How to future-proof your hospital with evidence-based design

Dec. 18, 2018

Improving the design of healthcare environments today is about much more than prettying up the scenery, although that’s important. Industry research and real-life examples offer growing proof that evidence-based design (EBD) can tangibly enhance patient outcomes, the patient experience and a hospital’s bottom line.

The trend of basing design decisions on credible research to achieve optimal results is yielding significant benefits. These advantages span areas including patient safety, quality of care, medication use, recovery and readmission, as well as staff satisfaction and hospital costs.

Contrary to common concerns, you can expect favorable ROI. According to the AHRQ report on “Transforming Hospitals: Designing for Safety and Quality,” features that added $12 million to hospital construction costs were projected to be recovered in one year, all through operational savings and increased revenue. EBD is ushering in a simpler design process, saving staff time, promoting risk avoidance, and creating efficiencies.

Tackling toughest challenges

 The AHRQ report revealed that EBD gives hospitals an opportunity to overcome stubborn issues, including:

  • Patient falls: By 2020, the annual cost of patient falls for the elderly population alone will exceed $30 billion, AHRQ predicts.
  • Hospital-acquired infections: HAIs have been estimated to add eight to nine days to a patient’s hospital stay and to cost facilities nearly $10 billion a year in treatment, often without insurance reimbursement.
  • Medication errors: Adverse drug events, many caused by human error, can be fatal or delay recovery. These mistakes have been estimated to cost facilities up to $5.6 million per hospital per year – not counting reputational damage from negative word of mouth and online reviews.

 How EBD helps

 Here are some examples of how even small design changes can produce better outcomes:

When it comes to preventing falls, watching how patients navigate a room can offer clues. Debajyoti Pati, a professor in the College of Human Sciences at Texas Tech University, Lubbock, led a study that did just that. His team had patients over 70 years old interact with a model hospital room and bathroom while connected to motion-capture technology. (The subjects were attached to harnesses to prevent falls and injuries.) The research identified pushing, pulling, turning and grabbing as actions most apt to cause falls. Design culprits included bathroom configuration, bathroom doors, toilet seats, grab bars, toilet flush handles, and obstructions along the path to the bathroom. One recommendation: Design a bathroom to reduce turns.

Lighting improvements are critical for averting falls – and provide other benefits. Interestingly, researchers at The Center for Health Design found that natural light can reduce pain, leading to a 21 percent decrease in medication costs. This reduction is connected to faster discharges and higher hospital reimbursement potential. A factor: Views of the outdoors can foster positive emotions and distract patients from pain, leading to less use of medication.

Private rooms, no longer perceived as a luxury, are an increasingly popular antidote to infections. Studies show that each exposure to a new hospital roommate increases the risk of certain infections by 10 percent or 11 percent. In a five-year period after opening a single-occupancy-only ICU, Montreal General Hospital saw MRSA, C. diff, and vancomycin-resistant Enterococci infection rates drop to 54 percent lower than at a nearby hospital’s similar ICU with a mix of private and shared rooms.

Dublin (Ohio) Methodist Hospital also has used private rooms to upgrade infection control and more. Single rooms result in fewer transfers, reducing the risk of falls, increasing patient comfort (better rest and family visits without noisy neighbors), and saving staff time. Dublin’s acuity-adaptable model of care keeps patients in the same room until discharge, regardless of their treatment. With flexible rooms, the hospital doesn’t have a separate medical floor, surgical floor or ICU. Medical equipment and nurses are brought to the patients rather than vice versa.

The transition to private rooms is leading to another change with its own advantages. Patients in single rooms may be farther from medications, creating extra work for nurses and increasing chances for errors. The solution: Decentralize medication storage, and outfit each patient room with a small, locked cabinet for medication. This makes medication administration more efficient, as well as more accurate, with patients’ meds far less likely to be mixed up. When Clarian Health Partners (now Indiana University Health) replaced its multi-level ICU with variable acuity-adaptable rooms, each with its own locked medication cabinet, medication errors plunged by almost 70 percent.

EBD provides numerous opportunities to enhance staff well-being and experience, with related business results. For instance, ceiling lifts can help hospitals address the leading cause of employee back injuries: lifting and transferring patients. By installing lifts, Sacred Heart Medical Center at RiverBend in Springfield, Oregon, almost eliminated such injuries. The lifts paid for themselves in two years, thanks to reduced workers compensation claims. In addition, decentralized workstations bring nurses, physicians and suppliers closer to patients. This streamlines workflow and boosts workplace satisfaction, turning EBD into a recruiting tool.

How to get started

These examples only scratch the surface but demonstrate how EBD is key to future-proofing your hospital. Considering the industry direction and potential gains, every healthcare facility should be open to implementing EBD in at least some respects.

So, how can your hospital get on board?

The Center for Health Design lists these steps:

  1. Define evidence-based goals and objectives.
  2. Find sources for relevant evidence.
  3. Critically interpret relevant evidence.
  4. Create and innovate evidence-based design concepts.
  5. Develop a hypothesis.
  6. Collect baseline performance measures.
  7. Monitor implementation of design and construction.
  8. Measure post-occupancy performance results.

To ensure success, it’s essential to prepare your staff to embrace EBD. Engage stakeholders as early as possible. Take the time to form a diverse team that includes architectural and construction professionals, designers, patients, caregivers, facilities operations people, advocacy groups, and support services professionals, as well as the C suite.

And above all, focus on value to help build a dynamic hospital ready to face the challenges that are transforming the healthcare space.