Event: Harvard Medical School Center for Bioethics, Organizational Ethics Consortium
Title: If Architecture Influences Health Outcomes, How Should Healthcare Systems Respond? Bioethics at the Frontier of the Science of Design
Date: January 20, 2023
To register for the event or for more information click HERE.
Event: University of Texas Southwestern Medical Center Ethics Grand Rounds
Title: Exploring the Untapped Nexus of Ethics and Health Facility Design
Date: January 10, 2023
Architecture inherently reflects the normative preferences of its time. This certainly applies to healthcare architecture, where design concepts have intentional and decades-long effects on patients, families, and staff. Employing healthcare architecture to alter behaviors, mediate interpersonal interactions, and affect patient outcomes make it an ethical matter. We propose that advances in design science and our understanding of its powerful effects warrant a shift how we think about space, and that the built environment in health care is analogous to a medical intervention. As such, all responsible stakeholders should openly discuss and thoroughly scrutinize the intentional use of the built environment to affect perceptions and change behaviors of patients, residents to a similar standard as conventional medical therapies. We highlight prominent examples of such architectural interventions, analyze their implementation, and offer perspective on how medicine and architecture can create ethically responsible spaces.
Read more about the ethical aspects of healthcare facility design HERE.
Publication: Health Environments Research and Design
Publication Reference: 2022, Vol. 15(2) 13-21
Author: Hamilton, DK
Editorial Excerpt
I like to tell my students that if there is compelling evidence that if design can improve clinical outcomes and patient safety, then healthcare architects have a moral and ethical responsibility to utilize such evidence. This is only a small step beyond every licensed architect’s obligation to protect the health, safety, and welfare of the public. Similarly, I propose that if credible evidence links design and outcomes, institutional boards and their executives have a moral obligation to engage architects, engineers, designers, and consultants who can and will effectively use such evidence
My colleague, Ray Pentecost, recently told me of a set of conversations he was having with friends about bioethics and responsibility as related to design evidence. It is a self-initiated, multidiscipline, and regionally distributed group including architects, physicians, and ethicists. The group’s overall focus adds a bioethics lens to the application of evidence in the health design field. They have been working for more than 2 years at the intersection of healthcare design and bioethics in order that healthcare environments and the way they are experienced can be markedly improved. The group perceives that despite well-intentioned healthcare administrators, architects, physicians, and others, the idea of connecting a strong, common ethos to a data-driven framework and research informed design for health has been slow to develop in comparison to other professions. Their ideas have slowly grown based on dialogue, publications, and presentations.
Pentecost (2022a) has produced an HERD guest editorial about the Union Internationale des Architectes Public Health Group (UIA/PHG) declaration of 2022 as the Year of Design for Health in our last issue. The group has an article published in Health Facilities Management (Hercules et al., 2022) and a piece in the Hastings Center Review (Anderson et al., 2022) and blog (Anderson et al., 2021). Hearing of their conversations led me to want to hear more. We arranged for some conversations on Zoom to further explore their ideas.
Figure 1. January 9, 2022, L to R, top to bottom; Hercules, Hamilton, Deemer, Pentecost, Anderson, Guenther, and Teti.
Read the full editorial HERE.
Peer-Reviewed Publications
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
Deci
sions 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
Event: Association for Practical and Professional Ethics (APPE) Annual Conference – Annual Conference
Presentation type: Conference presentation and discussion
Presenters: William J. Hercules, MArch, FAIA, FACHA, FACHE, David Deemer, MD, Diana Anderson, MD, MArch, Stowe Lock Teti, MA, HEC-C
Date: February 25, 2022
Learning Objectives
• Understand how the built environment can help resolve the conflicting obligations of isolation for disease mitigation and the need for socialization and autonomy.
• Demonstrate the increasing impact the healthcare built environment is having on health and as a dimension of duty of care.
