Monday, October 15, 2007

Healing Environments

While the housing market has bombed, new hospital buildings are the rage in California due to a law that says they need to be seismically (earthquake) safe. As hospitals are planning the hospital of the future, many are using architectural design to reduce stress and promote safety and healing.

What type of building promotes safety and healing? We know what doesn't work. I've practiced in hospitals where the beds are so close together I could examine two patients at once without moving my feet. One wall mounted TV services two patients, so if you don't want to watch another episode of "Cops" while you are recovering from surgery, you're out of luck. And what about those bed trays on wheels that hold your food, your medication, your cards from relatives and your personal grooming supplies all together... clutter does not promote healing or good sanitation.

Most hospitals are hip to the fact that "noise" is a problem for patients and they try to keep the nursing station area quiet. It usually doesn't work. Phones are ringing, trays are clacking, nurses and doctors are talking and the best a patient can do is treat it like "white noise".

Here is what I would like to see in a healing environment:
  • Windows looking out into nature with black out curtains. (The best sleep I ever get is in a hotel. Where do they get those curtains?)
  • Bathrooms that are designed to prevent falls. Bars on walls, plenty of room to maneuver an IV pole or walker. Toilets that are higher than usual for ease of sitting.
  • Standardized room designs so nurses can be efficient and have all of their supplies and medications handy and in identical locations. Wall computers in every room for nurse and physician charting. Cabinets to hide supplies and a closet for patients belongings.
  • Window bed for family to spend the night.
  • Priority on patient privacy. Private rooms, private conference rooms for family.
  • Warm and very clean play area for children and their parents to hang out. Updated magazines, coffee and tea, water and computer in the family area.
  • Garden/Atrium for patients, family and staff to be with nature quietly.
  • Nutritional, organic food for patients and staff.
  • Non-smoking inside and out.
  • Absolutely no eating or food at the nursing station. Cold pizza and stale Sees candy...ugh!
  • Nursing stations designed with input of nurses and their workflow to capitalize on efficiency, safety and patient centered care.
I don't think any hospital administrators should design a hospital without getting patient, nurse and physician input. I mean real input. Ask patients and their families what they would change. Query them while they are in the hospital and make them part of the design team. Nurses should work with the architect from the beginning. They are the backbone of the hospital and to design without their input is folly.


Rich said...

This is such a good post Toni. You have touched on something that is very important indeed to the healing process. I like your idea about windows looking out at nature. The sounds of nature would be good as well. Picture a running stream with birds and crickets chirping. I work in a hospital and hear a lot of staff say " this is not a hotel" but why can't it? At least the healing/recovery part should more in line with a hotel.

K said...

I agree with pretty much everything you say here. My pessimistic side, however, points out that rarely are things like hospitals (or university buildings, or museums) built on budget, and so whatever good intentions the designers had are often put to the wayside while contractors run up costs. Much as getting input from all involved parties makes complete sense, I have rarely known a place to come out unscathed from last-minute changes - hallways uncomfortably narrowed, ceilings suddenly too high for the spaces, electrical wiring incorrectly placed, etc. I love the idea of a well-built, well-designed hospital, I just keep seeing all the ways it would quite possibly be a let-down. Of course, this is a dumbass reason to not do something. :D

Anonymous said...

I agree that future hospitals need to redefine how the physical plant can and should promote health and healing. You and I both saw a great example of this at the Blank Children's Hospital in Iowa. For anyone else who's interested, check it out at

Raymond Bouchayer said...

I agree the only things missing is a little wine with meals is good for the morals

K said...

You mean "morale", right, Mr. Bouchayer? Not that I've got anything against wine, mind you.

Toni Brayer MD said...

It's a matter of opinion whether wine would help the "morals" too...for some folks it just might.

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