Evidence-based design a new protocol for hospital building

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An architectural movement is re-imagining the historically austere hospital of the past into a new building that brings in sunlight and nature, welcomes family and friends, and puts patients in charge in as many ways possible.

The movement, called evidence-based design, is influencing the construction of hospitals and medical buildings across the nation, including Northeast Florida.

"It's been an emerging field for 20 years, but it's moving toward the industry standard," said James Kolb, a senior health care designer with Gresham, Smith & Partners in Jacksonville. Kolb worked on the design of the recently-built Baptist Medical Center South, which incorporates evidence-based design. "Most of the new hospitals are being built with these considerations," he said.

The emerging philosophy takes a new, scientific approach toward health care design. It utilizes data from hundreds of existing studies that meet the criteria of scientific investigation, Kolb said. For example, he noted one study as early as the 1980s found that giving patients a view of a distant vista rather than a brick wall reduced their recovery time by 25 percent. Simply providing such a vista also is proven to reduce patient complaints for ailments such as nausea, thereby decreasing medication use, Kolb said.

Researchers from Texas A&M University and Georgia Tech University performed an analysis of hundreds of studies a few years ago for The Center for Health Design, a nonprofit organization based in Concord, Calif. They found a direct link between hospital construction and patient outcome, according to the Robert Wood Johnson Foundation, which has helped fund some of the center's efforts and supports the use of evidence-based design.

For example, patient falls declined 75 percent at an Indianapolis cardiac critical care unit after nursing stations were spread out and placed near patient rooms. And medical errors dropped by 30 percent on two units of a Detroit hospital that incorporated more space -- and noise-reducing features -- for medication rooms.

The researchers suggested hospitals will see improvements for both patients and staff if they invest in such design features as single-patient rooms, sound-absorbing carpet and ceiling tiles, brighter lighting and better interior design. Evidence-based design is "used to create environments that are therapeutic, supportive of family involvement, efficient for staff performance, and restorative for workers under stress," according to the center, which offers workshops on the process.

At Baptist South, virtually all the emergency room exam rooms have windows and the building incorporates three gardens. Baptist South Administrator Ron Robinson said research about healing environments factored into planning. From the landscaping and oversized windows to the use of natural-looking materials in earthtone finishes, the hospital intends to give patients the atmosphere of a resort, he said.

Allowing family and friends to be nearby is shown to improve patients' health, so designers are finding ways to make visitors comfortable and welcome. All the Baptist South rooms are private and offer oversized bathrooms, Internet access, movies, and daybeds and refrigerators for families' convenience. The hospital offers separate areas with washers, dryers and microwaves "that allow the families to continue keeping their batteries charged, so to speak," Robinson said.

Another key to evidence-based design is patient empowerment, which is shown to reduce stress, Kolb said. Architects are working to give patients some control through designs that help them move around a building without getting lost. Among other features, the designs let them control their window blinds or room lighting from their bed instead of relying on someone else. Baptist South incorporates those features as well, Robinson said.

"Positive distractions" also are built into evidence-based design in the form of particular types of artwork and music that take a prominent role in the building's overall atmosphere. "There is a strong body of evidence demonstrating how it improves patient outcomes," Kolb said.

Since evidence-based design is more easily applied to new construction than to existing, older buildings, the movement is a slow process, Kolb said.

However, the American Society of Interior Designers' Florida North Chapter won an ASID national community service award this year for its design of a new space within the Aetna Building for a Wolfson Children's Hospital clinic.

About a dozen interior designers worked on the project, spending a year just in planning meetings with Wolfson staff, said Madeline Osiecki, a licensed interior designer who oversaw the project during her service as the ASID chapter's director of professional development.

"Science moves so quickly, and methods change so quickly, that you depend on the staff to tell you what they need," said Osiecki, who has had years of experience in health care design.

The Drew Bradbury Center, now the primary Wolfson rehabilitation site for occupational, speech and physical therapy, was named for a patient who died of cystic fibrosis and whose family gave a $1 million gift to help fund the project. The family wanted the center to promote the wellness of family members, particularly siblings, as well as patients, Osiecki said.

The team created park-like settings that offer child-friendly activities such as a jungle gym and a fishing pond while parents sit on nearby park benches. The result, Osiecki said, is a better experience for patients and families.

"It's an ongoing battle to get people to understand that their surroundings affect who they are and what they do," Osiecki said. "These are things we've recognized over time and now they're actually documenting. The evidence is there."

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