Publication: Architecture Ireland
Publication Reference: February 26, 2019
Authors Diana Anderson
Closler.org has an email subscription of ~6,000 healthcare providers and is regularly visited by thousands of individuals from 70 countries.
Emerging professionals in architecture and medicine are moving beyond infrequent intersections and seek a convergence of career models. What can clinical practice learn from the design field of architecture?
Here’s what I’ve learned in my career as both architect and physician:
Lesson 1: “Always design a thing by considering it in its next larger context – a chair in a room, a room in a house, a house in an environment, an environment in a city play.” – Eliel Saarinen, Finnish Architect, 1873-1950
Architects are taught to respect context and design for the experience of being in a place. As providers, learning the context of our patients and their social determinants of health is key to the biopsychosocial model of care. It becomes more than just the pathophysiology of presenting illness or symptoms.
Lesson 2: One size does not fit all.
At a recent design meeting for a critical care renovation project, the intensivist noted the provision of a large conference room in the proposed floor plan which could be used for both rounds and to break bad news to families. The physician recounted that from his experience, under or oversized rooms can have an effect on the experience of these difficult conversations – a separate smaller room is often needed. As providers, we know that patients and disease effects are not created equal. Patient health burdens can be unequal within a similar pathophysiological framework.
Lesson 3: In architecture a “parti” is the central idea of a building, usually represented as a diagram in shapes to explain the design concept.
As designers, we need a way to explain the idea of our product. We use the parti as a guidepost in designing the many aspects of a building, and always consider how its design can express and reinforce the essential idea of the building. In medicine, our patient histories involve a chief complaint and history of present illness, but what would happen if our clinical parti was the social history and the patient’s overall narrative as our foundation – who they are, what is important to them. These should never become lost and should always ground us in the care of a patient.
Lesson 4: “We shape our buildings: therefore they shape us.” – Winston Churchill
Architects design for experiences by developing spaces for people. Indoor and outdoor spaces, buildings, landscape architecture, and city planning have important effects on us – design can promote exercise and health, keep us safe, inspire us and made us feel good or bad. As providers, we care for people and in the process impact their lives. In return, patients can profoundly impact our practice and lives as well. Just like architecture, medicine is not only a science but also a craft.
Lesson 5: “The Sun does not realise how wonderful it is until after a room is made.” – Louis Kahn, American architect, 1901-1974
In architecture, the concept of void or negative space is something we incorporate into design of buildings. There is a well-known series of black and white photographs which capture the sky by viewing upwards within narrow European streets. The building facades are in silhouette around the edges and the sky becomes a form, shaped by the buildings. One cannot have a building without the framing of abstract spaces/voids; the negative can become the positive and the two work in harmony to create the whole. As clinicians we cannot forget this “negative space” in addition to the positive. Sometimes not pursuing a treatment may be the best option for a patient, or even just a silent pause during a patient history can give someone a chance to mention something important.
Together, clinicians and architects can find a balance between illness, health, and design, inspiring the emergence of a new mode of practice. Therapeutic design as a form of treatment and support requires participation of both the clinician and the architect.Blog Post
The Lancet features Architectural Design and Health!
“During my medical residency, I realized how much burnout affected us as trainees on the front lines of care. In particular, I noticed that much of that difficulty was tied to the areas in which we worked—constant noise, poor lighting, and lack of daylight. Space design made patient care challenging at times, too; for example, not being able to access the correct side of my patient to perform the physical exam as I had been taught. I often considered that the built environment could improve care delivery with more collaboration amongst designers and clinicians.”— Diana Anderson
The disciplines of public and environmental health have long recognised the impact of the built environment on health. Yet clinicians have limited opportunity to engage with architects and design professionals, and the impact of health-care design is largely absent from health policy discussions. However, this is beginning to change.
Read more HERE!
peer, Peer-Reviewed Publications
Publication: KevinMD.com, Blog Post
Publication Date: December 6, 2018
Authors: Diana Anderson, MD, MArch & Keith Mankin, MD
The spaces where we live and work can exert both strong and subtle influences on the way our brains function. They can make us anxious, distracted, inefficient or tired, affecting not only our cognitive ability but also our emotional state, mental stability, and physical well-being. Clinical medical practice, like much of life in our society, is tethered to indoor space, so physicians, staff and patients alike are particularly prone to these psychological effects.
The good news is that continued study of the effects of design on our well-being, and of those we work with, has led to better recognition of “trouble” points and ways to improve them. Many of these improvements are easy and inexpensive to accomplish and may lead to a better environment for engagement and healing.
The first step is an honest assessment of the clinical space and the throughput from the focus of the physician, the staff and the patients. Look at the surroundings, listen to the ambient noise, feel the amount of room and the sense of space. Let your staff do the same thing and compare responses. Even consider a simple survey of the patients.
5 design flaws that can hurt your practice
So what can be done about these and other problem areas in the practice design? The following is a list of suggestions, but the most important factor is a willingness to try changes. Most of these are easily reversible if they don’t work. They are workable even in shared environments (although compromises about stylistic designs may need to be made). Most importantly they will not fundamentally change the organization of the practice, although clinicians should be open even to more drastic changes if necessary. The entire healing system may be in the balance.
8 simple ideas to improve your practice
In summary, the key to making a clinic work better is to first, understand what doesn’t work; second, know what the research suggests; and third, make small incremental changes (or even large ones if necessary) that will put these practices into effect. We as clinicians must understand that the healing process is not just the “laying on of hands.” It is the entire scope of a patent’s experience from the moment they step through the office door.
