The Center for Health Design Blog

Universal Design Living Laboratory Opening Soon in Columbus, OH

Environments for Aging closing keynote speaker Rosemarie Rossetti gave us a first peak this week of the Universal Design Living Laboratory — her brand new demonstration home in Columbus, OH.

Rossetti, who was paralyzed after a freak accident in 1998, had spent years living in a home that was not designed for a person in a wheelchair. When she and her husband Mark were looking for a new home, they couldn’t find anything that could accommodate her needs. So, they decided to build their own — and make it a living laboratory for other to learn about universal design.

Once complete later this year, the home will be open to the building industry and consumers for tours and educational events. Their hope is that it will serve to help all people better understand how to create a more comfortable living environment that will enhance their quality of life.

Rossetti is not the first to design and build such a home. Several years ago, universal design expert Cynthia Leibrock built her own demonstration home at Green Mountain Ranch in Livermore, CO, near Fort Collins. Her concept was to make it a retreat experience for people to come and learn about universal design. Because of its more accessible location, Rossetti’s home may get more visitors.

You might be wondering why Rossetti was a speaker at a conference about environments for aging. As opening keynote speaker Dr. Bill Thomas pointed out, we’re all aging. Universal design principals can serve all populations — from childhood to adulthood to elderhood. And not just in the home — in our healthcare facilities as well.

As Rossetti told us, “Good enough is the enemy. Do it better.”

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We’re All Aging

In his keynote address yesterday at the Environments for Aging conference, Dr. Bill Thomas correctly pointed out to us that we’re all aging.

He’s right. We’ve been aging since the day we were born. We go from childhood to adulthood, to “elderhood” — a term Dr. Thomas says is not used enough in our industry.

“We’re actually creating environments for those who have outgrown adulthood,” he stated. “Not aging.”

He went on to describe a society we’ve created in which the “busiest adult wins,” and once you reach elderhood and stop doing things you used to do, it’s a bad thing. Dr. Thomas believes that it’s not bad, its just part of growing older and that we should be celebrating and embracing our elderhood.

“Aging in our society is equated with decline,” he said. “And decline is not the only dimension of aging.”

I think he’s on to something here. But to change our society’s view on aging is going to take a major mindshift — a radical transformation, according to Dr. Thomas.

What if we started designing healthcare facilities for aging at all stages of life? This makes an even stronger case for universal design. We don’t need geriatric or elder friendly EDs. We need people-friendly EDs.

And maybe we don’t need special houses for the elderly. We need communities that support people as they grow from childhood to adulthood to elderhood.

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Noise, HCAHPS Scores, & Design of the Built Environment

Reducing noise has become a big issue for healthcare organizations, primarily because it one of the questions on the HCAHPS survey that all patients receive when they are discharged.

During this hospital stay, how often was the area around your room quiet at night?

HCAHPS, in case you didn’t know, stands for “Hospital Consumer Assessment of Healthcare Providers and Systems.” Developed and implemented by the Centers for Medicare and Medicaid Services (CMS), it is the first national, standardized, publicly reported survey of patients’ perspectives of hospital care. In a nutshell, it measures patients’ perceptions of their hospital experience.

According to Center for Health Design board director and patient satisfaction expert Mary Malone, the noise question on the HCAHPS survey is the lowest scoring question. Last week, the Beryl Institute released a white paper that offers insights on what U.S. hospitals are doing to address the issue of noise.

I haven’t read Beryl’s paper yet, but my guess is that it focuses mostly on operational strategies and not much on the design of the built environment. In 2007, The Center for Health Design published a paper about sound control in the healthcare environment — linking the known research at the time with outcomes. Suggested architectural and interior design strategies for reducing noise include:

–Single patient rooms
–Examination and treatment rooms enclosed with walls
–Private discussion areas in admitting areas and on units
–High-performance sound-absorbing acoustical ceiling tiles
–Effective wall and furniture design and layout

Some I would add to this list are:

–Decentralized or “distributed” nurse stations
–Carpet or sound-absorbing flooring material

A sound sleep study conducted by Jo Solet and colleagues at the Harvard Medical School and published by The Center for Health Design in 2010 offers more design recommendations for tackling noise problems such as phone and intravenous infusion pump alarms, staff conversations and voice paging, exterior noise, and other stimuli in the environment (ice machines, automatic hand towel dispensers, door hardware).

So, there is plenty of information available to help hospital administrators reduce noise through the design of the built environment. If you’re not looking at it as a way to improve your HCHAPS scores, you should be.

