An Architect's Response

Abstract

I began reading Mahbub Rashid's paper with great anticipation. After all, title promised something important: a model linking face-to-face interaction among clinicians to hospital design.As a practicing healthcare architect who strives to enhance this interaction, I am all too familiar with statistics, cited by Rashid, that make faulty communications a primary culprit in numerous medical errors and patient deaths. So his promise of a new face-to-face interaction model immediately piqued my interest. Whether Rashid delivered on this promise, I'll turn to later.His paper includes some solid content. For example, by highlighting relationships among face-to-face interaction, interdisciplinary collaboration, and patient outcomes, Rashid reminds designers and architects never to lose sight of these key relationships. He also reminds us that, although some spaces (such as a staff lounge) should be designed to promote informal, serendipitous interaction, others (such as a medication space) should be designed to promote focused effort and activities.Something else in paper that caught my attention is an acknowledgment that a growing body of literature supports proposition that the physical design of an environment affects individual and organizational performance and outcomes, including communication interaction, or collaboration. Healthcare architects are happy for confirmation of a phenomenon they have long observed in practice.At one point, Rashid notes that literature on strategies for improving communication in hospitals rarely mentions hospital design. Healthcare architects know, however, that design significantly affects communication. Yes, successful cultures can thrive in poor buildings-think of miracles in MASH tents. But creating and growing a successful culture is far more likely in well-designed buildings that promote and reinforce that culture.For me, and I suspect for many other practicing healthcare architects, Rashid's most intriguing idea is combining of two factors-patient acuity and medical complexity-to characterize hospitalized patients and determine their communication and interaction needs. These needs vary, depending on a patient's condition and complexity of care required. And these variances, Rashid correctly notes, create a dilemma for healthcare architects: how to design spaces (commonly known as medical planning) that fully accommodate interface between changing patient conditions and changing makeup of caregivers.Rashid's paper contains a detailed discussion of two key hospital communities: communities of practice and communities of care. Architects recognize their importance to patient care. In fact, when doing medical planning for hospitals, architects typically spend a great deal of time interviewing critical care group, one type of community of interest mentioned by Rashid.From another researcher, Rashid borrows concepts of and building programs. A strong program-Rashid's example is a courthouse-creates spaces where necessary interfaces among different types of users must happen in same way; in contrast, a weak program- Rashid's example is a newspaper's editorial office-permits unpredictable interfaces. …