Health Care Architecture: Building for Today and Tomorrow.

The ways in which healthcare services are delivered are changing dramatically, driven by competition in the marketplace and the increasingly selective consumer. The patient-care environment itself has been shown to have a significant impact on treatment outcomes. To be successful, healthcare architecture must meet people's diverse needs with sensitive solutions that are socially, fiscally and environmentally responsible, as well as creatively expressed.

During my 20+-year career in healthcare planning and design, I've followed these principles:

* Build for change

* Remember the human factor

* Be aware of local issues

* Look for the trends of tomorrow

* Embrace a collaborative approach

* Watch the bottom line

Accommodating Change

The typical hospital is an amalgamation of different buildings, constructed separately over the course of time. Nevertheless, these buildings must work well and work well together. This can be a difficult challenge. Change in the functional use of the space--driven by new technologies and treatments--occurs rapidly, transforming a state-of-the-art facility into a complex of functional compromises and performance inadequacies.

In fact, change is the only constant in healthcare design. Only a few years ago it was industry practice to plan a facility according to a 20 year lifespan of consistent building usage. Today, these expectations have narrowed to 5 to 7 years, and we plan for long-term flexibility at the outset. As the pace of change in healthcare delivery continues to accelerate, hospital plans must be a venue for-- not a roadblock to--adaptability.

Thorough planning and thoughtful design can accommodate change, even if substantial in scope. At Adventist Health Simi Valley Hospital, a 40-year-old facility in need of substantial modernization, we are in the midst of an ambitious multiphase plan to replace each building on their hospital campus over the next 10 years. In developing this program, we first acknowledged that the birthing clinic of today might be a geriatric unit tomorrow. Therefore, our goal became to embrace the prospect of change by planning for shifts in functional need overtime. In addition, we developed a building infrastructure that is highly flexible.

Humanizing High-Tech

Individuals and families entering a hospital typically experience a heightened state of stress and anxiety, and designers must be sensitive to this aspect of patient care. Therefore, it is important that parking and building entrances be clearly identified, and that way-finding (directional signage and other elements) within the facility is clearly understandable.

The often intimidating, high-tech nature of medical care necessitates greater attention to space planning, interior design and materials in order to humanize the environment. A number of studies have demonstrated that elements as diverse as color, sound and lighting can positively affect coping and healing processes. Increasingly, the spiritual well being of the patient must be addressed as well. Soft, natural materials can be calming, as are fountains that produce white or background noise. Corridors with loud overhead paging and jarring alarms are no longer acceptable.

At Arizona State Hospital (completion Fall 2002), our goal is to create a healing environment for the mentally ill. We have drawn from natural materials that convey a home-like atmosphere in order to minimize stress. We have also paid close attention to landscaping. By creating a setting that is both peaceful and accessible, patients may directly experience the intrinsically therapeutic qualities of nature.

Emerging California Issues

For healthcare institutions in California, seismic upgrade requirements mandated in Senate Bill 1 953--passed after the 1994 Northridge earthquake--will have a significant impact. Many facilities have and will be making decisions about seismic renovation in the coming months. Informed sources estimate that state requirements may cost hospitals a combined $24 billion in the coming years. My own experience leads me to believe that the impact will be even greater--reaching almost as much as $40 billion--as design and cost estimates are finalized.

The California energy crisis also has an impact on hospital architecture. Although healthcare providers are exempt from rolling blackouts, proactive choices lead to significant cost savings. For the past 25 years, our firm has emphasized environmentally sound and energy efficient design, to the benefit of both our clients and the global community. For example, we recently designed a screen mechanism for the west face of a building for a Southern California client. This simple intervention had a dual purpose: it enhanced the aesthetic intent of the building and at the same time deflected sunlight, mitigating intense sun exposure and minimizing the expense associated with cooling over the building's lifespan. Additionally, the screen is designed so in the future it may even help generate electricity for the facility through photovotaics.

Charting the Future

Consumers have become increasingly sophisticated, seeking out a provider of their choice based upon facilities that are best suited to their individual needs. Healthcare institutions have responded by focusing their resources on selective medical specialties, a movement embraced by nationally recognized medical centers, as well as smaller community-based hospitals. Providers now cater to the demand for focused care, constructing smaller, self-sufficient clinics for women's and children's health, cancer treatment, rehabilitation therapy, and diagnostic and treatment imaging, to name but a few growing specializations. Often located at a distance from the main hospital campus, each of these facilities requires a design solution specific to its respective purpose and surroundings.

This continuing shift to ambulatory or outpatient care has had a dramatic impact on the traditional mission of the hospital, as profoundly ill patients now constitute the majority of hospital admissions. Healthcare planners must address the needs of both patients and medical specialists, providing the technological infrastructure for diagnosis and treatment in a setting that supports the healing process. Although healthcare delivery will continue to evolve, it is unlikely that this divergence between outpatient and inpatient care will reverse.

We believe that through knowledge, partnership and collaboration, our clients come to appreciate the potential for architecture to support their health care mission.

Timothy M. Rommel, AIA, ACHA, Principal, is a member of Cannon Dworsky's team of healthcare specialists, and is widely recognized for his ability to plan and design diagnostic and patient-care facilities that meet the needs of healthcare delivery.