Now imagine this scenario could be different. Imagine that when your mother was born, a sample of her blood was analyzed and tested for a host of diseases, genetic abnormalities or predisposition to specific illnesses. Imagine that during the span of her life, a collaborative team of doctors, researchers, and health professionals had that information at their fingertips; able to tap into a national informatic database, and diagnose, counsel, or prescribe courses of action that would direct her toward a healthier life. Imagine, now, that the aforementioned illness never presents itself because this predictive methodology steered her out of harm’s way.

What if this were possible? What if academic medical centers were designed to unite every faction of the healthcare process? What if technology made it possible for healthcare providers, researchers and educators to truly collaborate on behalf of patients? What if architectural decisions to support such collaboration could alter the future of healthcare as we know it?

Challenges to Change

Healthcare providers today face a host of serious challenges. Aging medical facilities, financial pressures, staffing shortages, patient dissatisfaction, increasing litigation, and low staff morale all contribute to an increasingly unsafe healthcare environment for patients and staff, with hospital-acquired infections, medical errors, and operational failures on the rise.

Research scientists face challenges as well. Historically, scientific knowledge flowed one way; from bench to bedside. Basic scientists performed research at the cellular and molecular level and created tools that clinicians would use to do their work. Today, however, it’s becoming a two-way street, as feedback from clinicians is being fed back to the researchers. Hurdles exist, however, whether through the lack of physical proximity to clinicians, or due to lack of collaborative electronic databases of research findings.

Further, the state of medical education in the United States is on the threshold of significant change. The days of huge lecture halls and nameless medical students are passing as educators realize that the only way for students to keep up with compounding course material is through smaller communities of students, including members of multiple medical disciplines. Added to this is a new, agile focus on addressing widely varying learning and study needs, and enhanced levels of technology to provide everything from virtual library materials to simulated learning environments.

“Design decisions can play a huge role in combating these problems,” says Rohit Saxena, senior vice president and director of Science + Technology for Hellmuth Obata + Kassabaum Inc.’s (HOK) Atlanta office.

Trends Toward Health

Emergence of the interdisciplinary model of patient care, which draws upon recent scientific findings, looks to provide more individualized care regimens that emphasize prevention and overall health. Accordingly, providers of medical education are integrating the new interdisciplinary model into their course offerings. One such initiative—the Predictive Health Initiative, embarked upon by Emory University, a biomedical research powerhouse; and Georgia Tech, renowned for engineering, nanotechnology, and information technology research—combines an interdisciplinary research core with a clinical testing ground for new predictive biomarkers of health, disease risk, and prognosis.

Advances in genomics and proteomics are enabling physicians to assess individual patients’ genetic predisposition for specific diseases, implement preventive measures, and administer highly personalized medical treatments when patients do become sick. As evidence mounts that this preventive, personalized approach makes real financial sense, healthcare providers, seeking to reap the benefits both to patient care and to their bottom lines, are changing the way they conduct business to capitalize upon such scientific advances.

“The built environment must also change to accommodate this new connectivity in clinical care, medical education, and biomedical research” says Saxena. “This change must go far beyond campus master planning issues. It has to affect design at all levels.”

Changes in Medical Education Spaces

As the interdisciplinary model of health becomes more refined, development decisions by academic institutions are beginning to show the impact of this paradigm shift.

When Florida International University (FIU), already home to an established nursing program, added a medical school, the university paid a lot of attention to the development of its academic medical center master plan. FIU considered, among other things, proximity of its future medical school to the existing and new nursing and allied health buildings. Relationships to existing research and basic sciences buildings were strengthened to create strong connections between research and clinical functions. The university is also taking into consideration community outreach programs that include county hospitals and research parks that could be located within the academic science precinct.

“With the business of interdisciplinary sciences becoming more and more common, what Florida International University is doing is extremely forward thinking because these architectural choices are enabling the medical school to jump on this trend sooner than a school that already has all the systems in place,” says Saxena.

Another trend that institutions with both medical and nursing schools are implementing is in standardized operating and simulation spaces that can be used for training of both nurses and doctors. Institutions are working to bring the curriculum together so that students in the nursing program are graduating at a certain pace that keeps up with the way that the medical schools are teaching.

