Healthcare, and wellbeing in all its forms, feels like it’s permanently notched at the top of our minds. COVID-19 has people and organizations the world over rethinking what being healthy means, how best to stay healthy and safe, and the dichotomy between public and personal health.
For the second issue of our “Healthcare & Wellbeing” themed October, we reached out to the designers at HDR, which ranks as the #1 healthcare architecture firm on Building Design + Construction’s 2019 Giants 300 Report, to talk about how our healthcare environments are designed today, and how they might be designed in the future. Eric Meub, Design Director at HDR Los Angeles, talks shop.
“The number one thing we’ve been doing in the last six months is listening to our clients. Healthcare organizations are having a lot of different experiences in relation to the pandemic; some are struggling, some are failing, and some are doing fine. A lot of hospitals have lost revenue because of delayed surgeries and other procedures. At HDR, we’re centering our efforts around a ‘beyond pandemic planning and design’ approach.”
“The biggest word coming out of COVID in healthcare environments will be resiliency – resiliency to changing demographics and to changing acuities [severity of illness and level of attention or service patients require from professional staff].”
Meub notes three key areas where the healthcare landscape is changing – site design, technology, and patient experience.
“A lot of the concerns people are having about going to the hospital or to their doctor’s office has to do with going to the physical space. Entering and exiting these facilities now have to protect people – but we also need to safeguard the patient experience. Entering and leaving should still feel comfortable, and nurturing.”
“Entry access points, and the ability to separate and streamline the flow of people in and out of facilities, is key. More strategic site design and technology can both help control the flow of patients and visitors, and also help to create a more comforting experience.”
Meub noted a number of new challenges we now face due to COVID. One of the most impactful challenges lies in connecting patients to family and loved ones.
“It’s really nerve-wracking to think that you can’t connect
with a loved one at a critical time. One lesson we’re learning is that finding the balance between safety/protection and the patient care experience, isn’t always easy or straightforward. The rise of behavioral and mental health issues as a result of the pandemic is real. A lot of people are suffering from increased anxiety, loneliness and isolation, and the ability of healthcare organizations to be flexible enough to support those people is critical. Flexibility was already the number one goal we heard from healthcare clients, but now that need is even more critical.”
Meub said that stringent cleaning procedures are an evolving, short-term response to the pandemic, and we’re already seeing it changing. Longer term changes to our healthcare environments will center around revisions to patient flow, and to how people are accessing healthcare.
“Telehealth will become a mainstay, and pre-screenings will increase. Healthcare organizations are now beginning to focus on the ‘exam’ as a process. Some parts can be done digitally, and it’s often easier and more comfortable for the patient. It’s not about just going in for one in-person exam. I think we’ll also see more full-time drive-through healthcare facilities.”
Changes to entry sequences in healthcare spaces are coming too.
“There will be more one-way flow of infectious patients, and more separation of people modalities within healthcare environments, i.e. oncology patients, pediatric patients, and geriatric patients, will come into their space without crossing other paths, as they are often higher risk populations.”
HDR is also creating more ambulatory team-based care spaces in two phases, where the patient does not travel through physician team rooms and hallways to get to their patient room.
“Instead, the facilities are set up so that the patient enters their patient room directly from a waiting space,” Meub said. “We call it onstage-offstage healthcare, and we’ve been doing this for some time and it’s not entirely new, but it has new possibilities to help reduce contact and the spread of contagious diseases.”
“The dichotomy of clean versus non-infectious has become more important during COVID.” – Eric Meub, Design Director at HDR Los Angeles
Hospital organizations are now considering creating specialty units that can accommodate more specific needs, as well as rethinking isolation rooms and other building systems to create more long-term resiliency in flexible design.
“In acute care, we’re rethinking isolation rooms, which are equipped to create negative air pressure that reduces the likelihood of germs and disease leaving that room and traveling to someone else. There’s the thought that we need entire negative pressure wings. This idea also brings up operational and comfort issues, as the staff has to be gowned for longer periods of time in these spaces. When we think of flexible design, it might mean that in the future we’ll be better equipped to convert a regular wing into an isolation wing more easily and quicker.”
The COVID-19 global pandemic is helping us think differently about the patient experience.
“Our clients are questioning traditional care models here and looking at new models,” Meub said. “They’re paying attention to what some European countries are doing now, too.”
“We’re reimagining the patient room to reduce mistakes and improve the patient’s overall experience when they come to the doctor. For example, what is the first thing a patient sees when they enter the patient room? Is it an open door leading to a toilet? Or is it a window view out to a garden? Seemingly small things like this matter.”
Healthcare environments of the future will also do a better job of helping patients and their loved ones be aware of what time of day it is and what it feels like outside.
“That’s really important because it connects them to life away from the hospital. The biophilic design movement will continue to be so important in helping us do that, because there’s too much evidence showing it works.”
“There’s also a growing body of research that is showing that that nurses are one of the most important touchpoints in the care experience, so many organizations are creating added visibility and more touchpoints around nurses and patients.”
Meub noted that improving the patient experience correlates closely to improving the staff experience.
“Our healthcare clients are trying to take better care of their staff, because the patient is going to feel more nurtured and happier if the staff feels nurtured and happy. All of that comes across in the care. Staff areas must also have access to daylight, and the ability to get out of the clinical environment to recharge. In new projects, we’ve begun to lift the café up, instead of placing it on the ground floor where its traditionally located. Staff food options, conference spaces, and meditation spaces with outdoor components can all be located on higher levels of the hospital, mixing in the acute healthcare environments with supportive spaces.”
The idea of flexible outdoor space used to be a nice-to-have element. Now, however, a lot of medical campuses are realizing the necessity for it.
“The number and scale of outdoor environments that we plan into our healthcare spaces will increase in direct response to COVID-19, with new and better outdoor gardens and rooftops, outdoor dining, storage options, and staff areas,” Meub said. “Introducing more outdoor experiences at higher levels of a building – and designing spaces more vertically allowing patients to remain in the patient area but still have access to the outdoors – creates a better patient experience.”
Meub noted that while some COVID-inspired changes feel huge and expensive, there are some other very interesting shifts happening at a smaller scale, too.
“The use of materials – and moving away from ones that aren’t holding up against hourly cleaning procedures – will encourage an evolution of the healthcare environment materials and finishes we use.”
“The materials, finishes and color palettes we use to create an atmosphere in interior design – some of these things need to change. There are strict code limits on these things to ensure cleanliness levels, but the movement to de-institutionalize the healthcare space is still so important. People should feel like they’re not just a number, but a person who must be heard. We want to create spaces that people can find joy in again.”
Perhaps beyond all of these new concepts, Meub says he sees more integration between healthcare organizations and the communities they serve. If that integration does indeed occur, it will be one of the biggest silver linings to come out of the COVID-19 pandemic.