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New Princeton Medical Center Latest Gem in Pebble Project Portfolio

This week, while at The Center for Health Design’s Pebble Project colloquium, I had the pleasure of getting a sneak peak the new University Medical Center of Princeton (UMCP) at Plainsboro, NJ.

The 630,000 sq. ft. hospital, which opens at the end of May, sets a new bar for healthcare facility design and is the latest gem in the Pebble Project portfolio. Visionary CEO Barry Rabner and his team, along with project architect HOK and evidence-based design and artwork consultant CAMA Inc., are to be congratulated on pushing the envelope for architectural and interior design excellence.

I was struck by the attention to design details — and not just in the public spaces. There is color and texture on the walls in the OR and linear accelerator room. Shelf lighting in the ED — although a cleaning nightmare — adds architectural interest. The building’s curved glass facade offers a bold statement for access to natural light that is carried out on the interior through use of translucent panels.

Healing gardens, artwork, carpet — a chapel that starts with a shimmering floor and leads up to a rainbow of colors washing down from the ceiling — are evidence-based design features that are beautifully executed. Some of the clinical spaces are still rather “plain vanilla,” but if you weigh that against everything else, it doesn’t seem to really matter.

The new hospital is also following the U.S. Green Building Council guidelines for the Leadership in Energy and Environmental Design (LEED) standard. Approximately $60 million is being spent on sustainable design that not only creates a healthier environment, but also enables UMCP to achieve energy operating cost savings of 25 percent of what it would have spent if the building was constructed with conventional energy infrastructure

As part of the Pebble Project, UMCP has committed to measure and document the results of its innovative design on outcomes. It will take a few years to do this, but I can’t wait to see the results.

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Environments for Aging Conference Not Like Any Other

The Environments for Aging conference is coming up at the end of this month, April 29-May 1 in Orlando, FL. If you’re involved in designing any type of residential care facility or wanting to explore new models to meet the needs of the next generation of seniors, this is a conference you won’t want to miss.

E4A as we like to call it, is unlike any other event in the healthcare and design industry. First of all, with 500-600 attendees, it’s smaller than most conferences. But that’s okay. Smaller meetings give you a better chance to seek out and find those you most want to talk to.

It’s also the only industry conference specifically focused on creating living environments that meet the needs of our aging population. There are other conferences that touch on this subject, but none whose entire educational programming is devoted to it.

And it’s not just about architecture and design. It’s also about the culture and philosophies that support environments for healthy aging.

New ideas — from a national demonstration home to a developmental approach to aging for remaking our residential care environments, integrating technology, a co-housing model, innovative products, and more — will be shared at E4A in a few weeks. The conversation has already started. Won’t you join in?

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Waiting on the Supreme Court

While I was on vacation last week, the U.S. Supreme Court held a hearing to discuss health reform. You go away for one week and look what happens.

What did happen? Not much, according to experts, as summarized very nicely by Hospital & Health Networks’ Matthew Weinstock. Lots of arguments, but it’s too early to predict what the justices will rule in the summer.

In the meantime, it’s full steam ahead for healthcare organizations, who are already doing things around accountable care and quality to address some of the law’s mandates.

As I predicted in a March 2010 blog post, increase in funding by $11 billion for community health centers has stimulated some expansion and renovation to handle bigger volumes. We have seen great interest in The Center for Health Design’s Clinic Design website as a result of this.

An issue at hand in the current debate is the mandate to require most Americans to buy health insurance by 2014 or play a fine. If more people have insurance, more will use the system, which is also causing many healthcare organizations to re-evaluate how their facilities will be used and if they need to renovate or expand.

According to the latest construction survey by Health Facilities Management and the American Society for Healthcare Engineering, healthcare organizations plan to spend more on facility renovation than construction in 2012 — building more ambulatory or outpatient facilities than hospitals. Emergency departments, outpatient facilities in neighborhood settings, medical office building expansions, and primary care clinics/urgent care centers in neighborhoods are future projects likely to be driven by reform.

The survey also reported that healthcare organizations seem to be eschewing the “hospital as hotel” approach in favor of designs that “maximize value and improve medical outcomes” in anticipation of Medicare reimbursements being tied to performance. There’s clearly a happy medium here, because as evidenced by some of our recent Pebble Projects, good design doesn’t have to be one or the other — it can be pleasing, cost-effective, and help improve medical outcomes.

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Getting Our Voices Heard

Sometimes I feel in our efforts to get the U.S. government to fund research on how the design of the built environment impacts the quality of healthcare, we are like the Whos down in Whoville.

