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When a hospital is designed, who are the first people kept in mind by the architects? Who benefits the most from planning the design and physical space? Here’s what leading industry experts have to say.

Many researches have already established a direct relationship between physical environment and human development;   after all the average human being spends around 80% of their time indoors. Doctors, nurses hospital staff and patients are no exception to this. In fact the staff is the only link which bridges the gap between the customer satisfaction, employee satisfaction and profitability. Additionally, everyone wants to operate in an environment which is friendlier and smarter.

Having said that, the most important question is – “Who is a hospital built for?” Is it built for the doctors, the nurses, and the large number of staff or is it built for the patients who visit the hospital?  Is it built as a second-home for doctors or as a live-saving hotel for patients?

Here’s what leading hospital design experts from the industry have to say:

Bhumika Jeswani – Lead Architect with Apollo Hospitals

Bhumika“Design does not have a bias towards employees or patients. The ultimate aim is to provide an optimal healing environment which is enabling staff to care for patients effectively and achieve improved healthcare outcomes for patients. Employees, unlike patients, get acquainted with the facility hence do learn to manoeuvre with ease. Patients and visitors prefer corridors which are more accessible from a greater number of spaces and have minimum turns.

Better physical environment will result in patients being stress free and comfortable. This will also positively impact the rating of care provided by staff. Better work environment for staff means reduced errors and better outcomes for patients. Thus, physical environment works as a link which develops a symbiotic relationship between patient and employees which benefits both.”

Swati Rane – Founder and Medical Planning Expert at Healthcare Synergy Consulting and PhD Scholar from Tata Institute of Social Sciences

“The prime aspect of hospitals is that they are only concerned with the beds.  How many beds can be installed and what are the profit margins; are the two most important factors for private hospitals. Hospital structures are more profit-centric as opposed to patient/employee centric.

swati raneThe hospital is designed according to the ‘form follows function’ principle. But, what is of utmost importance, is this question – ‘Who is going to be at the hospital?  So I believe, the design should be employee-centric.

An employee-centric design is necessary to ensure the output of work is patient-centric. If a hospital is designed keeping in mind the patient’s requirement, the room size etc, and doesn’t consider the requirements of the caregivers, taking away any rest and recuperation area; then the work output is affected. If the design is patient-centric and the employee’s responsible for providing care are tired and exhausted, then the patient-care itself is affected. Doctors and nurses are currently frustrated by their jobs as it is and the workspace design doesn’t help.

The most important thing is to ensure during planning and designing the hospital has a team of users, composed of doctors and nurses. Planning a hospital without taking inputs from doctors and nurses is like planning a house without taking inputs from the residents and it’s near impossible to follow the ‘form follows function approach.”

Aditya Kashikar – Senior Project Manager at Imperial College Healthcare NHS Trust

“In the UK, we focus on hospitals being more patient-centric. However, it is a combination of both, say 60% patient-centric and 40% employee-centric. If a hospital is patient-centric the time taken to recover by a patient is far lesser. At the same time, the operating staff must be able to manage the services. So it’s a marriage between both these aspects.

AdityaIf employees are not considered right from the pre-planning stage then the day-to-day processes and space management techniques completely miss the point. We follow basic guidelines and international stipulations which constantly change and are upgraded, so the space is flexible.

In the UK, we have different stakeholders involved from the first stages of planning a hospital. These include doctors, nursing staff, GMs, CEOs, patient representatives and operational estates and facilities colleagues. There is an amalgamation of basic requirements and business needs which leads to a lot of coordination between different elements of the hospital. When a single stakeholder is left out, the effect it has on the business and its functioning is huge.”

Nandini Bazaz – General Manager – Architecture at HOSMAC Pvt Ltd.

“If there was a hierarchy of importance given to design, it will generally follow a client first, patient second and employee third structure. In India, planning is done according to features which economically feed the clients.

Nandini BThat being said,hospital design always weighs more on the patient side as opposed to the employee side. There’s a lot of neglect in India with regards to staff facilities and utilities. Clients usually don’t want to spend money on that and this occurs in both public and private hospitals. In some cases, staff members literally beg the architects for more consideration to their needs and requirements. We, at HOSMAC, push ourselves to accommodate all the employees and give them facilities for rest and recreational purposes. From an architect’s perspective, we design spaces from the people in the building and staff comfort is essential to us. My experience abroad in healthcare and that India has a stark difference. Internationally, doctors, nurses and staff members enjoy certain spaces and recreation as opposed to here, where break rooms and doctor’s lounges are almost unheard of.”

What Actually Works Best

These problems have given rise to an ever-increasing number of health care activists, trade union formation and joint strikes against individual or multiple institutions such as the recent events in Kerala.

Simple proven solutions to a widespread problem have been proven by research and application. Adopting a similar structure, international health care stakeholders have accelerated growth by cutting costs and ensuring higher job satisfaction and retention. A couple of examples include :

– In 2016, Royal Australasian College of Physicians conducted a study to improve non-clinical workplace solutions using a Human-Centred Design process, involving ‘Hear, Create and Deliver’ stages. Using extensive employee engagement and design experts, innovative solutions were created that focussed on creating the optimized functional workspace which helped hospitals save money on resources and resource management.

– Institute of Patient-Centred Design Inc, is a non-profit healthcare organization that advocates a patient-centric design approach. IPCD conclaves are attended by major stakeholders in the healthcare industry to ensure maximum client satisfaction and profitability which in-turn fosters a healthy workplace environment for the employees.

Clearly, Indian healthcare has a long way to go in terms of catering to the needs of the employee or the customer. Neither is the hospital staff on the winning side, nor are the sickly patients who come to be treated. There are several factors – including higher demand than supply, income disparities and accessibility – in the mix, but the same mix also features extremely rich business owners. No one doubts their hard work in bringing in health care, or them championing a noble cause or even the fact that it is a money sucking industry. The only issue is quality, particular in terms of employee standards and patient standards, which seems to be lacking. Furthermore, designing a hospital with inputs from board members who have a working experience in a hospital along with an active participation of both patients and employees during its working, can go a long way towards ensuring a constant quality and functionality check.

While working on this piece, I asked the experts a simple question – “Is the design language of a hospital built around an employee or a patient?” What I heard was quite shocking, but really not unbelievable. Without a stronger healthcare network which brings in qualitative infrastructural and aesthetic development, the Indian healthcare design model is bound to be stuck in an infinite abyss of unmotivated staff and forever growing number of patients.