Health Design Timeline

  Historically, patients with similar health problems were segregated into wards, marking the beginning of specialty care. The shift from multi-bedded wards to private patient rooms has largely occurred to reduce hospital-acquired infections. Today the private room is the standard of care for new construction and unsurprisingly receives a lot of design attention. Nxt Health's Patient Room 2020 Prototype may offer a glimpse of what's in store for the future.

 

Historically, patients with similar health problems were segregated into wards, marking the beginning of specialty care. The shift from multi-bedded wards to private patient rooms has largely occurred to reduce hospital-acquired infections. Today the private room is the standard of care for new construction and unsurprisingly receives a lot of design attention. Nxt Health's Patient Room 2020 Prototype may offer a glimpse of what's in store for the future.

As we celebrate the new year, it is natural to reflect on the past while looking to the future. Drawing inspiration from the U.S. National Library of Medicine's Images from the History of Medicine, this timeline explores historical events that continue to influence the future of health design.

1800s Therapeutic Pessimism - Most Americans give birth, endure illness, and undergo surgeries at home. Medical tools fit easily into a doctor’s little black bag, and diagnoses are based more on instinct than on science.  Most people sent to the hospital exit through the morgue.  Doctors frequently move between patients and procedures without washing their hands.

1860 Nightingale Wards - St. Thomas’ Hospital in London where Florence Nightingale establishes the first secular nursing school, utilizes a pavilion system with dimensions based on the cubic feet of air deemed necessary for each patient. The pavilion hospital hugely influences hospital design for the next 50 years.

1865 Hospitals Emerge - The American hospital as we know it today emerges around the time of the civil war.  Patients with similar health problems are segregated into wards, marking the beginning of specialty care. The first children’s hospital opens in Philadelphia in 1855 and enforces strict visiting hours for parents.

Minimally invasive procedures are more commonplace in part due to the use of robots.  Surgical Systems such as those by da Vinci create smaller incisions which leads to less tissue damage, a faster recovery, and less exposure to infection.

Minimally invasive procedures are more commonplace in part due to the use of robots.  Surgical Systems such as those by da Vinci create smaller incisions which leads to less tissue damage, a faster recovery, and less exposure to infection.

1870-1880 Germ Theory - Louis Pasteur and Robert Koch establish the germ theory of disease.  Surgeon Joseph Lister correctly attributes hand-washing practices to the difference in mortality rates between midwife-delivered and surgeon-delivered babies.  Surgeons under his direction begin wearing gloves, and washing their hands and instruments with carbolic acid.  Lister suggests replacing the handles of medical instruments with nonporous materials.

1900s Growth in Hospitals - Many hospitals trace their origins to this period.  Hospitals become safer and more sterile with interiors composed predominately of non-porous easy to disinfect surfaces.  While these surfaces help prevent the spread of infection, the overall effect is cold and noisy.

1917 American College of Surgeons - Predecessor agency to the Joint Commission on Accreditation of Healthcare Organizations.  They develop the Minimum Standard for Hospitals.  Requirements fill a single page, and on-site hospital inspections follow soon after.

1930s-1950s Penicillin & Signs of Resistance - The first antibiotics are prescribed.  There is evidence of antibiotic resistance, however, many new antibiotics are being developed to combat them.

1970s Growing Complacency - Prior to the 1970s, physicians and nurses are trained not to touch surfaces such as doorknobs, cabinets, and curtains after they have scrubbed and gloved. Overtime these behaviors no longer seem necessary due to the effectiveness of antibiotics.

Today, mothers typically labor, deliver, and recover all in the same room and their babies remain with them for most of this time.  Long gone are the days of nurses whisking newborns to the nursery so that mothers can recuperate in quiet.  

Today, mothers typically labor, deliver, and recover all in the same room and their babies remain with them for most of this time.  Long gone are the days of nurses whisking newborns to the nursery so that mothers can recuperate in quiet.  

1946-1964 Baby Boom - 76 million babies are born, accounting for 25% of the population.  The sheer numbers of this generation will have lasting impacts on healing environments.

1965 Medicaid and Medicare - Congress enacts Medicaid and Medicare to provide healthcare to the poor and elderly. These programs enable patients to apply to hospitals of their own choosing, but does not resolve what experts begin to call the “plight of the public hospital.”

1967 Hospice Care - The first modern hospice, St. Christopher’s Hospice is established in a London suburb. On Death and Dying a book based on more than 500 interviews with dying patients is published in 1969 and is an international best seller.  Hospice care gains momentum as Baby Boomers care for elderly parents.

1970s Institutional Design - Healthcare design is referred to as institutional design.  Primary drivers of hospital design are medical disciplines (cardiology, surgery) and functions (emergency wards, intensive care units, radiology labs). Medical equipment and its required supportive infrastructure greatly influence the planning and design of healthcare facilities.  Radiology often is the only air-conditioned department because the equipment cannot tolerate the summer heat.

1978 Planetree - A negative hospital experience causes Angelica Thieriot to imagine a new, more holistic model of care.  She founds Planetreee to personalize and humanize the healthcare experience. In 1985, the California Pacific Medical Center in San Francisco successfully applies the patient-centered philosophy to a 13-bed medical-surgical unit, becoming the first Planetree model hospital.

