For healthcare architecture projects, physicians are ideal team members to work beside designers to translate technical language, to illustrate problems through stories, to share pain points in the built environment, and to suggest healthier, more efficient, and effective spaces. But many don’t understand the connection between the two seemingly distinct fields. As physicians working with an architecture and design firm, we encounter plenty of puzzled-looking faces. Clients — who are often physicians and nurses — ask, “What does architecture and design have to do with medicine?”
Recently, an academic medical center received a multi-million-dollar allocation to expand and renovate the emergency department (ED). The ED leaders were navigating unprecedented growth in patient volume, with long wait times, crowding, and falling patient satisfaction scores. At the same time, ED clinician team members were experiencing violence, burnout, and low morale. Physical elements of the built environment — limited space for patients, and lack of privacy for interviews and examinations — had a significant influence on these metrics. The ED chairperson asked the architecture group to add a physician to its team and described the following four benefits.
Physicians know what it’s like to work in the spaces that architects design. Physicians bring their lived experience to the design process. Most physicians can identify pain points and problems in the spaces where they work. They can think about and offer ideas on how to improve those spaces for patients, themselves, and their teams. Physicians look through a different lens than architects. People with different roles, experiences, perspectives, and backgrounds lead teams to greater success. Since diverse teams are smarter, the work is more fact-oriented and innovative. Team members are productive, and have the potential to provide a higher return on investment.
Traditionally, EDs were positioned in basements and alcoves of the hospital without adequate lighting. Years ago, we trained in EDs lacking windows and natural daylight. We knew this was a bad experience, and now research supports this, with studies showing that the lack of natural light negatively affects the mood, stress, and burnout level in healthcare workers. Moreover, the positive sustainability effects of daylight include preventing the growth of bacteria and viruses and eliminating the need for artificial light.
Physicians are educators and storytellers. Physicians can share the knowledge acquired from thousands of patient encounters to inform design. We are taught to develop skills in speaking, listening, interviewing, collecting and collating information, and ultimately storytelling. It is storytelling each time we chart a patient encounter, or when we call a consultant colleague for input. These skills could help the design team understand the patient experience.
For example, the ED can be large, loud, chaotic, and confusing. Signage helps guide patients around the department. However, many times during a shift, we are asked “How do I get out/exit?” or “I am lost. Can you tell me where my room is?” Unclear signage causes frustration and can trigger aggression and violence in the ED.
Physicians can share such stories and help create signs that are educational, low cost, and instructive. The physician could, for example, lead the design team through a “persona” or fictional patient exercise. The personas are derived from real-life ED patients. Each design team member can then imagine and role-play the experience of walking from place to place in the ED, and feeling confused and frustrated.
Most physicians are researchers, comfortable asking questions and methodically working through problems. At the foundation of every medical education program and residency training is a process all doctors learn: quality assessment (QA) and quality improvement (QI). QA/QI is an assessment process typically performed on an ongoing basis to evaluate, critique, and improve patient care and healthcare delivery. Topics include patient complaints and unexpected patient outcomes (e.g. a patient death). QA/QI inspires many research projects.
For example, an unexpected number of elderly patients were falling in EDs across the country. This led to geriatric fall protocols and a series of steps that are now standard screening for all patients coming to the ED. All patients over a certain age undergo an assessment; ED healthcare team members are educated and told to keep bed rails in the up position; patients are also asked to wear non-slip socks. Pilot studies were conducted and now falls are an ED quality-care metric that is reportable. Ultimately, the physician and architecture team develop tools to create safer patient care spaces through the design of floor textures, choice of colors of finish materials, and use of products with low slip coefficients.
Physicians have extensive networks. Over time, physicians become deeply integrated and active in the healthcare and medical education communities. From college to medical school to residency specialty training to research and clinical fellowships, physicians have broad connections with experts. They are accustomed to working on teams spanning levels of expertise. Since training programs are time-limited and physicians often change institutions, our networks grow beyond a single institution. These connections are powerful conduits for gaining perspectives on the impact of design decisions.
Physicians can organize conversations to capture these insights and add them to the mission, strategy, and implementation of the design. For example, architecture firm Perkins&Will recently interviewed for a project on the East Coast. A college friend, who works at the university affiliated with the hospital center, shared his insights about the city and the surrounding residential community, the hospital, and the institutional culture. The physician designer and architecture team had an impactful interview with design solutions and specific insights to which they otherwise would have lacked access.
Physicians draw on their training and their lived experience taking care of patients in the built environment. Healthcare professionals should not minimize the essential role they can play in facility design.
Resa E. Lewiss, MD, is a professor in the Department of Emergency Medicine at The University of Alabama at Birmingham. She is also a physician consultant at Perkins&Will, and the host and creator of The Visible Voices Podcast. Danika N. Franks, MD, is an emergency medicine physician. She is also the founder and CEO of Community Flourish Consulting, and a medical education and clinical advisor at Perkins&Will.
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