Resilient Design in Healthcare Will Affect Pandemic Response

Reimagining clinical environments is a key part of handling the pandemic — and any hurdles that come next.

Dr. Diana Anderson is a healthcare architect, an internist and a geriatrician. She has worked on hospital design projects globally and is widely published. Anderson is currently a geriatric neurology fellow at the VA Boston Healthcare System and a principal at Jacobs.

Hospitals have always been places of healing, and the challenges of COVID-19 further underscore the value of evidence-based design to ensure care and continuity. This practice relies on empirical data to inform changes that better position physical and technological infrastructures to handle an evolving pandemic.

Simply put, buildings can protect our health.

A focus on design as a determinant of health has emerged in recent months — with insights and action plans moving beyond architects who conceive these spaces. Increasingly, people working in public health, health IT and clinical care delivery acknowledge and want these measures in place.

The scale of the public health emergency has also shifted the design conversation beyond a hospital’s walls to encompass new protective efforts in community spaces.

In designing for better infection control, regardless of a project’s size or scope, a number of priorities have emerged.

Among them: maintaining physical distance while fostering virtual connectivity, avoiding social isolation and related health impacts, maximizing air quality, and incorporating collaboration tools and mobile technologies to ensure caregivers are prepared for anything. These elements are also central to a safe, positive patient experience.

4 Design Changes to Drive Better Health and Safety

While our design lens has shifted to make infection control a primary driver, all parties involved must be cautious to maintain architectural resilience.

For example, an effective COVID-19 prevention strategy for hospitals and long-term care buildings is to maintain patient or resident isolation. But this strategy doesn’t promote mobility, human interaction, access to nature or general quality of life.

Safety within buildings is both perceivable (physically distanced seating) and unseen (ventilation systems, germ-resistant and easily sanitized surface materials). In all instances, several overarching hallmarks of resilient design for pandemic preparedness should be considered:

Have easily convertible spaces: Designing for flexibility is paramount to adaptable buildings. Plan for larger open spaces — ideal for fostering community and connection — that staffers can subdivide, if physical distancing is required, or easily outfit to safely accommodate contagious patients. Incorporate multiple entries throughout a building for one-way flow to avoid disease transmission.
Be visible in person (and on screen): During recent COVID-19 surges, many hospitalized patients were treated in standard patient rooms with solid doors that prohibited clinicians from safely seeing conditions from afar (some facilities installed “vision panels” in doors as a result). Enhanced technologies for connectivity are arguably as critical in any purposeful design; COVID-19 reminds us of the need to consider informatics and technology at the initial drawing board.
Make room for safe socializing: For patients in nursing homes, the pastimes of viewing streetscapes or indoor passersby help prevent loneliness. Both here and in a hospital setting, reimagining the architecture of intermediate spaces — alcoves in corridors with seating, outdoor porches, smaller and more socially distant waiting areas for guests — can reduce risks while maintaining safety and comfort.
Promote design equity for everyone: The pandemic has put high emphasis on burnout and mental health effects on frontline workers, but the functionality of staff and clinician spaces has too often been overlooked. In addition, as access for visitors and loved ones resumes, facilities must explore design solutions that allow people to come together.

Some low-impact strategies for existing facilities may include variations of the above by temporarily converting existing spaces or adding new permanent or modular ones.

Although design thinking is a valuable healthcare resource, the challenge of how best to integrate this approach remains — and a multidisciplinary strategy is essential. Collaborations among clinicians, policymakers, healthcare and IT administrators, designers and architects will be paramount to turn smart ideas into lifesaving realities.

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