Remedies for Healthcare Design: Major industry directions you need to address

Sometimes as architects, we get so myopically focused on what we do, in the process of design and project delivery, we fail to see the biggest picture. Our clients and colleagues often suffer this same malady, leaving us in need of a new place to go to seek perspective, and get out of the healthcare design echo chamber. One of my sources of choice is MedCity News. Founded in 2008 by Chris Seper, MedCity is a clearinghouse for information on all things related to healthcare and life sciences (which I often find includes many other aspects of design as well). Precisely because of his vantage point as a journalist, not a designer, with his finger on the pulse of macro issues impacting healthcare world, Chris has some amazing insights into what we’re missing:

There’s been a lot of focus lately on the patient experience. How do you see these trends impacting healthcare spaces themselves?
Patient engagement is emerging as a big issue, as healthcare consumerism rises. This will include a bigger emphasis on wayfinding, guiding patients around the hospital, as well as designing hospitals to provide more information through integration of data and organization of the space. It is also important to make the hospital feel less institutional and more welcome. Hospitals are the least inviting of any buildings, but now they are the largest buildings being constructed in most cities. For example, when you compare past architecture and current major building projects here in Cleveland, you are comparing structures like Symphony Hall and Playhouse Square to the University Hospital’s Seidman Cancer Center and Cleveland Clinic’s Sydell and Arnold Miller Pavilion or the Medical Mart. Healthcare will sculpt the face of many of the metropolitan areas of the country, it’s where the jobs are and the donors. There is an external aesthetic, and a legacy that will be written by hospital designers, something that was not even thought of seven to ten years ago. City planners will wake up too late to understand how to integrate them into the urban context. In 50 years, these hospitals will be the historic buildings we will be looking at. It’s an unknowing legacy.

How important do you think employee satisfaction will become in healthcare? What are some ways that amenities offered in the work environment will affect this?
You hear about shortages of high quality talent, but the indicators are that this is a buyer’s market. Many physicians are running to be acquired by health systems. Nurses have suffered notoriously poor treatment and are being laid off. Unless you are a rock star clinician, most systems will treat you like a widget. Any changes to your environment will be based on how it will extract value to patients because of the emerging reimbursement model and business model. The answers for shortages are to leverage technology and increase productivity, i.e. telemedicine.

How can design work to support the technological change taking place in the way healthcare is delivered?
There’s a lot of product fulfillment going on, leveraging RFID, sensors, wireless networks, better inventory management. There needs to be a level of consideration of how you manage and supply these systems. How patients flow matters, but so does inventory management to avoid over or understocking of supplies and correct delivery of drugs. Security will also be a bigger issue. How do you design a hospital where these are no visiting hours and people come and go all day?
I was at the Digital Health Summit this year and came away realizing that there were three major issues impacting healthcare; changes to government policy on reimbursement of sick care vs. management of wellness, the food people consume or are forced to consume (i.e low income residents of food deserts), and unlocking the desire of human beings to be healthy. Most people who need health and wellness don’t seek it or can’t do it. Most people who do seek healthcare are the worried well. Therefore, hospitals are dealing with managing the seriously ill or crisis conditions, while at the same time trying to pivot their focus on wellness.

We are a third of the way at most to achieving optimal healthcare delivery. Despite the resources out there for people to manage their own health, no physician is going to trust information gathered by a patient. Technology is still in the background. Mobile apps are useless when it comes to the clinical diagnosis of your problems because the rules and regulations and ability to quickly scan or tag information is still not there. There is also still a tendency to look to a clinical solution instead of a lifestyle one. For example, they are inventing all of these high priced ways to deal with sleep apnea when the number one way to deal with it is weight loss.

As architects, we often have to place design in the context of a hospital’s value vs. cost propositions. How many of these emerging value scenarios will actually improve quality through innovation in delivery of care or process?
Innovation is the biggest challenge. If there’s one thing healthcare is panicking over, it’s how to change their innovation and interface. Motivations have changed. How do you leverage data, and keep it accurate and of high quality, much less tap into big data potential? Everything has been structured for silos. Healthcare over the past ten years has moved into a real overall ROI through cross pollination of ideas. A hospital will spin off and partner with early stage companies in ways they never would have in the past and pharmacy companies will pursue a mobile app as aggressively as they would have a molecule. The whole ecosystem is changing, but the structures have not changed with it. An triumvirate of healthcare has emerged; patients/customers, clinicians, and the B to B side. One of the things we have been able to accomplish with Med City is to provide a forum for all sectors to interact, especially the underserved B to B side of healthcare.

Chris Seper (chris @ is the CEO of MedCity Media, which publishes Chris drives the culture, oversees business and editorial directions, and manages the governance of the company (he also writes periodically for Chris is a former journalist turned media entrepreneur who launched MedCity Media in December 2008. He sits on the board of directors of The Civic Commons and the advisory boards of Spoke Software and Your Teen Magazine.

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