Drawing from Evidence-based design

Increasing medical costs bring
unproven method into the mainstream

Story by Caley Meals

Architects used evidence-based design when planning American Family Children’s Hospital in Madison. The hospital’s innovative design incorporates kid-friendly elements such as a town square-style lobby, complete with a movie theater, replica lighthouse and play center. It also features floor coverings designed with farm, lake and tree themes. Photo by C&N Photography

Sick people want to get better as quickly and effectively as possible.

Few would argue against incorporating a hospital design that shortens a patient’s stay and improves the working environment for physicians and staff.

Yet many in the health care industry were skeptical 15 years ago that it was worth the cost to find such design elements or to at least determine if any existed, said John Balzer, vice president of facility planning and development for Froedtert and the Medical College of Wisconsin.

Today, the skepticism is fading fast.

“A few years ago, you really couldn’t say if all the time and effort that you’re going to put into this effort is going to pay off because the data wasn’t out on the street,” he said. “There’s more and more research now that says that, ‘Hey, that investment will result in X, and that might be documented staff satisfaction that might result in shorter lengths of stay with patients.’”

Turning ideas into reality Flad Architects, Madison, already incorporated evidence-based research into a few of its projects. Here are a few of them: dthe University of Florida Shands Cancer Hospital, Gainesville, Fla. dan outpatient cancer center for H. Lee Moffitt Cancer Center & Research Institute, Tampa, Fla. dthe Affinity Health Systems Pediatric Clinic, Neenah For Affinity Health System, FladArchitects, Madison, used The Center for Health Design research methodology to achieve four specific outcomes for an outpatient clinic. The outcomes include an improved operational model supported by the space plan that was implemented, use of sustainable-design principles and a repeatable plan used in multiplelocations to help brand the system and improve patient satisfaction.

Photo by Phil Prowse

Photo by Phil Prowse

Joye Kuehn, a senior health care planner with Flad Architects, Madison, said proof that incorporating design elements can improve and expedite care is only part of the reason why health care folks are more willing to shell out cash to research new design.

While economics previously inhibited such efforts, the rising costs of health care encourage spending money to save money.

“The bottom line is the cost and the efficiency of facilities and operations are going to have to be verified, thus the evidence-based requirement,” Kuehn said. “Anything that can improve patient outcomes and therefore lower health care cost will be implemented.”

Rising health care costs are fueling the widespread acceptance of evidence-based design, an architectural method basing decisions about the design of a building on credible research to achieve the best possible outcomes.

The increasing price of hospitals, staff and other key elements created an ever-growing need for greater accountability in health care design.

But Kuehn said more research needs to be completed so there is actual evidence to back up everybody’s good ideas.

“It is a moving target that requires us to be diligent on new findings,” Kuehn said, “and critical on how we incorporate them into our projects.”

HDR Architecture Inc., Omaha, Neb., incorporated evidence-based design into the American Family Children’s Hospital in Madison.

Completed in early 2007, the 420,000-square-foot hospital features patient windows facing a tree-lined neighborhood, an atrium with an abundance of glass and natural light, walls painted with soothing colors and ample space for young patients and their families.

“There are plenty of studies showing that natural light and views of nature and natural materials aid in healing,” said Jim Hohenstein, a senior project manager with HDR.

“Evidence-based design became a buzzword or concept in the last three to five years, but it’s really just learning from experience.”

Gaining that experience comes at a cost.

Balzer said Froedtert could spend up to $100,000 researching its own evidence-based design efforts.

“The cost is driven by the type of research project you’re undertaking,” he said, “so there’s not one figure that applies to all.”

Hallways, floors and ceilings of American Family Children’s Hospital feature a rainbow of lively colors to soothe young patients. Photo by C&N Photography

Patients of the Froedtert & the Medical College of Wisconsin Clinical Cancer Center can choose the setting in which they want their care to take place — private rooms, semi-private bays or open “social” settings. Patients also can control smaller elements such as the lights, thermostat and blinds in the private rooms. Photo submitted by Froedtert Hospital

All the maincirculation corridors at the Froedtert & the MedicalCollege ofWisconsin Clinical Cancer Center go around theperimeter of the building and are always connected so patients feel oriented to their position. Research shows cancer patients should react better to open spaces than dark and dreary corridors typically associated with hospitals. Photo submitted by Froedtert Hospital

The Froedtert & the Medical College of Wisconsin Clinical Cancer Center’s staff areas feature shared spaces that allow for greater communication. These areas give physicians and caregivers a place to gather and talk about cases in a group setting. Photo submitted by Froedtert Hospital

Laura Stillman, a principal with Flad, said application of evidence-based design needs to be influenced by early planning, including organizing the right team and securing money upfront.

“To follow the procedures required for statistical validity, the study plan should be developed before any traditional facility planning starts,” Stillman said. “A [doctorate-level] researcher needs to be engaged to help develop the study protocol, decide with the project team what will be measured, and how change will be measured pre- and post-occupancy.”

Froedtert opened the Froedtert & the Medical College of Wisconsin Clinical Cancer Center to doctorate-level researchers.

The 173,000-square-foot facility is a Pebble Project for The Center for Health Design, a California-based organization that promotes improving the quality of health care through architecture.

Even before the center opened, research was conducted in the existing hospital’s cancer program.

New research with focus groups found cancer patients really want a home base, a factor that was incorporated into the design, said Jim Mladucky, a principal at OWP/P, the Chicago architecture firm that designed the building.

Now that the center is up and running, teams of researchers, through the Pebble Project, are evaluating aspects of the building’s design and organization with the goal of publishing results late next year.
“I felt very compelled that with all the challenges with the cost of health care, that Froedtert could demonstrate that the money we’re investing in real estate is being done appropriately,” Balzer said. “And the only way you can do that is to measure the impact of that real estate on patient outcomes.”

Uriel Cohen is a professor at the University of Wisconsin-Milwaukee and is the project manager for Froedtert’s involvement with the Pebble Project, which is named for the ripple effect evidence-based design can provide.

Cohen said research at the cancer center focuses on three different areas: the day hospital, the Quality of Life Care Center and the building’s interdisciplinary organizational model.

For the day hospital, architects designed private, semi-private and social treatment environments for patients who receive chemotherapy and infusions. Researchers will study which option and attributes of those options are most needed and desired by patients and staff, Cohen said.

The Quality of Life Center was designed to bring all levels of support, from financial and nutritional counseling to information on the latest clinical trial, into one area. Studies there focus on whether the one-stop-shop design and organization make for greater awareness and use of the center.

The interdisciplinary organizational model of the center is enhanced by specialty hubs designed by architects. Researchers are examining the interdisciplinary model, which involves using several specialists for specific aspects of a disease, to determine if there could be greater participation and involvement and exchange between staff.

“We think that solid research is very important,” Cohen said. “Fact finding is critical in order to say what makes a difference and what really affects the quality of life and health outcomes of patients and residents.