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Articles and Publications

The Bioethics of Built Space: Health Care Architecture as a Medical Intervention

May 1, 2022 / Dochitect / Health Design & Ethics

Peer-reviewed publication

Publication: The Hastings Center Report
Publication Reference: March-April 2022, https://doi.org/10.1002/hast.1353
Authors: Diana C. Anderson, Stowe Locke Teti, William J. Hercules, David A. Deemer

Abstract

Decisions made in health care architecture have profound effects on patients, families, and staff. Drawing on research in medicine, neuroscience, and psychology, design is being used increasingly often to alter specific behaviors, mediate interpersonal interactions, and affect patient outcomes. As a result, the built environment in health care should in some instances be considered akin to a medical intervention, subject to ethical scrutiny and involving protections for those affected. Here we present two case studies. The first includes work aimed at manipulating the behavior of persons with neurocognitive impairments, often in long-term care facilities. This is done to ensure safety and minimize conflicts with staff, but it raises questions about freedom, consent, and disclosure. The second concerns design science in service of improved outcomes, which involves research on improving patient outcomes or the performance of health care teams. There is evidence that in some ICU designs, certain rooms correlate to better outcomes, giving rise to questions about equity and fairness. In other cases, a facility’s architecture seems to be putting a finger on the scale of equipoise, raising questions about the intentionality of clinical judgment, freedom of choice, and disclosure. As a result of this innovation occurring outside the boundaries of traditional care delivery and oversight, important ethical questions emerge concerning both the individual patient and patient populations. We discuss, analyze, and make recommendations about each and suggest future directions for these and related issues.

Read more HERE!

Peer-Reviewed Publications

Architecture and Bioethics: A new value proposition for health care facility designers

February 5, 2022 / Dochitect / Health Design & Ethics

Commentaries

Publication: Health Facilities Management Magazine
Publication Date: February 5, 2022
Authors: William J. Hercules, Diana C. Anderson, Stowe Locke Teti, David Deemer
View article

Excerpt:
“Johann Goethe, the 18th Century polymath, once remarked, “Architecture is frozen music,” by which he meant architecture interprets and expresses the values of its time — sometimes in a general epoch and sometimes at a very precise point. Experienced health care architects will appreciate this phenomenon, as current project drivers may have eclipsed those of decades past. It is in precisely this context that designers are studying the decisions and tradeoffs that result from these normative preferences.

In health care architecture, design is being increasingly employed to affect patient outcomes, alter specific behaviors and mediate the interactions of those within health care spaces. The advances in design science have progressed to the point that the built environment in health care can be considered akin to medical interventions. And, as with medical interventions, the nature, risks, benefits and alternatives should be disclosed to patients and caregivers.

The ethics of buildings and construction typically involve environmental impacts and social equity of the built environment. And while these are important, the focus of this article is on the health care setting itself and how it affects patients, families and health care teams. While some of these effects bear on individual patients, such that an informed consent process may be sufficient, others have a population-level impact that will persist for generations, well after the designer’s direct influence.

Focused work in medicine, neuroscience and psychology is being employed to several ends but, to date, there has been little investigation of these practices. This is because the elements affecting control are neither providers nor medications, but the health care facility building itself. Broadly, this raises issues about the nature of the built environment, what constitutes a medical intervention, what architecture is expected to do and, importantly, what obligations emerge from designers’ choices.”

Read the full article HERE.

Commentaries

No Place Like Home: As the pandemic proved, long-term care homes are a health hazard

September 1, 2021 / Dochitect / Design for Geriatrics, Design for Resiliency

Commentaries

Publication: Zoomer Magazine
Date: Published in print and online Aug/Sept 2021
Author: Nora underwood
View Article

As the COVID-19 pandemic proved, long-term care homes are a health hazard. In this Zoomer Article, Nora Underwood investigates how better building design can help.

