Kerianne Graham

Kerianne Graham

Architect, NBBJ
Kerianne Graham, a healthcare architect at NBBJ, has worked on projects for some of Boston’s and New York’s most well-known institutions, including Massachusetts General Hospital, Brigham and Women’s Hospital, Faulkner Hospital and NYU Langone Medical Center. Although her career in healthcare design began largely accidentally, her passion for it grows with every project. When she is not expanding her knowledge of the industry, she spends her time outdoors — and learning the New York subway — with her pitbull Dolce.

In a Virtual Age, Physical Connection Still Matters — Especially During a Hospital Stay

The Inpatient Room of the Future Must Appeal to Baby Boomers and Millennials Alike. Here's How It Can.

February 8, 2017

Architect, NBBJ

Editor’s Note: At NBBJ, we’re at the forefront of using research and technology to drive breakthroughs in healthcare, from streamlining the design process with virtual reality, to incorporating digital analytics in healthcare planning. At the same time, we know technology isn’t the only tool for solving healthcare challenges — after all, studies show the most effective care occurs when caregivers themselves are satisfied.

This week, we’re highlighting some of the human factors that must be paired with data and technology in order to bring healthcare into the future. This article was originally posted by Becker’s Hospital Review. It was co-authored by Kerianne Graham and Ryan Hullinger.

 

Demographic changes are pulling healthcare in contradictory directions. Millennial patients, born into a mobile world, are driving investments in telemedicine, on-demand services and dispersed ambulatory care. Yet an aging population of baby boomers will soon require more acute and inpatient settings. Given these conflicting demands, what can institutions do to meet the needs of both demographics? And how do these needs specifically inform the design of the inpatient room?

In proposing a solution, we first need to understand who these patients are, what they value and how they lead their lives. First, the differences: the two generations are at unique stages in life, have different health needs, have different relationships with technology, and while one group is exiting the workforce, the other is entering it for the first time. But interestingly, the two generations have more in common than might be expected. Both are at critical points in their lifetimes, and both generations are cost conscious, socially minded and value family relationships.

Boomer-Millennial-Chart

 

When members of these generations require a hospital stay, they want to remain connected — to their families, to their work, to their care providers, to anything and everything outside the walls of their hospital room. These days, in-room connectivity is more than an amenity. It is a care imperative. It ties patients and families to their broader support network at a time when they need it most. Additionally, both generations want to understand the value of their care and be able to tie their choices to that value. They want technology to work for them, to improve how they are cared for and the outcomes of that care. And perhaps most importantly, they want to be able to involve their family members in their care.

At the same time, many providers operate within extremely tight cost and space constraints and need to do more with less. In order to resolve this tension, we took a page from the “micro apartment” movement when considering how to design a hospital room that will meet the expectations of both boomer and millennial patients. Like a micro apartment, our patient room design economizes space and maximizes flexibility. It can be reconfigured by the family or staff throughout the day to support consultations, plug-in time for working, dinners with family, sleep and, of course, use of technology.

Consultations: This setup resembles the most typical use of a patient room, and is meant to provide a space where the patient, family and providers — both present and remote — can connect as an integrated care team.

Work+Relaxation-web

Plug-in
We all have different activities that are important to us or help us relax, and we need time and a place in which to do them. Providing a space for patients or family members to stay connected to their work, social networks and entertainment helps them return more quickly to their routines.


Dining
Meals together have always been celebrated as a unique opportunity for providing comfort and encouragement to loved ones. Creating a way for visiting family members to share meals in the room rather than leaving for the cafeteria allows their time to be less fragmented and more normalized and supportive. Plus it reduces the abandonment concerns that trouble many family members (especially parents) who feel like they can’t afford to leave the patient/s side.

Dinner-web

Bedtime-web

Sleep
While it is not new to provide family members with a pull-out chair or couch, their ability to stay overnight and get real rest is often limited by space. Using a full size Murphy bed gives family members a more comfortable space in which to spend the night, rest well and wake up better prepared to support their loved ones the next day.

Consult-web

Technology
Present throughout the patient’s stay, technologies that are both visual and non-visual enhance experience and support better outcomes. Visual technologies — such as a video screen and camera — allow for telemedicine consults with an outside or remote provider; they can also display the patient’s stats, care plan, food and nutrition and can help them better engage in their own care. Invisible technologies — such as sensors embedded in the room — can track any number of vital statistics, deliver medications or supplies and take unnecessary burdens off of staff so they can work at top of license. All of the panels in the wall system are rail-based and demountable to easily support repair and upgrades as technology evolves.

For addressing infection control, UV disinfection technology could be built into the system to clean the surfaces between uses. And while this proposal entails a moderate cost increase, we believe that the increased family engagement that that the system promotes can accelerate healing, reduce average length of stay and decrease costs in the long run.

Whether we’re designing for millennials, baby boomers or the generations that surround them, increasing the value of care through increased involvement of patients and their families is a concept that everyone can benefit from. It’s clear that the future of healthcare is about choice and value, and healthcare design needs to rise to that challenge.

