Enhanced Healing by Design

By Paulla Shetterly —

Over the past decade, we’ve seen a tremendous push to rethink hospital design and safety. This is mainly because Evidence Based Design (EBD) proves a strong relationship between the physical design of hospitals and key patient outcomes which include patient safety, hospital acquired infections (HAI), medical errors, and injuries. Furthermore, there’s a deep need to reduce stress on hospital staff while increasing effectiveness in patient care. For our clients one of the true marks of success rests on providing positive patient outcomes and improving the overall quality of healthcare.

Actually, there are many parts to the healthcare equation. Some are basic and if implemented correctly can reduce the rate of Hospital Acquired Infections (HAI). Over the last five to ten years, we have seen a tremendous rise in HAI. The fact is: ten years ago diseases were not as smart as they are today. They responded well to treatment with antibiotics, but this is not the case today.

Many of today’s viruses and bacteria have become resistant to treatments—this type of treatment—something that once worked well. Because of this, the healthcare industry seems to have taken an “all-hands-on-deck” approach, especially when it comes to fighting new strands of bacteria. According to the Centers for Disease Control and Prevention (CDC), a large number of patients die each year from nosocomial infections. This is alarming, especially given the advances we have in the area of patient care. As a interior designer, I found myself asking: “What can we do even if it is on a basic level to address this situation in the medical facilities that we design?”

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When it comes to hospital design, I believe we need to —

• Think differently —We continually evolve and broaden our design approach to ensure we meet the challenge of thinking strategically, efficiently, and effectively when creating a built environment to reduce HAIs. Our projects utilize state-of-the-art heating and cooling systems to improve air quality, reduce pathogens, and help to prevent the spread of infectious diseases. Recent studies have shown a link between the increase of infectious diseases such as C-diff, MRSA and VRE and something as simple as proper hand washing and sanitizing. While that may seem shocking, it is understandable when we realize the pressure and workload that is placed on healthcare providers. (A Review of the Research Literature on Evidence Based Healthcare Design by Ulrich.)

Even though hand washing is a part of the clinical processes and culture of a facility, the built environment can play a positive role with high impact.  For example, our team was challenged to increase hand washing compliance for nurses and physicians while designing the Paulding Replacement Hospital in Hiram, Georgia. The design team rose to the challenge with specially designed hand washing and sanitizing stations located inside and outside of the patient rooms throughout the hospital to increase the opportunity for hand washing.

We designed the patient rooms to operate on a smarter platform. First, the room layout and spatial design of the support spaces allows nurses and the doctors to be closer to the patients for excellent “bedside care.” Plus, we’ve incorporated technology that tracks nurses and caregiver’s proximity to hand washing sinks, encouraging them to wash their hands. Each care provider is tagged with a small device that allows the hospital to track opportunities for hand washing compliance. This device can also monitor how many times a care provider enters and exits a patient’s room. This isolated example proves how serious hospitals are about stopping the spread of bacteria and disease.


• Promote and use surfaces that help to prevent diseases— Surface materials make a tremendous difference in patient outcomes, especially when dealing with hospital acquired infections. When appropriate, this is why we make a concentrated effort to specify materials that are anti-microbial and anti-bacterial. In the past, hospitals have used plastic laminate countertops, which are basically compressed paper with wood substrates. These materials are porous and over time they absorb moisture and bacteria. Wet wood harbors bacteria. Therefore, we recommend non-porous surfaces such as Corian solid surfacing or solid acrylic surfaces in high-risk areas. This material is nonporous, inert like stainless steel. It also is more hygienic and easier to clean, which aids in fighting diseases. Plus, it can help eliminate the spread of infections and cross contamination of things like Staph, Hepatitis B and C, and HIV.

Once surfaces are installed, they must be maintained correctly. Just because a surface is white and shiny does not mean it is clean. The truth is that we can design a warm, welcoming, and inviting space, but if the surfaces are not maintained properly, viruses and germs will grow. We also can install great products, but the success of these depends on proper cleaning and maintenance.

• Use bacteria and moisture resistant fabrics— Our particular design process also takes into consideration the daily use and lifespan of materials. Fabric companies are always researching and creating fabrics that will fight against cross contamination and HAI’s. NanoTEX and Crypton fabrics are non-porous and were designed to be easy to clean. They are also resistant to stains, which can help to reduce the spread of infections. However, certain cleaners can actually shorten the life of surfaces and fabrics and damage the overall effectiveness of the material. Therefore, we often use hospital approved vinyl, which are scrubbable, antimicrobial, antibacterial, and moisture resistant.

• Include light and spaciousness — I truly believe healing is directly connected to the quality of patient care delivered and the ability of the built environment to support care delivery processes. Therefore, we design healthcare facilities to be warm and welcoming, to reduce stress for patients and staff. We design specific family zones inside and outside of patient rooms for families and loved ones to meet, rest, and regroup. Window walls in patient rooms allow natural light to penetrate into the structure and provide views to the outside. Natural distractions along with lighting, art , and neutral colors create a calm, warm and safe healing environment.


Advantages of LEAN design

As a final note, we also take advantages of the principles of LEAN design. More than ever before, our healthcare design practice focuses on efficiency and patient safety. We utilize a holistic view of the design concept and implement the best practice approach that will lead to a successful outcome while eliminating redundancies and reducing waste.  For example, visual and physical access to patient rooms has become increasingly important to many of our clients.  Historically, nursing stations were centrally located, which often removed the caregiver from the patient’s bedside.

Today, many of our clients want caregivers at the bedside and have implemented a six-second rule to prevent extended time hunting and gathering. Meaning, nurses should not have to travel more than six seconds to reach common supplies. Additionally, nurses may be equipped with mobile devices that connect to landing and perching stations. These areas permit doctors, therapists, and technicians to collaborate and simultaneously monitor patient progress. The perching stations allow them to record data quickly and remain focused on patient care. Hospitals monitor many aspects of patient/nurse interaction for process improvements in order to be more effective and efficient.

Healthcare design has a broad and bold scope, but when we address this changing industry, we still must begin with the basics. But with such high stakes, we cannot afford to simply create pretty spaces that flow from a set of great drawings. We must create efficient and effective healing environments where patients are confident that they will receive the best and most advanced care possible.

Paulla Shetterly is an associate principal and director of Interior Design at CDH. Her broad experience includes working with major healthcare clients and complex projects. She has been interviewed and published in Healthcare Facilities Management Magazine. She is a graduate of Kansas State University where she received a B.S. in Interior Design. To learn more about this subject or to contact Paulla Shetterly, you can email her at: paulla.shetterly@cdh-partners.com.


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