Archives for category: Hospitals

Check out this article on the 2010-2011 Best Hospital Rankings from the U.S. News and World Report. These rankings, which include 152 hospitals of the 5000 considered nationwide, help guide patients who need “high-stakes” care because of the complex and urgent (often life-or-death) nature of their conditions. 16 specialties, from cancer and heart disease to respiratory disorders and urology, were considered. A hospital made it onto the list of 152 if it appeared in the rankings for at least one of the 16 specialties.

As far as ranking overall “best” hospitals, the 14-hospital “honor roll” included in the Rankings may be as close as you can get. Highly detailed criteria were used to determine which hospitals made the list and in which order, which is further detailed in the article. Here, a run-down of the 10 hospitals that are arguably America’s best:

1. John Hopkins Hospital, Baltimore
2. Mayo Clinic, Rochester, Minn.
3. Massachusetts General Hospital, Boston
4. Cleveland Clinic
5. Ronald Reagan UCLA Medical Center, Los Angeles
6. New York-Presbyterian University Hospital of Columbia and Cornell
7. University of California, San Francisco Medical Center
8. Barnes-Jewish Hospital/Washington University, St. Louis
9. Hospital of the University of Pennsylvania, Philadelphia
10. Duke University Medical Center, Durham, N.C.


Worth a read: “Beautifying hospitals: a tough sell,” posted yesterday to Canadian Medical Association Journal Online, discusses how our design knowledge is getting lost in translation when it comes to hospitals. More and more designers, health professionals, government representatives and other decision-makers are acknowledging design’s influence on health, but with a few exceptions, we aren’t designing hospitals any differently than we did before “evidence-based design” was a recognizable term. (Check out my post on evidence-based design here.)

Fascinating quote by one Dr. Alan Dilani: “The health care industry is typically looking for the cause of diseases, instead of focusing on the causes of health. We have 8000 diagnoses or causes of diseases. We might also find 8000 causes of health.”

Why the slowness to change? Evidence-based design isn’t some fuzzy postulate about “emotions” and other “soft,” unquantifiable variables – not anymore. It’s science – and no one questions that health and science go together.

What I think is the answer: existing hospitals get the job done, and sticking with traditional design allows us to avoid the scary unknown quantities, coughs and hiccups involved in trying anything new, even a new thing supported by scientific evidence. What’s more, we don’t yet know how to translate the theoretical into the practical in many design situations; just because we know design affects health doesn’t mean we’re always sure about how it does so. There’s a lot to learn.

But we shouldn’t hesitate to put into practice what we already know.

Human-oriented design.

Does this term seem redundant? Of course design is human-oriented: humans design things for human use. But bear with me. Recently I stumbled across a rather stunning article on The article, by designer-researcher-writer Ingrid Fetell, is titled “To Change Hearts and Minds…Change their Chair!”, a title that refers to a study in which participants, some sitting in soft seats, some in hard seats, were asked to negotiate with a car dealer. As Fetell describes, those in soft seats made far more generous second offers to the dealer than those in hard seats. Related studies have shown a link between temperature and social attitudes: in a recent study at Yale, researchers split 41 college students into two groups and casually asked those in the first group to hold a cup of hot coffee and those in the second group to hold iced coffee. All students were then asked to evaluate an imaginary person’s personality based on a packet of information about this person. Students who had held the hot coffee were far likelier to judge the imaginary character as warm and friendly than students who had held the iced coffee. Other studies have shown correlations between weight and perceived seriousness, between “clean” smells and moral behavior.



It all seems too obvious to be true. As Fetell puts it, “There’s an almost comic lack of elegance in a mind [so] literal” that it associates generosity with softness, adversity with roughness or friendliness with warmth.” But it appears that this is just what our minds do, and the growing field of embodied cognition is proving it.

In 1954, the architect Richard Neutra predicted that “A workable understanding of how our psychosomatic organism ticks, information on sensory clues which wind its gorgeous clockwork or switch it this way or that, undoubtedly will someday belong in the designer’s mental tool chest,” he predicted. Three decades later, behavioral scientist Roger Ulrich published his revolutionary 1984 study showing that hospital patients whose windows looked out on greenery healed faster than those patients whose windows looked out on brick wall. Over the course of the study, Ulrich had examined the hospital records of forty-six gall bladder surgery patients, twenty-three of whom could see trees from their beds and twenty-three of whom could not. Patients who had looked out at greenery during recovery left the hospital nearly a full day sooner than patients who had not and also required significantly fewer doses of moderate and strong pain medication.

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Since the publication of this study, we understand the relationship between environment and well-being much better…but we have much more to understand. We know that our “built environments” influence our mental processes every moment of every day. And it seems that this influence is most critical in times of healing. It follows that hospital design should accommodate the humans – not just the technology – inside, because the well-being of patients and staff hinges on more than just the proper functioning of an MRI machine or CT scanner. As stated in its January article, “What’s Next: Health Care,” “Thanks to a field known as evidence-based design, we now know that how a hospital looks and feels plays a big role in how well it treats patients.” Evidence-based design can detail “the environmental particulars of recovery down to the best floor pattern for Alzheimer’s patients.” Embodied cognition is showing us that the smallest details of our environments – from chair softness to floor patterns – influence our cognitive activity, which in turn dictates everything from how amenable we are to compromise to how fast we heal.

And that’s why health care facility designers aren’t just designing buildings, they’re designing “built environments;” they’re not just creating objects, they’re creating systems. Trending away from assuming humans will adapt to design and instead adapting design to humans reminds me of the artistic exercise of drawing upside down, which allows an artist to draw what she sees rather than relying on a preconceived characterization of her subject. Evidence-based design – which is truly human-oriented design – is about releasing preconceived notions of what a hospital, courthouse, student center, chair, etc. “should” look like and instead looking to the interconnected physiological and psychological needs of the human beings who use them. And that gives me a warm feeling inside – although that may just be from the cup of coffee in my hand.