Diana Anderson is an architect and physician. She is principal, Steffian Bradley Architects, Boston, MA. She can be reached at Dochitect. Keith Mankin is a pediatric orthopaedic surgeon and host, PeerSpectrum Medical Podcast.Blog Post
Publication: Journal of General Internal Medicine
Publication Reference: 2018 Oct 25 [Epub ahead of print]; In print 2019;34(2),312-316
Author: Diana C. Anderson
The volume and rigor of evidence-based design have increasingly grown over the last three decades since the field’s inception, supporting research-based designs to improve patient outcomes. This movement of using evidence from engineering and the hard sciences is not necessarily new, but design-based health research launched with the demonstration that post-operative patients with window views towards nature versus a brick wall yielded shorter lengths of hospital stay and less analgesia use, promoting subsequent investigations and guideline development. Architects continue to base healthcare design decisions on credible research, with a recent shift in physician involvement in the design process by introducing clinicians to design-thinking methodologies. In parallel, architects are becoming familiar with research-based practice, allowing for further rigor and clinical partnership. This cross-pollination of fields could benefit from further discussion surrounding the ethics of hospital architecture as applied to current building codes and guidelines. Historical precedents where the building was used as a form of treatment can inform future concepts of ethical design practice when applied to current population health challenges, such as design for dementia care. While architecture itself does not necessarily provide a cure, good design can act as a preventative tool and enhance overall quality of care.
Read more here!
Publication: The BMJ Opinion, Blog Post
Publication Date: March 12, 2018
Author: Diana Anderson, MD
In this latest BMJ Opinion blog post, Dochitect explores the gap between user experience in medicine and design intent in healthcare architecture.
Read the full Blog Post here.
Book Title: Irwin and Rippe’s Intensive Care Medicine, 8e
Book Editors: Richard S. Irwin, Craig M. Lilly, Paul H. Mayo and James M. Rippe
Publisher: Wolters Kluwer, 2017
Chapter Title: Intensive Care Unit Design: Current Standards and Future Trends
Chapter Authors: Diana C. Anderson, Neil A. Halpern
Except: Hospital-based intensivist administrators at some point in their careers may be asked to participate in designing new or renovating existing ICUs. For simplicity of presentation we have divided this chapter into five sections; the ICU design process, the ICU patient room, central clinical, visitor and staff support and administrative areas, ICU informatics, and future trends. While we classify these areas separately, they are indeed heavily interrelated.
Healthcare and design are actually very complex processes that must accommodate and address continuously evolving guidelines and regulatory standards. Several core principles should guide ICU-specific design.
Link to Purchase Irwin and Rippe’s Intensive Care Medicine, 8e:Intensive Care Unit Design: Current Standards and Future Trends Book Chapter
Publication: Critical Care Nursing Quarterly
Publication Reference: 2018 Jan/Mar;41(1):60-67
Authors: Diana C. Anderson, Ashley A. Jackson, Neil A. Halpern
Advanced informatics systems can help improve health care delivery and the environment of care for critically ill patients. However, identifying, testing, and deploying advanced informatics systems can be quite challenging. These processes often require involvement from a collaborative group of health care professionals of varied disciplines with knowledge of the complexities related to designing the modern and “smart” intensive care unit (ICU). In this article, we explore the connectivity environment within the ICU, middleware technologies to address a host of patient care initiatives, and the core informatics concepts necessary for both the design and implementation of advanced informatics systems.
Publication: Critical Care Nursing Quarterly
Publication Reference: 2018 Jan/Mar;41(1):3-9
Authors: D. Kirk Hamilton, Sandy M. Swoboda, Jin-Ting Lee, Diana C. Anderson
There is controversy today about whether decentralized intensive care unit (ICU) designs featuring alcoves and multiple sites for charting are effective. There are issues relating to travel distance, visibility of patients, visibility of staff colleagues, and communications among caregivers, along with concerns about safety risk. When these designs became possible and popular, many ICU designs moved away from the high-visibility circular, semicircular, or box-like shapes and began to feature units with more linear shapes and footprints similar to acute bed units. Critical care nurses on the new, linear units have expressed concerns. This theory and opinion article relies upon field observations in unrelated research studies and consulting engagements, along with material from the relevant literature. It leads to a challenging hypothesis that criticism of decentralized charting alcoves may be misplaced, and that the associated problem may stem from corridor design and unit size in contemporary ICU design. The authors conclude that reliable data from research investigations are needed to confirm the anecdotal reports of nurses. If problems are present in current facilities, organizations may wish to consider video monitoring, expanded responsibilities in the current buddy system, and use of greater information sharing during daily team huddles. New designs need to involve nurses and carefully consider these issues.
Excerpt: Currently, there are two materials that qualify as preventive biocidal surfaces. Copper and copper alloys are one material. There is now an additional material that suspends cuprous oxide in a polymer, resulting in an equally efficacious substance that can be used both as a slab and as injection-molded shapes. Distinguishing itself from copper alloys, the cuprous oxide in a polymer looks and feels like any other synthetic quartz surface with a smooth, natural stone appearance, without rusting or oxidizing, and fabricates like any other hard surface, with lower cost implication.
For more information, read more about EOS Surfaces here.Letters to the Editor, Peer-Reviewed Publications