4 Healthcare Leaders Discuss Evidence-Based Design: An HCE Original Report

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healthcareix-itunes-artworkIn many of the conversations HCE has with healthcare leaders, the topic of evidence-based design (EDB) frequently enters into discussions about construction and expansion projects. For our latest HCE Original Report, we decided to explore this trend a little deeper.


Below are four perspectives on how evidence-based design has been incorporated into even the most routine healthcare construction projects. In the process, EDB has reinvigorated how hospitals and healthcare facilities envision the purpose of the structures in which they’re housed.


Bill Cunningham, Campus Architect at Weill Cornell Medical College in New York, N.Y.

NewYork-Presbyterian/Weill Cornell Medical Center recently completed the Weill Greenberg Center at the Weill Cornell/New York Presbyterian Medical Center. Prior to entering the programming phase of the project, campus architect Bill Cunningham and his team consulted surveys, some conducted with assistance from Press Ganey, of the patients, physicians, and staff.

“We were able to use the data we collected from those surveys as a basis for the programming and then the design of the building,” Cunningham said. “And that really did influence us.”

The surveys revealed several previously unknown facts about Weill Cornell’s patient population. For one, Cunningham said, the geographic distribution of their patients was farther away than the college had assumed. He and his team were also surprised to discover the various transportation modes used to get to the hospital.

As a result, the building was designed to be more automobile-friendly than other facilities located in Manhattan. Feedback from these surveys also affected the building layout and choice of materials.

The decisions implemented on Weill Greenberg have continued to impact other college projects, Cunningham said, such as the satellite clinical facilities Weill Cornell is currently constructing and the recently opened clinical facility on the Upper West Side of Manhattan. Cunningham said the college continues to survey its patients, faculty, and staff, and all Weill Cornell buildings are now required to reach a minimum standard of LEED Silver, in spite of the difficulties in applying these standards to clinical and research facilities.

“I would say that sustainable design and patient-centered design are not mutually exclusive,” Cunningham said. “That, in fact, you can create excellent environments that are both sustainable and are centered around a patient experience and enhance the patient experience and therefore, also contribute to the effectiveness of the treatment they’re getting.”


Mark Haney, Senior Vice President of WellStar Health System in Marietta, Ga., and President of WellStar Paulding Hospital, in Dallas, Ga.

Mark Haney, president of the newly opened WellStar Paulding Hospital in Dallas, Ga., was advised by an executive within the WellStar Health System to join the Pebble Project when planning began on Paulding.

A collaborative based at the Center for Health Design, the Pebble Project includes those hospitals that decide to embrace the general concept of evidence-based design, while contributing their own localized research to the data.

If you cast a pebble in a pond, the Pebble Project’s philosophy goes, the ripples will spread outward and change the pond. In this scenario, the pebbles will be those projects that hopefully change the industry.

Haney said WellStar immersed itself in research prior to designing the new hospital. He and his colleagues visited over 30 hospitals with new projects, evaluating what they liked and what they didn’t like about each one. The entire executive team was then involved in determining what their goals were for the new hospital.

“It wasn’t just repeating what everybody else has repeated,” Haney said. “And to me, that was the game-changer. It’s made the hospital very successful for many reasons.”

Several innovations were incorporated into the final hospital design because of this process. For one, Paulding is heated and cooled by geothermal energy, circumventing the chillers and cooling towers of the traditional energy plant.

“Most of ours is underground using the ground to heat and cool the hospital,” Haney said. “And that was very innovative in the heathcare industry. There are very few hospitals that have committed strictly to geothermal heating and cooling.”

Whereas traditional patient rooms are mirrored, with the head of the bed back-to-back to the next room’s bed since plumbing is only installed in one wall, Paulding instead features same-handed rooms. Every room is facing the same direction so the bathroom door is close to the head of the patient’s bed and the bed’s handrail is between the two. Haney said it has been proven that this will reduce the number of patient falls. The handrail itself has a light in case the patient needs to get up in the middle of the night.

Most of the doors are sliding as opposed to hinged. If a patient starts to fall, the sliding door is more likely to help ease them to the ground. On the other hand, a hinged door is more likely to throw them to the side.

Other features include concentrating most of a nurse’s supplies within the patient room, so the caregiver doesn’t have to leave to retrieve items, and ultraviolet technology in every air handler. Each ultraviolet light is at a level that will mutate the DNA of organisms or viruses, swiftly killing them.

