Health care leaders are increasingly recognizing the important role hospital architecture plays in patient experience and outcomes, Cheryl Heller, founding chair of the first MFA program in Design for Social Innovation at the School of Visual Arts, writes, for Harvard Business Review.
For patients, facility design makes a difference
In the past, factors such as room layout and equipment volume weren't "considered predictors of health outcomes," Heller writes. But the rise of social design is changing that mindset, Heller contends. She explains "social design addresses the needs of whole communities or societies." For a hospital, Heller writes, that "means reimagining the role a building can play in the health of its inhabitants" and the surrounding locale.
Take, for instance, work done by MASS Design Group, a nonprofit architecture firm, and the Delivery Decisions Initiative at Ariadne Labs, a partnership between Brigham and Women's Hospital and the Harvard T.H. Chan School of Public Health, to get to the bottom of one pervasive public health issue: Unnecessary caesarean deliveries.
After a one-year investigation into the layouts of 12 facilities, including unit scale and room scale, researchers with MASS and Delivery Decisions Initiative found that the hospitals with more operating rooms, but fewer labor rooms performed more C-sections, Heller writes.
The 4 key principles of social design
But before hospitals can effectively integrate "social design" into their facility planning, they must understand four key principles, Heller writes.
1. Your visions should reflect your end goal
When building or redesigning a health facility, architects and health care leaders need to acknowledge and prioritize the objective: delivering better care. Traditionally, hospitals have been designed to deliver "more health care," according to Neel Shah, director of the Delivery Decisions Initiative. But Heller explains the focus on "more" rather than "better" care results in facilities with a lot of private rooms, beds, and very little space to move around. Through social design architects and leaders of health organizations are realizing that designing facilities with space for patients to move and interact is crucial to the objective of delivering better care, Heller writes.
2. Look for people who think differently
"Patients, families, physicians, nurses, administrators, and architects look at issues through different lenses," Heller writes, adding, that each of these perspectives is "important." As an example, Heller cites MASS' work at Butaro District Hospital in Rwanda. She explains that it was stakeholder input lead the hospital to break from the traditional room layout to give patients window views.
3. Find the invisible—and make it visible
When you recruit players with differing perspectives to solve a problem, "[d]rawing is the only reliable way to make sure diverse people are seeing the same thing," Heller writes. Maps of the facility used for research or redesign should include staff and patient flow, room layouts, and interactions. She explains, "An architect's instinct to measure size and traffic flow in labor units helped make the causes of the C-section epidemic visible."
4. Keep experimenting
Heller cautions against habitual planning, as it "almost inevitably stifles ongoing innovation." She writes, "Planning builds in assumptions about the future at a time when things change faster than ever—in health care no less than in other areas of our lives." She continues, "Counterbalance long-term planning through constant experimentation that proceeds on the belief that complex problems can be unraveled and innovation hastened by really listening to feedback gleaned from prototypes that keep designers' work connected to the needs of the communities they serve" (Heller, Harvard Business Review, 10/15).
Advisory Board's take
Jessica Liu, Practice Manager and Viggy Parr, MPH, Senior Analyst, Facility Planning Forum
"Social design" is not just a buzzword—hospitals and health systems are actively looking for ways to construct visually appealing yet operationally efficient facilities. A recent survey of providers revealed that one of their top facility planning priorities is the ability of the design to improve workflow and efficiency.
Providers are increasingly partnering with architects and design firms to make this goal a reality. For example, CannonDesign and the University of Minnesota Health System recently worked together on a new ambulatory care center that completely rebuilt the check-in process from the ground-up. Instead of long lines at registration and stuffy waiting rooms, Cannon designed mobile concierge kiosks, a variety of wait areas where patients could wander freely, and screens with real-time updates of provider whereabouts and delays. These design features improved operations and patient satisfaction—and led to a 14% growth in new patient volumes.
“These design features led to a 14% growth in new patient volumes.”
The push for social design is perhaps strongest in the behavioral health space, where design must be not only social, but also safe. Forward-thinking providers have tackled this challenge in a variety of ways, such as incorporating a "Main Street model" into their facilities. In the Main Street model, patient rooms are interspersed with common residential features, such as gyms, libraries, salons, and general stores. This type of design encourages social interaction and provides a sense of normalcy which can speed patient healing.
The key to successful social design is to consult a variety of stakeholders and carefully consider how patients will actually engage with the facility. Is patient check-in an issue? Set up a mobile kiosk. Will behavioral health patients feel disconnected from everyday life? Incorporate residential elements into the design. As Cheryl Heller points out in this article, this outside input is key to achieving meaningful change.
To view more examples of providers that have successful paired innovative design with healing, view our interactive map of the facilities featured in our Architectural Design Showcases.
Then, learn more about how to incorporate social design thinking into behavioral health facilities—including the five core design characteristics essential to new era behavioral health environments—by reading our briefing on How Healing Design Can Overcome the Security-Comfort Tension.