Feature Story: Why design matters

BOMA conference panel discusses the healing power of architecture

By John B. Mugford

Gone are the days when the main goal of designing and building a shiny new healthcare facility was to attract new patients, and hopefully retain them, with plenty of bells and whistles.

Today, while attracting patients remains a fundamental objective, healthcare design has plenty of other objectives as well – some new and some simply receiving greater emphasis than in the past – such as being more cost-effective and efficient, maximizing sustainability, being able to seamlessly integrate the latest in medical technology, and more.

On top of all of this, architects have a new goal in mind, a profound paradigm shift that Michael Pukszta, a principal with CannonDesign, sums up in this way:

“When most people think about architecture in healthcare, they think about it as a tool in which a firm can design and build a new building. But we’ve discovered that design has become, and should be, a very powerful tool to actually improve patient health.”

Mr. Pukszta was part of a panel discussion concerning design at BOMA International’s 2014 Medical Office Buildings + Healthcare Facilities Conference in May. The annual event, which was held this year in Nashville, Tenn., had a record-setting attendance topping 1,000 people.

The architectural session was titled, “Why Design Matters in Healthcare.” Joining Mr. Pukszta from CannonDesign was Whitney Austin Gray, who is part of an initiative focusing on “whole person health.”

Also on the panel were two professors from Cornell University’s Design + Environmental Analysis Department: Chair Sheila Danko and Professor Alan Hedge. Chris Sherwood, the senior VP and business development director at Lend Lease, took part as well.

Moderator Jonathan L. “John” Winer, senior managing director & chief investment officer with White Plains, N.Y.-based Seavest Healthcare Properties LLC, told the crowd that the inspiration for the design panel came from a nationwide, collaborative program that has its roots at Cornell, “The Healthy Futures Institute.”

“When I learned about this initiative it got me thinking about what we do at BOMA, and quite frankly while there are so many things we’ve done well and covered in depth, design is not one of them,” said Mr. Winer, who has been involved in planning the healthcare conference for a number of years. “Hopefully, we’ll use this as a launching pad for further discussion about design at upcoming BOMA healthcare conferences.” Ms. Danko talked briefly about the Healthy Futures Institute that Cornell is instigating.

“What is the Health Futures Institute?” she asked. “It is the goal of creating a consortium to bring together people from industry and academia so that we have best practices, scholarly information, and end up with explorations, solutions, and ultimately innovative designs that are research driven, practice informed, and innovative in their approach to the design process. The key word that I want you to leave with when referring to the Healthy Futures Institute is alliance, because we cannot solve problems in isolation anymore.”

Cost-effectiveness is key

As noted, healthcare design today places a heavy emphasis on building cost-effective buildings, as most providers are preparing for reduced reimbursements under aspects of the Patient Protection and Affordable Care Act (PPACA). At the same, health systems are feeling pressure to invest precious, dwindling capital in the latest in IT and medical technologies in order to remain viable and keep up with competitors.

“Healthcare’s going through some dramatic changes today, tomorrow, next year, the year after,” Mr. Pukszta told the audience of developers, owners, brokers and property managers. “We as designers and you as builders cannot focus too much on today because the buildings we’re designing are going to be there for the next 30 to 50 years. What we need to do is imagine how care will be provided in the future and work our way backwards.”

He pointed to a 160,000 square foot outpatient building under construction in Wisconsin for the Milwaukee-based ProHealth Care system as an example. Originally planning a significantly larger building, ProHealth ultimately decided on a smaller, more streamlined, and less-costly building.

CannonDesign’s assignment involved determining how the provider could maximize the streamlined amount of space by extending the hours of operation to include nights and weekends, according to Ms. Austin Gray.

Also instrumental in the design, she noted, was adding features that exemplify the shift that needs to take place within the delivery of healthcare itself: moving from a “disease care” model to one that focuses on “whole person health.”

The new and necessary approach to healthcare design involves gaining the patients’ perspectives, learning what matters to them, especially those who have received extensive treatments in overcoming illness and disease.

While designing buildings focused on “whole person health” should include using healthy, non-hazardous materials and an abundance of natural light, which has been proven to aid in healing, it should also include design features that help “empower” patients, giving them a sense of remaining in control of their medical care. Improving the workplace

Mr. Hedge, the Cornell professor, noted that the university’s design department has studied and determined a series of features that can improve the work-place environment for doctors and nurses, which has been proven to increase patient health and recovery. He noted that the U.S. Bureau of Labor Statistics has found that being a healthcare professional is “now the second riskiest occupation.”

As the country’s populace ages and a shortage of doctors and nurses becomes more acute, more and more health systems will rely on e-visits to provide care in order to treat more patients in less time. However, architects, Mr. Hedge said, need to design buildings and spaces in ways that can reduce the workplace stresses and injuries being suffered by healthcare professionals who use all of the new technology.

