Dochitect
Menu
  • Home
  • Dochitect Bio
  • The Physician-Architect Model
  • Articles & Publications
  • Presentations
  • In the News
  • Contact

Health Design & Ethics

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

View Blog Post

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

View Blog Post

“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
Author: Diana Anderson, MD

View Blog Post

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

 

 

 

Click HERE to read the full article

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!

Peer-Reviewed Publications
12

A Book from Dochitect

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

Find out more here.

Search

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

Publication Type

  • Blog Post
  • Book
  • Book Chapter
  • Book Review
  • Commentaries
  • Letters to the Editor
  • Peer-Reviewed Design Guidelines
  • Peer-Reviewed Publications

Presentation Type

  • Conference Presentations
  • Keynote Presentations
  • Lectures
  • Panel Discussions
  • Podcasts
  • Webinars

Design Topics

  • Commentaries & Event Reviews
  • Design for Clinical Staff
  • Design for Critical Care
  • Design for Geriatrics
  • Design for Infection Control
  • Design for Palliative Care
  • Design for Patient Safety
  • Design for Resiliency
  • Design for the Future of Health
  • Dochitect in the News
  • Evidence-Based Design
  • Health Design & Ethics
  • The Physician-Architect Model

Archives

Follow Dochitect

Follow me on:

** ©2022 Dochitect :: Site by KPFdigital :: Admin Login