Excerpt: For Dr. Diana Anderson, design is a parameter of care, as important as other determinants of health, such as where you live and what you eat. “We don’t talk about that a lot, but buildings have a huge impact on us,” says Anderson, a Boston-based doctor and architect who calls herself a “dochitect.” “It’s almost akin to a medical intervention. It has that much of an impact on people.”

Read the full article HERE.

Commentaries

Designing for Healthcare Sustainability: A Framework

August 3, 2021 / Dochitect / Design for Resiliency, Design for the Future of Health

Blog Post

Publication: American College of Healthcare Executives (ACHE)
Title: Designing for Healthcare Sustainability: A Framework
Date: Published online August 3, 2021
Author: Diana Anderson, Principal, Jacobs & Shari Blanch, Architectural Graduate at Jacobs
View article

Excerpt:

Traditionally, concepts related to sustainable design focus on the co-existence of both the natural and the built environments, often conjuring up images related to saving our earth: planting trees, building wind farms, collecting pollution from the ocean. Over the last few decades, the concept of sustainability has gained traction in the design community with building rating systems and standards alongside the emergence of professional credentialing.

There is a recognized need to expand the facets of holistic, sustainable design given the complex challenges within healthcare. Usually, three pillars of sustainability are considered to include economic, social and environmental dimensions. In this blog post, we propose and describe a fourth: systems sustainability.

The traditional pillars of sustainability: social, environmental and economic, in addition to systems sustainability in the context of healthcare. Sketch by: Shari Blanch

Read the full article HERE.

Blog Post

Designing The Hospital Of The Future

March 17, 2021 / Dochitect / Design for the Future of Health

Blog Post

Publication: Medical Futurist
Date: Published online March 17, 2021
Author: Diana Anderson, Principal, Jacobs & Cath Lewin, Senior Health Planner at Jacobs
View article

What would someone do who equally loves medicine and architecture? For Diana Anderson, it was simple: she became the world’s (probably) first dochitect: doctor + architect. As a published author in both fields, she creates hospital design projects globally, and shifts the paradigm on both ends, focusing on the impacts of healthcare design on patient outcomes, staff satisfaction, and related topics.

As we immerse ourselves in the operation of the hospitals on The Medical Futurist site in the coming weeks, we asked Diana what she thought the hospitals of the future would look like. She gave us responses together with Cath Lewin, Senior Health Planner at Jacobs.

“The complexity of the current pandemic has led to successful inter-disciplinary alliances between designers, architects, engineers, public health officials, health facility operators, and others to work together on design-related solutions.”

Concept sketch for healthcare public space. Sketch by: Jorge Anaya, Jacobs

Read the full article HERE.

Blog Post

Hastings Center Bioethics Forum: The Bioethics of Built Health Care Spaces

January 13, 2021 / Dochitect / Health Design & Ethics

Blog Post

Publication: Hastings Center Bioethics Forum
Title: The Bioethics of Built Health Care Spaces
Publication Date: January 13, 2020
Authors: Diana Anderson, Bill Hercules and Stowe Locke Teti

View Blog Post

It is time for the built environment to be considered alongside other parameters of care.

In recent decades, our understanding of the role the environment plays in shaping us and our interactions has expanded immensely. Researchers have examined the profound effect social and environmental factors can have on ethical behavior and decision-making. Yet, design choices in the built health care environment raise substantive bioethical issues that demand the attention of bioethicists and ethical inquiry.

Read the full essay HERE.

Blog Post

How will COVID-19 Change Healthcare Design?

January 1, 2021 / Dochitect / Design for Infection Control, Design for Resiliency

Commentaries

Publication: Design Museum Magazine
Date: Published in print and online Winter 2020
Author: Diana Anderson, MD, ACHA & Matthew Holmes, ARB, RIBA
View article

Globally, the COVID-19 pandemic has tested the overall resilience of our health system infrastructure to cope with increased demand. It has also brought the importance of design and the built environment to the forefront when considering emergency preparedness and infection control.