The Whos, you may recall are the small, but important group of beings called the “Whos” in Dr. Suess’ classic story about the elephant Horton who fails — at first — to hear them.

Last week, I wrote about the opportunity to comment on the Patient Centered Outcomes Research Institute’s (PCORI) national research agenda. PCORI is an independent organization funded by the U.S. Congress with the goal of funding patient centered research in support of the Healthcare Reform Act.

PCORI has billions of dollars to hand out grants and because it is a new organization, its board issued a research agenda and priorities for public comment.

The deadline to submit comments was yesterday, and I’m happy to report that The Center for Health Design, along with the Institute for Patient Centered Design, American Institute of Architects/Academy of Architecture for Health, and several other individuals in our community added our voices for PCORI to include the design of the built environment in its research agenda.

Like the Whos down in Whoville, we hope we will be heard.

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Celebrating National Patient Safety Awareness Week

My Google Alert box has been filled with notices about the activities that many healthcare organizations have been doing in recognition of National Patient Safety Awareness Week. Stuff like seminars with guest speakers, flyers distributed to patients, challenges to staff, posters promoting awareness.

My guess is that very little of this education focused on the design of the built environment as a contributor to safety. The Center for Health Design missed the boat by not doing some sort of media blitz around this topic, but we will do better next year.

Since safety in hospitals has become a condition of being paid under Medicare, it has become more of a national priority. A report issued by the Department of Health and Human Services in January said that hospital employees recognize and report only one out of seven errors, accidents, and other events that harm Medicare patients when they are hospitalized.

Mostly this is because hospital employees don’t recognize what constitutes patient harm or don’t realize that events should be reported.

If I was a healthcare administrator or an HHS official, I’d be looking at everything that could be done to reduce medical errors. And that includes the design of the built environment. To find out how the design of the built environment promotes health, safety, and effectiveness in hospitals, read this free report.

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Submit Your Comments for National Research Agenda

A wonderful opportunity exists for any of us in the healthcare design industry to comment on the Patient Centered Outcomes Research Institute’s (PCORI) national research agenda. PCORI is an independent organization funded by the U.S. Congress with the goal of funding patient centered research in support of the Healthcare Reform Act.

PCORI has billions of dollars to hand out grants and because it is a new organization, its board has issued a research agenda and priorities for public comment.

Deadline for comments is Thursday, March 15.

The Center for Health Design is working on formulating some comments and responses, but it would be great if other individuals and organizations submitted comments as well. It’s relatively easy and simple. Here’s how you do it:

1. Download and review the document explaining the priorities and agenda. The most relevant area for the built environment appears to be “Improving Healthcare Systems,” described on page 17, but there are connections to the other priority areas as well.

2. Submit your comments on the PCORI website.

Our goal, of course, is to propose that the role of the built environment in improving quality and safety be a part of PCORI’s research agenda and that some of the billions of dollars in funding be directed towards this area. The time is right for this to happen.

Won’t you help?

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The Buzz About Social Impact Design

I’ve been hearing lots of buzz about social impact design. MASS Design Group, whose work on a hospitals and schools in Rawanda and Hati and other projects earned it Contract Magazine’s 2012 Designer of the Year Award.

And just this week, leaders from design, academia, the community, and both public and private sectors met in New York for the Social Impact Design Summit. This invitation-only event provided an opportunity to discuss the current and future state of socially responsible design: What is it? Who’s doing it well? Why does it matter? What does it mean for the future of design practice?

The Summit was planned in partnership with Cooper-Hewitt National Design Museum, The Lemelson Foundation, and the National Endowment for the Arts; supported by the Surdna Foundation; and hosted at The Rockefeller Foundation.

The Center for Health Design was not at the table for this discussion, and because most of our work focuses on the U.S. healthcare industry, I’m not surprised we weren’t invited. But social impact design involves building clinics and hospitals. And since we believe good design should be for everyone, it is becoming increasingly relevant to our work.

Several of our academic colleagues at the healthcare architecture schools, such as Texas A&M and Arizona State, have engaged their students in wonderful projects in developing countries. Healthcare specialist firms like Anshen+Allen (now part of Stantec) and Mazzetti & Associates; and organizations such as the Lurie Children’s Hospital in Chicago have also participated in social impact design. I’m sure there are many more.

According to the National Endowment of the Arts, a white paper will be released in May documenting the discussion at the Summit and recommendations for next steps.

Anyone can contribute to the white paper by participating in the conversation via Facebook and following the ongoing discussion via the Cooper-Hewitt blog.

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