Radboud University Medical Centre & Cleveland Clinic leading the way into the future of hospitals
The scenery takes place at the Oral and Maxillofacial Surgery Department of Radboud University Medical Centre Nijmegen in the Netherlands. The head of the department, Prof. Stefaan Bergé redesigned his whole department based on the book, The Guide to the Future of Medicine and designed the rooms based on patients’ suggestions. Dr. Bergé said patients asked for the simplest things: to have more privacy, more information and more new games for kids in the waiting rooms – to kill time more easily. They asked for amiable architecture with a lot of light and friendly colors, and round tables instead of the square one: to put an end to the “confrontation” between the “contending parties” and to have a more balanced patient-doctor relationship.
Across the Atlantic, the Cleveland Clinic invested heavily in digital health: the Health Essentials Blog for the patient and provider education, Consult QD for medical professionals and corresponding social media sites or mobile apps. Patients are able to access their personal health records or pay their bills online, live chat on medical questions, have a second opinion service, view their imaging studies and request a telehealth service. Physicians are able to offer teleradiology or view records of a referred patient. The medical center is among the few hospitals in the US providing same day appointments in ambulatory clinics in areas surrounding Cleveland, Ohio, in southern Florida and Toronto.
Ambient Experience solutions for more relaxed patients
The reputation of the Cleveland Clinic grew so successfully that even people in Abu Dhabi decided they have to build one. John Sharp, a Senior Manager at the Healthcare Information and Management Systems Society (HIMSS), who previously worked at Cleveland Clinic, believes in the idea of digital first, physical second. He said that the Abu Dhabi hospital applied the same patient-and-digital first philosophy and combined it with state-of-the-art facilities and a group practice model.
The fuelfor healthcare design consultancy believes in changing healthcare into human care by turning painfully long waiting hours into consciously designed time periods, by designing family-based cancer care centers, by rethinking the hospice service or personalizing the imaging experience for patients. Three children’s hospitals in Stockholm/Sweden, Adelaide/Australia, and Orlando/US applied their Ambient Experience solutions with amazing results. Due to the special lights, decorations, toys and playful tools, kids are distracted and their fears are played away. The results: examinations are less painful, doctors have calmer patients and can work more effectively. Since the introduction of fuelfor’s design in 2008, the volume of patients in the Emergency Department of the Florida Hospital for Children has doubled and the overall patient experience rating index is soaring.
What’s common in all of these projects?
They all point towards the future of hospitals. They all suggest that the average hospital with its sterile, neutral and mostly unfriendly rooms, the closed doors of doctor’s offices resembling hierarchical positions, the long and narrow, monotonous corridors and many windowless spaces without plants where the only sound is the buzz coming from the vending machine is an overaged and oversized dying dinosaur.
Currently, there is a howling difference between the average hospital and the level of technological development. Healing, a 19th-century process is actually taking place in 20th-century buildings while technology is already in the 21st century.
As if hospitals had cognitive dissonance needed to be resolved. So how could it be done?
Beyond the projects already mentioned above, trends are setting the path of future hospitals crystal-clearly. John Sharp believes that hospitals will shrink in the future to emergency units and post-surgery rooms to heal patients with injuries and illnesses requiring operations, while chronic diseases will be treated at home with the help of healthcare sensors, wearables and the constant connection to a medical professional (telehealth). Paul Farmer, co-founder of Partners In Health, also believes that we need hospital-based care for those who are critically ill or injured, but for chronic conditions, community-based care is more suitable than clinic-based.
21st-century medicine will be about technology coupled with patient empowerment. We believe that adequate hospital design could accelerate our journey into 21st-century healthcare and will help turn these monstrous, unfriendly buildings into truly positive, life-giving spaces. So, here we have some suggestions.
Who says that patients need to lie in bed all day long in a hospital?
What if patients could sit in comfortable chairs instead of lying somewhere constantly? Why do we put everyone to bed-rest when Dr. Morton Creditor already in 1992 wrote that there is no therapeutic value to strict bed-rest. In fact, immobilization of patients leads to muscle breakdown, which can be quantified: approximately 2 percent per day for an elderly person and 1-1.5 per cent for a younger adult. Thus, staying in bed is not only super boring and depressing, but it actually causes damage, especially to the elderly. So why don’t we design hospitals with smaller rooms and more space for therapy? Why don’t we design more lively social spaces to keep up a more positive and less lonely environment? Why don’t we use the corridor spaces more effectively – where medical professionals and family members could meet, chat, while patients might keep themselves fit by walking around more?
