The hospital of tomorrow

There’s no time like the present to plan for the future

If hospital administrators expect to be able to provide the best care for their patients in 20 years, they had best start planning now. The folks at Spartanburg Regional Healthcare understand this. They are tapping into the minds of their experts – the patients, clinicians and staff who use hospital rooms every day, and the architects who design them – to build a hospital that can accommodate a healthcare landscape that is in a constant state of flux.

“We must be proactive and forward thinking,” says Tom Jennings, principal of NXT, a non-profit organization that serves as a catalyst for innovative research and design in healthcare, and former vice president of planning and facilities at Spartanburg Regional Healthcare. Once construction of a new hospital begins, it is difficult if not impossible to consider new ideas, he adds.

The NXT step
Looking at innovative processes and workflow design for better patient care is nothing new for Jennings, who has built this approach into his 30-year career with Spartanburg Regional Healthcare. In fact, in 2006, the United States Department of Defense invited the health system to participate in its Hospital of the Future program. As a result, in 2007, NXT was developed as the foundation for testing and evaluating new healthcare concepts from a holistic perspective.

By uniting healthcare experts, researchers and clinicians with patients and architects/design experts, NXT develops, tests and executes new ideas. Through its partnership with Clemson University’s Healthcare Architecture program, NXT has enlisted graduate students and research professors to design the patient room of the future, which eventually will serve as the room model at the recently constructed Village Hospital in Greer, S.C.

The goals of NXT include:

  • Decreasing care delivery costs.
  • Improving patient safety through proactive elimination of medical errors.
  • Improving the transfer of medical information between caregivers and patients.
  • Improving patient access to care through electronic health management.
  • Improving the environment of care for patients and providers. “We developed a patient room of the future in our lab, and are emulating it at Village Hospital,” says Jennings. The opportunity to study and evaluate the room in both a lab setting and an actual hospital environment should provide good empirical research for continued design and planning, he adds.

The program looks at four areas in healthcare: technology, people, facilities and clinical care. So, for instance, Jennings and his team are working on an interactive surface – or series of screens or monitors – to be placed along the footwall facing the patient in the hospital room. One screen would provide television and entertainment. Another might keep the patient up-to-speed on his or her daily schedule, from blood drawings to meals. A third screen might educate the patient on his or her condition, while a fourth screen could provide the physician with a means of communicating details/explanations about procedures.

In conjunction with researchers from the Massachusetts Institute of Technology, Jennings’ team of architects is testing a bedside patient control center, which would provide a continuous display of the patient’s vitals, glucose levels, blood pressure, etc., through his or her stay, as well as those taken prior to the stay. “This would help eliminate the need for repeat tests and scans,” Jennings points out. In addition, the control center would enable the patient to control such things as noise levels and room temperature, or even enjoy an online chat with family. Often, patients feel they lack control over their hospital surroundings, notes Jennings. “That’s often the most frustrating part of the patient’s stay,” he says.

Clemson University student architects have also been exploring the opportunity to incorporate “smart materials” in the design of toilets, tubs, floor surfaces, countertops and more, further enhancing the patient experience and patient safety. “We know that certain materials help prevent the spread of infections, such as methicillin resistant Staphylococcus aureus (MRSA),” says Jennings. Architects are also working on a “smart flooring material” that can sense if a patient is about to fall, he adds.

In a move to prevent medical errors, Jennings’ team of student architects is investigating human assistive devices. “So, when a nurse walks into the patient’s room, a light might alert [him or her] that the patient is diabetic and needs [his or her] sugar level tested,” he says. Or, the system might remind staff and clinicians to wash their hands upon entering the patient’s room, he adds.

Back to the drawing board
“Our research works in a spiral [fashion],” says Sally Whitman, a consultant with NXT. The first stage is conceptual and involves a lot of brainstorming, she explains. Next, the architectural and design people develop a prototype (or computer plan), which they can take back to the group for further discussion. “They decide on a plan and build it in the lab, where it can be tested with pure and empirical research,” she says. “For instance, in the past, no one has tested what is the best location of a bathroom to prevent patient falls. That’s the sort of thing we look at. Are we placing things so that they are ergonomically good for the patients and nurses?”

The end design is then placed in the actual hospital, where it is tested and evaluated in the patient environment, she continues. “Then, we take it from the hospital setting back to [the drawing board] to look at how to fix or improve it,” she says. Today, NXT is doing mock-ups of rooms to get the footwall [concept] down pat and look at processes to facilitate staff efficiency.”

“The hospital of the future is really a concept involving technology, clinical care, environment and the patients/staff who use it,” Whitman continues. Nor is this a static concept, she notes. “Once you build a hospital of the future, it inevitably will become outdated very quickly,” she adds.

“We try to build in a flexibility component,” says Jennings. But, it can be difficult to plan for the unknown, he adds, particularly when it comes to accommodating hospitals as more and more go paperless, or as more healthcare is performed in home settings and hospitals are reserved primarily for critical care.

“We take that which we know today [as a basis for] brainstorming,” says Whitman. “We have chosen to focus on the patient room setting, because this area is most widely used. In the future, we hope to branch out to outpatient care and family practices of the future.”

Getting it right
NXT is bound to catch the eye of many healthcare administrators. In fact, Jennings and Whitman are looking to offer NXT as a resource to other hospitals, as well as tap into the expertise of other industries. “We’d like to see NXT [become] a national and international organization,” she says, noting they already have collaborated with a German organization.

Given the ongoing economic downturn, hospitals might resist budgeting for their own hospital of the future. But, that would be short-sighted, notes Whitman. “Hospital administrators must understand that the work we are doing in the lab may not take hold for another 20 years,” she says. “But, if we don’t start looking into this now, it will be too late [down the road]. ” Taking such steps as exploring ways to keep rooms cleaner, reduce the spread of disease, etc., is a great investment, she adds.

What’s more, planning for the future doesn’t have to be prohibitively expensive. “In this [slow economy], hospitals may have to abandon the $5 million renovation project,” Whitman continues. “But, maybe they can invest $5,000 in test rooms and get their nurses to provide input and feedback. When it comes to healthcare, we can’t afford to become stagnant and fearful of poor economic times. Let’s get it right before we spend millions and billions on end products that may not work.”

“Administrators today are in a conservative frame of mind,” admits Jennings. “But now is the time to [brainstorm] ideas for change. For example, it may be an issue of looking at how to care for more patients at home rather than in a critical care environment. We expect to see more of this in the future. Hospitals can form collaborative relationships with their employees and outside industries. The best ideas come from people who are already working within the organization.

“We are retraining the way architects [look at] hospital design,” he continues. “We have had architecture students spend the weekend at Village Hospital to see what other architects have done. Then, they can add their own ideas to make the hospital rooms even better.” In fact, the students came up with a new bathroom concept featuring movable walls, he notes.

Early planning can save hospitals time and money, he adds. “We have saved about $220,000 in architectural fees alone,” says Jennings. “And this doesn’t include savings we expect to generate in nursing efficiencies.”

About the Author

Laura Thill
Laura Thill is a contributing editor for The Journal of Healthcare Contracting.