Hospitals Should Be Redesigned to Improve Care

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Written By Robby Macaay

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Hospitals are such important places in our lives. It’s where we are born, where we go for help when we’re not well, and where we turn to when cancer, a heart attack, or major injury leaves us hanging by a thread. It’s also where our loved ones spend their time anxiously waiting for us to get better, to hear good or bad news.

So then, why are hospitals such miserable places?

Most hospitals are so poorly designed, you feel their negative effects the moment you walk through the front door. The unintuitive layout immediately disorients you. The stark, cold lighting and hard surfaces create a feeling of sterility. There’s no soothing music to put you at ease, just the beeping of machines and rushing of hospital staff. It always feels like something is wrong. Like the worst is about to happen—which it sometimes does.

Architects have known for decades how design can improve people’s experience. In my own work, for instance, I’ve designed a technology lab for teenagers in Oakland, Calif., where 93% of them said the lab’s design made them feel like an inventor and 73% said the lab inspired them to pursue a career in STEM. Similarly, I believe we can improve the hospital experience, too—for patients and staff alike. By adjusting the acoustics, lighting, layout, colors, furniture, and view we can make hospitals places of peace and rest, not anxiety and fear.

We have no excuse not to do better. From pre-operation to surgery and recovery, here are three ways hospitals can be redesigned to make life better for everyone.

Increasing privacy and reducing noise for patients

A few years ago, I accompanied my mom to her hysterectomy operation at a prominent Atlanta hospital. Sitting beside her bed in the pre-op, I noticed several problems with the space: The room was cold enough to make you shiver. The lights were gloomy and fluorescent. Worst of all, there weren’t any walls—only a curtain so thin you can hear doctors and patients talking to your left and right. It was a cacophony of harsh sounds, and I could see that my mom was clearly not relaxed—and she is one of the calmest people I know. She could hear every nurse rushing through the halls, all the beeping from machines in the halls and those of her neighbors. How could anyone relax in a place like this?

From the 1960s to the early 2000s, noise levels in hospitals more than doubled, and they continue to increase. This leads to increased patient stress. In addition, patients who are heard (or even seen) between curtains are less likely to speak openly with their doctors, which can result in misdiagnosis, according to one study. Designing better acoustics in a hospital could make a big difference.

That acoustic redesign could be as simple as replacing curtain dividers with solid walls. That would have other benefits, too. The same study discovered that when a patient’s room had walls versus flimsy curtains, the patient tended to be more amenable to more sensitive portions of their exams than patients who only had the privacy of a curtain.

Better design leads to better communication, which leads to better care.

Creating a better flow in the operating room

In 2018, researchers at Clemson University and the Medical University of South Carolina did an in-depth study of what causes “flow disruptions”—essentially interruptions to a smooth, orderly procedure—in an operating room. These disruptions can cause nurses and doctors to make errors that negatively affect the outcomes of procedures.

It turns out, these flow disruptions are rampant. More than 2,500 disruptions were observed over 28 surgeries—an average of 90 disruptions per surgery. Perhaps most shocking is that more than half of the disruptions were caused by the room’s layout, such as the surgeon’s view being blocked by a piece of equipment, or the entire surgical team having to pause in a critical moment because the necessary supplies were in a closet that was blocked by another piece of equipment, or in a different room entirely.

Other common disruptions include operating staff bumping into one another, the anesthesiologist not having adequate space to do their work without being jostled or disturbed, and nurses not being able to see vital signs or what the doctor is doing to the patient.

If this sounds scary, it is. We shouldn’t have to roll in there with a fear of things going wrong—especially when many of the potential errors are preventable.

Hospitals could redesign their operating rooms in a few notable ways to minimize flow disruptions. For starters, they could adjust the shape and size of the operating room (OR). In a separate study, when Clemson and MUSC researchers tracked the movements (and collisions) inside of ORs, they discovered that there is an optimal shape and size of an OR: rectangular, longer than it is wide, and roughly 570 square feet.

In this orientation, the flow of people and supplies in the room is optimized. There is less bumping into one another, and more space for everyone to play their part without it being so big that traveling to a supply cabinet takes too long.

The Clemson and MUSC researchers also found that hospitals can rearrange the layout of the OR to create a smoother flow. For example, instead of the operating table being in the center of the room and on axis with the walls (which is an industry standard that’s rarely been questioned, the researchers note), there will be a smoother flow of staff if the table is positioned diagonally in the room, angling out from the top left corner.

This layout creates a nice corner at the head of the table for the anesthesiologist to work without interruption. In addition, the nurses can easily get to the operating table, the nurses’ station, and the supply storage in the bottom right of the room.

Lastly, ORs are visually busy. There is a lot to see, and it can be hard for nurses to find what they need. Sometimes a nurse is across the room gathering supplies or preparing equipment, and at the same time needs to know what’s going on with the patient. By hanging displays around the room that show vital signs, as well as a top-down camera (like a cooking show’s aerial camera that shows what the chef is doing), everyone in the OR, no matter where or who they are, will have the information they need. No longer will they need to rush over to the table and crowd over the patient to see it themselves.

Recovering with help from nature

While recovery rooms sound good in theory, most of them are actually not designed to help you recover as fast as possible. Noise is already a known factor—but we also need to make hospitals pleasing to the eye.

Years after her hysterectomy, my mom had a heart attack and stroke. So, I watched again and again as the design of the hospital failed to help her in all the ways I know it can. This time, not with an assault on her ears, but on her eyes.

In the 1980s, researcher Roger Ulrich conducted an analysis of patient recovery times. He compared cases where a person’s room overlooked either a set of trees or a brick wall. Overwhelmingly, Ulrich found patients’ recovery was much worse when they looked at the wall than the trees. People who faced the wall required stronger forms of pain medication, and in higher doses; they received lower assessments of mood from their nurses; and they were even kept at the hospital a day longer, on average.

Ulrich concluded that the design of the recovery room played a major role in how quickly patients recovered from the same procedures. Which is why it was so surprising that the recovery room my mom was given after her heart procedure faced the side of another building. When we know how healing nature can be, why do we build hospitals where some patients only see a blank wall?

It would be a simple decision to make during the design process. Sometimes hospitals don’t have the luxury of being perched in a beautiful landscape. Other times, what’s around the hospital, especially in urban areas, are other buildings. In those instances, painting the neighboring buildings a natural shade of leafy green, or growing ivy and other plants up their facades, could do wonders for the patients who are staring at them. Better yet, when building new hospitals, we can position recovery rooms to face inner courtyards that are lush landscapes—not only to look at but also to walk around in.

I saw these benefits firsthand. After leaving the hospital, my mom was admitted to a rehab center. I was with her when she checked in. Her room’s window didn’t look out onto other buildings—she could see grassy hills and tall pine trees. Within 30 seconds of being in the bed, she remarked how wonderful she felt and how much she enjoyed the view.

Hospitals don’t have to become “happy” places. Most of what happens there is scary and anxiety-inducing. But they can be designed to work better for all of us, so that we feel supported in the most important moments of our lives.

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