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Health Design & Ethics

Healthcare Interior Design 2.0 Podcast

November 11, 2019 / Dochitect / Design for Clinical Staff, Evidence-Based Design, Health Design & Ethics, The Physician-Architect Model

In the News

Publication: Healthcare Interior Design 2.0 Podcast
Date: November 11, 2019

Dochitect is featured on the Healthcare Interior Design 2.0 Podcast!
Listen to @dochitect discuss the idea of what is the moral imperative of the architect to communicate research to clients and discuss potential benefits and harms of design. “Architects are sometimes torn between thinking about the state of healthcare outside of their individual project to a client,” Diana shares. “And I think we often have reservations about measuring design quality.” This and more on the changing face of the healthcare design from a “dochitect’s” perspective.

Click HERE to listen to the full podcast!
Podcasts

Clinic room designs must fit care models

October 9, 2019 / Dochitect / Design for Clinical Staff, Health Design & Ethics

Blog Post

Publication: The Medical Post, Canadian Healthcare Network
Title: Clinic room designs must fit care models
Publication Date: October 9, 2019
Authors Diana Anderson, MD

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“Where should I sit?” my geriatric patient asks as he enters the clinic room, his walker just barely clearing the doorway.

I glance around­ at our choices—there’s the clinician’s chair-on-wheels positioned towards the desk with the computer monitor, the examination table itself, or the designated patient chair. I know that today my priority is to discuss advance care planning and goals of care—a discussion that warrants equal footing and a potential surface for reviewing paperwork. Sitting on the exam table for these discussions can be physically challenging for frail patients and is not conducive to discussion equity. The patient chair is an option, only its position next to the desk or across from it implies a hierarchy and awkwardness in formulating conversation.

And wait—my patient has brought a family member, where will they sit?

As medicine increasingly becomes a family affair, especially in the realm of pediatrics and geriatrics, how can clinic room design foster these new models of care? As the emphasis on advance care planning grows with communication of difficult topics now being taught as a clinical skill, there is immense value to re-envisioning the primary care clinic room to support these changes. As a health system we have mainly concentrated on throughput and outcomes required by clinic encounters and not necessarily the experiences of the various user groups—space design and care appear to be more divergent than ever. Now I believe it is the time to focus on the clinic environment to better support all-inclusive care.

Innovative clinic room design can (and should) advance the practice of collaborative thinking and decision-making in medicine by abolishing the “doctor behind the desk” phenomenon. The round table makes an appearance in rare instances of new clinic design, but could become a standard with some clinician advocacy—at least three chairs around it, all of equal design (sturdy, with arm rests). Reminiscent of the Arthurian legend around which knights congregated, the implication was that everyone who sits there has equal status. A computer screen can be used to support the discussions, preferably mounted in a way to be referred to if needed or even retracted—but should not dominate or obstruct the physician-patient interaction.

Clinic rooms should expect family members and be prepared—foldable chairs can be hung on the wall or stored in custom-designed millwork, for quick and easy access. And the examination table often feels like the awkward elephant in the room in its size and placement. In busy clinics where patients rarely undress and gown for a full physical exam, this design element could transition to a specialized reclining chair model. A single procedure room elsewhere in the clinic can be maintained when specific examinations are required.

And while I am reflecting on my “clinic design wish list”, a few wall hooks for patient canes, outerwear and bags, are simple enough and would enhance the encounter. Effective patient encounters do not happen by chance—the impact of design should be realized.

We cannot expect a generic room design to adapt to the changes in medical practice. Can health architects design the clinic room for equitable patient interaction and incorporation of family? Yes, we most definitely can. But a paradigm shift in thoughtful healthcare design is needed with the incorporation of clinicians at the drawing board. This will ensure patients and their families enter clinic rooms which intuitively invite a seat at the table—supporting, not hindering, patient-centered and team-based care.

Dr. Diana Anderson is a Canadian currently doing her geriatric medicine fellowship in the U.S. She thinks of herself as a “dochitect” as she is a board-certified internist, a licensed architect and also a board-certified healthcare architect. Find out more at www.dochitect.com.

Blog Post

Is Hospital Design Equitable?

September 16, 2019 / Dochitect / Design for Clinical Staff, Health Design & Ethics

Blog Post

Publication: CLOSLER.org, Johns Hopkins Medicine
Title: Is Hospital Design Equitable?
Publication Date: September 16, 2019
Authors Diana Anderson, MD

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There is increasing recognition and understanding of the impact built space has on people. While healthcare architecture has strongly advocated for patient-centered design, can the resulting fragmentation and concealment of clinical spaces devalue the role of medical professionals?

Closler.org has an email subscription of ~6,000 healthcare providers
and is regularly visited by thousands of individuals from 70 countries. 

Blog Post

The Ethics of Healthcare Architecture

February 26, 2019 / Dochitect / Evidence-Based Design, Health Design & Ethics, The Physician-Architect Model

Commentaries

Publication: Architecture Ireland
Publication Reference: February 26, 2019
Authors Diana Anderson

View Online Journal Issue HERE

 

 

 

Commentaries

Bricks and Morals—Hospital Buildings, Do No Harm

October 25, 2018 / Dochitect / Evidence-Based Design, Health Design & Ethics, The Physician-Architect Model

Peer-reviewed publication

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

Abstract

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!

Keywords

Healthcare design, Evidence-based design, Architecture, Ethics, Hospital 
Peer-Reviewed Publications

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The Dochitect’s Journal: A collection of writings on the intersection of Medicine and Architecture

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Recent Articles/Publications

  • The Intersection of Architecture/Medicine/Quality and the Clinical Nurse Specialist: Designing for the Prevention of Delirium

    December 2, 2019
  • Clinic room designs must fit care models

    October 9, 2019
  • Is Hospital Design Equitable?

    September 16, 2019

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  • Healthcare Interior Design 2.0 Podcast

    November 11, 2019
  • Habitats for Healers: Architectural Design for Clinicians

    October 28, 2019
  • GeriPal Podcast: Architecture and Medicine

    October 17, 2019

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