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Architecture and design get new focus in safety and quality of patient care |
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Architecture and design can have significant effects — good or bad — on people’s health and health care, a fast-growing body of research has found. Those studies point to a disturbing conclusion: Too many health care facilities are built all wrong, making patients sicker, slower to improve — and even killing them. It’s a view that the coronavirus pandemic has only reinforced. Long before the pandemic, Dr. Druv Khullar, an M.D. and M.P.P. at Massachusetts General and Harvard Medical School, wrote a trenchant Op-Ed column in the New York Times. He argued that the bean-counting financial types who run hospitals must stop thinking about architecture as an aesthetic or “trophy”-creating concern. Instead, he emphasized the significant harms that patients suffer in hospitals, most notably due to infections acquired there. Hospital-acquired infections (HAIs) add to the woes of hundreds of thousands of already ailing patients annually, and they’re part of the broader problem of medical errors, which some experts estimated in pre-pandemic times claimed 250,000 lives annually and may be the No. 3 killer in this country. As Khullar noted, hospitals could achieve sufficient cost-savings with reduced HAIs alone, so that they could put all patients in single rather than shared rooms. These would give doctors and patients greater privacy, comfort, quiet and calm, and lessen infections’ spread. (Separate research, for example, has found that curtains that screen patients can themselves be germ-ridden, with one California hospital finding that a third of them in use there carried multi-drug-resistant bacteria.) Further, by rethinking the solo suites’ design, hospitals could make rooms safer from the growing problem of patient falls: Bathrooms could be built nearer to beds and be made more navigable with handrails. By starting from scratch in designs, other research has found, hospitals could create adjacent rooms in mirrored fashion, sufficiently alike left and right, so important medical equipment in the suite would be better positioned and in places instantly familiar to staff to avert error. Better designed rooms also would relocate and improve their sinks, both in patient bathrooms and for caregivers to wash their hands — a major way to reduce hospital infections. More attention must be given to hospital sinks, other research shows. That’s because fatal infections, such as an outbreak at the National Institutes of Health clinical flagship in Bethesda blamed in the deaths of 11, may be tied to persistent bacteria flourishing in hospital plumbing and splashing up from sinks. Khullar says that redesigned hospitals could better position nursing stations with clearer sightlines into multiple patient rooms, lessening the need for the many noisy electronic alarms with which so many medical devices now are armed. Better design would eliminate hard, slick hospital floors that may be easier to clean but also contribute to falls and add to hospital clatter. (Hospitals are trying to help patients by quelling noisy environments to give them peace and quiet to get a decent night’s sleep.) During the pandemic, news articles have reported how doctors and hospitals were and will be forced to rethink an array of institutional design issues, notably ventilation, quarantine capacity, infection control, and the inflexibility of spaces in many fancy, giant buildings. When trying to treat overwhelming numbers of very sick patients, many hospitals came close to collapse, partly because they were designed when policy makers sought to slash capacity — keeping costly beds at the lowest numbers possible. That meant too many hospitals had become sealed fortresses to handle fewer, specialized, and complex cases — forcing the virally ill to wait in halls, jammed waiting areas, and worse. The pandemic will force politicians, doctors, and hospitals to reconsider whether networks of satellite centers — for surgical procedures and urgent and emergency care — provide sufficient facilities for future situations involving mass treatment. By the way, the pandemic has made painfully clear that giant nursing homes and other long-term care facilities, towering facilities packed with residents in hopes of making business operations run more efficiently, also demand changes. These were outlined in a expert research investigation by the National Academies of Sciences, Engineering, and Medicine As the Associated Press reported, quoting David Grabowski, a nursing home expert and Harvard Medical School professor: “Among the more routine subjects in the report, but one that nonetheless impacts residents’ everyday lives, the authors call for homes to prioritize private rooms and bathrooms, instead of the communal ones that can fuel infections and underscore the institutional setting. And in a blunt reminder of how bleak life in nursing homes can be, the report notes most residents spend ‘little if any time outdoors,’ calling for facilities to make outside access more accessible. The proposals, Grabowski said, have the potential to improve the days of residents who, even when they are having their basic medical needs met, are frequently lacking in other areas of their lives. ‘I think the average nursing home resident has an OK quality of care but a poor quality of life,’ Grabowski said.” |