Tapping into Research

Through the introduction of programs like the Predictive Health Initiative, academic medical centers are faced with the challenge of physically bringing together the traditionally disparate realms of clinical care and research. In addition to locating research buildings closer to medical centers and ambulatory clinics on campus, some institutions are also integrating research areas into medical buildings themselves.

“A research floor may be located within a certain zone of an ambulatory clinic or hospital,” says Saxena, “or it might be in the diagnostic chassis of the facility. You also might see them sprinkled throughout the building.”

However, distributing research areas throughout a diagnostic or clinical facility is a decision that should be carefully considered, cautions Saxena, since fragmenting research areas could impact the collaboration that naturally occurs in a peer-to-peer research environment. Its benefits include the enabling of cross-cutting initiatives with other clinical sciences, but it can also inhibit the interdisciplinary resource that could exist if all of the researchers were in one space. There are pros and cons, and many institutions are choosing to strike a balance.

“We’re seeing small satellite cores in conjunction with a research base,” says Saxena.

When physical proximity is neither prudent nor possible, connections can still be emphasized through alliances between clinical and research entities. Partnerships between medical centers, hospitals, medical schools, engineering colleges, public health agencies and biomedical research agencies are integral to the success of the holistic health movement.  Information systems and knowledge-sharing issues are becoming as important or more important than the provision of medical services to patients.

Such alliances become even more important as the distributed model of medical education becomes more prominent. Universities are realizing the benefits of having basic medical education occur on the university campus, and then sending third- and fourth-year students out to medically underserved regions to finish out their training. Florida State University’s College of Medicine is just one of many medical schools finding success with this distributed model.

“Florida State University is graduating more physicians, and with a number of additional new medical schools in Florida as well, will soon be able to better serve the medical needs of its diverse population,” says Saxena.

Sharing Spaces Across Generations

One outcome of the increasing integration of research and clinical facilities is the integration of age groups.

Each generation brings a different perspective on life: what they want in their work life, how they learn, how they are taught, and how they interact with other people. The goal is to create an environment that supports and serves a wide range of people, from physicians born in the 1940s to patients or visitors born in the 1990s.

“Young people can have positive experiences in a healthcare facility, and they may be attracted later as students, researchers, or professors” says Gordon Stratford, senior vice president and design director for HOK’s Toronto office.

In addition, to facilitate interdisciplinary collaboration and conserve resources, these facilities also need to provide spaces that can be shared by disparate groups and disciplines.

“Traditionally, different departments live separate lives on campus,” says Stratford. “We are asking them to do something quite different. We want them to integrate, collaborate, and be capable of accommodating visitors and partners; working with them in highly non-traditional ways. One way to achieve this is to have them share space.”

In the traditional model, nearly everything is owned. A room belongs to a certain department, and they may only use it two times a week. The rest of the time it’s empty, and all the equipment is sitting there idle. In the new model, the emphasis is on sharing with a focus on creating an environment for highly collaborative learning, research, and care. The result is a facility that is much more effectively used. At the same time, a new community emerges that is thoroughly connected and transformative.

Achieving these shared spaces requires seeing the commonalities between groups, exploring precisely which resources can actually be shared, and thinking in terms of “community building.”

“Everybody understands what it means to live, work and play in a well-designed community, and what the concept of a village, town, or city is all about,” says Stratford. “We transpose this universal concept into buildings to help create an efficient, enjoyable, and provocative working community.”

As an example, a neighborhood is created by placing a mix of faculty offices next to  undergraduate and graduate commons which can facilitate interdisciplinary and intergenerational bonds. When the focus is on the creation of civic spaces—combining key meeting and conference facilities, nutrition and flexible work spaces—it creates a major crossroads which attracts people. Ideally, this approach is worked throughout the entire facility in a way that allows flexibility and adaptability over time.  The key in all of this, though, is to design these functions in highly non-traditional ways.

“It really is ‘business not as usual,’” says Stratford.

Loose Fit = Long Life

Finally, for long-term survival in a world of accelerating change, Saxena says that flexibility is paramount.

“Loose fit equals long life,” he says. “If you want to create a building that is going to last for 100 years, create spaces that can accommodate the full spectrum of ways people will work, learn, train, practice, and access information. Always plan for the never ending constant of change.”

By Deborah Kreuze