Medical practice has come a long way since the days of applying more leeches as a cure-all; modern advances in hospital design anticipate and accommodate changes in technology and practice while bolstering the case for healthier patients through better spaces. Architects can shape facilities around broad strategies such as patient-first thinking and evidence-based design. But they can also incorporate more finely grained details, down to optimal placement of equipment and lighting fixture arrangement as well as staff and visitor amenities that, in concert, produce healthcare facilities that help people heal faster–and with fewer leeches.

Better spaces, healthier people

A 2004 report examining more than 600 studies on the impact of hospital design on clinical outcomes found evidence that design plays a significant role: “Improved physical settings can be an important tool in making hospitals safer, more healing, and better places to work.” Yet figuring out where to begin design decisions in an ever-changing realm of technological innovations can be daunting.

It can help to have early conversations with your architect about your needs, whether the scope is a renovation of an aging hospital facility or a new structure designed to house doctors practicing the most current medicine with state-of-the-art devices. Every hospital project has its own unique set of constraints, such as site and budget, and an architect shows the possibilities that will work in each specific situation.

Guiding principles

Joan Suchomel, AIA, a senior vice president with CannonDesign, collects a client’s guiding principles at the start of each healthcare design project to determine its roadmap. For one of her projects, the Christ Hospital Joint and Spine Center in Cincinnati (which received an AIA 2016 Healthcare Design Award), the guiding principles included “experience and access, efficiency, flexibility, innovation, and brand.” “Understanding and defining what you’re trying to achieve is the most important thing,” Suchomel says. “Whenever there’s a question about competition for resources, you can go back to those guiding principles and ask how we’re meeting them.”

Suchomel adds, however, that while an architect can elicit ideas and prompt conversations, ultimately these guiding principles are the client’s responsibility: “We can’t be the final authors, because the client needs to own them. The design team needs them as much as the client to make sure everyone’s headed in the right direction.”  

Designing for change

With an ever-evolving array of technologies entering practice, it can be hard to know whether the direction in which you’re headed is the right one. That’s why flexibility—both as a mindset and in terms of physical space—is so important, according to Chad Beebe, AIA, the deputy executive director of the American Society for Healthcare Engineering. “Flexibility in design helps solve the issue of an ever-changing field,” Beebe says. “Flexible spaces allow us to adjust to current delivery models and adapt to regulatory changes.”

Lighting the path to recovery

From the patient standpoint, simple changes like the substitution of indirect lighting sources for direct ones can make a big difference for patients who might be lying on their backs for most of the day. “Our goal is to have an even level of light created by indirect lighting, which casts up toward the ceiling to wash the walls as opposed to straight down in someone’s eyes,” says Brenna Costello, AIA, a principal in SmithGroupJJR’s Healthcare Studio. “This is balanced out by providing task lighting at staff work areas to help reduce medical errors.” Costello employs strategies such as maximizing northern exposure to increase that indirect daylighting, and using fixtures that wash ceilings to reflect softer, indirect illumination and reduce glare for sensitive patients.

Suchomel agrees on the importance of light in a healthcare setting, but also emphasizes the importance of a modulating that light to echo circadian rhythms. “We need to be able to accommodate the indoor light to be in alignment with how natural light changes,” she says. “Whatever light you have on at night needs to be less disruptive and more of a yellow light.”

Hospital noise has been another area of note, according to Costello, especially for people who have just come out of surgery or are adjusting to a difficult diagnosis. “The reduction of noise has made a huge impact on patient outcomes, and we’ve seen that over quite a few facilities,” she says. “We’re able to do that in the flooring and the acoustical ceiling tiles, and also in the design of the actual units themselves.”

Healing beyond the patient

Patients, visitors, and staff can all have experiences shaped by the spaces in which they’re receiving, observing, or providing care. While longer-term patients might eventually find themselves receiving therapy outdoors, healing gardens are often places for visitors to cope with the traumatic experiences their loved ones have had. “In inpatient settings, gardens are important for families of patients who are going through the trauma, along with the patient who experienced the trauma,” Costello says. “But they’re equally as important for staff, who are there 24 hours a day, seven days a week, and need the ability to feel natural changes throughout the day.” Suchomel agrees: “The staff are in better humor when they have a chance to take a break outdoors.”

Healthy futures

When architects get involved in the early planning stages of a new healthcare facility, they can see opportunities for spatial reconfigurations that will improve patient care and staff interaction. Understanding a client’s guiding principles will ensure an end result that meets current requirements while remaining flexible enough to anticipate future models of practice. Architects take evidence-based design strategies to provide hospitals with better outcomes, so the hospitals can help people feel better faster.  

About the author: Deane Madsen, Assoc. AIA, is a writer and architectural photographer based in Washington, DC. He is the founder of Brutalist DC and the former associate editor of design for Architect Magazine.

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