The Center for Health Design Blog

Evidence-based Terminology Showing Up in Other Disciplines

I read an article recently in Health Facilities Management about the devices manufacturers are introducing to measure the success of cleaning environmental surfaces in healthcare facilities. The whole notion of “evidence-based cleaning” seems to be gaining traction.

The same issue of HFM featured an article by Center for Health Design Board Director Emeritus Kirk Hamilton and Zofia Rybkowski on evidence-based construction management.

Hamilton defines evidence-based construction management as “the conscientious, explicit and judicious use of current best evidence from research, practice and the field, in making critical decisions and predictions, together with an experienced team and informed client, about the delivery of each individual and unique construction project.” This is very similar to the definition he proposed for evidence-based design in 2004 (see EDAC Study Guide 1, p. 3).

It makes sense that an evidence-based process can be applied to other disciplines within the healthcare design, construction, and operations field. This is because, as Hamilton and Rybkowski point out in their article, healthcare administrators and managers who are making decisions about building design, construction, and operations are “aware of evidence-based medicine, evidence-based nursing practice, and data-driven management.”

I worry, though, if we use “evidence-based” in conjunction with too many things, it will make the term less meaningful.. And it’s way too early for that. The science of evidence-based design, construction management, and cleaning is still relatively new. We’ve only just begun.

Designing for the Silver Stampede

I read two articles recently about the “Silver Stampede” — coined by H&HN writer Geri Aston in her December piece to describe the influx of elderly patients hospitals can expect in the next 30-40 years as the number of Americans 65 and over double.

Aston asked if hospitals “have the staff and protocols necessary to provide high-quality care for older, often medically complex patients?” And if “they have the processes and relationships in place to safely transition these patients to the appropriate post-acute setting and to provide a care continuum?”

She also points out the Affordable Care Act has some provisions that could “spur transformation in geriatric care” because of Medicare payment penalties for excessive readmissions and healthcare-acquired conditions. Aston goes on to describe steps hospitals should be taking to address staff, protocol, and process issues in order to handle an increasingly elderly patient population.

And issue she doesn’t address is whether hospitals have designed their facilities to accommodate an aging population — one whose eyesight, hearing, mobility, and cognitive abilities may not be what they once were.

So, another step I’d add in order to prepare for the Silver Stampede is to consider the risks the built environment poses to the special needs of seniors. Something like an environmental audit may be in order.

For example, could the flooring, other surface materials, and lighting cause tripping and falling? Does the surface materials have acoustical properties to reduce noise, which causes agitation and sleeplessness? Is there good signage and other visual cues to help people not get stressed out about finding their way around?

Of course, many of these design considerations don’t just benefit the elderly, as research done by The Center for Health Design — and others — points out.

That’s why I believe a universal design approach is needed — why just focus on one patient population when all could benefit? Do seniors want to go to a geriatric ED? Or do they just want to go to the ED?

What do you think?

Call for Nominations: Changemaker Award

Here’s to the crazy ones. The misfits. The rebels. The troublemakers. The round pegs in the square holes. The ones who see things differently. They’re not fond of rules, and they have no respect for the status quo.

And while some may see them as crazy, we see genius. Because the people who are crazy enough to think they can change the world, are the ones who do.

You may recognize these words from Apple Computer’s 1997 “Think Different” TV ad, which featured clips of 17 iconic 20th century personalities, including (in order of appearance): Albert Einstein, Bob Dylan, Martin Luther King, Jr., Richard Branson, John Lennon (with Yoko Ono), Buckminster Fuller, Thomas Edison, Muhammad Ali, Ted Turner, Maria Callas, Mahatma Gandhi, Amelia Earhart, Alfred Hitchcock, Martha Graham, Jim Henson (with Kermit the Frog), Frank Lloyd Wright, and Pablo Picasso.

The commercial ends with an image of a young girl opening her closed eyes, as if making a wish.

Why am I telling you this? Because we’re looking for people who are crazy enough to think they can change the world of healthcare design for The Center for Health Design’s annual Changemaker Award. Crazy may be a little extreme, but you get the point.

So, if you know of someone who you think has pushed the status quo and sees things differently, nominate him or her to be this year’s Changmaker. It can be anyone who is involved in healthcare facility design, construction, research, education, or advocacy — but it has to be someone or some organization who’s work has had national impact.