Kerianne Graham and Ryan Hullinger are leaders in NBBJ’s healthcare practice, an architecture firm that designs hospitals and clinics for 11 of the 15 U.S. News & World Report Honor Roll Hospitals, including Massachusetts General Hospital, NYU Langone Medical Center, and Brigham and Women’s Hospital.

Banner image courtesy of Pixabay.

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Hospital Rooms Should Stop Making People Sick

Three Strategies for Reducing Healthcare-Associated Infections

February 18, 2016

Architect, NBBJ

Editor’s Note: This post was co-authored by Kerianne Graham and Sarah Markovitz. An expanded version appeared in Becker’s Hospital Review.

According to the Centers for Disease Control and Prevention (CDC), about 1 in 25 hospital patients have a Healthcare-Acquired Infection (HAI) — that is, an infection that develops as a result of medical care — on any given day, and in 2011 an estimated 75,000 patients with HAIs died during hospitalization. Treatment for these infections has led to annual costs of between $28 and $45 billion, and with changing pay-for-performance penalties, their impact on a hospital’s bottom line will only increase.

Whether you work in a hospital environment, parallel to it, or only engage with it when you or a loved one falls ill, chances are each of us will be somehow affected by an HAI, which is why our awareness of the issue at hand is critical.

Although tracking the initial cause of an HAI can be difficult, studies have identified the leading causes, starting with human behavior and compliance: the CDC identifies hand-washing as “the single most important method to prevent hospital infections.” Hand-washing alone, however, cannot eliminate HAIs completely, because contact with bacteria-laden objects and surfaces can lead to re-contamination, and we’ve learned from more than one institution that turn-over time for cleaning is a major challenge.

It has became clear that eliminating HAIs requires a “systems” approach, with multiple interventions in the design and function of hospitals and clinics. As architects, we recommend our clients take three approaches to make a difference: reduce the number of high-touch surfaces, eliminate potential host surfaces for pathogens, and increase compliance of medical personnel.

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Reduce Touch

Approximately 20-40% of HAIs are the result of infection transferred by human touch. Therefore, we suggest reducing the times that staff interact with unnecessary objects before caring for the patient. We turned to the CDC’s list of high-touch surfaces to rethink how staff interact with these objects. Some suggestions can be simply implemented, like trading doorknobs with wave sensors (#1), installing touch-free faucets and hand dryers (#2) and built-in, closed bedpan washers (#3).

Other suggestions require more operational changes: using room-specific, UV-sanitized tablets (#4) for documentation or as controllers for anything from lights to temperature. Still other solutions may seem counterintuitive, such as duplicating the overbed table (#5) — an additional surface is introduced, but it allows for separation of staff and patient surfaces — or storage alcoves where equipment can be stored until needed (#6).

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Eliminate Pathogens / Hosts

Microbes are everywhere, but reducing the number of host sites can reduce the chance of infection. For instance, replacing cubicle curtains with electrochromatic “smart glass” (#7) removes an element that can harbor microbes easily passed by contact transmission.

The room layout also makes a difference; inboard bathrooms, by keeping humidity away from cold exterior walls, reduce the likelihood of condensation and mold (#8). The exterior also walls should include appropriate vapor barriers and insulation (#9).

Finally, if we keep harmful microbes out of the patient environment, we can worry less about how we remove them. An average of 421,000 units of bacteria are tracked in on the outside surface of each shoe, including E. coli, which indicates contact with fecal matter; shoe cover dispensers are a simple solution (#10).

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Increase Compliance

None of these features matter, however, without the cooperation of clinical staff. To make it easier for staff to follow hand hygiene and infection prevention guidelines, the environment should be optimized with strategic, easily accessible locations for such seemingly simple elements as sanitizer dispensers, masks, gloves, shoe covers, sharps containers, garbage receptacles and contaminated supply disposal units (#11), along with automatic hand washers and dryers at the entry (#12).

Where low-tech solutions aren’t enough, RFID technology can be used for immediate feedback and compliance reports, (though some worry about the “big brother” aspect), and when paired with color-changing LED lighting can provide an indicator and record of hand-washing (#13). Low-tech and high-tech strategies alike, however, require the involvement and buy-in of the staff.

 

Conclusion

HAIs have no simple solution. Product representatives and architects alike must prove that their solutions will do more good than harm, and the quantity of evidence needed to declare something safe is much greater than the evidence needed to declare it poses an unnecessary risk. For instance, a well-known U.S. institution recently banned antimicrobial additives from surfaces in its facilities because the known risk from harmful chemicals outweighed the promised rewards in infection prevention.

With limited scientific proof, and limited existing regulations, it’s vital that we continue with this research to better protect healthcare patients. HAIs may never be eliminated completely, but with careful design, we can build much healthier and safer environments.

Banner image courtesy of COD Newsroom/Flickr.

All other images courtesy Pablo Licari/NBBJ.

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