A Room with a View

How Evidence-Based Design Leads to Better Patient Outcomes.

“It is a curious thing to observe how almost all patients lie with their faces turned to the light, exactly as plants always make their way towards the light; a patient will even complain that it gives him pain ‘lying on that side.’ ‘Then why do you lie on that side?’ He does not know — but we do. It is because it is the side towards the window.”
                                                                                                                                                                           -Florence Nightingale from Notes on Nursing

Patients want a window. It’s human nature to seek a room with a view, and apparently, it’s also in our best interest, given the affect it has on our health.

Zofia Rybkowski, PHD and Assistant Professor at Texas A&M, recently addressed this idea at the Haas Business of Healthcare Conference. She shared an example of a scientific study conducted by a colleague of hers, Roger Ulrich, with a Philadelphia hospital. Using two groups of patients who underwent the same surgical procedure, they were able to isolate the effect that the view from the recovery room had on patient outcomes. One group of patients recovered in rooms that had a view of another building. The other group of patients looked out at a natural setting of trees. With all other conditions the same, the group that had a view of the trees showed much better outcomes including shorter recovery times, faster release from the hospital, better moods, fewer complications after surgery, and required less pain medication. “This highlighted, along with other evidence in the emerging field of mind-body medicine, the need to consider a broader picture, including physical environment, of factors that affect patient outcomes and the health of patients,” Ulrich says.

Zofia is researching the health outcomes and financial implications of Evidence-Based Design (EBD). According to The Center for Health Design, an organization that helps healthcare professionals improve the quality of care in the built environment, designers and architects use EBD to create physical environments by basing decisions on rigorous scientific research to achieve the best possible outcomes. EBD applies to the design of products and services as well as architecture.

It’s similar to how healthcare professionals make treatment decisions and how insurance companies determine coverage. They are heavily influenced by patient outcomes. If there is systematic evidence of statistically significant improved outcomes, then doctors will more likely prescribe certain treatment regimens (medication, lifestyle, devices, etc) and insurance companies or the government will more likely cover the costs. This is called evidenced-based medicine or evidenced-based treatment.  Although designers like the ones I work with at frog understand the importance of emotional and physical factors when designing a product, where we sometimes fall short, particularly in the design of healthcare products, services, and environments, is applying similar scientific rigor in testing that is required for widespread clinical support and adoption.

While there are different levels of rigor for testing a new drug versus designing a new patient waiting room, there are lessons to be learned from a clinical and scientific approach to measuring outcomes.

In evidenced-based medicine, the following factors can determine the quality of a clinical trial:
•    Trial design considerations: High-quality studies have clearly-defined eligibility criteria, and have minimal missing data.
•    Generalizability considerations: Studies may only be applicable to narrowly-defined patient populations, and may not be generalizable to clinical practice.
•    Follow up: Sufficient time for defined outcomes to occur can influence the study outcomes and the statistical power of a study to detect differences between a treatment    and control arm.
•    Power: A mathematical calculation can determine if the number of patients is sufficient to detect a difference between treatment arms. A negative study may reflect a lack of benefit, or simply a lack of sufficient quantities of patients to detect a difference.

To show improved outcomes, we need to consider how to design for and then measure appropriately per the above, one or more of the following:
•    Increasing patient, family and staff satisfaction
•    Speeding patient healing rates and medical outcomes
•    Improving patient and staff safety
•    Reducing patient and staff stress
•    Increasing staff effectiveness and reducing staff turnover
•    Reducing medical errors
•    Improving financial performance

These more quantitative and scientific approaches complement the qualitative approach to design and the combined results provide the necessary proof to get healthcare providers and insurers to pay attention and to change their practices.

With rising healthcare costs and rapid advances in medical devices, wireless communications, and electronic medical records, there is a race to not only design new products and services, but to validate them in a clinically meaningful way. Organizations like the West Wireless Health Institute and Robert Wood Johnson, among many others, are working to conduct research in clinical settings to measure the safety, efficacy, and cost-effectiveness of new products and services.

In healthcare, it’s not enough to design a better product or service. To gain widespread adoption and coverage, you need to prove that your product or service provides improved and cost-effective outcomes. Understanding and applying the principles of evidenced-based design is a good step in that direction.

-Barbara Pantuso, Director of Healthcare Innovation