only thing changing more than the weather this time of year
is technology. The rapid developments made recently in high-tech
healthcare are revolutionizing hospitals through advancements
in medicine, surgical techniques, and computerized procedures.
Although technology is possibly the most obvious driver of
facility design changes today, others include an increased
sensitivity to patient and family; a desire to provide amenities,
services, comfort, and convenience; and the realities of limited
with the Outpatient: Trend
With the invention and approval of minimally invasive surgeries,
patients increasingly find themselves walking in and walking
out of the hospital in the same day. Surgeries that once spanned
a doctor’s entire shift have become simplified procedures
through the assistance of modern technology. Because these
surgeries are less straining on patients’ bodies, recovery
times are shorter. What does all this mean for healthcare
facilities nationwide? Fewer beds. According to the AHA Annual
Survey Database, outpatient visits were up 20.3 percent in
1998, compared to 1994.
Due to great strides in telemedicine, and its ability to transport
critical patient data effectively and in lightning speeds,
many small outlying or suburban hospital facilities have become
largely diagnostic and outpatient-oriented. “The hospital
infrastructure has gone through a major rethinking of space
allocations,” says Andrew Alt, vice president, and project
executive for Jeffrey M. Brown Associates Inc., New York City.
Areas that previously functioned as medical records rooms,
darkrooms for x-ray development, etc. have all but vanished,
driven into obsolescence by the computer and the Information
Flexibility and Efficiency: Trend
As time changes, so does technology. With so many new developments
coming to light every day, healthcare facilities must be ready
to accommodate whatever the future holds. With the issue of
reimbursements becoming tighter and tighter, not only is flexibility
paramount, efficiency is key.
“One of the things that’s happening as a result
of the staff efficiency issue is … an erosion of departmental
boundaries. We’re beginning to see hospitals designed
around the clinical pathway of the patient,” says H.
Ralph Hawkins, executive vice president, HKS Inc., Dallas.
By making adjacencies and ancillary spaces within close proximity,
patients will not be routed all over the hospital for treatment.
When staff is cross-trained, personnel can be utilized in
more than one area during downtimes, maximizing their ability
to provide quality care in the most efficient manner.
It is impossible to predict what is on the horizon for healthcare
and, yet, providers everywhere are leaning on facilities professionals
to do just that. The design of new facilities must be more
flexible than the hospitals of old. Universal patient rooms
are proof of this. According to John L. Castorina, vice president,
RTKL Associates Inc., Irving, TX, “Acuity levels are
getting higher, so we’re trying to design patient care
areas to be flexible enough to handle any profile of patient
at any time.” Larger, single-patient rooms are becoming
the standard and are fitted with gases and equipment necessary
to treat varying acuity levels.
Home-like Environments: Trend #3
Click your heels together three times and repeat, “There’s
no place like the hospital.” Okay, so going to the hospital
isn’t exactly a trip to the Land of Oz. It’s cold;
it’s sterile; it’s uninviting – right? WRONG!
Facilities are doing as much as possible to contradict this
stigma, including taking hints from the other commercial buildings
industry that considers “home away from home” its
motto – hospitality. “Nobody seems to hesitate going
into the lobby of a nice hotel,” says C. Daniel Wardrop,
director of health facilities, Morris Architects, Houston.
The following characteristics increase the level of comfort
for both patients and their families:
• Low-wavelength colors that have a calming effect.
• Differentials in ceiling heights in both public spaces
and patient rooms.
• Views into exterior courtyards and gardens.
• Larger windows.
• Single-patient rooms instead of semi-private units.
• Upholstered furniture, such as three-seat couches and
A key element in a patient’s healing process involves
a number of caretakers – doctors, nurses, and loved ones.
“The family, being an extension of the patient, has become
more and more important [in the design] – as it should
have been all along,” says Richard L. Miller, principal,
Earl Swensson Associates Inc., Nashville. Resource centers
and Internet hook-up capabilities provide families with the
post-operative or post-treatment education needed to ensure
quality care once a patient is released. Visitation hours
are extended to accommodate the hectic schedule of today’s
society, while overnight stays are not only common, but welcome.
One-stop Medical Shopping: Trend
Perhaps taking its cue from big corporations that lure the
best and brightest employees in with a Starbucks, hospitals
and healthcare facilities are following suit in providing
patients with amenities and services that hinge on the big
“C”: convenience. An individual stopping in to have
a sprain x-rayed can check e-mail or access the Internet at
a computer station, drop the kids at the daycare center, grab
a cup of coffee, view a traveling art exhibit, and skim through
the latest bestsellers at the library – all while waiting
to meet with the doctor. Some innovative providers are even
distributing pagers to waiting patients. According to Castorina,
“[Patients] don’t want to leave the waiting room
because they are afraid to lose their space in the queue.
If you give them the ability or empowerment to go out and
do other things – experience other things – maybe
it will [remove] the intimidation of what they are about to
Not only are you able to Fed-Ex packages and stroll through
exterior gardens during your visit, you may also experience
a taste of holistic medicine. “We’re seeing almost
a spa-type development in some of these facilities –
where you can do anything from a massage to aromatherapy,”
says Miller. Too bad you have to check in to check it out,
High-tech Healthcare: Trend #5
Patients are more demanding, pickier, and better informed.
The doctor’s word is not “as good as gold,”
and many patients are seeking a second opinion – on-line.
“The healthcare industry is waking up and realizing that
they’ve got a new consumer now,” says Bradley T.
Barker, senior vice president, RTKL Associates Inc. This new
consumer has been watching TV and surfing the Internet –
he/she is a more educated patient and therefore expects more.
Because of advancements in technology and the recent strides
• Patient stays have decreased in length, benefiting
hospitals in a time when reimbursement is limited.
• Hospitals are maintaining a competitive edge and quality
care through the offering of these procedures and services.
• Small facilities are able to get diagnostic and treatment
suggestions from mainframe hospitals and specialists quickly
• Monitoring of an individual’s heartbeat and breathing
rate can occur in the home, reducing unnecessary patient visits.
• Files and films can be organized digitally/electronically,
allowing staff quick and easy access to patient data while
reducing paper storage requirements.
• Pre- or post-operative education is provided on-line.
Techno-savvy providers are offering the latest in technology,
despite the expense. “One of the problems is cost. With
the minimally invasive video monitoring, companies are starting
to lease this equipment because the technology is changing
so fast,” says Debbie Cameron, executive vice president,
EQ International, Irving, TX.
Telemedicine is an extraordinary means for communication and
requires adequate technology and networking. “If the
wiring closets aren’t large enough, if the right pieces
of telecommunications information systems equipment aren’t
bought, if you can’t get the services from your local
public utility, then you can’t do it because there’s
no way to send information on to someone else,” says
Vyoyan B. Cothron, director of telecommunications, information
systems, and engineered systems design, EQ International’s
Hold on to your hats: The winds of change are gusting through
healthcare facilities nationwide. Tomorrow’s forecast
calls for more of the same – technology-driven designs,
patient- and family-focused care, and warm environments filled
with all the best of today’s modern conveniences.
Jana J. Madsen (firstname.lastname@example.org)
is senior associate editor at Buildings magazine.