlined and organized experience. Despite the small footprint, the Newport Coast Urgent Care center provides a community-based resource that focuses on ease of access.
Case Study #2: Hoag Health Center (Foothill Ranch)
What was formerly a JoAnn’s Fabric Store is now a 45,000 square foot cutting-edge health oasis for all non-acute healthcare needs. Centered around patient experience, kiosks replace the traditional check-in lobby, opening up the floorplan to create a flowing, relaxed experience that diverges from the traditional healthcare layout. The ceiling within the crux of the space was punched in to allow for centralized, natural light to cascade throughout. The facility offers all of the facets of complete collaborative care: internal medicine, women’s health, pediatrics, orthopedics, physical therapy, and urgent care. A state-of-the-art laboratory is flanked by an OSHPD 3-compliant imaging center that includes MRI, CT, x-ray, and tomographic capabilities. As a leader of health and wellness, Hoag’s physical therapy floor is equipped with all-inclusive, interactive technology, in addition to a large conference room designed to host community classes and support the center’s growing outreach program. Seating niches are interspersed throughout to encourage patients to visit the coffee bar, relax, and enjoy the patient-centered focus of modern healthcare design.
Footnotes
1. Jones Lang LaSalle. “JLL Research Report: Healthcare Real Estate Outlook.” Accessed January 16, 2020. https://www.us.jll.com/en/trends-and-insights/research/2019-healthcare-real-estate-outlook-prognosis-for-growth.
2. Whitemyer, David. “The Future of Evidence-Based Design.” IIDA, Spring 2010. https://www.iida.org/resources/category/1/1/1/6/documents/sp10-ebd.pdf.
3. Joseph, Anjali, Robert Davis, and Andrea Wilkerson. “Evidence-Based Design for Healthcare Lighting: Where’s the Evidence?” U.S. Department of Energy, October 4, 2016. https://www.energy.gov/sites/prod/files/2016/10/f33/Evidence-Based-Design-Webinar_10-04-16.pdf.
4. Silvis, Jennifer Kovacs. “Having It All: New Trends in Clinic Design.” Healthcare Design, November 3, 2016. https://www.healthcaredesignmagazine.com/trends/architecture/having-it-all-new-trends-clinic-design/.
5. Moser, Sarah C., and Meredith Banasiak. “Bridging the Gap.” Healthcare Design, February 15, 2018. https://www.healthcaredesignmagazine.com/trends/operations-facility-management/bridging-the-gap/.
6. Kraus, Shannon, and Kate Renner. “How Architecture Can Help Progress Population Health.” Health Facilities Management, October 5, 2016. https://www.hfmmagazine.com/articles/2434-how-architecture-can-help-progress-population-health.
7. Simone Health. “As 2020 Approaches, Five Healthcare Facilities Construction Trends.” Facility Executive, August 26, 2019. https://facilityexecutive.com/2019/08/as-2020-approaches-five-healthcare-facilities-construction-trends/.
8. Silvis, Jennifer. “2014 HCD Corporate Rankings: Healthcare A/E/C Firms Correcting Course.” Healthcare Design, July 1, 2014. https://www.healthcaredesignmagazine.com/trends/architecture/2014-hcd-corporate-rankings-healthcare-aec-firms-correcting-course/.
9. Hoag Health Center. “Hoag Urgent Care Newport Beach Locations.” Accessed January 16, 2020. https://hoagurgentcare.com/locations/newport_beach/.
