Award-Winning Research Explores Facility Modifications for Future Pandemic Resiliency

HKS research exploring health facility preparedness has been recognized with two distinguished awards—‘CORE Merit status’ by the Environmental Design Research Association (EDRA) and the ‘research category’ winner by European Health Design (EHDC). EDRA and the European Healthcare Design Conference highlight the project’s valuable contribution to environmental design research and its innovative approach to addressing industry challenges. One jury member of the EDRA CORE committee highlighted that HKS’ research on pandemic resiliency “sets a good precedent for the industry,” writing that the study had a large scope and many sources of data. The project, “successfully infused data science into the workflow and delivery.”

HKS’ work was one of only three project teams to receive merit status by EDRA CORE this year. Their evaluation framework helps identify excellent environmental design research that adds value, addresses industry challenges, and promotes innovative thinking. It recognizes the importance of research in practice for all stakeholders involved. A panel of diverse reviewers assessed projects and awarded Merit status to those with high scores. EHD evaluates research according to its innovation, relevance, and practical application. They evaluate work according to its originality and how the work creates innovative methods to address existing issues.

The scale of the research is a differentiator, achieved through key partnerships. In collaboration with HKS and WSP, the U.S Army Medical Command conducted Functional Performance Evaluations (FPEs) of 15 medical treatment facilities (MTFs) within the continental U.S. to understand the effectiveness of existing COVID-19 modifications and to document recommendations for potential facility improvements to create a roadmap for future pandemic preparedness. The facilities we researched totaled over 15 million square feet. A framework comprised of five constructs: safety, flow, surge capacity, staff wellbeing and flexibility, was developed to evaluate all the facilities consistently.

Retrospectives on the global response to COVID-19 pandemic has only begun. HKS’ research adds a large-scale study measuring the overall pandemic response and staff experience across over a dozen facilities—and it is this scope that allows critical insights. As the delta variant ravaged hospitals during 2021, the Center for Disease Control found that capacity reaching 75% or beyond was leading to 12,000 excess deaths per week. It’s not only an audit of surge capacities that’s needed, but a mixed-methods investigation of on-the-ground experience.

We leveraged a mixed-method investigation—an under-tapped mode of inquiry in the design industry. And we supported our investigation using several different modes of analysis to guide our conclusions. We not only studied the factors that contribute to the effectiveness of facility response during the pandemic, but the magnitude of their impacts. Facilities responded differently to the COVID-19 pandemic, and we explored the good and the bad. We found significant differences in the performance by certain factors, as well as the success between sites. After studying these factors, we also researched how facility, operations, and MEP considerations impact the overall effectiveness of facility response.

What did facilities do well, and how can they improve? Using a rule-based sentiment analysis, or a way of establishing the polarity of open-ended responses, we found that facilities developed the infrastructure to quickly mobilize telehealth appointments, creating flexibility for staff rotations, providing visual cues for safe personnel flows, and providing additional space modifications for COVID-19 testing. Many facilities also did not provide the infrastructure necessary for telework, nor did they provide clear policies and leadership in the transition to working from home. Supplies and personal protective equipment (PPE) were also lacking. Our findings corroborate the reporting that hospitals were understaffed, which exacerbated poor patient care and staff burnout.

Lessons learned from this study will help to inform how to make existing facilities more resilient, as well as to inform the planning criteria for future capital investments. Here are a few key insights that directly impact how we will approach future facility design and care delivery:

Digital first solutions are challenging the status quo.

Digital health has proliferated across the healthcare industry. Emerging technology blended with physical spaces can help make care more personalized and responsive. Considering which service can be effectively delivered virtually and which cannot also helps to support more nimble and resilient care delivery during a health crisis.

Staff well-being has become table stakes. Clinical spaces must be designed for patient well-being—but also for those who deliver care. Designing for those who administer care is crucial to maintaining a resilient health system that adjusts and evolves over time. Environments and amenities may attract and retain top talent by addressing the emotional, cognitive, physical, and social needs of staff.

Optimized flows are vital for agile care delivery. Implementing agile solutions that allow healthcare to optimize flows – people, equipment, supplies, medication, and information – and avoid bottlenecks are essential to the success of efficient and effective care delivery process that can quickly pivot based on rapidly changing census and care needs.

Communication is key to building trust. Coronavirus pandemic demonstrated disconnect between front-line workers, administrators, and policy makers. Communication from leadership that is both informative and comforting is essential to bridging the chasm and building trust. Empathizing with personal stories of staff can help facilities build stronger and purpose-led teams.

The study is authored by Dr. Deborah Wingler, Dr. Rutali Joshi and Brent Willson from HKS, Dr. Abhishek Bhargava and Nolan Rome and from WSP, in collaboration with Brenda McDermott from the Defense Health Agency. The research team is actively pursuing publication in an academic journal.