Home Sweet (Medical) Home

As culture shifts so, does the space that contains the activities pursued by that culture.  Health and wellness have become so intertwined with our everyday lives that we are quick to self-prescribe activities like yoga or spa visits, join a gym or adopt a fitness regimen, consult a nutritionist or seek out alternative therapies like acupuncture.  We still view our healthcare system, however as something that we need only when we are sick.  That’s all changing.

In case you haven’t noticed, the emphasis on wellness has been adopted by your local hospital, clinic and physician.  If they haven’t they may find themselves in a change or perish position.  Healthcare reform is a loaded issue and what if any of it actually gets implemented is still in question.  What is not in question is the cultural shift in care brought about by the wellness movement.  It creates whole new archetypes for us; spaces that are permutations, hybrids and creations of a new set of functions and needs.  As architects we need to be first responders and help usher in this new breed of spaces.  Some trends of the wellness movement that will impact the built environment are as follows:

It’s all about integration.  Expect to see functions like education and community gathering spaces as well as gyms or outdoor exercise areas built into medical office or hospital facilities.  Some will even feature spa and cosmeceutical services as part of an expanded dermatology practice.  On the flip side, you may start to see unlikely clients dipping a toe in the healthcare water- like big box retailers, grocery stores, and spas or fitness centers.

There will be distillation points.  While the range of services and activities may expand at a given healthcare location, expect to see the emergence of an almost concierge-like approach to care management.  The medical home is a new model that seeks to integrate primary care with specialty care, social services and alternative therapies in a single location with a single coordinator.  This helps patients to receive a more holistic treatment for their diseases or disorders and streamlines their ability to access a broader range of services.

Patients have become consumers.  We have been hearing about this trend for a while now, but as it gains momentum, a more retail-based business model will emerge, and this will affect how space is programmed and designed. Finishes and lighting will take on a level of importance previously unknown in healthcare.   Every detail from customer service to appearance and philosophy of care will be factored into their decision of one care provider over another.  See a great example of this in Domokur Architect’s execution of Dr. Darrell White’s concept for Skyvision, patterned after upscale retail environments. Also note that the brand extends beyond the building to Dr. White’s comprehensive approach to care and social media/internet presence. 

A distinct shift to outpatient care. Expect more and more services that were traditionally considered inpatient to become less invasive and performed on an outpatient basis.  This will require more specialized procedure rooms in outpatient facilities.  We’ll also start to see traditionally hospital based-specialists needing to do more than a quick consult with a patient- they now will perform many of their procedures in that same office.

So what’s the emerging archetype?
1. More multi-use and multi-purpose spaces.  Healthcare will be about delivering comprehensive wellness strategies as a part of a continuum of care as opposed to treating only a particular disease when the patient presents.  It also will be team-based instead of physician based and a broader range of clinicians and social workers may be involved in the patient’s care plan.  Therefore, there will be a need to engage patients more fully in managing their own care.  A different range of environments for meeting and working with patients will be necessary.  You may find yourself really thinking about site design and amenities, or providing child-care or library space.  These spaces may also flex to become community rooms or group education rooms.  There may be fewer exam rooms, but more procedure and consult rooms.  There is also a need to create collaboration spaces where the entire care team can meet to review a patient’s status on a regular basis and determine how to address needs as they arise.

2. Image and accessibility matter. To compete for the consumer-oriented patient, facilities will have to be more accessible.  Not only will physical appeal be important, but good marketing efforts will be necessary.  As architects, we may find ourselves much more closely aligned with graphic designers and public relations professionals to produce a seamless corporate image that reflects a well defined philosophy of care.

3. A rethinking of what a visit entails.  Patients are going to expect to see a more involved discussion of their overall health record at each visit.  The design of the typical exam room will change. While most do include a charting area, it is usually quite small and does not enable the patient and doctor to sit side by side to review either on-screen or printed information.  Many patients do not even use an exam table for most doctor visits, so it might be beneficial to have consult rooms vs. exam rooms.  The consult room could have some of the same elements as a typical exam room like blood pressure cuff, oto/opthamoscope, hand washing sink and supply/work counter.  However, instead of an exam table, the room might feature a table and chairs- allowing the doctor to do a routine check of vitals, then spend the majority of the time reviewing the results of the exam within the context of the patient’s health history and health trends.  Especially for those with chronic conditions like high blood pressure or diabetes who visit the doctor on a monthly basis, this type of room would be far more comfortable and conducive to their needs.  It would enable the patient, physician and any accompanying family member to share the events of the visit within the context of a health profile. A table would also allow both doctor and patient to bring along their own supplemental materials to share or record the events of the visit.

4. More virtual access to care and medical records to allow real-time monitoring of patients’ progress.  This is not a new concept, but I am always amazed at how seldom anyone talks about HOW this monitoring will take place.  We may need to have more of a cybercafe for medical staff where they can take time to sit and do a download on a batch of patients, process the information and send back responses to them.  If a dialogue is encouraged, physician assistants need to have computer workstations where they can do a daily monitoring of patient results and respond to any emails or requests for information from patients.  It’s a much more hands-on and higher level of care than most doctors offices are used to delivering, but I see this as a trend that would also affect the physical space of an office in order to provide a private and secure location to view and respond to patient information.  Perhaps that interactive conference room space mentioned earlier might double as the data sharing area.

As you can see, the paradigm of the doctor’s office is rapidly being converted into a different type of health destination, one that supports more comprehensive, longitudinal and interactive care.  Share your experiences with recent medical offices and let me know if you are dealing with any or all of these issues.

Post-post update:  So many great thoughts were put out there on the Linked in shared version of this post that I am including them directly one the blog as comments as well.  Please feel free to add your thoughts to the mix.