The following is in response to the article “Is
Designing Healthcare for “Good Enough”… Good Enough?” by Martin Valins, a
Principal and Architect at Stantec (http://stantecinc.blogspot.com/2013/11/is-designing-healthcare-for-good-enough.html#!)
No matter the particular
program or building use, the Team working together on a particular project must
define "excellence" and "good enough" and then decide
whether "good enough" is good enough. In either case, one
cannot overlook the impact of the built environment on the health and
well-being of people. If "good enough" is merely a question of
coming in under budget, one must question the validity of the built environment,
particularly healthcare, whether inpatient or outpatient, in its role to attain
measurable and beneficial outcomes as they relate to the patient.
A definition of
primary care (from the American Academy of Family Physicians, http://www.aafp.org/about/policies/all/primary-care.html ): “…care
provided by physicians specifically trained for and skilled in comprehensive
first contact and continuing care for persons with any undiagnosed sign,
symptom, or health concern (the "undifferentiated" patient) not
limited by problem origin (biological, behavioral, or social), organ system, or
diagnosis. Primary care includes health promotion, disease prevention,
health maintenance, counseling, patient education, diagnosis and treatment of
acute and chronic illnesses in a variety of health care settings (e.g., office,
inpatient, critical care, long-term care, home care, day care, etc.).”
Primary care, any health
care service, should not be rendered in bare, gray, dimly lit, uninviting
environs. Primary Care is first contact, it is trying to get people to
sign on to the concept that it is beneficial to start and maintain a healthy
relationship with health care professionals, to prevent bad health outcomes and
catch early stages of disease, etc. As such, the premise that Primary
Care cannot “afford” excellence is weak. A well-designed,
psychologically, socially, culturally and humanely relevant Primary
Care/Outpatient facility must be deemed worthy of Excellence and its designers
(architects, engineers, owners, Authorities Having Jurisdiction) and
implementers (contractors) must be held to that. If the facilities that
are built to house these functions are warm, inviting, relevant, the communities
that they serve will use them and return to them. One has to remember
that Primary Care facilities are not Emergency Facilities, and--depending on
their particular location or healthcare insurance plan--none of their clients
have to go to any particular one out of necessity.
As Mr. Valins points out
in citing Dr. Ruth Cammock’s Primary Care Buildings, “(who is both an
architect and physician)…reminded us that the most important space in a
patient’s healthcare journey is the point where he or she first begins it –
likely just a room in which patients and their doctors or nurses speak
one-to-one about a condition and preliminary assessments and prognosis. For
many, that journey will end there, maybe with a prescription for medication, or
maybe a follow-up visit. The buildings required to house such basic activities
are more about ‘high touch’ than ‘high tech.’ “ This does not mean that we should put any less
thought into the Excellence of that particular touch point, as we should not
lessen the importance of the first touch point as one enters the site, nor the
touch points as one approaches the front door, enters, checks in, utilizes
services such as phlebotomy lab, checks out, etc.
Lastly, Excellence does
not necessarily = Expensive, nor does it mean that every space has to be
“high-tech.” With mobile technologies and cloud-based solutions, implementation
of high-tech patient care is becoming less problematic as it relates to a
Client’s capital outlay and operating budget. Excellence in Healthcare
Design most certainly should be the most Excellent environmental experience
that we can devise for the most beneficial outcome of the patients they seek to
serve, working with our Clients and their budgets.
(Martin Valins has left a new comment on the post "Is Designing Healthcare for “Good Enough”… Good En...": )
ReplyDeleteThanks, Susan – your comments are very well taken…………and I am pleased to be sparking a debate!
The question is rightly asked if "good enough" is merely a question of coming in under budget. I would say that budget and affordability has to be the key determining factor as to how the USA is going achieve a sustainable healthcare system that is accessible to as many patients as possible and, at the same time, achieving better patient outcomes.
Interesting that the current issue of Healthcare Design follows this same train of thought.
While the United States has one of the most expensive health care systems, its measurable and beneficial outcomes are below those countries that spend less. I am arguing that we can only provide facilities that we can we can afford – which I tried to get across in the car analogy.
My point is that the term “good enough” means it gets the job done…………a target we can hit and one that helps achieve all the clinical goals we set out for primary care. Yes, it’s a Ford and not a Rolls Royce. The Ford will get us to our destination safely and reliably. If a Rolls Royce is the only option, then just like with our current healthcare system, it would be a wonderful vehicle that only the few could afford……….the rest of us would be left stranded.
(Susan KlausSmith has left a new comment on the post "Is Designing Healthcare for “Good Enough”… Good En...": )
ReplyDeleteAh, but Martin, my argument is that even adhering to the rigors of a tight budget, one cannot lose sight of the effects of what that Ford has on the people who own it and ride around in it (how it looks like and how it feels driving), never mind if it is going to last beyond the 5 years you have financed it for (just to take your analogy a bit further).
It is my position that "Good Enough" does have connotations that no matter the look of the thing, or how one feels in it, we have to keep it at or under budget, which often comes across as a huge negative. In my humble professional experiences with public and institutional work, each project has had to come to grips with this fact. Some fell ill to this disease (pardon this pun, please), losing some--but hopefully not all--of the qualities of a beneficial built environment. It is not merely a question of aesthetics, but the impact on the health and well being of the clientele.
What would seem to be the issue at the crux of a sustainable healthcare system is ensuring that it is able to fend off or, at the least, lessen the higher ticket services by providing affordable and agreeable front line services, such as Primary Care, in supportive built environments served by supportive staff. It will be a matter of deciding not only what ‘good enough’ is, but budgeting correctly for the expected outcomes. Painted block is painted block. No feeling. No warmth. No matter how many murals you paint on that wall. If touch is the core of health care, good health care, we must ensure that even within the constraints of ever tightening budgets, we continue to care and push for materials and methods of construction that retain that desire to touch the world around us, poetically or otherwise. A cold place does not garner touch; a lightless place does not engender communication. Both are key to good healthcare, as I am sure you will agree.
As I said above, a tight budget does not necessarily mean that it just has to get the job done; it can also do so beautifully, humanely, relevantly, and the Team (designers + implementers) should not lose sight of that.
In the end, Excellence cannot be sacrificed for the sake of ‘good enough.’ We all deserve better.