Nominations are due March 9. Click here for more details and to fill out an online submission.

Could 90 be the New 80?

In 1980, there were 720,000 people who were 90 and older in the United States. In 2010, that number grew to 1.9 million; by 2050, it may reach 9 million, according to a report from the U.S. Census Bureau, commissioned by the National Institute on Aging (NIA) at the National Institutes of Health.

So, it stands to reason that the designation of the oldest-old probably should be changed from 85 to 90 years, as the report suggests.

Some other interesting facts from the report: a majority of the 90-plus population are widowed white women who live alone or in a nursing home. Most of them are high school graduates. Social Security provides almost half of their personal income, and almost all of them have health insurance coverage through Medicare and/or Medicaid. The vast majority say they have one or more types of disability.

Granted, this customer profile represents only one segment of the residential care market. But it is an important one to pay attention to for those who are designing environments for aging.

In January, a jury will review projects submitted for the 16th annual Environments for Aging Design Showcase issue, published by Long Term Living magazine in association with The Center for Health Design and the Society for the Advancement of Gerontological Environments.

We’re looking for newly built as well as unbuilt facilities that address the needs of the entire aging population – from 90+ year old nursing home residents as described above to active seniors. Deadline for submissions is January 6.

For more information, click here.

For a copy of the Census Bureau report, click here.

Oh, and Happy Holidays from all of us at The Center for Health Design!

ED Trends: Senior or Universal Care?

In October, I did a blog post outlining some of the trends that we think are going to affect the design of healthcare facilities in the next 10 years.

One of the trends I wrote about was the Aging of America — the Baby Boom generation as the driver of what is and what will be. The impact on facilities is that hospitals and clinics will need spaces that support the physical challenges faced by the over 60 crowd.

We will see more geriatric EDs; models for senior living that support urban renewal; and an emphasis on universal design for new or renovated homes so that seniors can age in place.

Obviously, some of this is already happening. According to an article published in the Cleveland Plain Dealer, two suburban Cleveland medical centers recently joined the ranks of 15 others across the country that have put new protocols in place and redesigned ED treatment rooms to improve care, enhance safety, and reduce anxiety for seniors.

Rooms have soft lighting, pressure-reducing mattresses on beds, high-back chairs for better support, larger signage, big clocks, and nonskid floors and handrails to prevent falls. There is also access to devices that amplify hearing and magnify printed materials.

While all this is good for seniors, what we’re really talking about here is universal design. Why wouldn’t a 30-year old also benefit from softer lighting, a pressure-reducing mattress, or high back chair? Many seniors I know would take offense if something that pointed out their “frailties” was labeled specifically for them.

So, maybe we need to shift the conversation and not just focus on seniors, but everyone.

Make Some Noise, Be Heard

Opening remarks by Debra J. Levin, President & CEO of The Center for Health Design, at the HEALTHCARE DESIGN conference last week.

Welcome to HEALTHCARE DESIGN 2011 and welcome to Nashville.

Like Cars, Hospitals Can be Designed to Keep People Safer

When Ralph Nader’s book, Unsafe at Any Speed: The Designed-in Dangers of the American Automobile came out in 1965, it was a wake-up call for the auto industry to spend money to create safer cars.

As a result of Nader’s advocacy, motor vehicle and highway laws were passed in 1966. Since then, the automobile fatality rate has dropped from 5.49% to 1.13% in 2009. This, in spite of the fact that Americans are driving almost three times more miles per year than in 1966.

The healthcare industry got a similar wake up call when The Institute of Medicine’s report “To Err is Human: Building a Safer Health System” came out in 1999. Soon, other organizations like the Institute for Healthcare Improvement and the Joint Commission took up the safety cause. And CMS did its’ part, too. Medicare and Medicaid reimbursements are now tied to safety measures.

But the healthcare industry is still largely clueless when it comes to connecting the design of the built environment to patient and staff safety. Just like the automobiles of the 1960s, many hospital facilities are not designed with safety in mind.

No doubt about it, though, the design of automobiles is one of the major reasons fatality rates have gone down. The other reason are the laws that were passed to change human behavior.