A 2-year old boy undergoing radiation therapy from a medical linear accelerator stands in stark contrast to the less threatening medical equipment and ambient lighting solution by Philips.  Positive distractions help reduce patient stress often resulting in a more seamless procedure and the use of less sedation medication.  Studies have shown that positive distractions also reduce feelings of pain, with more immersive environments providing the greatest pain reduction.

A 2-year old boy undergoing radiation therapy from a medical linear accelerator stands in stark contrast to the less threatening medical equipment and ambient lighting solution by Philips.  Positive distractions help reduce patient stress often resulting in a more seamless procedure and the use of less sedation medication.  Studies have shown that positive distractions also reduce feelings of pain, with more immersive environments providing the greatest pain reduction.

1980s A New Birthing Experience - Women give birth in labor and delivery suites as opposed to operating rooms. Many hospitals undergo renovations to create more home-like environments that encourage participation from the father and extended family.  Hospitals compete heavily for this market segment because women make most healthcare decisions for their families.  For the first time, facility upgrades respond not only to the needs of medical practitioners and emerging technology, but also to the demands and desires of the healthcare consumer.

1985 Press Ganey - Dr. Irwin Press develops a survey to measure patient satisfaction to improve performance.  Co-founder Dr. Rod Ganey, PhD, applies his expertise in research and statistical analysis and survey methodology.

1986 Picker Institute - Harvey and Jean Picker recognize that the technological and scientific advances in healthcare have begun to overshadow the most basic concerns and comforts of patients.  They found the organization to promote a patient-centered approach to care.

1988 Symposium on Healthcare Interior Design - The symposium promotes a broad perspective inclusive of patients, family members, and caregivers and focuses on how the design of the built environment impacts clinical outcomes.  Today we now know it as the Healthcare Design Expo & Conference, an annual conference attended by thousands in the field of architecture, design, and facility management.

According to Dr. Thomas Duffy, professor emeritus at the Yale School of Medicine, the length of a stethoscope is somewhat arbitrary and yet critical to conducting a thorough patient examination.  The device allows practitioners to listen to the internal workings of the body, but the tubing length permits them to lean in close, entering patients’ personal space with relative ease.  This close proximity allows doctors to utilize all their senses including smell and touch, which may in turn impact a diagnosis.  This seemingly insignificant act of touch may actually have a profound impact on healing.  One study found that eye contact and a pat on the back from a doctor may boost survival rates of patients with complex diseases.

According to Dr. Thomas Duffy, professor emeritus at the Yale School of Medicine, the length of a stethoscope is somewhat arbitrary and yet critical to conducting a thorough patient examination.  The device allows practitioners to listen to the internal workings of the body, but the tubing length permits them to lean in close, entering patients’ personal space with relative ease.  This close proximity allows doctors to utilize all their senses including smell and touch, which may in turn impact a diagnosis.  This seemingly insignificant act of touch may actually have a profound impact on healing.  One study found that eye contact and a pat on the back from a doctor may boost survival rates of patients with complex diseases.

1980-90s Grand Lobbies - Hospital lobbies incorporate hospitality-inspired design features such as atriums, fountains, and grand pianos.  These spaces are intended to establish a positive first impression but this level of attention typically does not extend into patient care areas.

1990s Complementary Medicine and the Brain - There is a greater demand for complementary and alternative medicine; at the same time, “soft sciences” gain credibility in the medical field due to improved imaging technologies.

1991 The Art of Healing - Surge in hospital art programs as money is reserved or raised exclusively for the purchase of art.

1992 The Institute for Patient- and Family-Centered Care - Promotes the active involvement of patients and family throughout the entire care process.

1993 The Center for Health Design - The Center for Health Design advances best practices and empowers healthcare leaders with quality research that demonstrates the value of design to improve health outcomes.  Through design research, education, and advocacy, The Center leads the way in transforming healthcare design.  

1993 Through the Patients’ Eyes - Focus-group driven study conducted by the Picker Institute determines what matters most to consumers of healthcare.  Eight dimensions of care are identified including Respect for patients’ values, preferences and expressed needs; Coordination and integration of care; Emotional support and alleviation of fear and anxiety; Involvement of family and friends; Information, communication and education; Physical comfort; Continuity and transition; and Access to care.

Distributed nursing is not a new concept.  In the March 1954 edition of "The Modern Hospital," Kaiser Permanante published the article “Efficiency Centers on the Corridor,” exploring the design of the new Kaiser Foundation Hospital in Walnut Creek, California.  Within a dedicated work corridor, individual nurse stations were located immediately outside patient rooms and equipped with supplies such as medications and linens.  Nurses praised the design for improving patient privacy and nurse-to-patient communication.

Distributed nursing is not a new concept.  In the March 1954 edition of "The Modern Hospital," Kaiser Permanante published the article “Efficiency Centers on the Corridor,” exploring the design of the new Kaiser Foundation Hospital in Walnut Creek, California.  Within a dedicated work corridor, individual nurse stations were located immediately outside patient rooms and equipped with supplies such as medications and linens.  Nurses praised the design for improving patient privacy and nurse-to-patient communication.

