There’s a lot of pressure being applied to the healthcare industry today. There are penalties for readmissions within 30-days of discharge, reduced (or non) reimbursement for harm due to clinical error (i.e. the CMS “never events”) plus many programs that tie reimbursement to measurable patient outcomes and patient satisfaction (i.e. the HCAHPS survey). One approach to addressing these issues that’s increasingly backed by studies with favorable outcomes is the patient-centered (or evidence based) design of the facilities themselves.

The Center for Health Design’s definition of evidence-based design is “the process of basing decisions about the built environment on credible research to achieve the best possible outcomes.”

Patient-centered or evidence-based design of facilities offers potential benefits on many fronts:

  1. Improved patient outcomes and satisfaction
  2. Reduced costs and/or increased reimbursement
  3. Improved staff morale/satisfaction and reduced turnover

Payers stand to benefit too as working with high-performing provider organizations could reflect positively on their HEDIS scores.

Fable Hospital 2.0

Healthcare Design Magazine’s Fable Hospital 2.0 shows how evidence-based design might improve patient (and business) outcomes.  The innovations included in the analysis raised construction costs by about 7%, but were expected to achieve ROI in the first 3 years.  The design included items like:

  1. Increased natural light to make patients more comfortable and reduce energy use
  2. Noise reduction to lower stress levels for patients and staff
  3. Improved air quality and single-patient rooms to reduce the spread of infection
  4. Larger, more accessible rooms and bathrooms to decrease fall risks
  5. Better medication task lighting to reduce errors

These design elements, plus many more cited in the study could lead to a cumulative effect that’s a win for the patients, staff and the business itself.

Real World Examples

There are many examples of evidence-based design taking place in the real-world too. UPMC used similar techniques to “right-size” their patient rooms.  Despite settling on a room-size that was smaller than some of their counterparts, UPMC proved that a proper layout combined with other strategic design elements allowed them to maintain HCAHPS scores while decreasing construction costs and improving quality (by way of fewer falls and decreased readmission rates).

A similar design process was used when rebuilding the University Medical Center of Princeton at Plainsboro and they’ve experienced significant improvements in clinical and financial metrics since opening the new hospital in 2012.

Getting the Patients Involved

While the use of evidence-based design is on the rise, I was unable to find examples where the design process or subsequent measurement included direct interaction with patients (save for the HCAHPS survey results).  That is until I met Dr. Justin Smith (@TheDocSmitty), Dr. Smith used his successful social media presence to source design ideas for a new pediatric clinic being built by Cook Children’s Healthcare System.  Not only are these ideas being seriously considered, but a few have made it into the final design.  Dr. Smith has even tapped a few of his most engaged patients to sit on a design panel that has provided feedback throughout the build.  The clinic is physically under construction now. I look forward to following the story and am optimistic that we’ll see favorable results.

Patient Centered Design

#hcbiz 20: Discussion Details

On Wednesday, June 29, 2016 the Business of Healthcare community welcomes Dr. Justin Smith to talk about his innovative approach to patient engagement and clinic design.

12:00 PM EST — Tweet Chat

The tweetchat begins at 12:00 PM EST and will ask 3 questions in 30 minutes:

Q1: Does the increased cost associated with patient-centered facility design make sense, or would these resources be better applied elsewhere?

Q2: What aspects of healthcare facility design could benefit most from a patient-centered, evidence-based overhaul?

Q3: What real-world examples of beneficial healthcare facility design have you seen, worked on or experienced? What were the benefits?

Follow the #hcbiz hashtag on Twitter or use an app like to join the conversation.

12:30 PM EST — Blab

Then at 12:30 PM EST, join me (@dflee30), co-host Shahid Shah (@ShahidNShah) and special guest Dr. Justin Smith (@TheDocSmitty) on The #hcbiz Show! Episode 20. We’ll dig into Dr. Smith’s design methodology and try to understand the culture at Cook Children’s that allows for such an inspiring and innovative approach to clinical design.