The New Health Dialogue

Senate Majority leader Harry Reid probably hasn’t given too much thought to hiring an interior decorator to help him with the Senate health care bill.  But while most minds are concentrated on “evidence-based medicine,” Allison Arieff in an essay in  the New York Times this week argues that we should also give some thought to “evidence-based design.” 

Kaiser Permanente, the country’s largest not-for-profit health plan, has been hard at work exploring ways to improve the patient experience -- looking for ways to make hospital visits and doctors appointments less unpleasant for patients and families. Since 2007, Kaiser's "Total Health Environment"  program has looked at  everything from carpet color to natural light to the dismal waiting areas to making people know that it's safe and healthy to take the stairs (they won't get locked in between floors). 

While we usually associate Kaiser Permanente with primary care, care coordination and integrated delivery system type of stuff,  they’ve also been pioneers in another area. A collaborative and multi-disciplinary team settled on 22 key patient experiences -- which they dubbed the “Total Health Journey” -- and brainstormed innovative ways to address (and improve) every step of the patient experience. Arieff explains: 

Though the hospitals will end up looking better, these efforts aren’t about decorating, they’re about outcomes. Numerous students point to the benefits of the design strategies and environmental interventions KP has proposed and implemented. Factors like the quality and intensity of light, access to natural light, the noise level in a room, the privacy afforded by single-patient rooms -- all of these affect patient health, satisfaction, soundness of sleep and speed of healing. 

For example, Key Experience #19 addresses the patient room. Kaiser developed a template that can be adapted for patient needs across Kaiser facilities. The new and improved patient room -- now called a “guest room” -- includes “more effective and attractive receptacles for waste management and soiled linen, increased storage space, better equipment organization and more readable patient care information in the nurse zone; and greater privacy and more comfortable furniture in the family zone.” Not only is the new design more aesthetic -- it's cost-effective. Redesigning the bed headboard saved Kaiser $2,369 per room. And, as we’ve written about before, confusion and disorganization can contribute to errors and other disruptions in the workplace. Better design and more thoughtful floor plans can make it easier for everyone. (See the picture above.)

A recent eight-year study at the University of Groningen, in the Netherlands, concluded that “hospitals are built catastrophes, anonymous institutional complexes run by vast bureaucracies, and totally unfit for the purpose they have been designed for. They are hardly ever functional, and instead of making patients feel at home, they produce stress and anxiety.” The book, The Architecture of Hospitals, is partially based on the project initiated by the University Medical Center Groningen. It explores how the architecture and design of a hospital does indeed contribute to a patient's health and well-being.

Yet while “design may seem frivolous to consider when lives are at stake,” Arieff explains, “proactive change in the realm of healthcare could help to make that context about wellness more than illness.” Back in 2000, Kaiser decided it would work to remove polyvinyl chloride (PVC) from products and materials frequently found in the health care setting. They partnered with a carpet manufacture to create a PVC-free carpet backing. It's now in Kaiser Permanente facilities and available to the entire health care community.

Kaiser isn’t the first health care system to make medical facilities more patient-friendly. (For example, San Francisco’s remodeled Laguna Honda Hospital will include a therapeutic farm and garden. The architects hope that it will improve the quality of life, reduce stress and nurture health and well-being for the entire hospital community.) But Kaiser's size and scope certainly gives them a lot of reach -- and potential. 

“We are trying to make human-centered design and designing for emotions as meaningful for the patient as possible and as doable for health care organizations as possible,” states Barbara Denton of Kaiser Permanente.