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.