So, healthcare industry, listen up! You may be able to improve safety by changing human behavior via CMS’s “never events,” but you also need to make changes to the design of your buildings.

If you’re not convinced, check out this research report and others on The Center for Health Design’s website.

Tell Us Your EDAC Story

If you are EDAC certified and attending the HEALTHCARE DESIGN conference in a few weeks, come by The Center for Health Design’s booth and tell us your story.

We would love to hear what prompted you to become EDAC certified and how it has influenced your decision-making and design choices. We will be videotaping 3-5 minute segments to post on the EDAC website.

For example, has being EDAC certified changed the way you present concepts to clients? Are you enthusiastic about continuing to learn about evidence-based design? Do you have any personal stories to tell about your EBD and EDAC experiences?

If you’re interested in sharing your thoughts and stories with us, email Dianne de Guzman at ddeguzman@healthdesign.org.

10 Trends Impacting the Next 10 Years of Facility Design – Part II

Last week, I did a blog post outlining some of the trends that we think are going to affect the design of healthcare facilities in the next 10 years. What I didn’t do is say exactly how they would affect facility design.

So, here’s a recap of the trends and some facility predictions.

1. Aging of America: the Baby Boom generation as the driver of what is and what will be. Impact on facilities: hospitals and clinics spaces that support the physical challenges faced by the over 60 crowd; geriatric EDs; models for senior living that support urban renewal; universal design for new or renovated homes.

2. New Technologies: advancement of Nano technology, telemedicine, home monitoring equipment, “do-it-yourself” diagnostic apps for smart phones/tablets. Impact on facilities: shrinking of the hospital; spaces that support use of these technologies.

3. Patient, Worker, and Environmental Health and Safety: corporate responsibility for sustainability, increased focus on reducing infections, errors, injury. Impact on facilities: more green hospitals; emphasis on evidence-based design.

4. Experience Architecture: movement from service economy to experience economy, customer-focus. Impact on facilities: access to nature and natural light; positive distractions; places of respite.

5. Healthy Living: emphasis on physical activity, connection to community. Impact on facilities: spaces that promote physical activity; more destination locations, gathering places for community support and socialization.

6. Wellness: connection to other living things, mind-body relationship to illness. Impact on facilities: access to nature; positive distractions; places of respite.

7. Decentralized Healthcare: shift to managed contracts, clinic-based care. Impact on facilities: shrinking of the hospital; smaller tertiary clinics; more retail clinics.

8. Staying Home: becomes an extension of the acute care system. Impact on facilities: shrinking of the hospital; home renovations to accommodate different abilities/needs; universal design in new construction.

9. Flexibility: need for adaptable buildings to meet changing modes of delivery. Impact on facilities: more modular concepts for walls, floors.

10. Accountable Healthcare: changes in reimbursement policies, focus on care coordination and keeping people well. Impact on facilities: spaces that foster interaction and communication for team-based care.

10 Trends Impacting the Next 10 Years of Facility Design – Part I

Recently, Center for Health Design President and CEO Debra Levin was asked by the Samuelli Institute to give a keynote address on trends impacting the next 10 years of healthcare facility design. We put our heads together, and with input from several of our board members and staff, came up with the following list of trends and some key drivers:

1. Aging of America: the Baby Boom generation as the driver of what is and what will be.

2. New Technologies: advancement of Nano technology, telemedicine, home monitoring equipment, “do-it-yourself” diagnostic apps for smart phones/tablets.

3. Patient, Worker, and Environmental Health and Safety: corporate responsibility for sustainability, increased focus on reducing infections, errors, injury.

4. Experience Architecture: movement from service economy to experience economy, customer-focus.

5. Healthy Living: emphasis on physical activity, connection to community.

6. Wellness: connection to other living things, mind-body relationship to illness.

7. Decentralized Healthcare: shift to managed contracts, clinic-based care.

8. Staying Home: becomes an extension of the acute care system.

9. Flexibility: need for adaptable buildings to meet changing modes of delivery.

10. Accountable Healthcare: changes in reimbursement policies, focus on care coordination and keeping people well.

The second part of this, of course, is what facility design changes will occur as a result of these trends. That’s the subject of the next blog post.