To describe the soaring costs of healthcare in the U.S. as a crisis would be to put it mildly. A survey released in November illustrated the problem to dramatic effect. Using data provided by the Organisation for Economic Co-operation and Development, the Commonwealth Fund found that between 1980 and 2009, average U.S. health spending per capita rose from roughly $1,000 to almost $8,000. That’s 16 percent of gross domestic product for 2008. The same report finds that U.S. spending on healthcare greatly exceeds that of the next highest spender, Norway, where spending amounts to roughly $5,000 per person.
The diagnosis gets grimmer. In September, The Washington Post reported on a separate study that found that income gains among middle-income American families over the last decade had been almost completely wiped out by rising healthcare costs.
Hospital care accounts for 31 percent of the $2.3 trillion Americans paid in healthcare expenditures in 2008. One way that these costs can be reduced is by increasing efficiency. The Henry J. Kaiser Family Foundation notes that policy experts estimate that some 30 percent of healthcare is unnecessary. While many if not most factors driving healthcare costs are beyond the reach of the designers creating healthcare facilities, efficiency is a primary concern of designers who build crisis-response centers—to cut costs and to save lives.
“The best way to control costs is to reduce waste. Waste comes from medical error. Your best bet is to create the best care in the first go-round,” says Henry Chao, AIA, principal at HOK, which is the design architect and architect of record for a significant expansion to the Ohio State University Medical Center (HOK is working with local firm Moody Nolan on the project). “You reduce the chances for medical errors, you reach better outcomes, you minimize the number of patients who return.”
HOK’s work for the $1.1 billion expansion at Ohio State includes the design of the new James Cancer Center Hospital, and Solove Research Institute, and Critical Care Tower, which will be completed in 2014 for more than $500 million. The Medical Center’s emergency department is a Level I trauma center that provides presidential-level services—meaning that if the president were to befall an emergency in Columbus, Ohio, he would be ushered there.
Chao says that the trend in crisis-response-center design has moved from an open-cubicle format to individual rooms that promote acoustic privacy. But the most important factor mitigating the design of Ohio State’s three critical-care floors, which feature 48 beds per floor, is visual connectivity.
“Nurses need to be able to see the patients as quickly as possible. At that moment, every single minute matters,” Chao says. He notes that nurses at each attendant station have visual access to three patients. “We have a corridor that allows nurses to see from one end to the other end. They can hear a commotion and come to help. From an architect’s perspective, I don’t typically like this big box thing. But at this floor, function absolutely drives the design.”
Flexible free space is crucial for anticipating future medical technologies and requirements. The facility’s lower portion’s 90,000-square-foot floor plate features a riser-free area 400 feet long and 120 feet deep. With no ductwork, mechanical shaft, or stairs, this “podium” can be rearranged to accommodate future needs.