Healthcare Design - October 2018 - 46

The

Center

DRIVING CHANGE

Looking back on the past 25 years reveals a few
key trends and issues that have shaped healthcare
design By Debra Levin

INCE THE CENTER for Health Design's founding in 1993,

we've spent a good amount of time monitoring the industry and looking for patterns and trends. Through this
exercise, we begin to recognize key drivers that are or will
soon be impacting our industry. As we reflect on our work
over the past 25 years, there are four issues that stand out.
1. Move toward measurement. Roger Ulrich's 1984
study "View Through a Window" got the attention of
both the industry as well as the mainstream press. People began to understand that the built environment, in this case patient views, impacted
health outcomes. In 1985, Press Ganey and Picker Institute offered the
industry measurement tools to start quantifying the impact of the built environment. Then
PEOPLE BEGAN TO
in 1986, the book "Design that Cares" by Janet R. Carpman and Myron A. Grant made the
UNDERSTAND THAT THE
case for why researchers should be part of a
BUILT ENVIRONMENT
design team from the start, foreshadowing the
evidence-based design process that's commonIMPACTED HEALTH
place today.
OUTCOMES.
2. Drive for safety and quality. Two landmark reports from the Institute of Medicine
(IOM), "To Err Is Human" and "Crossing the Quality Chasm," came out
in 1999 and 2001, respectively. In "To Err Is Human," we learned that
nearly 100,000 people a year were dying in healthcare environments
because of faulty systems, including design, that led to people making
mistakes. In "Crossing the Quality Chasm," IOM outlined six attributes
of care that lead to quality: safe, effective, patient-centered, timely, efficient, and equitable. Many of these can be positively impacted by built
environment decisions, such as designing noise-mitigating features to

OCTOBER 2018

HCDMAGAZINE.COM

both improve the quality of sleep for patients
and reduce staff distractions that may lead to
medical errors.
3. Focus on the regulatory environment.
In 2001, the Facility Guidelines Institute included an "Environment of Care" chapter in
its Guidelines for Design and Construction.
By 2006, that chapter introduced the singlepatient room as a standard and provided the
opportunity to focus on all aspects of the built
environment that could improve quality and
care outcomes. In 2006, CMS implemented
the HCAHPS survey as a means to measure patients' perspectives on hospital care, and the
first public reporting of HCAHPS results was
in March 2008. Coupled with passage of the
Affordable Care Act (ACA) in 2010, these changes fundamentally altered the way healthcare
systems are reimbursed, leading to organizations looking at everything that could contribute to the financial bottom line-including the
built environment.
4. Growing holistic view of health. As
the ACA decentralized care, the industry reenvisioned what a continuum of care might
look like through alternative settings like retail clinics and urgent care centers. Simultaneously, aging baby boomers' expectations
surrounding their health shifted and they began to interact with healthcare for more than
just treating illness-they're using it to try to
achieve wellness. Also moving beyond a focus
on the physical side of health, The Joint Commission released a sentinel event alert in 2016
regarding suicide in all types of healthcare facilities, acknowledging that mental health concerns are found everywhere, not just in settings
traditionally dedicated to mental health treatment. This attention on behavioral health is
one that's still of significant interest today.
Looking ahead, what trends and drivers do
you see impacting healthcare in the next decade
or two? No matter what they may be, we know
our industry will work together to respond to
them and to continue to improve healthcare
environments to produce the best possible outcomes for patients, families, and staff. 
Debra Levin is president and CEO of The Center for
Health Design. She can be reached at D L E V I N @
H E A LT H D E S I G N . O R G .

http://www.HCDMAGAZINE.COM

Table of Contents for the Digital Edition of Healthcare Design - October 2018