Architecture Instead of Antibiotics
Comment on the article “Architecture Instead of Antibiotics”
by Alexa Blum and Jean Odermatt
A research project at the TU Braunschweig together with industrial partners documents how architecture and design can reduce the risk of multi-resistant germs multiplying in hospitals and leading to infections. The aim of the project was the planning and implementation of a “patient room of the future”. The special focus was on the topics of infection prevention and hygiene, the comfort of the patients and the workplace quality of the employees.
This is a further research project (see our blog entry “Colour in the intensive care unit” of 15.04.2020), which investigates the question of how design measures can contribute to recovery processes. It continues the debate as David Schwappach (Patient Safety Foundation Switzerland) also expressed it in an earlier blog entry (04.05.2020) in an interview with Arne Scheuermann under the title “How design can improve work in crisis situations”.
The following article about the research project at the TU Braunschweig describes how even fields of work and research, that have so far received little attention, can make a significant contribution to reducing infectious diseases. It once again becomes clear how not only purely functional but also emotional qualities can play a formative role in the interior design of health care institutions. A small overview of authoritative studies in this area can be found in the appendix (1). Nevertheless, such aspects, which have now also found widespread use in Europe under the term “Health Care Design”, still tend to form a niche in the construction industry.
And the question arises as to why. This question is all the more legitimate because, especially after COVID-19, the question of the future of creative measures in the health sector is more urgent than ever.
According to David Schwappach in the already quoted blog, the systemic problems in the health care system are accentuated after and through COVID-19:
“Many systemic problems in the health care system are now worsening, but they are otherwise already present. For example, the issues of light, noise, interruptions at work, no space.”
New solutions are required and the question arises as to the chances of implementing research results in the concrete planning, design and practice of health care buildings.
In view of changing competitive conditions and the growing trend towards health, the ability to implement innovations has become an indicator of the long-term success of health care institutions. However, the high failure rate of innovation projects raises the question why hospitals in particular differ in their ability to innovate (2).
It is noteworthy that an estimated 75% of all innovations come from the manufacturers themselves (innovators and early adapters range between 15 and 25%).
For a successful implementation of innovations, however, the “path dependence” is crucial, i.e. the development history of an organization, a product, a technology, etc. This influences and limits future development possibilities and procedures. Under such premises, it is then no longer possible to achieve any desired innovation goal.
This must be thought in the current and future hospital construction, since in Switzerland alone, over the next 20 years, over 25 billion Swiss Francs will be spent on hospital construction. The planning, development and realisation of these works is in the hands of planners and builders.
Switzerland tends towards perfection (“Swiss Finish”) rather than innovation. 10 hospital projects on the list of the 25 most elaborate hospital buildings in the world come from Switzerland (3). And yet – as COVID-19 shows – even the second most expensive health care system in the world is already at the limit after a short period of time.
What is obviously also needed in Switzerland are institutions that not only develop sustainable projects in the medical-technical and pharmacological fields together with industrial partners, which not only function according to the motto “More of the old, proven”, but also develop new topics and solutions in the creative field. This applies in particular to those systemic problems in the health care system mentioned by David Schwappach.
A new culture of innovation is therefore required. It is obvious that the management of hospitals can only focus the further development of their institutions on areas that are presented and defined as development areas. In doing so, they can usually only respond to offers that are available on the market. A hospital management itself will hardly be in a position to actively gain an overview of the innovation landscape, especially if innovations are not linked to technical solutions but to innovations in the area of processes or environmental design.
In order to be able to detect, classify and assess the applicability of innovations in this area, specialists are needed as “trend scouts” who deal with the question of optimal design for the well-being of patients and employees in a permanent process. They are in a position to draw attention to various innovative approaches at the same time and, where appropriate, to network them with one another.
The efficiency of new measures such as the redesign of patient rooms can be significantly improved by coordinating a wide range of innovations whose effectiveness has already been scientifically confirmed. For example, two innovations are worth mentioning here: the above-mentioned research project of the Technical University of Braunschweig on the reduction of infections and the study of the Bergische Universität Wuppertal with the Heliosklinik, which proves the positive effects of colour on patients in intensive care units.
Both studies lead to an improvement in the situation of patients and their health – both studies are based on a spatial intervention, i.e. they intervene in the interior design. Thus, two studies are already available that provide clues for a truly innovative design of patient rooms. Although one study has not yet been completed, the example shows well that it does not make sense to pursue only partial aspects, but that hospitals only develop a sustainable innovation culture if they consciously take different innovations into account and, in this case, design a patient room that combines the findings of different studies.
However, hospitals need partners who are familiar with the research landscape of “Health Care Design” and at the same time do justice to the complexity of the issue – partners who are at home in design as well as in health care. Since innovations in “Health Care Design” are usually always linked to concrete construction projects, partners should therefore have a connection to research and practice in equal measure. Thanks to such links, theory can actually become practice.
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Some literature references as overview:
Andrade Claudia C., Devlin Ann S. (2014), Stress reduction in the hospital room: Applying Ulrich’s theory of supportive design, Journal of Environmental Psychology, December 2014
Brambilla A., Rebecchi A., Capolongo S. (2019), Evidence Based Hospital Design. A literature review of the recent publications about the EBD impact of built environment on hospital occupants’ and organizational outcomes, Ann Ig 2019; 31: pp. 165-180
Bosch S. J., Cama R., Edelstein E., Malkin J. ( 2012), The Application of Colour in Health Care Settings
Dahlke H., Little J., Niemann E., Camgoz N., Steadman G., Hill S., Stott L. Colour and Lighting in Hospital Design
Hamilton Kirk D. (2011), What Constitutes Best Practice in Healthcare Design? HERD Volume 4(2): pp. 121-6, Vendome Group, llC
Kobler I., Schwappach D., Patientensicherheit Schweiz, Tink Tank Nr. 2
Medical Futurist (2017), The Finest Examples of Brilliant Healthcare Design
Mogenson Jeppe E. (2017), Textiles and Space: The Experience of Textile Qualities in Hospital Interior Design
Schwappach D. (2014), Patientensicherheit. In: Egger M., Razum O., Editors. Public Health. Sozial- und Präventivmedizin kompakt. 2. Auflage, Berlin: de Gruyter, p. 123-5.
Ulrich R. S., Zimring C., Zhu X., DuBose J., Seo H.B., Choi Y. S. et al. (2008), A Review of the Research Literature on Evidence-Based Design
Ulrich R. S. (2006), Evidence-based health-care architecture. Lancet 368: pp. 38-9.
Ulrich R. S. (1984), View through a window may influence recovery from surgery. Science Apr 27; 224(4647): pp. 420-1.
Wolstenholme D. (2015), The State of the Art of Design in Health: An expert-led review of the extent of the art of design theory and practice in health and social care, Sheffield Hallam University.
Zimring C., Augenbroe G. L., Malone E. B., Sadler B. L. (2008), Implementing healthcare excellence: the vital role of the CEO in evidence-based design. HERD 1(3): pp. 7-21.
A capricious travelogue through the Swiss hospital landscape by Thomas Hürlimann, published on 28.04.2019 in the NZZ
Piening Erk P. (2001), Prozessdynamiken der Implementierung von Innovationen. Wiesbaden, Gabler Verlag/Springer Fachmedien.