Form follows...Hospitalist?

As architects, we’ve all - willingly or not - participated in a move toward practice specialization, and sub-specialization. However, in the quest to become, for example, not just a healthcare firm, but a surgery department firm, we risk losing site of the most important reason we design any type of building at all- the end user. The silo mentality that accompanies specialization fails to fully account for the interdepartmental and interdisciplinary processes that must take place in all healthcare environments. More importantly, it contributes to a lack of focus on the total patient experience.

Hospitalists, physicians who work for the hospital, in the hospital; may be the agents of change in the delivery of care dynamic. What is interesting to me is that their specialty is not disease-based, but location based. Because hospitalists act as a care coordinator for all treatment that a patient receives during their hospital stay, they have a unique perspective on the process of care delivery and how well it did or did not serve the needs of the patient.

I believe that this emerging specialty in general hospital care will drive three important healthcare design trends:
Increased focus on understanding process and promoting efficiency through design. Hospitalists are involved in hospital management and operations as they specifically relate to patient care and offer a unique perspective on inpatient flow and quality of care. Specifically, they are involved with developing and tracking quality initiatives. Proponents of Lean design, and EBD have been saying for years that the focus should be on process, streamlining it so staff can focus on providing the highest level of care to the patient with the greatest amount of convenience for that patient. This approach will only become more important as a means to optimize care delivery and quality.

Greater sensitivity to the culture(s) of patients and their families. Hospitalists’ role in the specific care management of inpatients forces them to deal with acute care situations without the benefit of having any established history with a patient. They need to deal with issues such as cultural sensitivity, and no or low English proficiency on a case by case basis and need space that is flexible enough to respond to customized plans of care as well as care management. Design implications will be greater emphasis on wayfinding, and smaller, more flexible waiting areas within each unit that can be enclosed to allow for extended family consultations.

More versatile and consistent patient space. Cooperative care is one of the hallmarks of a hospital medicine. In fact, the smaller the hospital the greater the range of duties a hospitalist will have. Because the hospitalist manages the care for a patient for the duration of their stay, they oversee a wide range of care in many different units. Therefore, it is beneficial for the design of a patient room, ICU or ED room have certain fundamental consistencies in design to allow a physician to quickly orient to patient care in a variety of departments. This also will create a greater need for more universal rooms that allow the greatest range of care in a single location and increase the decentralization of core processes such as lab and other diagnostics. We may also see hospitals develop room standards or tweak their existing standards to reflect greater consistency among units and departments.

Hospital Medicine represents a different paradigm for care delivery that may spur a different design paradigm as well. Please share your experiences and thoughts on the effect that you think the growing shift towards hospitalists will have on healthcare design.