Doctor Helps Make Hospital Healing Place

Only a handful of people nationwide have the dual designations of MD and AIA following their names. The Stanford Medical Center Renewal Project is fortunate to have one of them on its team. As a licensed physician and architect, Dr. George Tingwald has devoted his career to creating innovative healthcare environments. He previously was Director of Health and Science at the leading architectural firm Skidmore, Owings & Merrill LLP, including serving as the Director of Planning for California Pacific Medical Center’s five campus master plan in San Francisco.

Dr. Tingwald speaks the language of physicians and care providers, as well as the vernacular of architects and designers. In his role as Director of Medical Planning for the Renewal Project, his translation skills and fluency in both provide unique insights into the full potential of designing hospitals for the 21st century. He recently shared his perspective with Stanford Hospital Executive Director for Public Affairs Shelley Hébert.

When did the notion of a ‘healing environment’ become part of healthcare planning?
In the early 20th century, the creation of sanitariums for tuberculosis patients first introduced the idea that physical environments where patients could benefit from fresh air and even sleeping porches would enhance healing. Some of these fascinating old buildings still exist and two in Lake Placid, New York and Colorado Springs, Colorado have even become training centers for U.S. Olympic athletes. Starting with the age of antibiotics, however, emphasis on the environment went by the wayside and the focus shifted to rapidly advancing medical treatments.

How has our understanding of the role design plays in promoting healing changed?
Over the past two decades of my career, there has been an absolute revolution. What used to be considered wishful thinking is now fundamental to our understanding of how to design new healthcare facilities. We are returning to a more balanced view, informed by our knowledge of how social, psychological and environmental aspects of a patient’s experience actually impact physiology.

Is there proof that the physical environment influences healing?
Yes and the concept is known as “evidence-based design.” There is strong scientific evidence, for example, supporting the advantages of single-patient rooms, which have been shown not only to provide better infection control but impact a wide range of issues, from improved comfort and privacy for patients and families to reduced medical errors related to transferring patients between rooms during hospitalization.

Have patients and families influenced medical and architectural planners?
Their influence has been transformational. It began in the 1970s and 80s when women began asking for (or should I say demanding) a more humane labor, delivery and recovery experience with a more home-like atmosphere. Children’s hospitals led the way in recognizing the importance of involving families and introduced innovations such as rooming-in and family-centered care. These innovations have now expanded to include all areas of care for all types of patients.

How are these concepts influencing the design of the new Stanford Hospital and expansion of Lucile Packard Children’s Hospital?
The potential for rooming in by family members will be available in every room and single-patient rooms are the new standard. Our goal is to create hospital rooms that are as much like the home environment as possible. Today that means providing the same kind of information, communications and entertainment technology that people have in their homes. It is especially important for families at the hospitals to communicate with friends and relatives. We are designing family-friendly, comfortable rooms that will help them do that.

What role does the outdoor environment play and how is that a special consideration here?
This is a truly extraordinary physical environment, with weather, views and sunlight that simply are not present elsewhere. It offers us the opportunity to bring these unique outdoor experiences inside in individual patient rooms and to make healing gardens, contemplative outdoor spaces and breathtaking views integral to what our patients, visitors, caregivers and staff will experience. The challenge is to do this in a way that reflects and responds to the unique environmental controls that are required in the hospital setting.

To describe a setting as being “like a hospital” generally means cold, sterile and institutional. How is that changing and why?
Healthcare is learning from other sectors in which the design of environments is very important. For example, the hospitality industry has taught us that people form their impressions of quality very quickly upon arrival, often in the first few minutes. The experience of parking, entering a lobby and encountering a place that welcomes and reassures rather than intimidates and confuses is critical.

The fields of seniors housing and long-term care have taught us important considerations for elderly patients to help prevent falls. For example, in designing a hospital room, do you locate the bathroom close to the head of the bed for ease of access (which would be typical in an acute care setting) or opposite the bed so that the patient can see it? Studies have shown that considering visibility is just as important as distance for the increasing numbers of elderly patients we will be serving in the years ahead.

Given the changes certain to occur in treatments and technology, how is flexibility being considered in designing new hospital rooms?
A key concept is acuity adaptability, also sometimes referred to as universal design. Essentially, this means that we want to be able to keep patients in the same room while their medical status changes during a hospital stay. We also want to standardize rooms as much as possible, but make them adaptable to the next highest level of acuity with the least amount of renovation. Having the right framework for current and future technology present in the room will make this possible.

How can we design today for advances we cannot even imagine?
Fortunately, human nature and interpersonal dynamics change very slowly, so we focus design on these fundamental responses. By focusing on the underlying issues rather than on how we respond to specific diseases with specific current technologies, we can design hospitals at Stanford today that will serve our community for decades and always assure that the most advanced treatments and technologies will be available here first. That is both our challenge and our commitment.

About Stanford Hospital & Clinics
Stanford Hospital & Clinics is known worldwide for advanced treatment of complex disorders in areas such as cardiac care, cancer treatment, neurosciences, surgery, and organ transplants. Ranked #16 on the U.S. News and World Report annual list of “America’s Best Hospitals,” Stanford Hospital & Clinics is internationally recognized for translating medical breakthroughs into the care of patients. The Hospital is part of the Stanford University Medical Center, along with the Stanford University School of Medicine and Lucile Packard Children’s Hospital at Stanford. For more information, visit http://stanfordhospital.org/.