Rethinking Healthcare Hubs In The Post-Covid Era

Three ways technological advances will shift healthcare delivery, from the traditional hospital to at home services.

November 2, 2020

Principal, NBBJ

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

This post initially appeared on Forbes. It was co-authored by Sarah Markovitz and Ryan Hullinger.

 

The explosion of telehealth prompted by the COVID-19 pandemic has accelerated a shift in care delivery away from the hospital and clinic and into homes and communities. While hospitals have historically been the main hub of care, technology and new care models are enabling a different approach to care delivery. Rather than episodic preventative care, in which a patient periodically goes to a physician or hospital with a health concern, this new model of care is continuous and ubiquitous — with ongoing care reinforced in the home, office, school and throughout the community. There are three key aspects to this shift: advancing technology, new care settings, and the future evolution of hospitals.

 

Advancing Technology

Healthcare may follow a familiar path blazed by online retail. It was not that long ago that virtually everyone preferred in-person retail experiences to shopping online. The technology that would later make online shopping experiences superior to brick and mortar just didn’t exist. Telehealth, by comparison, is still in the dial-up days. It’s difficult to imagine now, but based on the patterns we have seen clearly in other technology sectors, it’s probable that some healthcare experiences will be better remotely than in-person—more convenient, and less stressful and time consuming. The technology that will transform telehealth is on the horizon. It will take several R&D cycles, but it will come. In fact, there’s evidence that in areas like behavioral health telehealth is already comparable in efficacy to in-person care.

What might the next generation of telehealth look like? For one, rather than sequential visits with separate specialists, patients may be able to connect to a suite of caregivers, all working collaboratively to provide more coordinated, effective care. The type of continuous, convenient touch-bases and flow of information enabled by telehealth and wearable devices could be particularly effective for the elderly and those with chronic conditions, where communication and ensuring compliance with medication and preventive care are often an issue. There will also likely be an expansion in the types of care and services that can be provided, including everything from post-surgical appointments, to ED triaging, and eventually more complex tests as new diagnostic technologies emerge.

Automated technologies and artificial intelligence will also play an increasingly vital role in improving health throughout the community. AI technologies are being used to scan patient records, identify patients with hypertension and diabetes, and remind physicians to check in regularly with them. Hospitals have already shown good results using telehealth, texting and improved monitoring to help vulnerable populations and those with chronic conditions. Improved telehealth and health data capabilities could extend widescale efforts like these, improving population health efforts.

 

New Care Settings

With technology acting as a facilitator, more and more forms of care, especially routine procedures, will migrate away from hospitals and clinics. The home could become the new healthcare hub, with prefabricated telehealth units for the home that integrate medical technologies with telehealth capabilities. The explosion of smart home, home health and health monitoring devices, encompassing everything from sensors that detect sudden falls to smart watches that monitor heart rate and O2 levels, is only the tip of the iceberg. With the ability to monitor health data and communicate effectively with caregivers, the home could be a crucial site for preventive medicine, chronic disease management and ongoing care.

The home health model is only one possible model—the technologies that enable it may have shortcomings, or prove unaffordable to large segments of the population, further exacerbating health inequities and the digital divide. But healthcare can still be provided in a wide range of locations distributed throughout communities. Libraries, schools, community centers, homeless shelters and pharmacies could become hubs for telehealth resources and care, serving a vital role in improving the health of communities. A key consideration will be access and location—ensuring that healthy equity and care for vulnerable populations drives where these new care hubs emerge.

 

How Hospitals May Evolve

As care becomes increasingly continuous and ubiquitous, the role of the hospital may evolve. Rather than serving as a destination for all patient types, it will become increasingly specialized and streamlined, focusing on high acuity cases. They may expand their capabilities and efficiency in areas like perioperative and high-end imaging that are not available in community settings. In the process, hospitals are likely to become more compact, high performing and efficient by narrowing their focus. As part of this evolution, hospitals may also need to bolster their ability to expand capacity by 50-100% in anticipation of emergencies like epidemics, mass casualties and weather-related crises.

