VISUAL QUANTIFICATIONS OF WELL-BEING (audio)
December 16, 2011 – In today’s economy, perhaps no artifact is quite as visibly quantifiable as the bottom line. As explored in the America’s Design and Health 2011 communications series, economic concerns dominate conversations among both architects and healthcare professionals.
In his accompanying audio, Craig Zimring suggests that providing for health in all design is a way to increase the dollars directed toward architects while reducing fiduciary demands on healthcare providers. The key, he emphasizes, is in establishing shared goals and designing beyond those expectations: “If even experienced clients of architecture believe that what architects do is make buildings more creative, but don’t help them achieve their key mission of helping students learn faster if they’re a school, or getting well better if they’re a hospital, then it’s not surprising that architects are remunerated like artists, rather than like engineers or physicians.”
The outcomes from the 7th World Congress on Design and Health provide a guide for professionals in both the health and design arenas to steer toward a collaborative, health-focused product. Three key facets of the conversation, addressed by Zimring, are research methodologies associated with evidence-based design; an expanded team with shared responsibilities and language; and a sustained consideration of economics that connect first-cost architectural investments with the larger operating healthcare costs.
EVIDENCE-BASED DESIGN: RESEARCH
At the 7th World Congress on Design and Health, Hui Cai’s doctoral research, completed at the Georgia Institute of Technology under Zimring, connected sight lines from nurses stations with nurse-patient co-awareness. The presentation, “The Impact of Nurse Station Typology on Nurses’ Informal Communication and Peer Co-awareness,” used elegant diagrams to visually map the range of vision from a decentralized nursing station compared against nurses’ awareness of patient names on the floor. From these diagrams, teams were able to reach design conclusions to foster staff awareness and patient healing.
The effectiveness of this research is two-fold. First, it displays precise data that quantifies nurse awareness and patient well-being in a visually concise manner amenable to design teams. Second, it considers the research agenda through three very important approaches: place-based, systems-based, and processed-based.
- Place-based strategies connect a physical environment with a user’s response. “We often say that there’s good evidence to show that the design of place—of a patient room, of a nurse’s station, of an operating room, or a doctor’s office, of a clinic, etc.—impacts people’s behavior,” explains Zimring. “It reduces falls, it reduces infections and improves satisfaction, so it is a place-based strategy.”
- Systems-based strategies address how the way architects design buildings relates to the larger systems of peoples’ lives. Some of that—consider sustainability—is about how much energy a building uses, or how much energy it creates. Some of it may be how it contributes to the health of the community, or encourages everyday physical activity, or how healthcare can monitor chronic disease.
- Processed-based strategies speak to the process of navigating a building. Largely, they work to make the way the customer, user, patient or staff members move through buildings shorter, faster, safer or more efficient.
As evidence-based design and research continues to influence the industry and health-design dialogue it will be important for researchers and designers to understand the impact of place, the impact of systems, the impact of process and the importance of designing to support all three.
EXPANDED-SCOPE: BUSINESS/ PATIENT/ DESIGNER
One of the largest challenges facing designers interested in research-based approaches is that individually nuanced projects cannot be entirely forecast through research exercises. “It’s not one size fits all, but understanding how the built environment can be a strategic tool in improving performance,” explains Zimring. “What we’re seeing here is that health operates in a couple of ways, right? One is that one definition of health is that it is organization health.”
In order to provide for organizational health—which may be characterized by effective, open, flexible communication measured against performance outputs—architects need to understand how organizations behave at their core.
“The real breakthrough is to sit the clinicians down at the tale with the health IT people and the people who do supplies and logistics, and plot out the path of the patient and see if you can make that shorter, faster and safer,” explains Zimring, citing Sutter Health, Intermountain and Kaiser Permanente. “Then think of how the built environment can help you do that.”
ECONOMICS: MEDICAL CARE V. HEALTH CARE
In the 7th World Congress on Design and Health outcomes, the difference between medical care—the cost spent treating illness—and health care—the cost spent promoting health and wellness—was spelled out. Less explicit, though no less important, is the distinction between Healthcare and health care.
Homonyms, each phrase exists independently of the other. A Healthcare facility is most often a space for treatment or healing. It might be a hospital or a clinic, but it doesn’t happen only there. Economic pressures, changing populations, and more are pushing healthcare to the clinic, into the clinic, into the workplace, and even into the shopping center.
Conversely, health care maybe repositioned as design for wellness, or well-being. In this light, design talks about the spaces and decisions that promote well-being; the places that don’t just cure people when they’re sick, but keep them from getting sick in the first place. “A big opportunity for some architects will be other kinds of settings where health and healthcare can be delivered. For example, how do you deliver healthcare in the home?” asks Zimring.
The importance of answering the question is substantial. As Ray Pentecost explores in his presentation “Setting the Course,” the current economics of Healthcare are not sustainable. He cites extraordinary statistics on daily medical expenditures in the US:
- Heart Disease: $501,000,000
- Cancer: $430,000,000
- Digestive Disorders: $337,000,000
- Obesity: $320,000,000
- Diabetes: $273,000,000
Design decisions rooted in research may be able to reduce those costs. If you walk in a building and the first thing you see is the stairs, you’re more likely to use them than if they were concealed. If there is a connection between a building and the street, you may be more inclined to go for a walk than jump in a car. Introducing active design decisions upfront can help reduce the economic strains on healthcare, and in healthcare facilities.
“Healthcare workers are some of the least healthy workers in the United States,” explains Zimring. “Children’s Healthcare of Atlanta, for example is devoting $25 million to reducing childhood obesity, but they’re starting with their own staff. Some of that is around the built environment.”
In an accompanying podcast, Craig Zimring, PhD discusses how evidence-based methodologies can visually validate active and health-design agendas across a spectrum of project types. The podcast is available here. Additional resources and articles can be found at www.aia.org/cvd/