When One Size Does Not Fit All

Posted on July 21, 2012


Hospitals walk a fine line today between differentiating themselves from competitors, and unnecessarily running up expenses.

The Emergency Department is one place these two ideologies clash. On one hand, we see EDs catering toward a particular population.  Senior EDs have been discussed for a couple of years.  Children’s EDs are also coming into vogue in some areas. 

On the other hand, how does a hospital reconcile the specialization costs associated with spaces dedicated to particular demographics—especially when it can contribute to inefficiency of service delivery?  Aren’t hospitals and designers supposed to move toward consistent quality (six sigma) initiatives?  If so, how can those be put in place when one room is set up for kids, and the next room is for elderly patients? 

Or specifically, why would hospitals focus on making EDs more attractive to potential patients, when I though the idea was for hospitals to remain financially stronger by driving people away from ED usage?

In general, healthcare rooms are too inflexible; we need more flexibility, and that is where the real design heavy-lifting is done.  I find the hyper specialization of interior spaces problematic in the long-term, unless a patient population is so dominant as to warrant it.  Is 25% of ED visits by kids enough to create a Children’s ED—one out of four?  As an architect, particularly one focused on outcomes and adaptability, that does not seem convincing to me.  Contributing to the problem are architects who just do what they are told and refuse to question the business case behind a project’s genesis.

Will it create scheduling problems when the kiddie rooms are the only ones available?  Treatment errors?  Slow down room turnover by being harder to clean or stock?  Don’t we have Children’s hospitals for that?  Whether dedicated spaces for certain patient populations negatively affect care delivery remains to be seen. 

One school of thought already pegs doctors and care givers as having too much influence on facility design, i.e. doctors and nurses are inadvertently contributing to wasting millions of dollars at their hospitals through inefficiency by not using every treatment room equally, not scheduling all time slots evenly, and trying to reinvent department layouts that do not need reinventing (this is where you need the aforementioned gutsy architect).

With so much emphasis on streamlining systems to eliminate waste and normalize quality and results (and most facilities are just beginning to buy into this and begin to execute it), why do so many hospitals feel the need to be so contrarian as to create yet more variation and anomalies?