Healthcare Design - August 2019 - 19

5/5

PERSPECTIVE

DID ARCHITECTS REALLY RUIN
HEALTHCARE?
WANT TO RAISE the ire of healthcare architects

worldwide? Then publish an opinion piece titled
"How Architects Ruined Healthcare" on Toronto's
The Globe and Mail newspaper website. Judging from my colleagues' responses on social
media, the piece published in May really hit a
nerve and, I felt, deserved a response.
The author, Dr. Joshua Landy, a Canadian
critical care physician, blames a host of healthcare industry issues on how
architects design hospitals. He decries that "a well-intentioned effort to make
things better for patients (i.e., a patient-centered approach) ended up making
them worse for everyone." His epiphany was inspired by the paper "Building Patient-Centeredness: Hospital Design as an Interpretive Act," published
Sept. 1, 2012, by Dr. Elizabeth Bromley, a UCLA medical anthropologist
and psychiatrist, in Social Science & Medicine. Because Dr. Landy draws his
conclusions from this paper, I decided to read the source myself.
In the paper, which studies one unidentified hospital completed in 2008,
Bromley notes, "Hospital designs reflect the sociocultural, economic, professional, and aesthetic priorities prevalent at a given time," acknowledging,
where Dr. Landy does not, how the architect responds to the needs of their
hospital client in a given time and place. This particular hospital administration chose to hyper-prioritize patient-centeredness through the "Disney Effect"
of all clinical spaces being offstage. The hospital emphasized a concierge
approach to patients and scripted communication like the hotel industry. Unfortunately, this one-sided approach located staff spaces remote from patients
and didn't provide enough conference rooms and staff lounge areas. The
study didn't include whether or not patient experience or outcomes improved.
Citing this one 10-year-old study, Dr. Landy states in his op-ed that "modern
hospitals are specifically designed to eliminate collegiality." It's true that many
projects do prioritize patient space over staff support when economics drive
a Lean approach, but I don't know of any projects that intentionally sought to
reduce clinician interaction. Instead, I see today's healthcare designers and
clients seeking a more balanced, research-based approach, recognizing
patient-centered care means bringing caregivers closer to patients and that
supporting a team-based approach is the future of healthcare-something I
hope Dr. Landy will recognize.
One intriguing issue I found in his op-ed was the comment that physically
hiding the "messy part" of healthcare devalues medical professionals. Bromley's studies also indicate that in a consumer-driven environment, clinicians
can feel their technical skills are unappreciated, especially when behind
closed doors. I agree this is worth further study. Understanding staff psychology is an important factor in hospital design, especially as their own health
and well-being are threatened.
Finally, Dr. Landy asks, "Is this place built to make us healthy-or to distract
us from thinking about our health?" I don't believe the two are mutually exclusive. People, process, and place must all support care delivery, the patient's
recovery and emotional well-being, and family involvement in a balanced
approach. Dr. Landy's op-ed does disservice to the dedicated healthcare
designers who work tirelessly to meet these goals.- S H E I L A F. C A H N M A N ,
P R E S I D E N T, J U M P G A R D E N C O N S U L T I N G L L C



AUGUST 2019

http://modulararts.com http://modulararts.com

Healthcare Design - August 2019

Table of Contents for the Digital Edition of Healthcare Design - August 2019