Can Design Rehabilitate The Ailing Health Care Industry?

Posted: 8/5/2013

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By: Clay Dillow

FORTUNE -- There's very little that's sexy about the health care industry. Within the tangled threads connecting government regulation, opaque insurance policies, and the actual work of patient care itself, there's not a lot of room for glitz or style, and certainly very little time for those working within the health care machine to step back, take inventory of the larger system, and reflect on what's working, what's not, and what could be better if only someone would stop and think through certain problems. This aspect of health care ensures that virtually nobody in the industry has the time or the inclination to dwell on the role of design.

According to a small group of architects and designers, this lack of design-thinking is precisely why the health care industry struggles to deliver on so many levels. Design, after all, isn't just about form. It's about function. "We think that design has the power to revolutionize industries, just as it has in electronics, in cars, in everything else," Salley Whitman says. "But in health care we haven't tapped into that in a systematic way."

Whitman is the Executive Director of NXT Health, a non-profit health care design organization that she describes as something like the research and development shop that the health care industry has always lacked. NXT Health got its start back in 2006 via a Department of Defense grant asking the organization to lead a design collaboration in producing the hospital room of the future -- not a futuristic operating theater or a suite of new treatment technologies, but a patient room that could improve health care outcomes at the individual level. The room itself and the design principles underpinning it have undergone some changes and alterations in the interim, but fundamentally the objective has remained the same: to create better patient care strictly through better design -- no game-changing technological breakthroughs or federal legislation required.

The final product of that effort -- christened Patient Room 2020 -- was unveiled this month at the DuPont Corian Design Studio in New York City. On its face the differences between the patient room of the present and the patient room of the future might appear largely cosmetic. But the NXT Health team and its collaborators -- more than 30 industry partners kicked in technology, materials, and know-how to produce the prototype -- insist that Patient Room 2020 not be taken at, well, face value. The streamlining and packaging of disparate technologies for patient and caregiver use might seem like obvious solutions, the redesign of the bathroom a nice aesthetic touch. But what this really represents, the team says, is a wholesale rethinking of the patient environment, which has remained largely unchanged for decades.

"The health care industry itself is really at a crossroads, it's really being turned upside down from a clinical perspective," says Andrew Quirk, senior vice president for the Health Care Center of Excellence at the U.S. outpost of global construction firm Skanska (SKBSY), a collaborator on the Patient Room 2020 project. "So when you turn to the built environment, you can't expect to deliver health care in the future the same way -- and in the same space -- as you did in the last few decades."

What drew him to the project, Quirk says, was the idea that for the first time in the history of modern health care, a team of designers was being seriously challenged to integrate technology and architecture into a seamless environment rather than retrofit a handful of pre-existing health care technologies into a pre-existing space. "Every other time I've heard, 'This is the patient room of the future, there's nothing new about it," Quirk says. "This project really took a leap of faith in integrating technology and architecture and really incorporating all of the activities that will typically go on in a patient room into the design."

Patient Room 2020 is indeed a highly integrated orchestration of technologies, materials, and plug-and-play capabilities, encompassing the customary technologies one would expect to find in a hospital room as well as wholly new ones aimed at enhancing patient comfort and care or caregiver efficiency. For instance, the so-called patient ribbon wraps all the way around the bed, from headwall to ceiling to footwall. The headwall contains the necessary machinery for capturing vital signs as well as any oxygen tanks or other hardware that might be necessary. The overhead panel contains patient-controlled lighting, while the footwall contains a display that can be used for everything from video-consulting with doctors to pulling up hospital information to viewing entertainment (all controlled from the bed via tablet computer). Caregiver tech in the room includes a hand-washing station, built-in RFID tech for tracking instruments, and simulated UV sanitation of workstations to cut down on the risk of hospital-acquired infection.

The underlying technologies were provided by more than two dozen companies large and small -- Osram Sylvania provided some of the lighting, fabrics-maker Milliken customized antibacterial textiles for linens and scrubs, Duracell chipped in charging technology -- and largely packaged up in DuPont's (DD) Corian, a non-porous surface material selected by the design team for its ease of cleaning and the fact that it is thermoformable, leaving few seams or joints where bacteria might thrive. Taken altogether, Patient Room 2020 is designed to address some glaring shortcomings rife in the health care system today: a lack of patient engagement in his or her own treatment, hospital-acquired infections, caregiver inefficiency, and overall patient discomfort, which can distract from rehabilitation and generally can make hospital rooms miserable environments.

That's why Patient Room 2020 isn't just technology for technology's sake, Whitman says. Each element was chosen for a reason and placed in the right location to enhance both patient engagement and caregiver performance and efficiency. It's a systems approach -- something that has long been employed to boost efficiency in other industries but has been sorely lacking in basic patient care, where things are often still done piecemeal with pen and clipboard. Most importantly, it's design influencing behaviors and outcomes, Whitman says, and in a health care environment where fixed costs and other inefficiencies are often beyond an individual hospital's control, enhanced human performance through design gives administrators a unique tool for cutting costs and improving care.

"I do not believe that building things the same way but at lower cost is going to help with things like readmission, with hospital-acquired infections," Whitman says. "These are some of the big issues we're dealing with with payment reform, because you're paying for performance. Hospitals are going to get paid because their patients don't fall, because they don't get sicker while they're there, because they understand their care so when they leave they don't come back -- these are all performance metrics the federal government is tracking. So this is not just about putting in technology so we can have fancier electronic medical records."

Rather it's about a value proposition for the industry. The kinds of technologies and materials integrated into Patient Room 2020 certainly aren't less expensive than the contemporary alternatives. But long-term they'll improve both patient outcomes and bottom lines. In the near term, converting patient rooms to something like Patient Room 2020 will likely remain somewhat cost-prohibitive for many hospitals, Quirk says, but over time costs will decline and ROI for these technologies will come more quickly.

And besides, Whitman says, the idea behind Patient Room 2020 isn't for hospitals to graft this model directly onto their hospitals, but to inspire a paradigm shift in the way the health care industry thinks about the role of design in general. The prototype provides a practical model from which administrators and architects can directly borrow or simply draw inspiration. But more than that it provides a clear example of how meaningful good design can be, even in an industry as unsexy as health care.

"In the future there are going to be fewer hospitals, so when we build those hospitals we better build them right," Whitman says. "We need to build them in a highly engineered, highly technological way so that they are actually part of the care process, not just an appendage."