A Patient-Centered Future for Healthcare

I had the privilege of leading a team of Facility Guidelines Institute (FGI) volunteers at an Innovation Summit of the Patient Centered Design (PCD) Inc. The purpose of this organization is to encourage the incorporation of the patient perspective into the design of healthcare spaces.

I have to say, first, that the summit was both ambitious and wonderful. I go to a lot of conferences and meetings as I try to read the tea-leaves of the healthcare future, and this one was pretty unusual for at least two reasons. First, the mix of people it brought together was very stimulating. We used the simulation lab from the Medical University of South Carolina (MUSC), and each lab space was “staffed” by conversation starters who were patients (yes, real-live patients), clinicians (doctors and nurses), designers, and facility operators. Then, other groups of patients, clinicians, designers, and facility operators filtered through the spaces talking about the kinds of activities and challenges in these spaces and working collaboratively to create design solutions. And that mix of conversation collaboration design techniques was really a unique catalyst for deep, multi-perspective conversation and learning that I have not found elsewhere; this is the second reason this meeting was wonderful. Congratulations to PCD for the meeting and deepest thanks to them and to the attendees for making it so vibrant and useful.

The reason I was there was two-fold. First, I was representing the Healthcare Institute, on whose Board I serve. That group is dedicated to enhancing the skills of facility managers in healthcare organizations. Certainly, the facility people who participated in the PCD meeting came away with new insights that will help them in their work.

My second role was as a representative of the (FGI). The FGI publishes the Guidelines for design and construction of Hospitals, Outpatient, and Residential Healthcare Facilities. (The Guidelines are the model licensing documents for most of the US and a de facto standard for much of the rest of the world.) The FGI is in the midst of its every-four-year cycle of accepting public proposals. One priority we are working towards is to better ground our work and our thinking on the best available evidence. To that end, we are doing a number of things that are unique in the industry.

But, one of the things we struggle with the most is our minimum space and clearance requirements. The Guidelines have minimum requirements for many spaces in a healthcare building and clearance requirements around the bed in many of these spaces. Some people blame the Guidelines for the “super-sizing” of health facilities, at least partly due to these requirements; these same groups call for science-based codes. Well, on the FGI, we have struggled in vain to find any kind of double-blind empirical studies to show better outcomes with a 36” clearance compared to that of a 24” clearance in a patient exam room. Our best available evidence comes from the consensus of volunteer experts that we represent.

So, the PCD and its simulation labs offered us a unique opportunity to test our thinking. A team of FGI volunteers, Tom Gormley, Bryan Langlands, Dr. Christine Carr, Dr. Jonathan Ross, John Dombrowski, and Ella Franklin facilitated conversations in OR/PACU, LDR/P, ED Treatment/Trauma, Outpatient Exam, Inpatient Bed, and NICU/ICU rooms. We taped the current minimum and clearance requirements onto the floors of these rooms, and we talked with the participants about them. Were they enough? Were they too much? What else should we be doing?

The FGI will soon be publishing a White Paper summarizing the results of this work. In the meantime, I can tell you that the feedback suggested that the minimums in the Guidelines are probably too small; that is, the smallest possible space within which to deliver effective healthcare is probably too small. (One Dr. told me, “No wonder nobody is willing to go into primary care, anymore; this space is too depressing.”) More exciting, the work resulted in a huge number of ideas that the FGI can use as it moves into a world of not just code minimums, of Fundamental Requirements, but as it starts to look at what is beyond fundamentals.

At a ceremony the first night of the event, Tammy Thompson gave me an award for helping to bring the FGI to the meeting. I was too dumbfounded to do then what I should have done, and what I would like to do now, that is, to recognize the contributions of the FGI volunteers who participated in this event, giving their time, their travel money, their expertise. I would like to thank them, the PCD, the HCI and all of the people who participated and shared so liberally in such a wonderful learning event. All of our patients, all of us, will benefit from this work.

Walt Vernon