By: Prof. Shlomo Maital

Everything on this planet not provided by nature (like trees, carrots and apples) is designed by someone. In the case of hospitals, good design can be the difference, literally, between life and death, or between controlled costs and runaway budgets.

This was the theme of an international conference on 21^st century hospitals held at The Technion on October 11.  Billed as a “gripping interaction between architects, designers, medical practitioners, Academe, and decision-makers”, the conference was organized by Prof. Noemi Bitterman, who heads Technion’s industrial design program, and by the Architecture Faculty and School of Medicine.
In her opening talk, Prof. Bitterman noted the gap between the English word “hospital” (related to hospitality, implying warmth, friendship, and welcome) and the Hebrew “beit holim” (place of the sick). We must close that gap, she said.    The main achievement of the conference, she told me later, was the productive dialogue between those who design hospitals and those who work in them daily.

Two key issues trouble hospitals in Israel, the U.S., and elsewhere. First, mistakes that cause patients injury or death. A World Health Organization study showed that one person in 10 is “subjected to a human error in his or her treatment and almost 1 patient in every 300 dies because of it.” JAMA (Journal of the American Medical Association) once published a study showing there were 195,000 hospital deaths yearly in the U.S. from medical errors, far more than from car crashes (about 33,000) and nearly all preventable. Some 100,000 deaths alone occur in the U.S. from hospital-acquired infections ‒ germs that evolve to resist nearly all antibiotics.

No data exist on error-induced hospital deaths for Israel, but there are persisting hair-raising episodes, like the woman undergoing a Caesarean section at Sheba Medical Center who was badly burned when antiseptic material on her bed sheets ignited. The Ministry of Health has a quality control section but crowding and overworked staff continue to cause deaths and injury from errors.

Second, soaring costs. New medical technologies in hospitals are astonishing ‒ and astonishingly costly. Last June, the Supreme Court blasted the Finance Ministry for “emptying of meaning the right to health care (in the National Health Care Law)” by underpaying Israel’s four HMO’s for hospital days. At a pricey NIS 2,300 ($600) per day, the reimbursement still does not cover the actual cost. The Finance Ministry says it will continue to cut the per diem, to induce efficiency improvements. That bodes ill for the sick.

Prof. Shlomo Mor-Yosef, head of the National Insurance Institute, noted that it takes six years to design and build a hospital, which then stands unchanged for 40 years. So by definition, hospitals are obsolete the moment they open. On the bright side, he described the newly-opened building at Hadassah Hospital, Jerusalem, where each floor has a ‘healing garden’ indoors.

Dr. Kobi Vortman, CEO of InSightec Ltd., brought some striking data. America spends about 18 percent of its GDP on health care, compared with 8 percent for Israel, yet Israel’s life expectancy at birth is 81.5 years compared to America’s 78.4. Not all medical technology raises costs, he noted. His company has developed proven focused MRI guided ultrasound surgery that removes brain tumors without an incision by dissolving them with a beam of sound, a rare technology that saves money rather than squanders it.

One of the most interesting speakers was Jos Stuyfzand, a Dutch designer specializing in ‘ambient experience’ for Philips Healthcare. He described a remarkable experiment in which Philips designed a special CT (computer tomography) scan suite in a Chicago children’s hospital. CT scans are frightening for children; hence, completing one took an average of over four hours. By simply making the suite friendlier, less threatening, more reassuring, the time for a scan was slashed to half an hour, and sedation declined by 28 percent. I think this will work for adults, too. It is not only kids who are scared by CT machines.

Prof. Paul Barach, of the Utrecht (Netherlands) Medical Center, told a lovely story to show how clever design alone can solve problems. Amsterdam’s busy Schiphol Airport once had a problem with its men’s urinals. Men were missing the target, as they are wont to do, causing germs, odors and costly cleanup. The design solution? Paint a fly on the center of the urinal bowl. Men love to aim and hit targets. Those painted flies are now ubiquitous worldwide. Barach’s point? Technology separates patients and doctors. Use design to bring them together again, reduce errors and cut costs. Substitute creative design for big bucks.

The fact is, Israel’s hospitals are in crisis. The number of hospital beds has fallen from 5.83 per 1,000 in 2007, to only 3.5 per 1,000 in 2010, far below the world average (7.3) and abysmal compared to Switzerland’s 18.3. Ashdod, a major city, has no hospital. There is a desperate shortage of nurses. The supply of doctors is adequate only because of the fortunate accident of massive aliyah from Russia, but many of those immigrant doctors who came in the 1990’s will soon retire. The 24 government hospitals are overcrowded, with only about 12,000 beds, and many are outmoded. A tiny fraction of the annual NIS 60 billion ($16 billion) expenditure on health care, perhaps three percent, goes toward capital investment.

Jaime Lerner, the former Jewish Mayor of Curitiba, Brazil, once said, if you want real creativity, knock two zero’s off your budget. I don’t recommend it for Israel’s health care. But his point is a wise one. Lack of money can spur great ideas. Lerner himself practiced what he preached. He cut the grass in his city’s parks with goats.

Here are a few design ideas I found, implemented at a new U.S. hospital, Palomar, in Escondido, CA., just south of San Diego. Palomar itself is hugely costly, $1 billion  But some of its design innovations aren’t.

For example: There are no nursing stations. (Ever tried to drag a distant nurse to a relative’s hospital bed, or your own?). Instead, there are small workstations outside each room. Next to each is a small closet, so nurses don’t have to rummage through distant supply closets. Each room has Wi-Fi, linked to an electronic medical record system, so medical providers can document care with smartphones or laptops. There are no separate doctors’ and nurses’ lounges. Instead, there is a multipurpose room where doctors and nurses can meet and chat. Outdoor gardens on each floor enable patients to get fresh air without leaving the building. Patients can control each room’s lighting, heating, cooling.

Palomar and other hospitals are introducing a simple idea that saves many lives: Checklists. Simply list step-by-step the precise procedure to be followed for treating a sick patient and check off each one. For harried, sleepless caregivers and for patients alike, this can be a boon. It works for the Air Force and for airlines, why not for hospitals? And it costs nothing.

Perhaps it is time to take the design of hospital buildings away from the architects, or at least put control into the hands of patients, doctors and nurses. Britt Sadler, a former CEO of a large U.S. children’s hospital, says in an article that “atriums [interior courtyards] win architecture awards but don’t save lives.” For years,  my office at The Technion was in a beautiful building with an atrium. That ‘hole in the middle’ kept me from easily interacting with my colleagues, because getting to them took a long hike. Beautiful architecture, bad functional design.

Worldwide, in Israel and abroad, the global economic crisis has caused governments to slash their budgets. As a result, hospitals have stopped modernizing and upgrading. But much can still be done to prevent error-induced deaths and to control soaring costs. The 21^st century hospital will feature creative functional design that replaces bucks with brains.  It will become a place where sick people are healed, not killed. Thomas Heatherwick, the designer who created the incredible London Olympics cauldron of light, has said he would love to work with hospitals, because “some of the worst environments in Britain are health environments.” And in Israel, he might have added.

So, designers, get to work. We need you.

This article was originally published in the Jerusalem Post Marketplace on October 16, 2012.