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It isn’t easy being green

Designing a hospital room to balance patients, planet and practicality

From the April ACP Hospitalist, copyright © 2009 by the American College of Physicians

By Stacey Butterfield

It’s either a dream or a nightmare. When architectural firm Anshen + Allen was asked to design a green patient room for a trade show, they set out to create the most environmentally friendly, patient-centered and attractive room possible.

“Because it wasn’t a real client, we were able to do things without the restraints of a conventional project. We saw this as great fun—a good exercise to get all of our best ideas into one place and see [whether] they make as good a space as we always imagined that they would,” said Suzanne Drake, a senior associate who worked on the project.

“Because it wasn’t a real client, we were able to do things without the restraints of a conventional project.” —Suzanne Drake

Whether the green and patient-friendly concepts actually do make for an ideal hospital room seems to be a matter of debate, depending on the priorities of the user. The green patient room, which showed at numerous health care trade shows in 2007 and 2008, is unquestionably attractive. The wood finishes, hidden medical equipment and natural light— even natural air—make the room an appealing place to convalesce. But as the architects learned when they took the model room on the road, not everyone sees a balcony (or any change) as a benefit.

“They had a patio door. Our first reaction was, ‘Oh my gosh, what if you have a patient who’s depressed or psychotic? They’d be jumping out the window and committing suicide,’” said Teresa Chou, who toured the room in Chicago and works in infection control for Advocate Health Care.

Design dilemmas

Whether it’s better to give patients a breath of fresh air or to protect them from the outdoors is only one of the many design dilemmas raised by the room. The model has an area for family members to visit and sleep over. Some observers thought the extra social space was really valuable, while others said the priority should be more room for nursing activities and quiet for patients.

The technological features of the room seemed to be more universally popular. In addition to being fully integrated with electronic health records, the room has a media wall that is much more than a television.

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The prototype has wood finishes, hidden medical equipment and natural light.

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“It’s tied in with the RFID [radio-frequency identification] system so that if the patient and family are in the room and the doctor walks in, the name of the doctor flashes up on the screen and what their role is. The patient history flashes up on the screen, and everybody can immediately get to work,” said Ms. Drake.

The room’s technological advances also allow patients greater control over their environment. In the green room, patients can control the lighting, temperature and privacy (through remotecontrolled blinds on observation windows).

Differences in opinion over the window controls highlighted the impossibility of designing a hospital room that is everyone’s ideal. The architects surveyed trade show attendees for their views on the room, and although 90% thought patients would benefit from having privacy control, only 60% said the design would be good for the hospital. As one attendee put it, the “patient may want [the window] closed when it may be medically necessary to keep it open.”

Form versus function

The conflict over priorities is a feature of all health care design, not just the green patient room, Ms. Drake said. “You want to have a very inviting space. You want to use materials that people might have in their own home, like wood finishes or a nice texture on the wall. Those things are in direct conflict with the need to keep a very hygienic space,” she explained.

She is, of course, not the only person to have noticed that problem. (“Maintenance nightmare!” commented one survey participant.) All of the products used in the green patient room are commercially available, so after touring the room Ms. Chou investigated how the furniture and finishings would hold up to her hospital’s infection control practices.

“My colleague and I went around and asked the representatives of the manufacturers and we found that nobody made anything that could withstand routine use of bleach,” she said.

Green manufacturers are working on the issue, according to Ms. Drake. “A lot of the manufacturers are creating finishes that are more durable. There are starting to be more innovations. It’s dependent on technology,” she said.

The good news is that the new technology is not as costly as one might expect. A preliminary financial analysis of the room found that the finishes and fixtures would cost more than typical new hospital construction, but not so much more. “They are within 2% of their competitors—like a linoleum floor instead of a vinyl floor or non-VOC [volatile organic compound] paint compared to regular paint,” Ms. Drake said.

The larger green changes to the room—affecting heating, cooling and water use—are more costly on the front end, but pay off in energy conservation, she added. Of course, there’s always a catch. That pretty, convenient, water-conserving handheld shower? Could be a breeding ground for legionella, noted Ms. Chou.

Despite their differences in perspective and opinion, both Ms. Chou and Ms. Drake were optimistic that closer cooperation between health care designers and the people who actually use the hospitals they design could lead to a new, better patient room.

Surveying hospital workers about the green patient room is only one step in the process, which should include early input from departments like infection control in every hospital construction or design project, the women said. “There’s a little bit of a changing in process that is more inclusive that can help us get over some of the hurdles without watering down the quality or the design,” said Ms. Drake.

The green patient room is already showing the results of the greater collaboration. In its 2009 redesign, and in a change that would have to please Ms. Chou, the staff support zone has been expanded with special space for infection control supplies.

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ACP Hospitalist provides news and information for internists about the practice of medicine and reports on the policies, products and activities of ACP. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated