Hospital of the future: How the typical hospital will change with technology and shift to patient-centered care

Preview of Sunday's report: Vitals -- What is the future of health care?



On a Saturday afternoon several years from now, you set off on a bike ride along the Monongahela River. After a couple miles, you're more winded than usual. You haven't noticed, but the smartphone strapped to your arm is identifying a problem.

While you've been enjoying the view, it's been analyzing your heart rate, blood pressure and breathing pattern. It's already sent the data to your doctor, and it interrupts the playlist you're listening to with a suggestion to give her a call. A couple hours later, you have a 5-minute chat with her on Skype.

In the near future, technology will change the way we interact with hospitals, many experts say. New medications and surgical techniques will reduce the time patients spend in hospital beds. Vidchat conversations will replace some visits. Some health problems that require a visit to the hospital now, such as a rash, will be dealt with by sending a photo from your smartphone. And personal data, from smartphones and networks between hospitals and pharmacies, will play a larger role in doctors' decision-making.

In addition to technological change, other trends, such as increased competition for patients and a growing emphasis on sustainability, are transforming hospitals.

It's difficult to imagine the hospital of the future, said Jeffrey Bauer, a health futurist and medical economist in Chicago who has written books about health trends. The healthcare industry changes fast, so it's foolhardy to peer more than a couple years ahead.

COMING SUNDAY
Vitals: "What is the future of health care?" Part two of our exploration of key issues reshaping our health care.

Check out Part One: "Rethinking the way we pay for care" with video from a public forum on the topic.

But technological developments such as video chatting, smartphones and less invasive surgical techniques might lead to less-crowded waiting rooms and smaller hospitals. That could bring several benefits, including lower fees and reduced exposure to diseases, said Mr. Bauer, who received his Ph.D in economics at University of Colorado in Boulder.

"There's simply no need for 800-bed behemoths," he said. "They'll be able to treat the same number of patients with half the beds."

Competition for patients

In the past, hospitals were designed mostly with the needs of doctors and nurses in mind, said Chu Foxlin, who designs hospital interiors for TK&A Architects in Cambridge, Mass. Hence the bright lights, helping doctors see everything as starkly as possible and the intercom system, helping nurses and doctors know where to go.

That emphasis is starting to change. In the Internet era, when it takes a few seconds to get information about prices and services from across the country, consumers have more options -- even with restrictions imposed by insurance carriers. A pregnant woman may be able to choose where to deliver her baby and a cancer patient may be able to decide where to get treatment. Hospitals are doing more to compete for these patients, including tailoring their designs to them.

This design trend also takes into account that some patients spend months in the hospital. Better design can reduce anxiety for them and even improve their health.

This is particularly important for children's hospitals. "Some of these kids return repeatedly on an annual basis for their entire lives. You have to be sensitive to all of that," said Allen Kolkowitz, an architect who worked on the team that designed the Charlotte R. Bloomberg Children's Center at Johns Hopkins University. The center, which opened in Baltimore in 2012, is full of statues and artwork based on popular children's stories.

To improve the experience of patients, some hospitals are nixing the intercom, which many find irritating and disruptive, Ms. Foxlin said. They're increasing the size of windows and building more gardens, cafes and lounges. They're giving patients more control over temperature, lights and window shades. Some are installing ceiling lights that throb in tune with music played on an iPod.

As part of her effort to draw patients to hospitals, Ms. Foxlin designs interiors around "themes" intended to engage patients. In 2011, she worked on a team that designed a "Passport to Discovery" theme for the University of Minnesota Amplatz Children's Hospital in Minneapolis. It based each floor around a type of habitat, such as desert and grassland. Nearly every detail -- lights, furniture, walls, ceilings, floors, plants, signs -- reflects the habitat. Children entering the hospital receive passports and can get them stamped at each floor.

"You walk away remembering the place," she said. "It's a branding exercise."

The Charlotte R. Bloomberg Children's Center's massive glass facade might have been unmemorable, but the building's designers tinted its windows in pastel colors inspired by Monet's impressionist paintings. It has the effect of making the exterior less imposing and more approachable, Mr. Kolkowitz said.

"It's all about the humanization," he said.

Healthy and sustainable design

When Robin Guenther designs a hospital, she thinks about ways to nudge patients to adopt healthier lifestyles.

For example, she might make sure that when they enter the hospital, they see stairs before they see the elevator, encouraging them to get a little more exercise. She might put windows in stairwells to make them more inviting places. She might install signs that remind patients that taking the stairs is exercise.

These techniques create healthier patients and save energy by reducing the use of elevators. It's all part of the trend of sustainable design -- a growing concern for hospitals, said Ms. Guenther, of the Perkins + Will architectural firm in New York City.

There are several reasons hospitals care about sustainable design. In addition to making patients healthier and reducing energy costs, it also protects hospitals in environmental catastrophes.

The memories of Hurricanes Katrina and Sandy still are on the minds of hospital administrators across the country. Those storms caused several hospitals' electrical and mechanical systems to fail, forcing messy -- and in a few cases fatal -- evacuations. It takes a long time -- two, three days -- to evacuate a large hospital, so there's an increasing emphasis on building them to continue operating after a disaster.

"It's not like you snap your fingers and a 1,000-bed hospital is empty," Ms. Guenther said.

It helps for hospitals to be more efficient with water and electricity, so they require less fuel when power and water are shut off. Other techniques include putting power generators on the roof, so they aren't inundated by a flood, and allowing windows to swing open so patients can cool off when there's no air conditioning, Ms. Guenther said.

Hospitals are also becoming more concerned about engaging with the communities around them, she said. That's because of laws that require nonprofits to show they benefit their communities and requirements in the Affordable Care Act for hospitals to respond to specific health needs in the area, such as high rates of asthma or obesity.

Some hospitals are investing more in the neighborhoods around them by subsidizing employees who rent apartments nearby and encouraging local businesses. For example, the Cleveland Clinic has partnered with other organizations in the city to create Evergreen Cooperatives, a program that helps employees open environmentally friendly businesses such as greenhouses and laundries.

In the past, many hospitals were isolated from their neighborhoods, surrounded by massive parking lots.

Now they're trying to weave themselves into their surroundings with transit stops and ground-floor retail.

"The days of hospitals being seen as islands of disease in an otherwise healthy city are over," Ms. Guenther said.


Richard Webner: rwebner@post-gazette.com or 412-263-4903

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