Nature has deep roots in keeping people well |
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Take a hike! Stroll through a nearby park. Pad around a beach, lake, river, or stream. Bike through the hills. Meditate in the wild. No matter how folks choose to do it, getting into the great outdoors for 120 minutes or so each week — indulging in what the Japanese call shirin yoku or “forest bathing” — can benefit your health. This is what British researchers found in their meta-analysis of almost 150 studies published in medical journals and examining the health benefits of those who are exposed to green spaces: “[Our] review suggests that green space exposure is associated with wide ranging health benefits, with meta-analyses results showing statistically significant associations with reduced diastolic blood pressure, heart rate, salivary cortisol, incidence of type II diabetes and stroke, all-cause and cardiovascular mortality, as well as health-denoting associations with pregnancy outcomes, [heart-rate variability], and HDL cholesterol, and self-reported health ….” The New York Times reported that clinicians in nations around the globe are prescribing outdoor time in response to patients’ various health conditions: “In Sweden, friluftsliv, the term for living close to nature, is so ingrained in everyday life — from commuting by bike to relaxing in lakeside saunas — that there are tax breaks offered as incentives for the lifestyle. In South Korea, the government is establishing dozens of “healing forests” for its stressed-out citizens. And last year, NHS Shetland, a national hospital system in Scotland, began allowing doctors at some medical practices to write scripts for outdoor activities as a routine part of patient care.” Dr. Qing Li, an MD and PhD who practices in a Tokyo hospital, has written a book on Japanese forest bathing, describing it in a Time Magazine article: “So how does one go about forest bathing? First, find a spot. Make sure you have left your phone and camera behind. You are going to be walking aimlessly and slowly … Let your body be your guide. Listen to where it wants to take you. Follow your nose. And take your time. It doesn’t matter if you don’t get anywhere. You are not going anywhere. You are savoring the sounds, smells and sights of nature and letting the forest in … Let nature enter through your ears, eyes, nose, mouth, hands, and feet. Listen to the birds singing and the breeze rustling in the leaves of the trees. Look at the different greens of the trees and the sunlight filtering through the branches. Smell the fragrance of the forest … Taste the freshness of the air as you take deep breaths. Place your hands on the trunk of a tree. Dip your fingers or toes in a stream. Lie on the ground. Drink in the flavor of the forest and release your sense of joy and calm. This is your sixth sense, a state of mind. Now you have connected with nature. You have crossed the bridge to happiness.” Those with appropriate skepticism about touchy-feely interventions also can consider that the importance of exposure to nature is informing experts’ rethinking of the design of hospitals and other health care facilities, as Dr. Druv Khullar, an M.D. and M.P.P. at Massachusetts General and Harvard Medical School, reported in an Op-Ed column in the New York Times: “Some of the most interesting research on the way hospitals are built examines the role of nature to promote healing. Research pioneered by Roger Ulrich, now a professor of architecture at the Center for Healthcare Building Research at Chalmers University of Technology in Sweden, suggests that when it comes to recovering from illness, the more nature the better. But too often patients and physicians find themselves cooped up in dim rooms and sterile hallways with little access to natural light or views of nature: too much concrete, not enough jungle. Dr. Ulrich’s early work explored how patients recovered after gallbladder surgery based on whether they were assigned to a room with a window that had a view of nature or of a brick wall. The study, now one of the most widely cited in the hospital design literature, found that patients looking out at trees had shorter hospital stays and took fewer pain medications than those viewing a brick wall … “Similar research has found that patients with bipolar disorder who are randomly assigned to brighter, east-facing rooms with morning sunlight had hospital stays nearly four days shorter than those with west-facing rooms. Even just images of nature may be beneficial. One study found that psychiatric patients tend to require far fewer medications for anxiety and agitation when photos of landscapes hang on hospital walls compared to walls adorned with abstract art or left bare.” |
Recent Health Care Blog Posts |
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Here are some recent posts on our patient safety blog that might interest you:
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HERE’S TO A HEALTHY 2022!
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Sincerely,
Patrick Malone |