Now, nine months into the pandemic, there have been lessons learned from the immediate challenges of medical facility design, in addition to ongoing discussions of the long-term changes which are likely to impact how, where, and when we access our care.

Read the full article HERE.

Commentaries

JHD Editorial – Widening the lens: Clinical perspectives on design thinking for public health

November 25, 2020 / Dochitect / Design for Clinical Staff, Design for Patient Safety, Design for Resiliency

Peer-reviewed publication

Publication: The Journal of Health Design
Publication Reference: Vol 5, No 3 (2020): The Year Like No Other
Authors: Bassin BS, Nagappan B, Sozener CB, Kota SS, Anderson DC

Abstract
The COVID-19 pandemic has created opportunities for innovation, ingenuity, and system reengineering. The next big investment in health care should be intentional and embedded partnerships between clinicians, designers, and architects who can collaborate to help solve health care’s greatest challenges.

“We think it is time to support a paradigm change and advocate for healthcare’s next big investment: intentional and embedded partnerships between clinicians, designers, and architects with dedicated resources to ensure an effective collaborative environment to help solve healthcare’s greatest challenges.”

Read the full editorial HERE.

Listen to the podcast with the authors HERE.

Peer-Reviewed Publications

Nursing Home Design and COVID-19: Balancing Infection Control,Quality of Life, and Resilience

October 31, 2020 / Dochitect / Design for Geriatrics, Design for Infection Control, Design for Resiliency

Peer-reviewed publication

Publication: JAMDA – The Journal of Post-Acute and Long Term Care Medicine
Publication Reference: COVID-19 Special Article| Volume 21, ISSUE 11, P1519-1524, November 01, 2020
Authors: Anderson DC, Grey T, Kennelly S, O’Neill D

Abstract
Many nursing home design models can have a negative impact on older people and these flaws have been compounded by Coronavirus Disease 2019 and related infection control failures. This article proposes that there is now an urgent need to examine these architectural design models and provide alternative and holistic models that balance infection control and quality of life at multiple spatial scales in existing and proposed settings. Moreover, this article argues that there is a convergence on many fronts between these issues and that certain design models and approaches that improve quality of life, will also benefit infection control, support greater resilience, and in turn improve overall pandemic preparedness.

Access the full article HERE.

Peer-Reviewed Publications

Resilient Design in Healthcare Will Affect Pandemic Response

September 11, 2020 / Dochitect / Design for Infection Control, Design for Resiliency

Commentaries

Publication: HealthTech Magazine
Publication Date: September 11, 2020
Author: Diana Anderson
View article

“Has your company implemented safety strategies when returning to work? One of the most important strategies is to make room for safe socializing and distancing, reducing risks while maintaining comfort. Thank you for sharing, @dochitect!”
– Cindy Dunnavant, SVP of Sales & Marketing, EMI Health

Excerpt: Hospitals have always been places of healing, and the challenges of COVID-19 further underscore the value of evidence-based design to ensure care and continuity. This practice relies on empirical data to inform changes that better position physical and technological infrastructures to handle an evolving pandemic.

Simply put, buildings can protect our health.

https://www.dochitect.com/wp-content/uploads/2020/09/article-audio-44186.mp3

Read the full article.

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Recent Articles/Publications

  • The Bioethics of Built Space: Health Care Architecture as a Medical Intervention

    May 1, 2022
  • Architecture and Bioethics: A new value proposition for health care facility designers

    February 5, 2022
  • No Place Like Home: As the pandemic proved, long-term care homes are a health hazard

    September 1, 2021

Recent Presentations

  • Ethical Obligations at their Nexus with Built Space

    February 25, 2022
  • FXCollaborative Architecture 5 10 20 Podcast Episode 2 with Diana Anderson the “dochitect”

    February 15, 2022
  • SALUS TV Series – The Future Hospital: Critical Care 2050

    January 26, 2022

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