In the last 20 years, many hospitals have invested heavily in improving patient comfort and satisfaction, and have even borrowed processes and designs directly from the hospitality industry—creating patient environments that nearly resemble hotel lobbies and guestrooms. Patient satisfaction will continue to be a driver, but the environments that promote satisfaction are likely to change drastically. New environments that convey a sense of safety and cleanness will begin to feel more comfortable than the hospitality-informed designs of the past.

As this shift and gradual downsizing takes place, there may be opportunities to adapt existing space for other uses. The COVID-19 pandemic has demonstrated the dramatic impact of stress on healthcare workers. Hospitals now have an opportunity to provide sufficient and appropriate space for staff, helping to build resiliency to counter staff burnout and ensure the well-being of these truly essential workers. Hospitals could also aim to provide more community, patient and staff resources, such as spaces to demonstrate telehealth technologies and how to use them, or new hybrid offices equipped for telehealth.

As technologies, new care settings, and hospitals evolve, care will become more embedded in our daily lives. The pandemic may have spurred new interest in telehealth, but the trends shaping the future of care predate social distancing. They will continue to transform how and where care is delivered, ushering in a new era of ubiquitous healthcare.

 

How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

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How Can We Mitigate Stress for Frontline Healthcare Workers?

Evidence-based Strategies to Build Worker Resilience During the COVID-19 Pandemic and Beyond

September 28, 2020

NCIDQ LEED® AP Senior Associate I Interior Designer, NBBJ

Editor’s Note: This post was co-authored by Katie Davis, Sarah Markovitz and Andrea Rufe. 

 

The impact of COVID-19 touches all aspects of healthcare, but is especially acute when it comes to the wellbeing of frontline workers. Communities look to first responders during times of crisis, which is why the wellness of these individuals is critically important now. The pandemic’s impact on the mental health of these workers is profound, causing psychological distress. It also increases burnout, which can lower work performance and raise the risk of errors. Yet the coronavirus crisis also creates opportunities for positive change.

Key neuroscience insights illuminate strategies to help alleviate the challenges frontline workers face. These findings paired with designs that bring moments of calm and foster connections can create a roadmap for healthcare facilities — from hospitals to ambulatory centers and clinics — now and in the months ahead.

Backed by neuroscience research from NBBJ’s Fellowship Program, this post examines three ways to boost healthcare employee resilience through changes to physical environments, operational protocols and organizational systems. The ideas center on a variety of practices and respite areas — each of which can be implemented at various scales — both in traditional and non-traditional healthcare settings.

 

Support Spaces

Spaces that offer opportunities for caregivers to turn to one another for support and share solutions, especially through talk therapy, can strengthen resilience and happiness. Offer frontline workers ways to connect with someone trained to listen, such as dedicated staff or virtual mental health services. Existing rooms that provide privacy can be repurposed for these conversations with comfortable seating and couches, tables and video conference support. Furthermore, a focus on total wellness via health coaching stations with programmed nutrition, mental health and exercise classes can offer a comprehensive growth-oriented suite of amenities to build a strong support network, improve memory, enhance cognitive function and create a better quality of life.

Restorative Zones

Restorative zones create space for frontline caregivers to recharge — in the good times, but especially so in times of crisis. Restorative zones are hyper flexible: they can leverage underutilized spaces for a moment’s rest such as a quiet alcove at the end of a hallway with a window that overlooks a garden. They could include comfortable high-backed sound-absorbing chairs with ottomans to rest one’s feet and a table to place a rejuvenating refreshment or inspiring book. On a larger scale, a refuge room filled with plants, natural light and the sound of running water — or even a digital wall of nature imagery — can provide an immersive sensory experience.

Mindfulness Rooms

Spaces that facilitate mindfulness can promote mental wellness and greater resilience to challenging situations. Mindfulness can be promoted at various scales. A small niche with room for a yoga mat can help build mindfulness techniques, like deep breathing, that can be called upon anytime during the workday. Mindfulness micro practices can also be cultivated during daily routines by incorporating biophilic design in transitional spaces like stairwells. In addition, meditation, yoga and massage rooms can offer regular mindfulness sessions and promote connections between staff outside of their normal work tasks.

