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Hospital design evolves, refocuses on inpatient care
By Rachel Pleasant
Staff Writer
Though the basic idea behind a hospital—to care for the sick—is unchanged, hospital buildingdesigns are constantly evolving.
The hospitals of today are drastically different than those a few years ago, and likewise, hospitals that are being planned today will encompass new ideas and concepts.
At Wilkerson & Associates Architects, a Charlotte, N.C.-based firm that specializes in planning and designing health care facilities, managing partner Roger Wilkerson said one of the most remarkable trends in hospitals right now is a renewed interest in inpatient care.
“Before the 1980s, outpatient facilities didn’t really exist. Everybody came in the hospital, and they stayed longer. As outpatient services have grown and developed, we’ve seen satellite facilities, imaging centers and outpatient surgery centers develop,” said Wilkerson, whose firm has been involved with projects throughout the Southeast, including the South Carolina cities of Newberry, Greenwood and Conway.
“At the point where we are now, a lot of the outpatient volume has been addressed, and we’re seeing populations growing coupled with sicker patients.”
The inpatient rooms being built reflect a number of changes in society, said Keith Fleming, senior health care planner with Wilkerson & Associates.
For instance, the most modern hospitals, or those undergoing reno
vations, are being designed to accommodate the increasing numbers of overweight patients and visitors.
“Americans are getting larger and larger, and it’s not just the patients themselves. The family is often times overweight as well. That’s impacted the design of facilities,” Fleming said. “It used to be that a bed would carry 500 pounds. Now they carry significantly more. The (Americans with Disabilities Act) requires a minimum doorway width of 32 inches, but the largest wheelchairs now are 42 inches wide.
“Hospitals are having to retrofit, and this is one of the main design issues for new facilities.”
Because of the issue of weight, Fleming said, hospitals are also creating more places for people to stop, sit down and rest.
In the 20 years he has been designing health care facilities, Fleming has noticed another significant, but more subtle change, in the design of hospital rooms.
“Typically, patient rooms have been mirror images of one another,” Fleming said, explaining that typically the heads of two beds in separate rooms abut the same wall. A piece of furniture to the right of one bed would then be to the left in the next room.
“Now the rooms are being built exactly the same. That way a nurse or a physician walks into the room and everything is in the exact same place. The staff can get to supplies and medical equipment quickly, and there are less errors in terms of grabbing the wrong thing.”
Another trend in rooms is to have the toilet on the same wall as the head of the bed so that a handrail can connect the two, making it easier to get back and forth.
Aesthetically speaking, a trend that emerged in the 1980s—an emphasis on creating a homelike environment—is still the standard, but the emphasis has increased.
“Competition in hospitals is fierce, but dollars are tight. Hospitals are still choosing to design less institutional facilities,” Fleming said.
In creating a comfortable, or “healing environment,” Fleming said, hospitals are increasingly using more natural materials, such as wood.
But the desire to create homelike environments, and the natural materials that achieve that atmosphere, has created a whole new set of problems for hospitals, said Val Satko, senior health care architect for Columbia-based GMK Associates, an architecture, engineering and construction firm that specializes in health care facilities.
“Hospitality continues to accelerate, and more and more facilities are looking more like hotels with soft, warm colors and wood,” Satko said. “But this is at odds with some of the problems we’re encountering with infection control.
“You don’t want anything organic because that fosters the growth of mold and mildew and the transference of disease. These are two competing entities.”
To have both the homey feel and the sterile environment, hospitals are seeking out synthetic products that have the aesthetic appeal they’re looking for but don’t compromise the sterility of the building.
“There’s a new drywall product out that doesn’t support the growth of mold or mildew,” Satko said. “We’re also seeing the use of synthetic fabrics instead of cotton.”
When it comes to hospitals of the future, Satko said, technology will have a growing influence on the design of facilities. Technology is constantly advancing, and hospitals have to be able to embrace it quickly.
“The biggest change in hospital facilities themselves over the last 40 years has been kind of an evolution toward a more flexible facility,” he said. “Forty years ago, it was all concrete, plaster, ceramic tile, hard and immovable materials. Now it’s about ultimate flexibility with minimum disruption to facilities.
“Technology changes so quickly. You can’t take two years to create a new technology suite because if you do, you’ll be left behind.”
Additionally, Satko said, because hospital construction costs are on the rise, hospitals built today are being built to last longer than their predecessors. Satko said the cost to build a hospital early in his 40-year career was about $100 a square foot, and now it’s $300 a square foot.
“Even adjusting for inflation, it’s astronomical,” he said. “(Hospital companies) can’t afford to throw them away. The buildings have to adapt because of the cost.”
Rachel Pleasant is a staff writer for the Business Journal. E-mail her at rpleasant@charlestonbusiness.com.
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