“What the Pebble Project did was open our minds to have us look and say, ‘What can we do that truly is innovative and is going to change the industry and provide quality and safety?’” Haney said. “And to me, joining the Pebble Project was an experience that really challenged us to think differently and be innovative.”


Jocelyn Frederick, Principal at Tsoi/Kobus & Associates in Cambridge, Mass.

As a principal in the healthcare division of architectural firm Tsoi/Kobus & Associates, Jocelyn Frederick approaches evidence-based design from a different angle.

Because it’s difficult at this point in time to quantify the metrics for EDB data, Frederick said she and her firm are focused instead on best practices that produce good outcomes, regardless of whether there’s evidence for it.

“There might be processes in place that inform and improve outcomes,” she said. “What are those? Are they operational or something as simple as the location of handwashing? What are some of the things that are tangible that would help improve patient outcomes rather than saying it’s strictly evidence-based design?”

Part of the reason for this approach involves the various stages in which Tsoi/Kobus’ clients have progressed in their ability to embrace EDB. Some, she said, are in a highly advanced stage, where general issues such as patient safety, reduction in medication errors, and patient-room design are routine. They’re now focusing on specific areas of concern, including lighting, thermal comfort, and acoustics or minimizing noise levels so the staff can concentrate and patients are able to rest more peacefully. These are measures that improve the patient experience.

“This is what I firmly believe and actually a client told me as well,” Frederick said. “If you’re telling me you’re doing evidence-based design, does that mean you never did strong design? Shouldn’t it be an innate part of how you design hospitals? My personal opinion is, for the projects that I’m working on, evidence-based design really is something that you just do. You don’t even think about it.”

Furthermore, evidence-based design is now expected as part of the baseline by hospitals and construction firms.

“It’s not a differentiator anymore,” she said.

What is the differentiator then?

Lean processes, she explained, and these processes are more complex than the traditional spaghetti diagrams.

“I think people are really taking a hard look from the minute a patient gets on the website or the minute they place that phone call to make an appointment. How can they streamline their movement through improved operations and staff interface? What can we do in terms of looking at the patient as a total person, not just as a disease or a treatment? Further, how can we enhance resource use and adjacency planning to reduce cost and improve outcomes?”

“I think we’re really starting to look at the comprehensive nature of healthcare,” she concluded.


Raymond Miranti, Managing Partner at Intra-Community Urgent Care in New York, N.Y.

It isn’t that smaller ambulatory care companies like Intra-Community Urgent Care in the Bronx aren’t expected to incorporate evidence-based design into their projects, Raymond Miranti, managing partner, said. It’s just that there’s less of a need for it, which opens the door for greater opportunities.

“With a smaller group of folks, we get to experiment more. The larger organization is looking at your LEED score and what you design to build. All of the discussions are about patient throughput. EDB has become the expectation with large health systems.”

This freedom to innovate has allowed Miranti to approach the design of Intra-Community’s immediate access-care sites in lower-income areas from a personalized angle. Or as he puts it, he carefully examines each zip code he goes into with the goal of understanding the acuity of disease and cultural distinctions that make each community different. For this reason, individual sites contain unique elements that Miranti may not have used if he was designing a structure 10 miles away.

“Some of the things we tried to do because it’s walk-in care, which is very similar to urgent care, is to create a soothing environment using colors and lighting,” he said.

One innovation was to use artwork over LED TVs.

“The idea was to use the artwork as a passive distraction, as opposed to television, that would calm patients down as they’re waiting to be treated,” he said.

Miranti and his team selected local artists and consulted the community on the final selections.

“You allow the people delivering and supporting the delivery of care to have an environment that really works best for them,” he said.

Miranti likens evidence-based design to the iPod, which, of course, transitioned into the smartphone.

“People are sensitive to the data because right now there’s a lot more theory that exists as opposed to real data,” he said. “Over time, we’re going to have the data to support the evidence-based design, and we’re just going to rely on that data more. Just like the smartphone, evidence-based design is going to get smarter and better.”


What about your healthcare organization? How are you incorporating evidence-based design into your projects? How important has evidence-based design become to you as a leader in achieving modern healthcare’s quest for sustainability and efficiency?

by Pete Fernbaugh

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