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
Event: American Society for Bioethics + Humanities (ASBH) – Annual Meeting
Presentation type: Panel presentation & discussion
Presenters: Stowe Lock Teti, MA, HEC-C, Diana Anderson, MD, MArch, William J. Hercules, MArch, FAIA, FACHA, FACHE, David Deemer, MD
Date: October 14, 2021
Overview
The COVID-19 pandemic continues to provide salient examples of the built environment’s impact on disease morbidity and mortality. While design changes are being proposed to address various high-risk design elements like congregate living quarters, it is uncertain whether or not these changes will be ethically informed. Advances in architectural design and a growing understanding of its powerful effects on health outcomes suggest that healthcare environments should be regarded as medical interventions. This panel will explore the ethical challenges related to architectural design modifications aimed to mitigate disease spread and improve quality of life. Examples will be drawn from proposed changes to long term care facilities and hospitals, as both are confined environments in which vulnerable populations live, in which healthcare is provided, and in which organizations have a duty of care to persons inhabiting those spaces.
Ethical challenges discussed will include: isolation for disease control versus the necessity of human socialization and autonomy, risks posed to staff versus the necessity of care provision, and the relationship between institutional policy and the built environment in disease control and well-being. The panel will inspire and empower attendees from various backgrounds to host compelling discussions with healthcare leaders and clinicians on how to utilize the built environment to improve out comes in their organizations.
Learning Objectives:
Event: Advances in Brain Health, hosted by Wolters Kluwer Health
Panelists: José Biller MD, Jason Karlawish MD, Diana Anderson MD
Date: October 12, 2021
Panel Discussion: Advances in Brain Health
Please join us for an interactive discussion about new and evolving topics in the treatment of neurological diseases and new ways to consider the long-term health of your patients. Join experts as they discuss current topics in neurology, including:
Panelists:
José Biller, MD, Professor and Chair, Department of Neurology, Loyola University Stritch School of Medicine, Loyola University Medical Center; Editor, Journal of Stroke and Cerebrovascular Diseases
Jason Karlawish, MD, Professor of Medicine, Medical Ethics and Health Policy, and Neurology, University of Pennsylvania; Co-Director, Penn Memory Center; Author, The Problem of Alzheimer’s: How Science, Culture, and Politics Turned a Rare Disease into a Crisis and What We Can Do About It
Diana Anderson, MD, M.Arch, ACHA, Founder, Dochitect, Fellow in Geriatric Neurology, VA Boston Healthcare System, Instructor of Neurology, Boston University School of Medicine
Moderator: Susan Dentzer, Senior Policy Fellow, Duke-Margolis Center for Health Policy, Duke University
Panel Discussions
Event: American Health Care Association / National Center for Assisted Living (AHCA/NCAL) 2021 Convention and Expo, Washington, DC
Speakers: Diana Anderson MD M.Arch, Thomas Grey Dip.Arch.B.Arch.Sci.MArch., Desmond O’Neill MD
Date: October 11, 2021
Nursing Home Design and COVID-19: Balancing Infection Control, Quality of Life, and Resilience
Many nursing home design models can have a negative impact on older people, and these flaws have been compounded by COVID-19 and related infection-control failures. There is now an urgent need to examine these 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, there is an understanding 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.
3 Learning Outcomes:
Upon completion, participant will be able to:
1) explain the overall impact of the built environment on nursing home residents in terms of quality of life
2) understand the main built environment related infection control issues that have arisen during COVID
3) explain how certain design approaches and models can be use to balance infection control while improving quality of life
Event: Jewish Hospital Foundation’s 2021 Patient Safety Fellowship
Title: Ethics and Design in the Long-Term Care Setting
Date: July 20, 2021
The Jewish Healthcare Foundation’s 2021 Patient Safety Fellowship will offer a unique curriculum to explore the challenges and opportunities facing senior residential living and senior care. After the disruption of COVID-19, options for seniors must embrace creative solutions that help individuals age well and safely in a range of settings. Fellows, working across disciplines — including health care, public policy, public health, tech, architecture, and beyond — will explore existing and conceptional models for transforming our community and healthcare systems that maximize quality of life for seniors and families. New models of care need to be wired for safety, built for continuous improvement, and efficient for providers, seniors, and families.
As part of the 2021 fellowship program, Dr. Anderson lectured around design ethics in clinical and long-term care settings.
Lectures