Designing for Change: Healthcare Design in a Post-COVID World

Ryan A + E, Inc colleagues Megan McNally, Senior Interior Designer, Linaea Floden, Director of Architecture – Southeast, and Jenna Shawver, Designer weigh-in on five considerations for the future of post COVID-19 design that allows our teams to respond more appropriately and implement more quickly during challenging healthcare times.

As a result of COVID-19, healthcare systems across the world are developing, planning and implementing modifications to their facilities to not only address the current crisis but to also identify potential surge capacities in the future. As we look past the existing pandemic, healthcare systems are tasked with creating a new delivery of healthcare which includes realized contingency plans. When pulling together those plans, organizations can consider using outpatient facilities; utilizing inpatient environments in unconventional ways to take advantage of areas and locations with existing infrastructure (i.e. ORs and prep/recovery); designing a “kit-of-parts” or planning modules for easy adaptation of spaces that meet a variety of patient care needs and staff workflows; and adding robust infrastructure for future flexibility.  

Healthcare design is not a one-size-fits-all solution. As we plan, design, adapt, remodel and build, it is crucial to consider the varying demographics health systems are serving. Asking questions like: How would the environment be different if you’re designing for pediatric use with high-touch patients and multiple family members? Or, what specific design solutions should be considered when designing for older adults that may have challenges with transportation, utilizing new technologies, or individuals with visual, hearing or mobility impairment? How can we design spaces that are safe, adaptable, flexible and effective in supporting quality care delivery while also supporting the different patient demographics we serve? Additionally, how can we design spaces that encourage patients and staff to communicate and feel understood during their healthcare journey? Knowing that the healthcare landscape is rapidly changing, we have begun to identify a few key considerations that will allow us to design smarter, respond more appropriately, be prepared and implement more quickly.

1. Leverage and invest in technology

Offering new methods of virtual care in both urban and rural settings, including primary, specialty, emergency and mental health to name a few, could limit physical contact with health professionals and offer easy and quick connections.

This may result in a decrease in space to physically care for patients and an increase in space for staff to teleconference, screen share and view/monitor data. Alternatively, increased technology may result in a total decrease in overall space needs and allows providers to deliver care from their homes.  There may be new opportunities for pre-screening visits, consultations, well check-ups, monitoring, medication checks and procedures.

With increased opportunities to leverage technology, cybersecurity and patient privacy, these will need to be addressed in new ways. Health systems may consider investing in application development to provide these tools to connect. Training and onboarding for staff will be imperative for success, as well as patient education that is intuitive and simple to connect patients to their providers.  This process may be easier for some users, depending on demographics and access to the proper technology tools and internet.

• Integrate technology for patients to communicate with family members and loved ones that are not physically with them during their healthcare experience, especially with inpatient environments and isolation spaces.
• Apply widespread Radio-frequency Identification (RFID) tracking software for equipment, supplies, patients and staff to not only monitor quantity and location but limit the amount of physical contact required to identify restocking and ordering needs.
• Implement use of robots for no-touch dispensing and delivery of equipment, materials and information as well as cleaning and maintenance. This could reduce the burden of increased cleaning for environmental services and nursing staff.

2. Plan for flexibility, adaptability and movement

• Increase flexibility in patient rooms or the building to allow for easy conversion into swing spaces that can serve surge capacities.
  • As an example, consider adding mechanical, electrical and medical gas infrastructure in areas not typically used for patient care, but capable of holding capacity for patient care if needed (i.e., cafeterias, auditoriums, training spaces, etc.). When designing non-patient care space, designers may evaluate fit and adaptability of accommodating patient care modules.
• Incorporate increased technology and infrastructure for inpatient (and outpatient) environments to align with an ICU environment in more rooms that can handle a surge. Nurse call, telemetry, physiological monitoring, oxygen, medical air, medical vacuum and electrical power for equipment will allow for increased flexibility for delivering care. Negative pressure rooms or units will also allow for flexibility.
• Account for opportunities for current distancing measures and possible future measures, during initial programming and planning to create flexible, agile environments.
• Develop travel path exercises with customers to illustrate patient, staff, visitor, equipment and materials movement and identify opportunities to streamline that movement to reduce cross-traffic.

3. Consider alternatives for material and furnishing selection and placement

• In-house and manufacturer-led environmental services and facility staff training for increased frequency and long-term cleaning and maintenance of materials and furniture.
• Post-COVID, designers and health systems may incorporate more interior finish products that are impermeable, scrubbable, gasketed and seamless. This will affect acoustics, comfort underfoot, visual preferences and will need to be weighed with initial and long-term lifecycle cost and maintenance.  

4. Rethink waiting, registration and triage processes

• Healthcare systems may need to consider developing new protocols for the registration process to reduce queuing and waiting.
• The typical waiting area benchmark is roughly 20 square feet per person, resulting in the “bus stop” seating effect. Waiting areas can also become crunched when programmed patient care spaces require more physical space. The result does not support healthcare environments aiming to provide a hospitality-like space with variety, comfort and connectivity. Post-COVID, we may see the following options to address the waiting and check-in process: Individual seats spaced further apart and less ganged furniture, more physical barriers between small groupings of seating and integrated barriers within furniture products. It’s important to note variety and choice can still be achieved and offer zones for work, quiet and small groups.
• To provide a comfortable, hospitality-driven waiting experience, facilities may consider:
  • Operational check-in changes with staggered appointment times to allow for reduced seating capacities and separation.
  • Self-rooming with arrival detections, just-in-time digital dashboards and signage to eliminate waiting space and provide waiting options within the patient care zone.
  • Increase waiting room sizes to meet the same quantity of seats if distancing is desired.
  • Virtual check-ins or the option for patients to check-in from the parking lot or outside of the building.
• Look for alternative ways to triage and assess patients prior to arrival or admittance, with less or no-touch interactions.
• Patients and visitors may be less focused on comfort and may value physical separation and cleanliness in waiting spaces.

5. Explore low touch, no touch and convenience care

• Pre-COVID, handwashing was challenging to enforce, track and monitor in a healthcare environment for both staff and visitors. In future healthcare environments, consider automated systems that can monitor handwashing. Additionally, there may be opportunities to incorporate wearables to notify and remind staff to handwash when approaching a patient.
• Implement drive-thru testing sites instead of mixing populations within the care environment of suspected illness.
• Eliminate the need to touch surfaces by implementing automatic door operators, card readers, no-paper, no-signature, etc.
• Complete pre-visit paperwork online or on a patient’s device, including patient information and copayments.

Changes in how patients seek care and the shift toward a more value-based care model have impacted how physical environments look and function. This in turn has caused the need for health systems, hospitals and provider groups to quickly rethink their facilities to provide both the capacity for innovation and social distancing considerations with the flexibility to foster an uncompromised level of patient care and financial sustainability.