The Hospital of the Future Will Be a Flexible, Dignified Place that Serves Patients and Caregivers Alike

Experts agree that COVID-19 has all but assured that the design of future hospitals will change. Ideas about those potential changes were the focus of a Jan. 26 webinar about pandemic-resilient health care design, presented by HKS and Arup.

Webinar participants were Jason Schroer, HKS Principal and Global Health Leader; Erin Peavey, HKS Architect and Designer Researcher and Bill Scrantom, Principal and National Healthcare Leader at Arup. They discussed their report, The Pandemic-Resilient Hospital: How Design Can Help Facilities Stay Operational and Safe, which offers several design principles that can lead to healthier, safer hospitals.

Also joining the panel were Althea Mills, Chief Nursing Officer and Vice President of Patient Services for Stony Brook Southampton Hospital in New York and Liz Youngblood, President of Baylor St. Luke’s Houston Market & SVP/COO Texas Division for St. Luke’s Health, who offered personal accounts of the pandemic’s trials and discussed how architects and engineers can help mitigate similar problems in years to come.

Here’s what we learned from the conversation:

Flexibility Is Here to Stay

Hospitals weren’t adequately prepared for just how quickly COVID-19 would sweep through their communities.

“We’ve seen across the globe that this pandemic has required a really swift response from the hospital,” said Peavey, who served as moderator for the event.

The panelists stressed that beyond the basic ability to be flexible, the ability to flex rapidly — almost on a moment’s notice — is just as, if not more, important. “We always design for flexibility, but what the pandemic has taught us is that we need to design facilities that are flexible and can quickly convert,” Schroer said.

Innovative interventions happened on the fly as hospitals started to manage COVID-19 surges last year — waiting rooms transformed into pre-screening areas, temporary walls divided open wards and special zones marked for circulation and staffing remapped hospital floors.

“At the beginning of the pandemic, we really didn’t know what to expect,” Youngblood said. CDC recommendations and information about how the coronavirus transmits changed on a seemingly daily basis. The fast-changing nature of the situation played a role in St. Luke’s need to be flexible.

“For us, it was about preparing for anything,” Youngblood said. Her staff assessed how much power was available on their units so they could accommodate additional systems and even determined what available machinery could be converted for other uses such as ventilation.

When the governor of New York ordered hospitals there to increase capacity by 100% in a matter of weeks, Mills and her team nearly panicked, wondering how they could fit any additional beds in their small hospital, let alone twice as many. They identified every private office in the hospital with a bathroom and repurposed those spaces as care rooms.

“Reclaiming those offices was one of our saving graces,” Mills said, who also mentioned other flexible strategies, like turning a gym and wellness area into an open ward to accommodate additional beds.

Mills and Youngblood said that one of their biggest challenges was the lack of negative pressure rooms in their hospitals — an issue that spans architecture, engineering, and operations in earnest. Prior to COVID-19, Mills said there was rarely a need for these types of spaces, but now she wants designers to make them a priority. “The first thing I would like to see is the ability to flex from a regular room to a negative pressure room,” she said.

Scrantom cautioned that while there are exceptions being made given the current crisis, building codes in some jurisdictions do not currently allow for pressure-switching in rooms. He believes the industry may have to consider re-evaluating codes moving forward to allow for that kind of flexibility.

The panel also discussed both “inherent” and “provisional” flexibility — the difference between permanent design measures that accommodate multiple scenarios on any given day and temporary features that can be changed during a crisis. The demands of treating an airborne illness like COVID-19 have caused experts to give more consideration to both types of flexibility.

Scrantom described an example of provisional flexibility: connections can be installed in a traditional hospital room for a pop-up anteroom in the event of a widespread airborne illness. Speaking about inherent flexibility, Scrantom said that designing oversized HVAC systems would allow for additional airflow when needed.

“You have to design systems for both scenarios,” he said, adding that infection control considerations must be made at all levels of the health system from campus-wide to individual rooms, another key theme from the report.

Partnerships in Health Care Settings Are Changing

COVID-19 brought communities together in ways previously not seen or heard about. For health care systems, this meant receiving support in unexpected forms. At Stony Brook Southampton Hospital, local entrepreneurs and business owners provided the hospital with additional supplies like PPE, an offer that Mills described as extremely helpful.

Youngblood said that St. Luke’s “ended up with some really unique partnerships, too, just to deliver health care to our patients.” She noted, for example, that the hospital reached out to local builders to obtain difficult-to-find air scrubbers.

Forging stronger partnerships in a pandemic-ridden world is an imperative for designers and caregivers, whose work will become even more intertwined as we head into an uncertain future. Mills believes the necessity of collaborative design processes with hospital staff, engineers and architects will be crucial moving forward. “We really do need to involve the caregivers in the discussion of the design. We know what our patients need,” she said.

The full range of people who design, plan, operate, and receive care in a hospital must work together to ensure a health crisis can be properly managed, even before it happens, because “COVID-19 is not going to be the last pandemic that we .  .  . see in our lifetimes,” Scrantom said.

Well-being and Dignity Cannot Be Sacrificed

The panelists agreed that the well-being of health providers is paramount, and they hope to continue the conversation about how to ensure that lessons learned from COVID-19 help hospitals and designers understand how to limit the risk of infection, exhaustion and mental health issues among hospital staff as well as patients.

Notably, the pandemic forced hospital workers to take on more challenging — and personal — roles. Necessary visitation restrictions meant to protect non-infected individuals from the deadly virus have required caregivers to step in as emotional support for sick and dying patients.

“Staff are often replacing family members in tough moments,” Schroer said. “How, through design, can we enhance dignity —for staff, families, and patients?”

Mills and Youngblood believe that design features like windows or glass doors in all rooms will help provide a visual connection when a physical one is not possible. More complex interventions like advanced digital technology for engagement and communication between patients, caregivers, and families will be fundamental to successfully navigating challenges of similar viruses and diseases.