1996 HIPAA - The Health Insurance Portability and Accountability Act increases patient privacy, speech, and confidentiality.

1999 To Err is Human - IOM publishes the landmark report To Err is Human: Building a Safer Health System increasing public awareness about the number of preventable medical errors that commonly occur in hospitals.

2000 Crossing the Quality Chasm - IOM publishes Crossing the Quality Chasm: A New Health System for the 21st Century, promoting safe, timely, equitable, efficient, effective, and patient-centered care.

2000 Superbugs - Around the world, resistance to commonly used antibiotics increases.  According to the CDC, the cost of treating hospital-acquired infections is estimated to be $5 billion per year.  By 2002, approximately 1 of every 22 hospitalized patients acquire an infection.

2002 HCAHPS Survey - Medicare & Medicaid Services develop the first national, standardized, and publicly reported patient satisfaction survey.

Time and motion studies reveal that medical-surgical nurses spend only a small percentage of time at the patient's bedside, with the majority of time spent documenting at the nurse station.  How will the electronic medical record change the documentation process?  How will the physical space support this new form of documentation?

Time and motion studies reveal that medical-surgical nurses spend only a small percentage of time at the patient's bedside, with the majority of time spent documenting at the nurse station.  How will the electronic medical record change the documentation process?  How will the physical space support this new form of documentation?

2003 Never Events - The National Quality Forum’s Safe Practices for Better Healthcare Report released in 2003 and updated in 2006, endorses safe practices to be applied in all clinical care settings to reduce the occurrence of 27 never events that harm patients.

2003 Perception & Quality - Research links patients’ perceptions of the quality of care delivered to aspects of the experience that they can understand including overall aesthetics.

2004 IOM 100,000 Lives Campaign - Over 3,000 hospitals pledge to adopt six safety initiatives to reduce instances of medical harm.  Two years later, IOM builds on the program’s success launching the 5 Million Lives Campaign

2008 A Review of the Research Literature on Evidence-based Healthcare Design - A report that builds on a literature review conducted by researchers in 2004.  The report surveys and evaluates the scientific research on evidence-based healthcare design and extracts its implications for designing better and safer hospitals.

2006 Private Rooms - Private rooms become the standard of care for medical/surgical and postpartum nursing units in general hospitals as stated in the AIA & FGI Guidelines for Design and Construction of Health Care Facilities.

Research shows that hormones are released as a result of feelings of love and peace and these hormones have a profound impact on the immune response.  Conversely, social isolation prolongs wound healing.  Family support and involvement in patient care can enhance clinical outcomes and increase satisfaction with the hospital experience.

Research shows that hormones are released as a result of feelings of love and peace and these hormones have a profound impact on the immune response.  Conversely, social isolation prolongs wound healing.  Family support and involvement in patient care can enhance clinical outcomes and increase satisfaction with the hospital experience.

2007 HCAHPS & Reimbursements - Medicare & Medicaid reimbursements are contingent on reporting of HCAHPS data.  The Hospital Compare website allows the public to view hospitals’ survey scores.

2008 Pay-For-Performance - Medicare and Medicaid no longer reimburse for “Never Events.”

2009 Zagat for Healthcare - Editors of the Zagat restaurant guides ask people to post reviews of their doctors and rate them in categories like trust and communication. The reviews are introduced online to millions of WellPoint’s Blue Cross plan members across the country.

2010 Affordable Care Act - The Affordable Care Act is signed into law by President Barack Obama reforming healthcare in America with the aim to increase the quality, availability, and affordability of private and public health insurance to over 44 million uninsured Americans.

2011 Pay-For-Reporting - Medicare and Medicaid require hospitals to participate in the Center for Disease Control’s National Healthcare Safety Network, a secure, internet-based system for monitoring healthcare-associated events such as infections.

2011 Happy Birthday Boomers - The first of the baby boomers turn 65 years old.

2015 Star Ratings - The Hospital Compare website adds star ratings to help consumers digest survey results more quickly and highlight facilities who demonstrate excellence.

Spaces such as the nurses’ recreation room pictured at left are often hard to find in hospitals.  Staff typically do not unwind with a cup of tea and piano music, but rather retreat to windowless locker rooms to wolf down lunch.  In response to high turnover rates, which cost hospitals more that $62,000 per nurse replaced, many facilities are beginning to invest in staff spaces to improve job satisfaction, efficiency, and effectiveness.  Access to daylight is one of the few environmental factors that has been linked by research to increase staff satisfaction.

Spaces such as the nurses’ recreation room pictured at left are often hard to find in hospitals.  Staff typically do not unwind with a cup of tea and piano music, but rather retreat to windowless locker rooms to wolf down lunch.  In response to high turnover rates, which cost hospitals more that $62,000 per nurse replaced, many facilities are beginning to invest in staff spaces to improve job satisfaction, efficiency, and effectiveness.  Access to daylight is one of the few environmental factors that has been linked by research to increase staff satisfaction.