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Health Design & Ethics

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

LiftOff 2020: Health Equity by Design

December 15, 2020 / Dochitect / Health Design & Ethics

Presentations

Event: Liftoff PGH 2020: A virtual healthcare innovation summit, Pittsburgh, PA
Title: Health Equity & Design / Panel discussion
Date: December 15, 2020

IKM Presents: Health Equity by Design
John Keelan, Dr. Diana Anderson, Juliet Rogers, Dr. Bon Ku

This panel explores the power of design to improve disparities in health. Panelists will upend current health care models, formulating systems that improve outcomes for all patients.

Conference Presentations

The Bioethics of Built Space: On the Shared Responsibilities of Bioethics and Architecture

October 16, 2020 / Dochitect / Health Design & Ethics

Presentations

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
Date: October 16, 2020

Session Overview

Over the past fifty or so years, our understanding of the role the environment plays in shaping us and our interactions has expanded immensely. Studies of social determinants of health have illuminated profound effects social factors and environment can have on medical outcomes and well-being. Studies of behavior have demonstrated the powerful effect environmental factors can have on decision-making. It is somewhat surprising, therefore, so little attention has been paid to the bioethics of the built environment in healthcare. We all know intuitively that the spaces we spend time in affect us, and while some intrepid healthcare architects have been exploring the power of environmental factors on behavior for decades, virtually none of this terrain has been contemplated in bioethics.

The physical environment in healthcare architecture has been associated with numerous quality and outcomes issues. As we will show, design choices can result in substantive ethical issues for not just the marginalized and vulnerable, but all of us, leading some to call for a shared decision-making in healthcare architecture that mirrors the movement in clinical medicine. In this panel discussion, we will begin by outlining a series of ethical issues in healthcare design, including the use of illusion, living laboratories, and the prevention or imposition of harm through design. We then examine the state of research practices in healthcare architecture: what has been accomplished, what hasn’t, and the challenges that lie ahead. We conclude by inviting the audience to discuss the role of bioethics in healthcare architecture.

Learning Objectives – At the end of this session, attendees will be able to:

  • Discuss the role the built environment plays in wellbeing and medical outcomes and provide several examples.
  • Be familiar with some of the most pressing ethical issues arising out of design decisions in healthcare architecture and be able to describe both evidence-based considerations and theoretical concerns.
  • Articulate the state of research in healthcare architecture, discuss the challenges of implementing modern research practices in ongoing and future work, and the benefits of solving the issues involved.
Conference Presentations

Ethical considerations in nutrition support because of provider bias

June 12, 2020 / Dochitect / Health Design & Ethics

Peer-reviewed publication

Publication: The New Gastroenterologust
Publication Date: June 12, 2020
Authors: Diana C Anderson, David S Seres

Excerpt:

Medicine’s emotive harms
Clinicians hold more negative attitudes toward certain patients – our implicit bias. It has been suggested that nice patients may be preferred by clinicians and therefore receive more humanistic care. Clinicians hold more negative attitudes toward patients with eating disorders than toward other patients.

Cases of starvation caused by eating disorders are often seen by clinicians as a form of deviance, which provokes a visceral reaction of anger and frustration. These reactions have been associated with patients’ lack of improvement and personality pathology and with clinicians’ stigmatizing beliefs and inexperience. One could argue that this type of unconscious partiality may be worse than intentional harm.

Read the full case report and ethics discussion HERE.

Peer-Reviewed Publications

Fix Room 16! Designing Healthcare Facilities to be More Resilient & Equitable

May 28, 2020 / Dochitect / Design for Clinical Staff, Design for Infection Control, Design for Resiliency, Health Design & Ethics, The Physician-Architect Model

Presentations

Title: Fix Room 16! Designing Healthcare Facilities to be More Resilient & Equitable
Podcast: Design is Everywhere, Design Museum
Date: May 28, 2020

This is one of the main reasons we’re quarantined, not just to keep ourselves safe from the virus but also to “flatten the curve,” and help our hospitals keep up with a growing number of cases. On this episode we talk about how hospitals are designing solutions for surge capacity and what lessons there are for the future of hospital architecture. Those lessons could be very important as we may see new spikes in COVID-19 and as we must adapt facilities to be equitable for all patients, healthcare workers, and staff. We’re joined by Dr. Diana Anderson, a doctor architect, or Dochitect, currently a geriatric medicine fellow at the University of California, San Francisco; and Dr. Esther Choo, she’s an emergency medicine physician and health services researcher based in Portland, Oregon at Oregon Health & Science University, and she’s the chief medical advisor for a startup called Jupe, which is creating pop-up medical facilities. Plus our weekly dose of good design.

Dochitect co-hosts the Design is Everywhere podcast! Listen HERE.

Podcasts

Covid-19: pandemic healthcare centres should have already existed

April 30, 2020 / Dochitect / Design for Infection Control, Design for Resiliency, Health Design & Ethics, The Physician-Architect Model

Letters to the Editor

Publication: BMJ, Letters to the Editor
Publication Date: April 30, 2020
Authors: Neel Sharma & Diana Anderson
View Letter

Covid-19: pandemic healthcare centres should have already existed

Excerpt: Too little too late are the words being uttered by medical professionals in both the UK and US at the rising numbers of confirmed covid-19 cases and deaths.1 Healthcare architects and engineers support these sentiments given the frantic scramble for adaptive reuse of existing spaces to deliver care.1 Knowing weeks in advance of the global spread of this virus did little to spark momentum in the US and UK health systems to prepare early for what lay ahead.

Read the Letter HERE

Letters to the Editor

Healthcare Architecture: A Moral Imperative

January 31, 2020 / Dochitect / Health Design & Ethics

Presentations

Event: Johns Hopkins Berman Institute of Bioethics – Seminar Series
Title: Healthcare Architecture: A Moral Imperative
Date: January 31, 2020

There is increasing recognition and understanding of the impact built space has on people.

Healthcare architecture has strongly advocated for patient-centered design, but can the resulting concealment of clinical spaces devalue the role of medical professionals? With a recent paradigm shift towards design quality measurement, has the social responsibility of health architects changed?

Obligations to develop an ethically-based framework to structure design decisions and allocation discussions in healthcare architecture are explored.

 

Keynote Presentations, Lectures

Ethical Dilemmas in Dementia Care Design

January 31, 2020 / Dochitect / Design for Geriatrics, Health Design & Ethics

Blog Post

Publication: CLOSLER.org, Johns Hopkins Medicine
Title: Ethical Dilemmas in Dementia Care Design
Publication Date: January 31, 2020
Author: Diana Anderson, MD

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The Seven Lamps of Architecture, written in 1849 by the English art critic and theorist John Ruskin, embodies the principles that good architecture must meet. One of the lamps is truth. Do our dementia care designs break this core architectural value?


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

Blog Post

Healthcare Interior Design 2.0 Podcast

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

Presentations

Podcast: Healthcare Interior Design 2.0
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.

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Recent Articles/Publications

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

    January 13, 2021
  • How will COVID-19 Change Healthcare Design?

    January 1, 2021
  • JHD Editorial – Widening the lens: Clinical perspectives on design thinking for public health

    November 25, 2020

Recent Presentations

  • Tulane School of Medicine: Architectural Design as a Determinant of Health

    January 14, 2021
  • AWMA Thinking Beyond the White Coat: Medical Hybrid Careers

    January 9, 2021
  • LiftOff 2020: Health Equity by Design

    December 15, 2020

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