I recently made presentations in Copenhagen and Rotterdam in which I shared my concern about the lack of rigor in architectural practice. I used my own years of practice as a designer of hospitals as an example. I told them that I have been responsible in my career as an architect for the design and construction of more than 15,000 patient rooms in which doctors and nurses care for individuals whose conditions warrant hospitalization.I know something about each of the hospital rooms I have designed. I can tell you how they are arranged into units in relationship to nurses and supply locations, or how their orientation may offer differing views and solar orientation. I know the physical dimensions of the spaces and the materials used on the walls, floors, and ceilings. I can describe the heating, ventilating, air conditioning, filtration, and temperature controls. I know where the sinks and hand hygiene positions are located, along with the sharps disposal containers. I can describe the types of patient toilets. I am aware of the furniture intended for each of the rooms. I am acquainted with the communication systems, life support utilities, monitoring devices, and the television or entertainment systems provided for patients. I am aware of the original decor and color selections, and in many of them I am aware of the artwork installed. In some cases, I have information on patient satisfaction and staff satisfaction. I suppose I know what any competent architect might be expected to know about his or her completed projects.What Don't I Know?I have recently come to believe that what I do not know about my projects is an indication that both the projects and my 30 years of practice lacked sufficient rigor. Although I am not ashamed of any of my past work, and I am proud of most of it, I realize that much of this evaluation is subjective, idiosyncratic, arbitrarily aesthetic, and unsubstantiated. I am certain that hospitals I designed are much better and more efficient places than the grim, cold, institutional hospitals so common in the 1950s. Any praise my work has garnered has, however, been based more on the observer's intuition than on rigorous study and analysis. The real question is whether I might have done better.On any given day there are surely more than 12,000 patients being cared for in hospital rooms that I designed; so in a year, something like three quarters of a million patients in many states and several countries experience them. I am embarrassed to say that I don't know which rooms have the lowest rates of hospital-acquired infections, medication errors, falls, or sentinel events. I wonder if some of those rooms have a better record of healing that might be measured by a reduced length of stay. I cannot identify the rooms with either a good or poor record of staff injury. I suppose my clients might not have been willing to provide me with some types of data, but I did not request it.Are some of the rooms I designed configured to allow more efficient and effective caregiving? Is care easier to deliver in one room than another? Does the configuration of medical gases, emergency power, and monitoring serve as intended? Is it inadequate, or is it perhaps excessive? Do some rooms serve the needs of families better than others? Which rooms have a record of accommodating procedures that have reduced the number of hospital transfers? Are there features in some of these rooms that nurses dislike or that create problems? Have some patient rooms stood the test of time, while others have subsequently been renovated to correct a condition for which I might have been responsible?If the rigor of my practice and the cooperation of my clients had supplied most of these answers, I must believe that I could have designed better, safer, more effective patient rooms. If other practitioners were also made aware of these answers, the entire field might be designing superior, better- performing patient environments. …
Read full abstract
May 25, 2011
Ashley K Kable + 2
Open Access