An architect’s firsthand experience reinforces that human-sized healthcare takes the dread out of hospital visits
The popular image of the aging 20th Century hospital building is that of an imposing institutional complex that’s confusing to get around, with its nondescript hallways full of unfamiliar faces and off-limits spaces. At many healthcare facilities, this image isn’t far off.
As a healthcare architect, I consider myself more engaged in my own healthcare than most. And generally I know what to expect in terms of patient flow at a healthcare facility. As a healthy young person, I never planned to be a patient, only the architect of such facilities. But in two separate instances in the recent months where I was a hospital patient, the limitations of traditional large-scale healthcare became abundantly clear to me.
PinnacleHealth’s West Shore Hospital is an excellent example of changing healthcare delivery. (Photo by Jeffrey Totaro)
In one instance, I was brought by ambulance to the emergency department, and in the other I came for an outpatient surgery. Both visits to an unfamiliar hospital were anxiety-ridden for my husband and I—often I didn’t know where I was and neither did he. With every healthcare environment that I design, I try to imagine the stress on a visitor and their loved ones, unfamiliar with the hospital landscape. Now I know some of that stress firsthand.
Hard to navigate, dark and uncomfortable, inefficient
Most large older hospitals needlessly induce stress. The wayfinding is often unclear, making it a challenge to navigate multiple elevator banks and facility wings. They have large, busy, noisy waiting rooms and there’s often a lack of privacy at reception where conversations about a patient’s sensitive health information take place. A lack of access to daylight and views of the outdoors can compound the visitor’s anxiety and perception of discomfort. These older facilities may have had many upgrades over the years to squeeze in the newest technology and clinical standards—they’re large but feel cramped. They were designed for healthcare of past decades, not the quickly changing world of healthcare today. By and large, they are far from energy efficient.
Knowledge, resources, and the bottom line
Yet, these large institutions are where a great deal of healing expertise, knowledge, and resources reside—so they’re where healthcare continues to be delivered. It’s worth asking, does this harrowing experience of the patient and their family really impact patient health outcomes and the hospital’s bottom line? Definitely. We’re in the age of the patient as a consumer, reimbursements are tied to patient satisfaction, and the industry is striving to provide valued-based care or, more accurately, person-centered care. Healthcare systems should focus on the relationship with the community they serve and the whole person’s health rather than isolated patient interactions.
When expanding healthcare systems take over older hospitals, they are often saddled with buildings (many built as a result of the Hill Burton Act of 1946) that are dilapidated and expensive to maintain or update. Older buildings can be plagued by health issues: lead-based paint, lead piping, asbestos in fireproofing and flooring, and mercury in the light fixtures. Sometimes they’re just too big, with small patient rooms, private offices, and limited daylight for today’s lean and evidence-based design.
An emerging building type, the “micro-hospital,” offers numerous potential advantages for person-centered care. Following all hospital regulatory requirements, they are small community-based hospitals geared more toward low-acuity patients. Typically, these micro-hospitals have around 8-15 beds, which can be universal rooms that adjust to the needs of each patient. They house an emergency department, lab, imaging, pharmacy, and may have operating rooms and primary care integrated as well. These small hospitals are often located in larger metro areas or suburbs, where they are needed to fill the gaps in access to care. And micro-hospitals can serve a similar purpose to “critical access hospitals” we have seen in the past in rural areas.
The beauty of a micro-hospital is that it is compact, efficient, and designed with the patient’s journey and staff efficiency in mind. In this time where healthcare systems are acquiring inefficient, community hospitals, a better option may be start fresh with a more appropriately sized micro-hospital model.
Small, efficient, and familiar
With a smaller more efficient footprint, micro-hospital staff take fewer steps, can spend more time focusing on patient care, and suffer less burnout. Because the staff numbers are lower than that of a large facility, the team members work in closer proximity to one another. Naturally, this allows for more collaboration and camaraderie among staff. They’re not just strangers passing in the corridors. Engaged and happy staff leads to less turnover.
Collaboration leads to better care. The magic of patient care right now is in breaking down the silos of care from specialists to physicians. We know that when they collaborate, they solve problems and make connections, find better prescriptions to treat conditions. A small hospital where everyone is connected lends itself to the collaboration.
These micro-hospitals are characterized by a small, compact, and efficient program, but are digitally wired to access the resources of a 1,000-bed hospital. With the connectivity and transport systems available today, the micro-hospital can function like the remote arm of a big hospital. Serious trauma cases (a car crash, for example) can be quickly brought to a micro-hospital where specialists from elsewhere can remotely conduct examinations and recommend care, directing staff until the patient is stabilized and transport to another facility can be arranged.
Micro-hospitals deliver hospital services closer to the community on a smaller scale. This means patient care and empathy can be the focus. Today’s healthcare systems want to build patient loyalty and engagement. Patient engagement in healthcare decision making with their care teams is proven to have better patient outcomes. The micro-hospital is suited to engage community members with nutrition, fitness, and stress-reduction classes before they get sick. When visitors view the hospital as a comfortable, familiar community resource, they are more likely to visit and trust that they’ll be taken care of there.
The micro-hospital can easily direct the loyal patient to the rest of the healthcare system as needed, whether it is a physician’s office for a follow-up exam or a larger hospital for a more complex surgery.
We may not recognize them, yet, but micro-hospitals have arrived. PinnacleHealth in Pennsylvania tapped Stantec for the design of new, cost-effective 108-bed community hospital to allow it to expand its services onto the west shore of the Susquehanna River. West Shore Hospital, designed and built in association with Quandel Construction Group, Inc. was completed in under two years. It’s worth noting that micro-hospitals cost less and tend to be quicker to build than traditional hospitals, shortening the time required to bring additional healthcare to the community.
I envision an ideal micro-hospital as one that is daylight filled with a clinically appropriate, safe, and effective layout plus wayfinding designed for the patient journey. This micro-hospital has the energy efficiency, advanced technology, and flexibility that is needed for today’s world but at a scale that encourages the collaboration and personal engagement that proves to be so important for our long-term health.
A micro-hospital may be just what we need to advance the business of healthcare and the art and science of health.
About the Author
Azure Logsdon is project manager, designer, and BIM lead modeler in Pittsburgh, Pennsylvania. Her career has focused mainly in the healthcare sector, encompassing cath labs, surgery suites, cancer centers, senior care, and facility design for visually impaired patients.More Content by Azure Logsdon