Center Voices
The Business Case for Building Better Hospitals
By Blair L. Sadler
Hospital trustees and executive leaders are dealing with a host of competing demands: shrinking reimbursement, workforce shortages, skyrocketing pharmaceutical and technology expenses, Sarbanes-Oxley disclosure requirements, increased consumer and employer expectations, and aggressive union tactics.
On top of this, the quality and safety revolution sweeping the country carries with it the understandable expectation by consumers, employers and insurers that hospitals will dramatically reduce system-based errors that harm, and sometimes even kill, patients.
Beyond this, many hospital facilities have simply ended their useful lives and need to be replaced. Indeed, Modern Healthcare’s annual Design & Construction Survey estimated that the health care field is spending $18 billion annually building new hospitals in the United States and that this will increase to $30 billion by 2010.
For trustees, deciding what to build and how to finance it is usually the biggest financial decision they will ever have to make. With so much at stake, the time is right for hospital leaders to invest a little more money, not just to build a new hospital, but to design and build a better hospital—one that will actually save the hospital significant dollars in the long run.
It is well-documented that hospital buildings are too often dangerous and stressful places for patients, families, and staff. Just as health care is increasingly moving toward “evidence-based medicine,” there has been an explosion of “evidence-based design.” Rigorous research studies have linked a hospital’s physical environment to its clinical and satisfaction outcomes for patients and staff.
More than 600 published evidence-based design studies have been identified by The Center for Health Design, Concord, Calif., a nonprofit research and advocacy organization whose mission is to transform health care settings into healing environments that improve outcomes. These studies are summarized in a report published by The Center that was funded by the Robert Wood Johnson Foundation.
In the report, authors Roger Ulrich, Ph.D., of Texas A&M University, College Station, and Craig Zimring, Ph.D., of the Georgia Institute of Technology, Atlanta, conclude that “the scientific literature is confirming that conventional ways that hospitals are designed contribute to stress and danger, or more positively, that this level of risk is unnecessary: improved physical settings can be an important tool in making hospitals safer, more healing, and better places to work.”
Given the hospital nursing shortage across the country, and the evidence that better-designed hospitals may increase nurse satisfaction and patient outcomes, incorporating evidence-based design into hospital construction plans is an important approach to enhancing nurse retention, which ultimately improves the bottom line.
Every hospital involved in a construction project should take the following steps immediately:
- Build larger, single-bed rooms that can reduce hospital-acquired infections significantly and include spaces for patient, family and staff activities, as well as in-room procedures.
- Make rooms adaptable for patients requiring various levels of care by standardizing shape, size and headwalls, thus reducing unnecessary, costly and dangerous patient transfers.
- Include double-door bathroom access to reduce patient falls and staff injuries.
- Install hand hygiene dispensers in each patient room to reduce staff-to-patient pathogen transmission.
- Provide positive distractions for patients and families through appropriate art, restful views and access to nature, which relieves unnecessary stress and improves patient satisfaction.
In the current health care economic environment, with capital so difficult to obtain, trustees may well ask their senior management team: “Can we afford to follow this advice? Is there a business case for building better hospitals?” The answer is “Yes.”
Based on published evidence and the experience of pioneering organizations using evidence-based design to construct new facilities, six people affiliated with The Center for Health Design—two CEOs, two architects, a business professor, and a futurist—analyzed the data and designed a hypothetical Fable Hospital.™ It’s called a “fable” because it has not yet been built—but it could be, at any time by anyone.
Fable Hospital is a 300-bed replacement hospital costing $240 million—the average cost of building a conventional hospital today. In Fable Hospital, an innovative board and chief executive decide to include the proven design innovations described above, as well as other designs that research has shown to improve operations, safety, patient outcomes, and overall patient and staff satisfaction rates.
After detailed analysis, they concluded that incorporating these changes would require only a modest one-time cost. Their surprise is that the analysis also shows significant operating cost savings and revenue increases in the first year alone, resulting from reductions in patient falls, fewer patient transfers and reduced drug costs, as well as a measurable increase in market share. Most of these savings will recur each year, making evidence-based design a superb long-term investment.
Armed with this evidence, the board and CEO decide to proceed and convert the Fable Hospital idea into reality. To do so, they: (1) formally incorporate evidence-based design into their vision of the construction project; (2) select an architect who is fully conversant in the latest design research; (3) hire researchers and advisors to develop easily usable instruments that measure the impact of their decisions; and (4) publish their results.
Trustees have an extraordinary opportunity and a serious responsibility to build better hospitals—ones that actually inspire physical, mental and social well-being, as well as productive behavior in the hospital’s occupants. In addition, through measuring superior performance, hospitals can actually improve their bottom lines.
Most hospital boards and executive leaders have only one or two opportunities in their professional lives to create a permanent legacy that can transform their organizations and their communities. Building a better hospital is such an opportunity and one that must not be wasted. The evidence for investing in facility excellence can no longer be ignored. The lesson for all health care organizations is clear—provide a physical environment that is welcoming to patients, measurably improves their quality of life, and supports families and employees—or suffer the financial consequences in an increasingly competitive and demanding economic environment.
Blair L. Sadler is president emeritus of Rady Children’s Hospital and Health Center, San Diego, and a board member of The Center for Health Design in Concord, Calif. To provide comments or ask questions, contact Blair Sadler at bsadler@chsd.org. For more information on The Center for Health Design and its programs, contact Sara Marberry at smarberry@healthdesign.org.
This article 1st appeared in the December 2099 issue of Trustee Magazine.
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