Assessing the current and future state of health care design

The growing emphasis of evidence-based design and other research continues to impact the state of the health care design field, which longtime design leader and professor D. Kirk Hamilton, FAIA, FACHA, EDAC, believes is better than ever.  

What is the state of health care design today? 

I am convinced that the field of health design is more robust than ever. Practitioners are more experienced and better prepared to deal with the complexity of health design than we were 45 years ago when I started as a young hospital architect.

There are focused health design programs at more universities. We have a board certification process in place through the American College of Healthcare Architects, and we have a journal Health Environments Research & Design (HERD), an international, multidiscipline, scholarly publication devoted to our field.

The Hamilton file

CV

• Board-certified health care architect with 30 years of experience in hospital design
• Fellow and associate director of the Center for Health Systems & Design and professor of architecture, Texas A&M University, College Station, Texas
• Co-editor of the journal Health Environments Research & Design (HERD)
• Faculty member of the Institute for Healthcare Improvement
• Founding principal emeritus, WHR Architects 

ACCOMPLISHMENTS

• Named to the American Institute of Architects (AIA) College of Fellows for his advocacy for excellence in architecture for health, innovations in design, for research and vision for hospital of the future
• Craig & Julie Beale Endowed Professor of Health Facilities Design, Texas A&M University
• Past president of the AIA Academy of Architecture for Health
• Past president and a founding regent of the American College of Healthcare Architects
• Served on the board of the Center for Health Design for two decades
• 2003 chair of the Society of Critical Care Medicine's design committee
• Widely published and renowned author and speaker at national and international design events and conferences

EDUCATION

• Enrolled in doctoral program at the College of Nursing and Health Innovation, Arizona State University
• Master of science in organizational development at George L. Graziadio School of Business and Management, Pepperdine University
• Bachelor’s degree in architecture at University of Texas at Austin

Some practitioners are beginning to perform useful applied research and many are adopting practice models that improve design decisions by referring to relevant, credible research. Lean design and construction are becoming widespread and integrated project delivery methods are improving project results.

Things have improved by leaps and bounds. When I started designing my first small, community hospital in the early 1970s, most hospitals were unbelievably drab, institutional, dark, dismal and dreary.

Today, we have turned physician-centric facilities into more pleasant environments that emphasize patient and family amenities. The patient room is more conducive to nurse caregiving and serves the patient better. Improved wayfinding and excellent art programs are more common.

Health designers have introduced attractive public spaces, many with an atrium and both indoor and outdoor green spaces. There is a higher quality of interior design, and more advanced technology in well-designed departments that make care delivery more efficient.

Of course, there is plenty of room for further improvement.

What are the major challenges health care designers face today? 

The health design field faces several major challenges. Health care is rapidly shifting from the hospital to ambulatory settings and the home, which require new models. Only the sickest patients, trauma and acute care cases, will end up in the hospitals.

In this country we have a profound problem with preventing drug-resistant infections, and there is an important role for design in finding solutions. We face the threat of the next pandemic and facilities that are not designed to deal with disasters of that scale.

As if these things don’t present sufficient challenges for health designers, we must reel in the soaring cost of health facility construction. People I respect say we must cut the cost of health care construction in half. That is a huge challenge for the next generation of designers.

How did you become involved in evidence-based design?  

Like most architects of my generation, I was introduced to sociology and anthropology as resources for understanding human behavior and how people respond to designed space. I always considered myself to be a rational designer, and health care didn’t seem to be well-suited to arbitrary decisions based on pure aesthetics.

The breakthrough occurred in 1984 when Roger Ulrich published a study in Science, a highly respected journal, linking the design and view from hospital windows to clinical outcomes like the use of pain medication and length of stay. As an architect, I was finally offered an example of research that indicated what I previously felt to be true: It was possible to link a design decision to a clinical measure.

That was the beginning of a journey of passion for me. I was exposed by Robin Orr to the Planetree movement as a philosophy of caring, and it appeared to be better for patients and their families. I pursued these fascinating ideas and ended up on the board of the Center for Health Design where I served with both Ulrich and Orr. Their work inspired me to use an evidence-based design process in my own international practice to deliver patient- and family-centered projects.

Evidence-based design was once controversial. Has it now become mainstream? 

Yes. I think evidence-based practice is now mainstream, or nearly so. Who, after all, wants to say that he or she refuses to improve design decisions by being aware of current research?

The problem is that my generation of practitioners had no education in research methods, and older leaders are often reluctant to take on this different way of practicing.

I believe that when today’s younger practitioners become leaders in the field and in the design firms, their generation will have a better understanding of practice models that use research. They will consider it to be the normal and expected way to deliver health projects.

As one of the founding editors of HERD, can you explain the role it plays in the health design profession? 

I have been told that a field cannot exist without scholarship and a path for young academicians to advance and receive tenure at their universities. Without HERD, there would be fewer scholars contributing to the field, and less relevant research produced. With less research relevant to our field, practitioners would have less data to inform their thoughtful design decisions. I believe the journal plays an important role by providing credibility to the practice of health design.

How does the journal encourage designers to conduct their own research and why is that important? 

The journal does not specifically advocate what practitioners should do, but we certainly have an editorial bias toward the positive role of good research as a means of improving the field. I suppose the best encouragement is when a practitioner sees useful published research by an esteemed colleague or someone with whom they compete.

Are you encouraged about the future of health care design based on the students you’re teaching? 

Absolutely! The students I see are extremely bright, talented and remarkably skilled with computers. They are making commitments to health design much earlier in their careers and are performing exceptionally well when they graduate and join firms.

I can clearly see that my personal legacy will be far more extensive as a result of what those I am teaching will accomplish than as a result of my own body of work. The future of health design looks bright.