Daily Briefing

'The future of hospitals': How health systems are remodeling for the next crisis

After struggling to handle an overflow of patients during the pandemic, many hospitals are now remodeling to help them prepare for future crises, Debra Kamin writes for the New York Times.

How traditional hospital design hindered care during the pandemic

According to Kamin, traditional hospital design typically has separate, specialized areas for the most vulnerable and contagious patients. These areas also have features that are not usually found in regular inpatient rooms, including changeable airflow systems; headwalls for electric, gas, and equipment mounts; and more space for specialized equipment, such as ventilators.

During the pandemic, there were not enough of these specialized spaces, and many hospitals had to scramble to make room for sick patients and ration necessary equipment. In the early months of the pandemic, many hospitals had to set up overflow tents in parking lots to handle the sudden surge of Covid-19 patients.

With the way many hospitals are currently designed, ICUs often did not have enough beds, healthy and sick patients were forced to be in the same hallways and waiting rooms, and ventilation systems "became conduits for airborne pathogens," Kamin writes.

"The general sense that I get is that this is not a one-time situation that we just went through with Covid," said Jocelyn Stroupe, co-director of health interiors for CannonDesign. "It's just one of many infectious disease conditions that we're going to be experiencing in the coming decades."

Hospitals turn to more flexible spaces to prepare for the next major crisis

To better handle new crises, many hospitals are now choosing to remodel their spaces with more flexible designs, which will allow them to adapt areas for different purposes at different times as needed.

For example, many designers are now considering how to quickly convert traditional inpatient rooms to isolation wards as needed. Some changes include upgrading or replacing heating, ventilation, and air conditioning systems, using more durable materials that can hold up against industrial-level cleaning, and pathways that will allow specialized spaces to be isolated if needed.

"When the pandemic came along, it really changed the lens of how we do health care design," said Nicholas Holmes, COO of Rady Children's Hospital in San Diego, which is currently undergoing a $1.2 billion remodel of its campus. "And what we learned over the past few years, first and foremost, is to be as flexible in the design process as we can."

Initially, Rady had designed a rectangular floor plan for a new seven-story tower that will house an ICU and ED, but designers have since moved to an X-shaped design. In the new design, the tower will have 60 beds that can be converted into 20 fully isolated rooms for contagious patients if needed.

"Rather than looking at it on a single-room basis, when you think about maximum flexibility, you think about banks of rooms," Holmes said. "Seeing it through that lens allows you to not have to transfer patients who are moderately sick into critically intensive care units."

Other organizations that have also embraced flexible design in their spaces include Doylestown Hospital, Barnes-Jewish Hospital, WellSpan Health, Ballantyne Medical Center, Grady Memorial Hospital, and CHA Hollywood Presbyterian Medical Center.

Many of these hospitals have added new rooms that can transition into ICU areas, increased the size of their rooms to have more space for extra equipment, and improved their ventilation systems to prevent harmful airborne particles from entering other areas.

"The pandemic proved the need to have flexible space," said Jim Brexler, CEO of Doylestown Health. "The impact of having adequate critical care space was essential, and you don't want to build all that out and not be able to use it for other purposes."

"This is the future of hospitals," he added.

According to John Swift, who leads the health care sector at Buro Happold, an engineering and design consulting firm, this shift to flexible design has not been limited to hospitals. "We're seeing these trends not just in health care but in all the facilities we do work in, from laboratory buildings to institutional buildings on college campuses," he said.

Over time, experts believe that modifications inspired by the pandemic are likely to be written in law, much like those that guarantee access for people in wheelchairs and structural requirements for earthquakes.

"This is no different from the code updates we go through every time there is an earthquake in California," said Carlos Amato, a health care architect with CannonDesign. "The lessons learned postpandemic will eventually make it into building codes." (Kamin, New York Times, 9/13)

Advisory Board's take

Facility flexibility is just one piece of the broader resilience puzzle

By Lauren Woodrow

Like with many aspects of the health care industry, Covid-19 exposed vulnerabilities in how our health care facilities respond to a global pandemic. Organizations could not rapidly scale capacity or effectively isolate patients, resulting in quick building retrofits or pop-up hospitals in convention centers or field tents. When Advisory Board spoke to architecture firms during the peak of the pandemic, one principal told us, "A health system came to us and asked if we could put together a plan for how to turn their parking garage into patient care space in 48 hours."

Flexibility is an important piece in the future of facility design, but I'd argue that it falls under a broader category of facility resilience. Covid-19 is certainly not the last major emergency we'll face in our lifetimes. But we're also facing widespread health inequity as well as a climate change crisis. We need facility design that:

  1. Ensures adequate capacity across facilities
  2. Protects patient and staff safety
  3. Safeguards patient access and advances health equity

Building completely new facilities is not always an option for a variety of reasons but namely capital budget constraints. A few ways leaders can weave resiliency into their existing facilities are:

  • Look to organizations like the CDC and WHO for guidance on how to adapt facilities to accommodate additional patients. These organizations provide ongoing guidance for emergency preparedness planning. During Covid-19, they also released guidelines on where and how to set up alternative care sites, necessary facility modifications to best care for patients, and how to set up an Incident Command System to achieve continuity of essential services while caring for patients during the pandemic.
  • Rethink patient and staff flow through facilities. Many facilities were designed with multiple entrances and opportunities for movement to create a welcome atmosphere for patients. In a pandemic, facilities should have plans to limit movement and clearly signal one-way passageways or different levels of infection control zones. Minimizing the number of times a person travels through a hallway and reducing two-way traffic are both opportunities to limit disease spread.
  • Reimagine the use of waiting rooms. Waiting rooms present a challenge during a pandemic, as they are large spaces where people congregate. While there are many strategies to reduce the use of waiting rooms, these spaces do represent an important access point, especially for patients who take public transportation or do not have private vehicles. These patients may arrive at the facility early, and waiting spaces represent a safe place protected from the elements for these patients. Rather than eliminating waiting rooms, facility designers need to reimagine the space. That could mean larger waiting rooms to allow for social distancing requirements or more smaller waiting rooms to reduce the number of people in each one.







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