It’s Time to Design a Better Experience for Behavioral Health Patients

How to Deliver Better Care While Freeing up Hospital Space

March 28, 2017

Partner, NBBJ

Editor’s Note: A version of this post was previously published in the Puget Sound Business Journal.

The United States faces a mental health crisis, with 26% of people nationwide suffering from psychological illness or addiction. When these patients are at their most vulnerable, our communities’ emergency departments (EDs) are used as dumping grounds and holding areas due to the shortage of appropriate resources.

While any treatment is better than none, EDs are often unequipped to treat these specific patients, especially in smaller cities that are challenged by less capacity and staffing or by fewer specialized facilities. Treatment in the ED often comes with loud noises, bright lights, chaos and seclusion — which can aggravate and trigger complications for a behavioral health patient. EDs are also an expensive treatment option, increasing the cost of care for the patient and the public.

The trend of patients seeking care in EDs instead of psychiatric institutions is not new. In 1963 Congress passed the Community Mental Health Centers Act to deinstitutionalize the mentally ill. The goal was to stop “quarantining” the mentally ill and provide voluntary humane treatment. Unfortunately, this act has not been successful; the deinstitutionalization movement has been called the trans-institutional movement, with patients instead filling EDs, jails, prisons, and homeless shelters.

A Healthy Path Forward

Luckily, healthcare organizations are working with partners in their communities to overcome these challenges. For example, Kaiser Permanente and MultiCare are actively participating in programs to provide appropriate treatment for behavioral health patients — from better training of emergency responders, to preventive health measures, to better funding models.

Another solution is to redesign our treatment facilities. In Portland, Oregon, is Unity Health, envisioned by the Randall Charitable Trust. Together with a series of healthcare institutions, the trust remodeled a shuttered hospital into an inpatient behavioral health hospital with a psychiatric emergency services department. Several architectural firms came together to design appropriate spaces for care and treatment, not just stabilization until a patient is “good enough” to be released.

For example, at Unity, the typical ED exam room allows patients to dim, brighten or turn off lighting completely. While a seemingly benign solution, there is conclusive evidence on the power light has to hinder or support healing, especially with those suffering from anxiety attacks.

The project also focuses on reducing noise. When sound becomes too acute in healthcare settings, it can raise stress levels, boost blood pressure levels and require additional medication. These side effects work against providers as they seek to support their patients. The new design focuses on creating quieter spaces — using sound-absorbing materials, sliding doors and acoustical tiles to decrease noise levels.

In addition, behavioral health patients often react to each other’s outbursts, so the design relies on patient monitoring for safety. Not only does this allow for patient privacy, it also prevents patients from being put in windowless, isolated rooms.

A Call to Action

Despite the best efforts of the Affordable Care Act, the cost to treat behavioral health patients is skyrocketing. To counter the cost impact, we need to create programs for understanding, rehabilitation and prevention to ensure behavioral health patients find wellness and stay well. Studies show that for every 10% increase in mental health spending, the prison population is reduced by 1.5%. It’s clearly better to spend our resources on creating a well-balanced environment — through programs, assistance and facility design — than incarceration.

While the nation grapples with the uncertainty of healthcare under a new administration, we can take steps now to ensure patients suffering from behavioral health issues are given the tools and resources necessary to lead healthier, happier lives.

Image courtesy of Pexels.

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Hospitals Play a Key Role in Building Pathways Out of Poverty

How Healthcare Providers Can Give Back to Their Neighborhoods, and Benefit from It

February 28, 2017

Planner / Architect, NBBJ

Editor’s Note: A version of this post was originally published by Next City.

As jobs in many low income neighborhoods have migrated to suburbs (or overseas), so have retailers and newer housing for those well-off enough to pull up roots and move out. Not so for the large hospitals that have substantial capital investments in existing buildings and, in many cases, social investments in existing communities. Public hospitals in particular tend to find themselves embedded in some of the most distressed communities in America.

As a planner working with many stressed cities in the “Rust Belt,” I frequently find local hospitals are the last and most committed economic anchors, but also the ones most impacted by economic decline in urban cores. City governments are searching for ways to leverage the economic benefits of these anchor institutions (hospital jobs certainly, but also subcontracting and services) for the benefit of the larger community. And some forward-thinking governments, along with aligned organizations and foundations, are now advancing policies and programs to do so.

