Evidence-Based Design

Designing the 21st Century Hospital

Hospitals produce stress in a variety of ways: excessive noise from paging systems, alarms, machines, and voices upset patients and distract staff. Poorly designed hospitals where people can get lost easily, or that force bedridden patients to stare directly at glaring ceiling lights, can cause anxiety and a sense of helplessness. Double-occupancy rooms that impinge on patients' right to privacy and rest can impede their recovery. In addition, hospitals offer few places where patients can talk quietly with their families or with staff.

According to The Center for Health Design (CHD), to create a model health care environment for the 21st century, hospitals need to be improved on several levels: their physical design and construction; the ways in which the staff does their work; and their institutional culture. This new approach is known as evidence-based design.

Evidence-based design improves hospital environments by:

• Enhancing patient safety through a reduction in infections, risks, injuries from falls, and medical errors;
• Eliminating environmental stressors, such as noise, that negatively affect outcomes and staff performance;
• Reducing stress and promoting healing by making facilities more pleasant, comfortable, and supportive for patients, staff and families.

To put this evidence into action, the CHD recommends that hospitals:

• Eliminate double-occupancy rooms and provide patients with single rooms that can be adjusted to their changing medical needs;
• Improve indoor air quality to prevent infection;
• Use sound-absorbing materials to reduce noise;
• Provide access to natural light to prevent depression, agitation, sleep disorders and medication errors;
• Offer pleasant environments to relieve stress and promote satisfaction among patients, staff and their families;
• Be easy to navigate;
• And make it possible for staff to better perform their jobs.

A new analysis of more than 400 research studies conducted by the CHD shows a direct link between hospital design, patient health and quality of care. For example:

• Patient falls declined by 75 percent in the Cardiac Critical Care Unit at Methodist Hospital in Indianapolis, IN, which made better use of nursing staff by spreading out their stations and placing them near patients' rooms; 
• The rate of hospital-acquired infections decreased 11 percent in new patient pavilions at Bronson Methodist Hospital in Kalamazoo, MI, that feature private rooms and specially located sinks; and
• Medical errors fell 30 percent on two new inpatient units at The Barbara Ann Karmanos Cancer Institute in Detroit, MI, that allocated more space for their medication rooms, reorganized medical supplies, and installed acoustical panels to decrease noise levels.

This evidence overwhelmingly shows that the health care environment—where care is actually provided and received—has substantial effects on patient health and safety, care efficiency, staff effectiveness and morale and patient satisfaction.