Finding Evidence of Culture part 3

A more global view of evidence-based design, formulated into a strategy that reflects the business plan and operational goals of a healthcare organization rather than emerging from a specific project can be an agent to change the culture of that organization.  Currently, there is a blurring of the understanding of value and cost in the mind of many organizations.  This makes it more difficult to understand and invest in evidence-based strategies because looking beyond first costs is often an interpretive process.  Analysis of long term costs and benefits can be interpreted differently by different departments, further muddying the ability of an organization to justify expenses with less than obvious and direct payback.  So I have identified three major areas that most organizations are likely to say are important areas of concern and connected these "business plan" goals to actual design decisions:

1.       Creating a healing environment for Patients

a.        Design measures that stimulate the senses such as natural light, employing color, texture and pattern, acoustic measures, water features, aromas/smells, visually interesting components that provide areas of focus such as artwork or architectural/lighting features.

b.       Humanizing the scale to provide visual cueing, assist in way finding, animating spaces with activity to make them feel less intimidating. Breaking down large spaces into smaller sub spaces, providing a variety of lighting and furniture options.  Concealing clinical elements when not in use, providing a sense of identity for individuals and elements that draw from the local culture and community.

c.        Customization and control to provide patients with the ability to adjust light levels, display personal objects.

d.       Accommodating needs be providing respite areas and places of solace/spiritual comfort.

2.       Creating a calming environment for Families

a.        Welcoming and easy to navigate facility with well thought out areas for drop-off/pick-up of patients, convenient parking and access to departments

b.       Child friendly with play areas and areas of respite

c.        Supporting communications needs with caregivers, other family members, and ability to work from hospital rooms. Ability to be a partner in care.

3.       Creating a supportive environment for Staff

a.        Balancing privacy and accessibility through proximities, acoustic measures, location and availability of resources (centralized vs. decentralized, lean designs).  Enhancing communication and collaboration among staff.

b.       Separate public, patient and staff circulation while promoting inter and intradepartmental adjacencies.

c.        Provide resources and amenities such as access to the outdoors, natural light in work spaces, quality break rooms

Finding Evidence of Culture part 2

So back to the conundrum of placing value on design, not just functionality, which I think is a pitfall into which Evidence-Based Design devotees often stumble.  If we weave in culture and not just evidence, a philosophy of patient-centered care can be mapped to a process of approaching design. This has the potential to lead us to a design solution that has measurable positive effect on those who use the space as well as the organization’s bottom line. 

These are my thoughts on how to begin relating methods of healthcare delivery to a design approach for new construction and renovation projects, determine ways to streamline costs and maximize efficiency through patient flow, staffing and treatment models reflected and reinforced by the built environment.  Oh yeah, and be something worth calling architecture too.

1. Establish a connection between the culture of a healthcare organization and its ability to formulate and communicate delivery of care goals with successful built projects
2. Illustrate the role that design professionals can play in structuring a design process that facilitates translation of delivery of care goals to the built environment
3. Empower the design process to protect design philosophies and elements that will successfully support the organization’s delivery of care goals.

Finding Evidence of Culture

Sometimes I feel more like an archeologist than an architect, unravelling the culture of both a community and an organization each time I begin work on a project.  Evidence-Based design is a buzzword that has emerged in recent years, in the healthcare sector where I mostly work and play.   I like the idea that cause and effect of design can be studied and documented and help give us some road markers.  But I also think that you can misinterpret facts and fool yourself.  A lot.  Evidence-based design, while a valuable tool, only scratches the surface of what it takes to deliver a successful project, healthcare or otherwise. It represents intent in design and measures outcomes after completion, but fails to fully connect with the process of design.
Conventional design parameters such as aesthetic guidelines, programs or budgets often override the design intent.  Department interests can conflict with those of administration, budget concerns override design intentions, and the desires of the patient and visitor population are derived through speculation, word of mouth or limited questions on Press-Gainey surveys.  The process of design can be frustrated by these constraints.  The inability to tie design elements or strategies to larger desired outcomes for the healthcare organization as a whole then results in their being undervalued by healthcare clients. 

But what if as architects, we could forge a more relevant connection between the bottom line and making great spaces that  inspire, support and heal?