Connecting the Dots

What do evidence-based design, improved outcomes, and the ACA have in common? Three case studies illustrate the link among them

By Jane Rohde, AIA, FIIDA, ACHA, AAHID, LEED AP, Green Globes CIEB Assessor in Interiors & Sources Feb 2015.

“Capture natural light and views of nature at an urban edge”

Each year at the Healthcare Design Conference there is a pre-conference session dedicated to coaching healthcare systems professionals, providers, design practitioners, educators, contractors, and other key players interested in learning or further developing an evidence-based design (EBD) process. The recommendation is always to start with what you know and grow the process appropriately depending upon the project and desired outcomes. Although the process is consistent, the priorities and benchmarks may vary greatly across project types.

However, in evaluating opportunities when establishing baselines for outcomes—which has always been a tenet of EBD—there is the necessity for measuring these improvements because they are tied to reimbursements under the Affordable Care Act (ACA). This is an important intersection between EBD and the ACA because evaluating these priorities can result not only in increased efficiencies and reduced costs, but also improved medical outcomes.

The following three case studies demonstrate an EBD approach based on varying goals and project requirements, and they also take new ACA requirements into consideration.

PRINCETON HEALTHCARE SYSTEM
In May 2012, Princeton HealthCare System (PHCS) opened a new 238-bed, 575,000-square-foot, non-profit acute care hospital as part of the University Medical Center located in Plainsboro, N.J. This Pebble Project consisted of a patient bed tower, a diagnostic and treatment building, an administration and education building, and an onsite co-generation plant that supports the hospital. The Center for Health Design utilizes the Pebble Project to assist clients with utilizing research to not only make informed decisions, but also to provide a framework for completing benchmarks and research within a healthcare setting to sustain continued improvement.

The vision for this project was to build one of the finest hospitals in the U.S. that would support and encourage outstanding clinical care, provide the most-advanced technology, and demonstrate commitment to the community by incorporating sustainable design and function.

Barry Rabner, PHCS president and CEO, along with the trustees hired Navigant to help manage the project and two architectural firms, HOK and RMJM Hillier, as part of the design team. As a participant in the Pebble Project, the decision-making process was led by the program’s guiding principles, which include the use of EBD for enhanced patient safety; the development of environments conducive to healing; ranking in the top 10 percent of U.S. hospitals for patient satisfaction; embracing patient-centered care concepts; and optimizing operational efficiency with related cost reductions. Flexible design was also adopted with the unusual caveat that included building 150 percent of the current project need to allow for expansion.

Under Rabner’s direction, every detail of the new hospital—from safety features to patient and family comfort to maximizing staff efficiency—was thoroughly researched. In working with the Center for Health Design, there was a review of approximately 1,200 articles of design research, feedback from staff and administration at 15 other hospitals, and multiple focus groups of stakeholders and patients.

YALE-NEW HAVEN HOSPITAL
Likewise, Salvatore Associates and CAMA, Inc. recently completed a new Adult Emergency Environment of Care for Yale-New Haven Hospital located in New Haven, Conn. It utilized an interdisciplinary design team that was guided by the following EBD objectives:

  • Reduce patient and visitor stress
  • Reduce wait times and improve flow
  • Improve staff sightlines—both from a security and clinical care point of view
  • Capture natural light and views of nature at an urban edge