Recently Payette’s Healthcare Core led an internal discussion about digital health technology and its implications for healthcare design in the coming decades. The conversation was inspired a by lecture presented by NBBJ and Vecna at ABX 2015 last fall and focused on developing healthcare trends, such as robotics, tele-medicine, nanotechnology/microfluidics and wearable/ingestible devices.
Healthcare provides an inherently complex design problem. Architects do not simply design a hospital; instead we participate in a network of people, technology and procedure to craft a wellness ecosystem. In this context, the accelerating adoption of emerging technologies has a profound impact. What will ‘hospital’ mean in 20 years? How must healthcare architecture adapt to best serve evolving programs, service infrastructure and spatial and experiential requirements?
In some capacities, robots in hospitals are already commonplace and have quantifiable architectural implications for the design of circulation corridors, surgical suites and equipment and medicine dispensaries: The Vecna QC Bot automates material transport and delivery; its use requires thoughtful consideration of circulation routes. The BD Kiestra WCA performs routine laboratory functions – and modifies the footprint needed for these services. DaVinci Surgical Systems augment a surgeon’s manual maneuvers – and change the configuration of the surgical floor.
The development of nanotechnology has less direct spatial impact, but carries substantial implications for how healthcare is executed. Advances in the manufacture of extremely small electrical circuits and mechanical devices bear the promise of highly precise, minimal impact disease treatments. Basically, very small machines could enter one’s body and perform tasks such as biopsies, cancer cell detection, drug delivery or focused cell destruction. Such therapies could reduce the need for skilled technicians, large equipment, and extended hospital stays.
Technology is both a driver of this evolution as well as a response to shifting patient attitudes.
With widespread use of personalized tech such as smart phones and biometric gadgets, we begin to expect a patient experience that is similarly tailored to the individual user. While the use of wearable medical equipment is already widespread, the trend is likely to accelerate as healthcare moves out of the hospital and into devices like contact lenses, biostamps, headsets and ingestible sensors. Personalized monitoring devices offer the potential of reduced outpatient visits, fewer diagnostic personnel and improved health management.
Similarly, technological advancements both motivate and respond to changes in government legislation. The implementation of the Affordable Care Act illustrates this relationship: The ACA promotes out-patient treatment as a method of controlling healthcare costs. New reimbursement models increase the viability of neighborhood walk-in clinics, promoting a dispersed service network for routine care outside of the centralized hospital system. Technology supports this diffusion of healthcare services while new advancements are spurred by restructured incentives.
By cascading effect, these interrelated phenomena create an altered landscape for healthcare design. As architects, we must move swiftly to retain currency amid this evolution; we must synthesize, adapt and continually invent new spaces for healing.
The team discussed a range of architectural tactics that respond to this rapid pace of change, from modular designs that allow for easy repurposing of spaces to the provision of infrastructure that facilitates easy growth and renovation. Some participants referenced successful techniques that have been implemented in built projects while others hypothesized about new motifs that might support mobile healthcare and in-home treatment.
Key points included our responsibility to engage the client in discussions involving capital investment: strategic construction enhancements might bring a higher up front cost, but provide long-term savings by facilitating renovation as usage needs change. For example, larger structural bays allow spaces to be retrofitted for other used with without restrictions due to column placement. Similarly, taller floor-to-floor heights allow easy modification to MEP and IT systems as needed to support expanding future use.
Smart planning is equally paramount. Certain layouts and adjacencies can support or hinder flexibility. For instance: setting easily relocated programs, like offices, next to less-flexible programs, like surgery suites, allows for the expansion of the latter into the former. From a construction stand-point, these strategies are supported by modular systems, such as prefabricated headwalls and bathrooms, or by using reconfigurable casework instead of fixed millwork. Curiously, standardization might be a key tool in delivering flexible, personalized healthcare.