What if patients had the chance to walk even more in beautifully kept, green parks around the buildings? Sometimes even the sight of green trees helps. A 1984 study published in Science, which brought the relationship between the built environment and health outcomes to the forefront, compared the recovery records of gall bladder surgery patients who had a bedside window view of either trees or a brick building wall with no nature. The results showed that those with the nature view compared to those who looked out at the wall had shorter hospital stays, suffered fewer minor post-surgical complications (such as a persistent headache or nausea), and needed far fewer doses of strong narcotic pain drugs.
Why are hospitals not applying more groundbreaking medical innovations into their everyday operations?
The hospital of the future might truly benefit from such current trends, as augmented reality glasses, walls that project virtual reality images, 3D printers, cognitive computers, telemedicine or medical robots which can render care less expensive and more efficient. Portable radiology devices will communicate wirelessly with other gadgets. Minimal waiting times brought about by cognitive computers that organize logistics will result in better quality of life. It will direct people when and where to go by analyzing their records, and automatically responding to doctors’ notes and prescriptions. Robots will move freely, engaging either in telemedical services or disinfecting rooms in seconds.
Healthcare facilities will be enhanced with high-tech devices and broad data availability projected on large screens and mobile devices. Rooms will accommodate families and technology seamlessly. For instance, hospital room TVs will be flat screens for entertainment and patient education. But they will also let the care team call up images and data to explain the patient’s health issues to both the family and patient. Mobile devices, like tablets, will be in the hands of providers as well as patients so that they can record their pain, for example, other symptoms, and contact the nursing station.
It is amazing how different a hospital visit might look like with all these technologies. While robots might help the nurses with monotonous tasks, doctors might provide medical advice from afar through telemedical services and AI aids for the diagnostic process, virtual or augmented reality, might help to get into a completely different world. Through a smartphone and virtual glasses, a Dutch company, VisitU makes live contact possible with a 360-degree camera at the patient’s home, school or special occasions such as a birthday celebration or a football game. Through the use of this technology, hospitalized, young patients and small children can escape the stressful and alien hospital environment, and stop thinking about going home all the time – since they will virtually be there.
Why are patients not involved in the design of hospitals?
How is it even possible that most of the hospitals were built and designed without having asked what patients need and only with blurry guesses about how they would feel better? Dr. Bergé already showed the direction, we believe that other hospitals should also consider design recommendations from patients.
And…why do medical professionals not have the chance to say anything about the environment where they work often 24/7?
The most striking discovery regarding hospital design was that medical professionals are often not involved in all the planning phases of their own working space. Designers should have the chance to walk the halls, shadow individuals as they go about their daily routines, talk to physicians to get a deeper insight into how a hospital works to be able to design a better and more adequate one.
Besides, alongside patient feedback, the needs of the medical staff might also be incorporated into the design plans. Recently the design pendulum has swung heavily towards patient care, but we also need to be caring for the caregivers. We should not design an exam room only for the patient. It is a common practice that doctors examine patients from the right-hand side, however more often than not exam rooms do not take that into consideration.
Dr. Bergé mentioned that during the design phase leaders of his medical department should not spare money and effort to build a great social room for the department. It is the space where colleagues could relax after or during a stressful workday, blow off some steam, play some billiard or drink coffee and chat. As Dr. Bergé said – everyone should keep in mind that the most brilliant ideas are usually not born in research meetings, but coffee corners.
Statistical research underpins his views. A study within laboratory design found that 80 per cent of scientific breakthroughs occurs outside the laboratory environment, in social settings. That is the reason why the architect Louis Kahn designed blackboards and gathering spaces at the Salk Institute in California, to draw scientists out of the labs and to share their ideas together.
So…are we ready to change?
In 2013, “Intel Health Innovation Barometer” was released by Intel Corporation indicating that patients’ healthcare needs worldwide are principally focused on technology and personalization. Traditional hospitals, according to 57% of people, will be obsolete in the future. Not surprisingly, 84% of people would be willing to share their personal health information to advance care and lower costs; more than 70% are receptive to using toilet sensors, prescription bottle sensors, and swallowed health monitors; 72% would be willing to see a doctor via video conference for non–urgent appointments; and 66% said they would prefer a care regimen designed specifically for them based on their genetic profile.
It seems that people are ready to incorporate the changes technologies bring into their lives. And they already have expectations which the hospitals of the future must meet. Let’s hope that medical centers and hospital complexes will live up to these expectations.