By: Dr. Velma Jackman and Dan Thomas
“We are assuming this is going to last for a long time,” said a senior healthcare executive when discussing their organization’s COVID-19 plan. This pragmatic statement summarizes the challenging situation hospital clinical operations have been facing since early spring. COVID-19 is an ongoing, chronic, emergent challenge that must be addressed alongside everyday issues like seasonal disease outbreaks, inpatient and outpatient capacity balancing, staffing, provider relations, annual budgets and a host of other operational items.
As architects, we hypothesized that hospital facilities, currently, may not be as adaptable as we need them to be—and we humbly admitted we were not the experts in the most useful to hospital operations adaptions during an extended pandemic. None of us had experienced a patient surge of this magnitude and duration before; so, we asked. Here are five aspects of operational flexibility for healthcare spaces we have learned from hospital leaders across the country through of series of our hosted Academic RoundTables.
More than Space
Operations and staffing needs far outweigh the challenges of space. Projections for the type of care needed dictate the requirements for the environment and spaces. Patient census and patient type, along with clinical and support staff assignments, drive the types and quantities of spaces needed.
Safe, then Welcoming
As beacons of health and safety, hospitals are designed with welcoming entry points. With COVID-19, everyone who entered the hospital had to undergo a screening process beforehand. Patients were triaged, visitors were screened and tracked and the staff was screened for current health status. Hospitals must redesign entry points and add security to control all access into and out of the facility.
No Waiting
The logistics of complying with social distancing regulations was no small feat. Waiting rooms, for one, are integral to many processes inside healthcare facilities. To avoid overcrowding, these spaces had to be completely redesigned. Some of these changes included furniture removal, furniture storage, cleaning protocol expansion and social distancing monitoring.
Air Quality, not just Negative Pressure
While every hospital already has negative pressure in patient spaces to accommodate infectious patients, the need for additional spaces drove the creative solution to negative pressure areas. The concept of “keeping the air clean” has now moved beyond negative pressure rooms to include overall airflow, air filtration and UV-light purification.
Space to Flex
COVID-19 increased the volume and frequency of personal protective equipment (PPE) use. Increased utilization was also coupled with the need to clean reusable PPE, which uncovered the need for flexible space near patient care areas to house these functions—including space for donning and doffing as well as additional space to store clean and reusable PPE.
Our questions are taking on even more importance as we look forward to several collaborative research engagements with the Texas A&M University Center for Health Systems and Design– starting with a synthesis of experiences and stories shared during the Academic Roundtable events. “The responses from our participants will impact hospital design moving forward as we apply research-informed design to improving the adaptability of existing spaces along with designing in flexibility for future facilities,” offers Dan Thomas, AIA, ACHA, NCARB, EDAC– and our findings go even further. Through collaboration with Texas A&M, our research will impact and inform future architects and their ability to design flexible health facilities. Bill Eide, AIA, Texas A&M University Professional Fellow, is excited about the future of design. “The Texas A&M University Center for Health Systems and Design was formed specifically to incorporate all areas of operational use into the design. These findings are vital to informing the design community of both how to approach design and to learn how design impacts health.”
Health facility design is changing. Based on our preliminary findings, the new designs should be beautiful, but also must practically support these new needs verbalized by the operational leaders using these facilities every day. How do we know? Because we asked.
Dr. Velma Jackman DSL, PMP, CPHIMS, LEED GREEN ASSOCIATE, CLGB. Dr. Jackman is a seasoned operational leader with over 35+ years of experience in adult education, project management, healthcare technology and supply chain operations. Her passion is helping clients address “change” through her expertise in the human side of transition. She has a unique blend of organization strategy, healthcare foresight, information technology, process engineering, project management and construction experience– which she uses to help clients navigate change related to new facility and technology implementations.
Dan Thomas EDAC, ACHA, NCARB, AIA. As a Studio Healthcare Leader, Dan has more than 26 years of experience in healthcare design and planning domestically and internationally. Dan brings a wide range of knowledge of master planning, schematic design and programming. He understands the unique demands of healthcare facilities by performing extensive research in current and future state analysis, industry trends and best practices. Dan leads the project team in establishing the overall design and planning vision and works closely with the owner and end-users to reach set goals.