Building better hospitals by keeping patients in mind.

LELAND Kaiser, an associate professor in the graduate program of health administration at the University of Colorado at Denver, is one of a handful of respected health care futurists. He spoke about current problems with hospitals, changes that are on the way, and the roles of patients and doctors in the hospital of the future.

Question: What's wrong with the hospitals that were built 40 or 50 years ago?

Answer: There are three dimensions to architecture. There is functional, there is aesthetic, and there is what we call consciousness-altering or healing. And those buildings were built to be functional and functional in a low-tech sense. They did not have a lot of high technologies. So when you look at them they look old, they look obsolete and they just don't accommodate themselves to the new philosophy of patient care, which is much more tuned to the aesthetic.

Q: What aesthetic is this?

A: The new design (requirement) is that, in addition to being functional, it should be pretty and pleasing and aesthetically nice. It means it looks like a modern hotel. It has lots of open space. It has lots of natural light. It has foliage. It's a nice place to be. It's not noisy, depressing, stinky and bad.

Q: What do you mean by consciousness-altering?

A: The new idea is that buildings can heal, what we call healing architecture. That is the whole idea that if we put in such things as meditation gardens, walking paths, reflecting pools and so forth, patients and their family members have a chance to regenerate, heal.

Q: Is this just the latest fad in medicine?

A: There is quite a bit of evidence behind it. We know, for instance, that if there are windows in a room a patient's stay is less, by a day. There has been some research on that. People like to be in nice places and they are going to go to the hospital that is that way. They are not going to go to the dumpy place. People feel dumpy hospital, dumpy doctors. And not only do patients love it, but we discover that the turnover among workers is much less.

Q: What is this new trend of "patient-centered care"?

A: That means building the hospital around the patient's needs, rather than just to accommodate the doctors or just to accommodate the nurses.

Q: Can you give me some examples of that?

A: One of the newest ideas is to bring the Internet to the bedside to allow the patients to chat with other patients who might have the same condition, to allow the patient to actually research their condition while they are in the hospital. You also want to bring everything to the bedside, so the idea is to move the patient as little as possible. It is inconvenient and upsetting to patients to move them, so why not move the building around them?

Q: Sounds like a lot of work.

A: The first idea with technology was that you just have one (piece of a certain equipment) in the building and you cart the patient down to it. Then the intermediate technology says, put the piece of equipment on a cart with wheels, and wheel it to the patient bed. The third technology is have it in a wall and have it in everybody's room.

Q: How close are we to this third wave?

A: There are special rooms called universal rooms, and rather than move the patient from room to room, you just move the panels in the room. So it could be an ICU. It could be a labor and delivery room. It could be medical-surgical, whatever you want it to be.

Q: Is this really being done?

A: To the degree that you can. The ideal design would be, in the best of all worlds, that everything can be done in the room. We are not that close. You are not going to see all the X-ray equipment you need in each room.

Q: There is an effort out there to create a "paperless hospital" in which medical records are replaced by computer files. Sounds great, so what's the hold up?

A: The hardware and software already exist. It is really not a technology problem, but there's a user problem, trying to get doctors to do it, trying to get nurses to do it. It changes their habits.

Q: So is this transformation going to happen?

A: Slowly. One of the advantages is the quality of the input, because you don't have to worry about reading a person's writing. Another advantage is you can develop all kinds of computer programs to see if you are dong the right thing for this patient, if anything is conflicting with anything else. So you get a much higher quality of care if you can do that.

Q: Will all this technology make hospitals safer? Don't computers make errors?

A: Not like people do. I mean it's possible for a computer to make an error but a lot of computers tell you when they have made an error, if they have redundant systems. I think the quality will go way up. A lot of medical errors are caused by "A" not knowing what "B" was doing.

Q: So what is the human place in the hospital of the future?

A: I use a simple rule. Never have a human do what a computer does better. Only have humans do what computers can never do. Computers don't love. They don't care. They don't heal. That is what people do. You concentrate on the human piece. That makes it a much better experience for the patient.

Q: How much does this all cost?

A: To really build what I call a healing health care hospital is going to cost 15 or 20 percent more. But compare that in terms of market desirability, patients' acceptance and lower turnover rates and you will capture it all back.

Q: But isn't there a tendency to cut corners?

A: There are in some institutions, and that is primarily because someone got weak knees and didn't follow through with what the architect had in mind. If you get into the cost-cutting mode you are going to cut out most of the neat things that made that design really attractive.

Q: Look into your crystal ball 50 to 100 years from now. What is that hospital like?

A: I think there will be some profound changes, and the changes will be detection of diseases before they manifest clinically. It will be what I like to call quantum medicine or atomic level medicine. What we are going to be able to do is diagnose it before it gets to the cellular level and design it out before it happens. Hospitals will be doing it.

Q: Does that mean no more sick people in hospitals?

A: No. You are going to die whether it's at 100, or 200, or 300 or 400 or 500, but at some point you are going to be pretty sick before you die.