A few days ago my sister-in-law was admitted into a large urban hospital to undergo open heart surgery to repair a valve. I had great confidence in the surgeon and the entire healthcare team and expected great outcomes. And secretly I was looking forward to an internal tour of this new heart institute to see how the design of the new spaces converged with the technology and clinical care practices to brought forth a healthy environment that could take my sister-in-law through this surgery and restore her to society a better person than when she entered the doors.
Most tours of new facilities look at the departments and rooms, and most appraisals of the new facility are more in regards to the interior design scheme and end up with photos of grand lobbies and how the hospitality environment of the facility can give a vacation resort a run for its money. But how does it work? Not how does the staff do their job, or what are the bells and whistles of the latest technology on display, but how does it all come together in the spaces that have been designed? After all, as good looking as my sister-in law is, she wasn't functioning right, her system was not performing at its optimum to allow her to keep up with her family and taking care of them. She wasn't healthy, and as a result she was wasting the precious resources of her life: her time, her energy, her works.
Her surgery set to start at 8:00 AM started after 11:00 AM. The surgical team needed to do an emergency heart transplant to save a life. All said and done, they get a five start rating. The nursing care, in all of its aspects from the patient touch to the meals to social services, the engagement with family members to help them understand the process, another five star rating! And the room was beautiful and spacious, far better than what I stay at when I travel on business. A workstation for dad, a built-in couch and bed for the kids, a large HD flat screen TV.
But how does it work?? After you are done chewing that food in your mouth and swallow it...how does it get to the cells in your body to do its job? What is the process it goes through? What is the flow? How efficient is your digestion process in absorbing the nutrients of what you just consumed so that you receive the value that benefits you to help you fulfill your goals?
Scrambled eggs is what I saw! The patient bed was a little over three feet from the corridor wall, and in that space was the patient tray. Recessed into the corridor wall was a sink and some cabinets, and a nurse server, the sink was towards the patients head, away from the door. On the opposite side of the bed was the patient monitor at a good elevation for observation, and right below it was the charting monitor and keyboard. The keyboard was hanging over the top of the recliner where dad was sitting. The kids were on past dad in their own world playing on the laptop. The huge bathroom, with a nice four foot door was opposite the bed. Hmmm... where do you put the IV pole?
The nurse came in, set her supplies down and squeezed between the patient tray and wall to wash her hands, then moved the patient tray to get close to the patient. Had some discussions, then walked around the bed to enter some data into the system. Dad had to stare at her butt. Walked back around the bed, gave her the meds and left the room. And this was happening room after room, floor after floor.
And all of the solutions were simple design solutions. Design. That mysterious word that means so much to the architect, that process they go through to shape our buildings, the principles they incorporate to define the function of the building that then shapes our activities. Design. That marvelous word the surgeon sees when he looks at the human body and sees all of the systems harmoniously at work. Beauty is an aspect of design. And so is function...and process...and efficiency...and sustainability...and integration into the entire environment and all that interact with it.
The sink could be moved to be closer to the door for prompt handwashing, and leaving counter space at the patients head for supplies to be at arm's reach. The bed could be moved over 1-2 feet to create a better nurse work zone and provide space for the charting station where the nurse can chart, maintain eye contact with the patient and glance up to see the monitor and talk to dad. The patient tray could be under the monitor so dad can hand things to mom. The gorgeous hardwood headwall could be at the patients footwall, the TV built-into it, with the couch/bed. nurse server and wardrobe units also built-into it. This allows the patient to see the natural wood beauty, have the kids in front of her and part of the activities. And all of those pesky medical gas outlets, and power outlets and other medical devices, they can be cut into a painted wall or consolidated into nice vertical headwall units at the fingertips of the nurse in her work zone.
And while we are at it, carve off 2-4 feet from the end of the long room for the workstation, dad wants to be next to mom watching Everybody Loves Raymond on the HD TV! And that extra 30 to 60 SF you save, and 270 to 540 CF of volume, in all of the rooms on all of the floors, use that to reduce the size of the air handling equipment, and the pumps and piping and ductwork, no sense having all of those 'air changes' for a space nobody uses. And take all of that extra square footage, from all of the rooms on all of the floors and create a new department to take care of that aspect of healthcare that your physicians need.
A study on program requirements and room sizes over the last 30 years show that patient rooms have been supersized beyond reasonable needs, just like your French fry orders and soft drinks at the convenience store. Do we really need a 64 oz cup? Technology and clinical care processes have made advancements and spaces need to adjust in size so that the built environment maximizes the performance of the task through the utilization of all of the resources and elements of flow.
The essence of this article is to take a look at a room. Not how pretty it is, but how much waste is there in that room, how confused is the flow? What is the body fat content of your organization? Is it obese or lean? Does your facility lend itself to be high performing in utility usage, staff usage, time usage, supply usage? Is it efficient in all manner of flow, from the patient, to the clinicians, the meds, the supplies, the equipment, the processes in the rooms and departments and the flow of communications and data? That surgical team was lean and mean and squeezed in an emergency heart transplant into their daily routine; that patient room was a fatty little kid that wasted the time of the nursing staff and the financial resources of the hospital in so many ways. And it is simple design solutions. Design. What a word!
Maybe the question is: design...by whose perspective and to what ends?
More to come on Lean design in healthcare performance... and in the design/construction processes!