Building the Twenty-First Century Hospital

Published May 1, 2002

The only thing changing more than the weather this time of year is technology. The rapid developments made recently in high-tech health care are revolutionizing hospitals through advancements in medicine, surgical techniques, and computerized procedures.

Although technology is the most obvious driver of health care 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 reimbursements.

In with the Outpatient: Trend #1

With the invention and approval of minimally invasive surgeries, patients increasingly find themselves walking in and out of the hospital in the same day. Surgeries that once spanned a doctor’s entire shift have been simplified by modern technology. Because these surgeries are less straining on patients’ bodies, recovery times are shorter.

What does this mean for health care 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 at 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. in 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 Age.

Flexibility and Efficiency: Trend #2

As times change, so does technology. With so many new developments coming to light every day, health care facilities must be ready to accommodate whatever the future holds. As reimbursements become tighter and tighter, not only is flexibility paramount, but 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 of HKS Inc., Dallas.

By designing facilities so that medical support services are in 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.

While it is impossible to predict with certainty what is on the horizon for health care, 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, designed to accept any type of patient at any time, are proof of this.

According to John L. Castorina, vice president of RTKL Associates Inc. in Irving, Texas, “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 the equipment and services 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!

Health care facilities today are doing as much as possible to nullify 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 for Morris Architects in Houston.

The following characteristics have been shown to 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 loveseats;
  • plants; and
  • aquariums.

A patient’s healing process depends heavily on 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 of health care facilities]—as it should have been all along,” says Richard L. Miller, a principal with Earl Swensson Associates Inc. in 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 being extended to accommodate the hectic schedule of today’s society, while overnight stays by family are not only common, but welcome.

One-Stop Medical Shopping: Trend #4

Perhaps taking a cue from corporations that lure the best and brightest employees with an on-site Starbucks, hospitals and health care facilities are providing patients with amenities and services that hinge on the big “C”: convenience.

The patient 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 on-site 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 go through.”

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 Swensson Associates’ Miller. Too bad you have to check in to check it out, huh?

High-Tech Health Care: 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 … online. “The health care industry is waking up and realizing that they’ve got a new consumer now,” says Bradley T. Barker, senior vice president at 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 of telemedicine:

  • Patient stays have decreased in length, benefitting hospitals in a time when reimbursement is limited.
  • Hospitals are maintaining a competitive edge and quality care.
  • Small facilities are able to get diagnostic and treatment suggestions from mainframe hospitals and specialists quickly and efficiently.
  • 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 of EQ International in Irving, Texas.

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 at EQ International’s Dallas office.

No End in Sight

Hold on to your hats: The winds of change are gusting through health care 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 ([email protected]) is senior associate editor at Buildings magazine. This article is reprinted with permission from the November 2000 issue. Additional information about Buildings magazine can be obtained online, at, or by phone at 319/364-6167, extension 5023.