Under the American Reinvestment and Recovery Act of 2009 (ARRA), “the government put aside $20 billion to encourage the use of information technology in healthcare,” Mr. Hedge noted. “The rationale behind this is to try and provide better healthcare with fewer healthcare professionals by using technology. However, it did not put any thought into how that technology should be used to deliver medical services.”

He pointed to a health system that spent $500 million on new technology but did nothing to change the environment in which it is used. The system, he said, saw a dramatic decrease in the face-to-face interactions between patients and caregivers.

“In this case, the physicians and nurses who are spending more and more time working with computers and iPads and other devices and less time with patients,” Mr. Hedge said.

A number of “rather inexpensive solutions” put together by Cornell can help change this, he said, making the workplaces healthier for those using all of the new technology.

An example is the new radiology reading room at a Michigan-based health system. Typically, radiologists spend hours at a time in these sparsely lit rooms reading anywhere from two to four screens at once, switching from case to case about every 90 seconds, he said.

“By the end of two hours, their attention, their visual abilities are dramatically reduced,” he said. “And that leads to increased error rates.”

In recent years, Mr. Hedge and his colleagues have developed a list of “aids that designers can use to evaluate the quality of the environments they create for caregivers. One of them is a digital reading room checklist.”

The result is a space with ergonomically designed work stations, better lighting that the radiologists can control themselves, better sound systems, and other features. The work stations are designed so that the doctors can access them without disturbing others in the room.

“We found that if we can improve the environment for the caregivers, we can improve their performance, which helps ensure that their diagnoses are more accurate,” he said. “And that leads to better health for patients.”

Better outcomes

Mr. Sherwood from Lend Lease pointed to a large U.S. Department of Veterans Affairs (VA) outpatient clinic that the firm is developing in Kernersville, N.C., as an example of how good, thoughtful design focused on patients can make a difference in outcomes.

“The VA says that only 30 percent of the veterans who are eligible to receive care from the organization take advantage of receiving that care,” Sherwood said. “They either don’t sign up, or in many cases we’re told that they come, use the facilities, and then never come back. It comes down to the experience they have, or the facility, or the care, something about it, that causes them to not come back. He pointed to three aspects of facility design that can help attract patients, in this case veterans, and make their experiences more enjoyable: make the facilities inviting and comfortable, not institutional; provide special places where veterans can spend their time, which often includes daylong visits in which they visit multiple caregivers; make the facilities easy and enjoyable to use and navigate.

The 400,000 square foot, three-story ambulatory facility in Kernersville, he said, is scheduled for completion in December 2015. Lend Lease will own the facility, with the VA paying an annual rent of $13 million under a 20-year contract.

“Design is important because we need the veterans to want to come there,” he said. “We need the healthcare that’s provided there to be good because we want the VA to come back and lease that facility from a developer and owner perspective for another 15 years.”

The building is expected to receive Leadership in Energy & Environmental Design (LEED) for Healthcare certification, which focuses on human health and recovery, from the U.S. Green Building Council. It also focuses, Mr. Sherman said, on reducing and eliminating toxic materials and energy efficiency. In addition to making such a large facility easy to navigate, which eases the anxiety of the patients, Lend Lease, the VA and the architect – the Charlotte,  N.C., office of Perkins Eastman – chose to create an environment that is reminiscent of the outside, “natural” world.

“We know that the environmental world has great healing power and it will help patients in their recovery,” Mr. Sherwood said. “So as part of the facility we made the canteen, if you will, an indoor/outdoor eating environment and something that can allow people to spend some significant time outdoors with other people.”

“The facility also includes a large porch area, areas to relax, perhaps with rocking chairs and ceiling fans, a rooftop garden on the third floor that is adjacent to some of the higher acuity areas, the ambulatory surgery center, and other higher acuity areas,” he said.

And the facility is designed to allow for plenty of natural light, including the main lobby and the wayfinding areas. This includes the use of light wells, where light from one level can penetrate another.

Once veterans do arrive at the future facility in Kernersville, near Winston-Salem, they will find a space that captures the many looks and feels of North Carolina itself. As a visitor starts at one of the building, the clinics are in an area filled with colors, murals and themes reminiscent of the coastal areas.

“Instead of having patients rely only on signage and maps to get around, which promotes an institutional feel,” Mr. Sherwood said, “the design of this building makes wayfinding intuitive, which we believe will make the whole experience more enjoyable and comfortable. We really think that design changes like these can make a difference and have big effect on how people perceive and use a facility.” 

Editor’s note: Starting with the September/October 2014 edition of BOMA Magazine, Healthcare Real Estate Insights™ will be contributing a regularly bimonthly column, “Healthcare RE Pulse,” which will explore the latest trends and information affecting the healthcare real estate (HRE) sector. We are pleased to collaborate with BOMA International on this new venture to further raise awareness and knowledge of the HRE business. For a free digital copy of BOMA Magazine, please visit: http://digital.boma.org/2014/September_October/files/51.html.

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