Archive for the ‘Healthcare’ Category
Or, if the health care model you want to improve is as outmoded as a typewriter, the best approach is to think in terms of transforming the entire concept, rather than reforming it.
“Reform involves tweaking and revising, whereas transformation means we are aiming to totally liberate people from depressing, disease-causing environments,” Tye Farrow has said. He sees the cost burden of chronic diseases as a problem that requires a bigger lens. “Obesity is not primarily a medical problem. We waste valuable time and money when we put pressure on the health system to solve problems that are rooted in built environment. People are being starved by their physical surroundings when they could instead be nurtured by design. Obesity is a sad daily reminder that we have gone way off track by creating desolate places.”
As Matt Miller wrote yesterday in The Washington Post, What Obamaomics is missing: Disruptive innovation, “A central theme of Obamanomics 2.0 should be “disruptive government” — making the world safe for such innovations to challenge wasteful establishments in sectors critical to middle class well-being…it has nothing to do with increasingly irrelevant “left” vs. “right” debates…Fresh blood can help the president see we’re in a race between innovation and calcification.”
A study released today by the Organization for Economic Cooperation and Development, reported in The New York Times “The World is Fat” states, “Until 1980, fewer than one in 10 people in industrialized countries like the United States were obese. Today, these rates have doubled or tripled. In almost half of developed countries, one out of every two people is overweight or obese. These populations are expected to get even heavier in the near future, and in some countries two out of three people are projected to be obese within 10 years.”
– Sharon VanderKaay
When salons were popular in France over 300 years ago they filled a need for people who were trying to make sense of confusing times. Three magic ingredients – diverse perspectives, a spirit of inquiry and social rapport – added up to fertile ground for sparking breakthrough thinking. Unlike a lecture format, which conveys pre-packaged information, these conversations addressed what we now call “wicked problems.”
Wicked problems are messy and full of ambiguity with no simple, right or wrong answers. To understand wicked problems calls for wrestling with questions that can be overwhelming to an individual. So what could be more appropriate for thinking together about today’s perplexities and opportunities than a return to the salon?
The rise of social media indicates a massive global yearning to wrestle with tough questions by making human connections. The salon format can be thought of as an offline version of social media conversations – full of emotion, doubt, and the willingness to share lessons learned related to a complex issue.
Recently we experimented with such a gathering of the minds which drew health care architects, media, engineers, academics, government representatives, programmers and students together to talk about the relationship between design for health and economic well being. The evening’s central question: At a time when health care design quality is threatened by “good enough” standards, how can we influence decision makers to believe we can all do better than that?
Our guests included Alan Dilani from Stockholm who was in Toronto to talk about the global shift away from expensive sick care to prosperous health care.
Richard Sommer, dean of the U of Toronto’s Faculty of Architecture, Landscape and Design, commented that the teaching of health design has been neglected over the past 20 years. He said his school is planning to emphasize this educational specialty as fundamental for a resilient and prosperous society.
Recognizing that merely pushing such a complex design agenda rarely leads to action, the salon provides a venue for pulling ideas from a diverse group. This open-ended spirit of inquiry seems like a good way to ignite changes in thinking AND doing.
Functional, efficient, light and bright hospital design is pretty much the norm for new construction today. There’s solid evidence that links design with reduced need for medication and shorter hospital stays. This proof is vital, but there is also a need to explore unproven intangible design qualities.
Before funds are invested in new hospital construction, it’s worthwhile to articulate the kind of space people seek when they’re at their most vulnerable due to illness. Is it enough to simply choose from the current healthcare design influences of corporate office, chic hotel or upscale health spa? Or should the design aim to address spiritual needs?
Dissatisfaction with proven norms can lead to breakthroughs. A spark of innovation is ignited when someone says: “We can do better than that!”
