By Barbara Wagner, DBIA, LEED AP
More than $200 billion has been spent over the past decade on U.S. hospital construction. To increase the likelihood of designing facilities that function well for patients and staff, and are cost-effective, hospital administrators and facility planners are drawing on evidence-based design to increase the likelihood that new facilities will generate the expected outcomes. Forward-thinking health care organizations, architectural firms and construction companies know that the built environment plays a key role in treating illness, especially if that environment uses patient-centered design. To that end, many are conducting focus groups with patients and staff with results that greatly influence the design and features of a hospital.
Importance of Research on Design
Research can help facility professionals, architects and hospital administrators make more informed facility decisions. For example, in 2006, researchers at Texas A&M and Georgia Institute of Technology identified more than 600 studies demonstrating the impact of hospital design on outcome measures, including reductions in staff errors and stress as well as the amount of pain experienced and medication required by patients. Their conclusion was two-fold: First, there is more than sufficient evidence from the scientific literature to guide current hospital design; and second, using that information to improve hospital design does have a significant impact upon patient and staff outcomes. However, what may have worked in 2006 to help in the design process is now being taken a step further with the use of focus groups.
Information garnered from facilitated focus groups provides patient input and guides the design of a truly patient-centered facility. In order to best meet the needs of patients, focus groups should be used to identify what is of critical importance to them in the design.
Designing hospitals to be comfortable and accessible benefits more than just patient-satisfaction rates. This approach to design helps make patients partners in their care, and high levels of patient engagement make them more likely to follow up with their doctors, continue their medication and maintain healthy living practices, which also provide quantifiable outcome results. Additionally, this methodology allows hospitals to be designed with maximum adaptability and flexibility in mind, to accommodate changes and provide for future growth. Another benefit for the health care facility is that by listening to both patients and staff and applying their feedback into the design helps in both recruiting and staff retention.
Looking at New Orleans
After Hurricane Katrina devastated New Orleans and destroyed the previous VA medical center there, national architectural firm NBBJ collaborated on the Southeast Louisiana Veterans Health Care System Replacement Medical Center with two local New Orleans firms, Eskew+Dumez+Ripple and Rozas Ward Architects. Together, the team set out to design a new four-story, 1.6 million-square-foot campus to serve more than 70,000 veterans in a 23-parish catchment area and across the Gulf Coast with an anticipated 550,000 annual visits. Building from the ground up gave everyone the opportunity to reimagine what a veterans hospital should be.
To begin figuring out this specialized patient population and its health care needs, the design team engaged experts in other domains, including a quantitative psychologist/industrial designer with a focus in disability studies and a clinical psychologist. The architects and the client also recruited veterans as research participants, including men and women of different age groups and backgrounds, such as homeless veterans, those who lived through the trauma of Hurricane Katrina, 20-somethings who had served in Iraq and Afghanistan, and 80-year-olds who fought in World War II.
Overall, the research effort included more than 100 veterans, 180 VA hospital staff from Louisiana (many of whom are veterans themselves), 70 hours of observation and 600 pages of notes. From these immersive and interactive activities, the design team distilled several major insights that informed the design priorities of the project, which continued through the end of 2011.
Challenges & Unique Construction Requirements
A major challenge was designing the facility to withstand potential future natural disasters. Designed and constructed for maximum resiliency, the medical center can remain fully operational during a major storm or natural disaster. The plan quite literally overturns the conventional organization of hospitals, moving the emergency room and essential utilities above the 20-foot flood line and filling lower levels with less mission-critical features.
The design and construction also had to meet the VA’s antiterrorism security requirements. The shatterproof-glass façade does double-duty by protecting occupants from the impact of an explosion or the 129 mph winds of a Category 3 hurricane. This facility blazes a new trail in terms of how to create a resilient facility and how to integrate that with the VA standards for physical security.
Stay tuned for Part II of this article by Barbara Wagner, senior vice president with Clark Construction Group – California, based in Irvine, Calif.