 

Wellness for frontline staff encompasses a whole-health approach for individuals, departments and organizations. It’s powered by meaningful work, relationships and uplifting spaces that support strength in and outside the work environment.

These ideas are part of a comprehensive report by the NBBJ Fellowship Program which outlines ways to mitigate stress for frontline healthcare workers, how to create new work rhythms and how to remain human in a hybrid virtual-physical world. To learn more about these concepts and the supporting research, please email socialmedia@nbbj.com.

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Person-Centered Design: The Importance of Balance in an Era of Constant Change

September 10, 2020

Principal, NBBJ

Editor’s note: Our healthcare clients are on the front lines of the coronavirus crisis. We seek to support them as they courageously care for the sick. So we’re posting design ideas based on work with them, in the hope that we can contribute from our base of expertise to help combat the epidemic. From all of us at NBBJ to the many doctors, nurses and support staff in hospitals and clinics, thank you from the bottom of our hearts.

 

As a child, I loved seesaws — one moment having my feet on the ground and the fate of the other person in my control, the next second trusting them to lift me so high into the sky I could see over my mom. I learned to create a balance of sorts across from my older brother by sitting far back or scooting closer so that he had a harder time throwing me off.

I’ve been thinking a lot about balance lately. As designers we use it as a basic element in composition; as a civilization we equate it with stability and fairness; as humans we need it to simply stand upright — all dynamic equilibriums needing our attentiveness lest an unknown thing threaten the equation.

This is how the world seems to many of us right now — all was moving along fairly balanced with a degree of control until the pandemic sent us teetering.

Recently, I’ve started two projects that have me thinking deeper about what role balance plays in design, specifically in creating hospitals for person-centered care. Person-centered care is the compassionate perspective that we are all individual human beings first before we are anything else: spouse, parent, student, friend, employee, patient.

Founded by Planetree — an organization that promotes the thoughtful response of healthcare systems to individuals’ human need for respect, control and supportive care — this philosophy focuses on creating environments for positive human interactions between patients, families and care givers. Primary tenets include empowerment with information, integration of the arts and complementary therapies and the nurturing aspects of nutrition, spirituality and human touch — all creating better outcomes.

The physical space within a hospital or clinic plays an important role for connection to take place. It can bring equilibrium between the often-conflicting goals of human-centered experiences and operational efficiencies — that’s where our design teams come in.

So how do I design something centered around another person when I barely feel centered myself in these turbulent times? Can my environment be a part of my solution just as we expect it to be for the patient?

The real work for the patient — and for me in this pandemic — comes from within. Perhaps the space we build outside the patient is only successful if it enables the construction of a healthy space inside the person.

One way to empower this internal effort is to create environments that anticipate personal needs. For example, we know through inquiry and observation that the most frequently asked question at information desks is often the location of the restrooms. Anticipatory design places those elements in easy sightlines before patients stop to ask. By developing experience maps, we can identify and eliminate the outside struggle with blockades that throw people off.

Another aspect is to make spaces that become easy portals to colleagues, friends, and family — more thoughtfully crafted to individual needs, making connections readily available to overcome the disruption of distance. Smart televisions in patient rooms that can accept a video chat from a private phone accompanied by an overbed table device to hold the phone camera would connect families during this isolated time.

By removing barriers to compassionate human interactions in the healthcare setting, we can create conditions for the patient to do the hard work of centering themselves emotionally in their new world of diagnosis, treatment and healing. To find a fulcrum for grounding. To feel themselves again.

On a seesaw, when both people put their feet on the ground, they create a bridge between them, a stable connection built on trust. Design created through a lens of person-centered care enables both those receiving care and those providing it to create balance, building bridges between them.

In a world that is teetering, perhaps extra attentiveness to human-centered design is our chance as architects to scoot closer to those for whom we design, stretch our feet down to the ground and bring back some balance on both ends.

 

How are you and your healthcare organization dealing with the coronavirus? We’d like to hear from you. Drop us a line at socialmedia@nbbj.com.

Banner image courtesy Adobe Stock.

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