Credit Valley Hospital was not afraid to wade into emotional conversations when they set out to define their vision several years ago. That level of commitment, combined with their willingness to break from conventional “healing environment” rhetoric, has made all the difference. Here’s how their inspiring words guided this hospital’s memorable design:
– Sharon VanderKaay
Rising out of polarizing debates concerning reform to the U.S. health care system are a variety of examples across America where health care costs are down and quality is improved. The Plexus Institute draws our attention to the notion of positive deviants (PD), which means examining situations where something is working to determine underlying principles that can be applied on a larger scale. For example, this PBS broadcast begins by reporting, “When President Obama talks about his idea of great health care, he usually singles out a few choice models.” Betty Ann Bowser quotes Obama on the NewsHour:
“Barack Obama: “What worked? The Mayo Clinic, the Cleveland Clinic, Geisinger, Kaiser Permanente. There are health systems around the country that actually have costs that are as much as 20 or 30 percent lower than the national average and have higher quality. What is it that they’re doing differently than other systems?”’
Looking at positive deviants is a way to get beyond primal fears of innovation. One of the paradoxes of innovation is that although the general concept of fresh ideas and progress sounds attractive, our first impulse when encountering a specific potential breakthrough may be to ask where it has been done before. For naysayers who insist, “That’ll never work!,” we can cite deviants from the norm to reply, “But it has been working in this situation.” Studies on ways to improve infection control in hospitals provide another example of the PD approach.
This human need for precedents is a central challenge for pioneers who are doing great architecture. That’s why we have an ongoing interest in gaining insight into the role, thinking and potential for influencing naysayers.
We’ve been experimenting with condensing years of thinking and practice into max.18-slide “short stories.” Here is the latest of three stories: Hospitals are Sacred Spaces In this set we acknowledge Joe Pine, who with his colleague Jim Gilmore introduced us to The Experience Economy exactly ten years ago. His current thinking on authenticity: TED Talk: What Consumers Want is especially relevant for hospital patients and families. Two other slide stories can be found here: Nursing Focused Design and here: Why Hospital Design Matters Don’t forget to use Full Screen viewer!!
What would it look like if the Canadian health care system actually produced “patient-centred care”? I mean, what evidence would we see in front of our eyes? Given that patients are human, I would expect to see places that looked humane. These places would look humane because they demonstrated obvious understanding for what it means to be in a vulnerable state.
After decades of loose talk about patient-focused care by various agencies, Jennifer Graham reports from the Canadian Medical Association’s annual meeting that these words are still up for discussion: “Dr. Robert Ouellet, the current president of the CMA has said there’s a critical need to make Canada’s health-care system patient-centred. He will present details from his fact-finding trip to Europe in January, where he met with health groups in England, Denmark, Belgium Netherlands and France. His thoughts on the issue are already clear. Ouellet has been saying since his return that “a health-care revolution has passed us by.”
Incoming CMA president Dr. Anne Doig says “we all have to participate in discussions around how we do that and of course how do we pay for it.”
What’s the solution? How can those well-intentioned words begin to match reality? Is it only about “efficient care” or “activity-based costing” or is it also about something deeply rooted in our view of the patient experience?
The Finnish modern master architect, Alvar Aalto, in his Paimio tuberculosis sanatorium of 1933 demonstrated how a humanitarian approach to the architecture of hospitals could provide comfort to patient at their weakest moment. His thoughts are summarized by Colin St John Wilson in Alvar Aalto: through the eyes of Shigeru Ban; a good read.
In Aalto’s extensive writing, including his 1940 piece The Humanizing of Architecture, he revealed the struggles he was facing in his professional practice between the emerging forms of modern architecture. His own work drew on the philosophies of naturalists John Ruskin and William Morris’s “democratic architecture.” This was in contrast to the prevailing trend of modern architects at the time toward, for example, Le Corbusier’s view of the house as a “machine for living.”
In response Aalto writes, “. . . the newest phase of modern architecture tries to project rational methods from the technical field out to human and psychological fields.” As Aalto points out, humans have a deep need for human responses that don’t conform to a rational mechanical method, and stated that “architecture is only authentic when Man is at the centre, grounded in human priorities.”
It seems to me that the incoming CMA president could benefit by looking at the evolution of modern architecture in terms of how it could truly put patients at the centre of care. As our aging hospital “infrastructure” is replaced, decisions must be made about humane physical environments. The delivery of care, as in the creating hospital architecture, is an equal mix of the science and art of healing.
– Tye Farrow