The new LSU hospital facility expected to replace Charity in downtown New Orleans isn't scheduled to open until 2012, but the design team already has been selected. Among the many contributors to the project is Richard Dallam, partner at NBBJ, an architecture firm in Seattle. Focusing on health-care structures, he has seen how a good layout can equate to better patient outcomes. Here he discusses the nature of space and healing in hospital design.
Q: What is the relationship between space and health?
A: There are clearly things you can do [in] architectural design to affect patient outcomes. We design a building around sustainable design principles. This entire [NBBJ] building is designed around daylight, fresh air and air flow ... You can go back to Florence Nightingale and see she talked about two things: fresh air and daylight. It was very forward thinking. People have connected the notion of space and healing for a long time.
Q: How can you design a hospital to improve patient outcomes?
A: One of the things you can do is essentially improve proximity of care delivery to patients. The more a care deliverer has to walk to a patient, the more time is wasted. The No. 1 satisfier of a patient is time spent with a care deliverer. It's the concept of "lean," looking at how you satisfy what your customer wants and how delivery moves. Follow the flow. Where are the supplies? Where is the medication? Where do they chart? Where is the patient?
If you look at the outside, programming the outside is just as important. You can design gardens where people can take their first steps outside. It provides a physical distraction for family and a respite for staff. ... If you have unhappy, dissatisfied staff, you'll have unsatisfied patients and family. You've got to serve all of them.
Q: How can a building design prevent the spread of MRSA (a staph infection) or other hospital-borne infections?
A: Hand hygiene is an important feature in that. How you design a space to encourage good hand hygiene can be planned. There are ways you can conveniently place sinks and other things that help ensure good hand hygiene. Here's another interesting issue: When you look at the spread of infection, you have to look at where the biological load (bacteria, virus or infectious agent) is. When I touch something with a biological load and touch something else, that can spread it. We know the floor can have a high biological load. If you move a computer on wheels from one room to another ... you're transferring biological load from one room to another with something you touch with your hands. We're not fans of using computers on wheels.
Q: What are some of the trends you're seeing in hospital design?
A: The trend has been to single patient room care. That has its benefits. One is the control of the spread of infection and another is dealing with incompatible patients. ... From a facilities perspective, it's more expensive because it takes more space. But what it also means is families can isolate themselves in a room. Patient families who used to get informal counseling or support in waiting rooms don't have that. How do you get social space integrated to actually increase socialization? Social healing is as important as physical, mental and spiritual healing.
People are beginning to understand again that hospitals are a community anchor that are going to be there for the next hundred years, and they need to be thought of that way.
Q: How do you research what works best?
A: We embed ourselves with all the different stakeholders. ... Part of that is to help us go in and do participatory research. I spent seven months mirroring a neuro-orthopedic practice so I could physically feel what they were going through and observe as an outsider. What it allows us to do is create a common ground of experience.
Q: What were some of those observations?
A: The No. 1 dissatisfier to patients is noise. ... I sat with a patient for eight days in the neuro-orthopedic unit. Their sleep would get interrupted, which slowed the healing process, which caused them to get more sedation, which further slowed the healing process.
I mirrored one physician and he didn't sit for 12 hours. You just think, "We need to do something as a designer to fix this."
One of the things we look at is turnover time (how long it takes to clear, clean and prep a surgical suite). One of the things we observed is physicians are doing their charting in the surgery site after the surgery. We created a place off a corridor with daylight overlooking a garden for them.
Q: What of this can be applied to other forms of commercial or residential architecture?
A: Make sure you have operable windows and allow for cross ventilation. Depending on where you're located, protect from sun when you need it and allow it when it's appropriate. Look at the orientation and shape of buildings. Heat gain will mean cooling, and cooling will mean more energy. Landscape outside for shading, seasonal shading. Then there's the issue in commercial or residential of places of respite. How do you think about where you give yourself a mental, spiritual, emotional or physical break? Being able to see the change in weather is a positive thing.