11 Thoughts on Rethinking Design and Healthcare in Post-Pandemic Environments

By Silvia Hoffman, AIA LEED ® AP

As architects and building owners team together to design spaces, we often wish for a crystal ball to predict the future. We know we need to balance the needs of the moment vs. the needs of the unforeseeable future, particularly now, faced with a pandemic. There is no manual on this or any class in architecture school, or most schools for that matter, that teaches you how to get through it and address the needs of the people you serve in the unusual circumstances we find ourselves in. Yet clients will look to us to help solve the challenge of creating ‘safer’ space. Particularly impacted by Covid-19 are our health care clients. Many of them have asked us for thoughts on how we move forward designing the built healthcare environment with respect to Covid-19. If I am to be honest, it’s a bit like trying to hit a moving target, but we keep taking aim.

That said, science continues to supply us with more data and frontline workers share their knowledge and experiences at the same time. All of this is enabling us to adapt and respond in a meaningful way. There are things we have learned so far, some related to architecture and some to process and practice. Here are a few to think about:

• We know that positive outcomes for patients is inextricably linked to the safeguard and wellness of their care givers. We must make the environment not only safe for patients, but for the nurses, doctors, transport staff and anyone else that they may interface with. In an era where we have become ‘patient centered’ (and rightfully so) we should not lose sight of the fact that our health care workers need our support too. We need to address infection safety from their perspective and even create areas of respite for them.
• Video communication and ‘virtual visits’ have become invaluable ways to communicate and important in helping to treat patients when we can’t see them ‘in person.’ It also has helped with family communication when hospital visits were not allowed. While many health networks tried to implement ‘virtual visits’ in the past with limited success, Covid-19 has forced both patients and caregivers to embrace it more strongly. The technology involved with this will continue to improve and should be more seamlessly integrated into our buildings.
• We know that high occupant density=greater risk of infection. This is not really ‘news’. This has been the basis for reducing double occupant hospital rooms to single occupant rooms for years. That said, in a surge situation, converting single rooms to double rooms, with both occupants having the same illness, could be an option to increase capacity. Infrastructure needs to be available to make that happen.
• We’ve learned that hospitals are not flexible enough and don’t have enough ICU rooms. We believe that in the future, we need to build patient rooms to flex and accept patients with different levels of acuities.
• We need to be careful to not ‘scare away’ patients who need surgery and treatment to stay healthy, even in a pandemic. We may have done too good of a job in trying to keep people out of the hospital. Hospitals are not able to survive without elective surgery and treatments and neither can patients. How do we make ‘elective procedures’ safe and allow them to continue? Separating patients within a hospital or even to another location if possible, may be a solution.
• Aggregating infectious disease patients within a floor or area of a hospital helps to mitigate the opportunity of spreading infection. Those areas of the building should have lighting that inactivates viruses through the use of specific UV spectrum light. They should also have a more robustly designed HVAC system that is negatively pressurized to take contaminated air out of those rooms.
• We need to create an emergency department ‘intake’ setting and triage process that quickly separates patients who may be infected from patients who are not, to mitigate the spread of disease.
• Identifying buildings and having plans in place that quickly allow us to develop ‘alternate sites of care’ (IE hotels, convention centers, gymnasiums, other medical office buildings) will allows us to quickly increase surge capacity.
• LEAN principals may have worked against us. As hospitals try and function with less and less resources and in less and less space, we have painted ourselves into a corner. Less space means less supplies to have on hand in an emergency situation. Less space means less area to be able to physically distance ourselves from others and more opportunity to transmit infection.
• Portable equipment is invaluable to minimize patient transport through a hospital. Bringing an X-ray or Ultrasound machine directly to a patient’s bedside reduces risk of transmitting disease.
• Flow is critical. The arrival sequence for someone coming into a building through their leaving, creates opportunities to ensure their safety and the safety of others along the entire route. You may allow patients to remain in their vehicle until they are able to be evaluated, thereby reducing the number of people in a waiting area or queuing line. Minimize patient travel through a building so that opportunities for infection are reduced. Separate entrances that are deemed ‘potential points of infection’ from other entrances. Implement physical, but transparent barriers, to direct pedestrian movement through a building.

What we are experiencing in our world today may create a long-term impact on our built environment. Recently, I’ve stopped looking at this as a problem or a ‘bad thing’ or opining that things will ‘never be the same.’  I have a new outlook that we should take this as an opportunity to create a better and safer experience for everyone. I believe that by working together as architects, building owners, building occupants and end users, we will collectively take a difficult situation and develop solutions that will make a lasting and positive impact on our world, our buildings and in each one of us individually.