For example, in Cleveland, the nonprofit development organization University Circle, Inc. has been cooperating with the city’s many world-renowned hospitals to enhance the surrounding neighborhoods. One such initiative, Greater Circle Living, is an employer-assisted housing program created to encourage eligible employees to live closer to their jobs, thus strengthening the local housing market and reducing traffic congestion on regional roadways. Another example, Next Step, encourages large institutions to focus their spending on local green businesses to supply cleaning services, food preparation or laundry. This not only advances green agendas but also bolsters local, and frequently minority-owned, enterprises and local employment in the services sector. Through programs such as these, local communities see direct benefits from the regional anchor institutions in their midst.

So how can regional healthcare institutions — that are struggling to provide quality care and attract new insured patients — benefit from these types of efforts and develop their own?

 

Think Local

By a biological analogy, a healthy organism thrives in a healthy environment. Under new accountable healthcare mandates, hospitals no longer necessarily profit from serving unhealthy populations as they may once have. Many local hospitals want to improve their positioning, marketing and general appearance for insured patients, but they also need to address the general health of the local populations which suffer from the highest preventable disease rates. Urban hospitals across the country treat residents in communities where nearly half the population is either uninsured or on Medicare. Treating population health issues and their causes is now more important than ever to reduce healthcare costs.

In the past, responses to poor local conditions may have led hospitals to clear blight in their vicinity, or to turn their backs on negative conditions in an effort to screen the problems and present a brighter face to their regional customers. Security frequently took the form of a siege mentality: fencing or large parking lots that separated troubled neighborhoods from secure zones within the campus. This approach did not do much to reverse neighborhood decline or negative impacts on the anchor institution, nor did it improve health outcomes of local residents.

 

Practice What You Preach

As in Cleveland, The Aultman Health Foundation (an integrated health system with two hospitals, a health plan and a college) in Canton, OH, is demonstrative of a more comprehensive approach to health. Aultman (and one other hospital, Mercy Medical Center) remains within the city limits, serving the city’s reduced urban population of 70,000 as well as the growing metropolitan-area population of 400,000. Employees and patients seeking specialized medical care must travel from far-flung suburbs and hamlets to one of Canton’s most distressed inner-city neighborhoods. While the neighborhood is arguably less blighted than the surroundings of other famous urban hospitals, the contrast is striking for patients and employees, and local conditions do not support healthy lifestyles for nearby residents.

The health district could eventually involve the entire neighborhood of 40 square blocks where, for example, existing residents would have access to a much-needed wellness (fitness) center, outpatient clinic, quality daycare and healthier food options. Local residents will share these resources with hospital staff, nursing students, patients and patients’ families. Nursing students, medical residents and staff will find housing in the immediate neighborhood in renovated homes or in new apartments. Redesigned roadways will reduce accidents and provide safer pedestrian crossings for kids and the elderly. Parks and tree-lined streets will encourage residents and patients to get outside in a safer neighborhood.

 

Be the Convener

As one might expect, some healthcare institutions are cautious about exercising skill sets beyond providing healthcare. They were rarely organized, or willing, to take on community blight or mixed-use development projects. But they are good at team-building. And this “Health District Strategy” takes many players — healthcare institutions, governments, foundations, private enterprises, even architects and planners — to succeed.

Aultman Health Foundation, by working with the City of Canton and their comprehensive plan, has begun to develop a comprehensive strategy for neighborhood transformation that involves an expanded group of stakeholders, city and state governments and the private development sector. At this point Aultman has convened city government, the Ohio Department of Transportation, the Canton Community Development Corporation, a local foundation and a private real estate developer to create a blueprint for a health district called “Aultman Health Village.” From fixing blighted houses to rebuilding roadways and adding needed retail and services, each of these players are addressing specific coordinated actions that are essential for success.

Aultman Health Foundation and Cleveland provide examples for other progressive healthcare institutions to follow. Anchor institutions can take a look at their surrounding communities to find win-win opportunities. One needn’t be a world-class center of medicine like the Cleveland Clinic to make a difference in one’s own community. Rather than retreat from each other in fear, institutions and communities can actively engage to reverse decline and surround the hospitals with the goods, services and housing that will heal both.

Photo courtesy of Pexels.

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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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