[From 2013, slightly updated]

Great question. I have spent my adult life in these places – hospitals – and I both love them (they feel like…..home) and hate them (so, so far from home).

Were I to design a new institution, I would focus on three parts: Environment, People, Care Processes. Clearly – as my dear friend Cynthia Henderson used to say when we were Interns at Cook County Hospital in Chicago – if I was to be limited because of a cash shortage, the parts would be arranged differently: Care Processes, People, Environment. But let’s pretend that our budget is unlimited.

Another thing, I am unsure if it is possible to design a single institution in this way, but a health system – were I in a position to assist with the design – would look something like this.

Environment:

By this I mean the inside and outside of the hospital. One of the most interesting things I’ve noted is that hospitals catering to relatively well-off people tend to be more manicured / elegant than those providing care for the less well-off. It’s not that I would reverse that dynamic, I would just try to eliminate the difference.

Hospitals are frightening places for most people; they do not feel that the hospital is “home”. They come to us because something is, or may be, dreadfully wrong. They are not our “consumers”. They are people whose lives are about to be thrown into chaos.

So I would make the outside and inside inviting and warm, with as much natural (green) space, water, and flowers as possible. I would eliminate the standard floor and wall coverings, utilizing as much wood, stone, and fabric ( walls) as possible. Colors would be as bright and warm as possible, no “institutional” colors. Natural light as much as possible, rather than fluorescent light. I recognize that there are difficulties with cleaning some of this stuff, so obviously there would be some trade-offs, but no linoleum, or grey walls, etc.

There would be large windows and the use of natural light would be to the maximum. Wireless internet would be widely available for those with computers and computer stations for those without. MD Anderson Cancer Center in Houston has elements of all of this.

The cafeterias would be several in number and relatively small, bistro-like; more cozy than institutional. The food would not include McDonalds, Burger King, etc. While the cafeterias would have “rapid food”, there would not be “fast food”, I would emphasize healthy eating in these places. And I would have – yes, I would – at least one relatively up-scale eating place. And ethnic food – based upon the demographics of the patient / family population – would be emphasized, heavily.

There would be a place for families to stay if they were from out of town, an inexpensive hotel attached to the hospital. Additionally, we would make the patient rooms large enough that a family member (one at a time) could sleep in the room on a recliner-type chair if they so desired.

I am not trying to recreate the Ritz Carleton in a hospital. Rather, I would want a place that is welcoming and soothing. By the way, there would be no televisions tuned to ranting talking heads. Screens yes, for education and music, soft and soothing (like western classical music).

People:

Every person working in my hospital / health system is important in the provision of care to the patients and the care given to their families. Thus, I would make it as “cool” to clean floors in my institution as it is to work in the Apple Store, or for Google. The heaviest emphasis for prospective workers would be their commitment to service: Our Patients and their families are not – nor can they be expected to be – at their best, we, on the other hand,  have to always be at our best.

I know it is easier to say this than it is to make sure it happens every time, but this would be my goal. I do not want you working with me if you are rude, mean, thoughtless, or think yourself “better” than the people for whom we care.

We would create Teams of Experts, who would care for the ill humans AND their families. These Teams would be charged with many things, including remembering that we are there for the patient’s convenience and care; it is for and about them, not us. This phrase – Teams of Experts – is something about which an entire essay could be drafted; for now, enough said.

The creation of a hospital Culture of Safety and Quality demands that every person in the institution, every worker, has a role in the provision of safe and high quality care. And this means that it is the right and responsibility of every member of the team – from ward clerk to environmental service worker to nurse to physician – to say something if they see something wrong; the problem is theirs until it is handed off.

Care Processes:

Despite all the broo-ha-ha about electronic records, they are SO bad. Yes, I can read the writing of all of the non-Catholic school trained physicians and nurses, but that is all. It is hard to find things, data elements, drugs given, etc. In some ways, paper is better, I hate to say it, but it is true.

None-the-less, we are moving toward a paperless medical world. So, you enter this hospital we are designing and, with either your Social Security number and date of birth, or a date of birth, gender, city of birth, and country of birth, your medical record is found or, if you’ve never been in our institution before, is generated.

If you had a record before, you would have to enter your (previously generated) password before going further; if a new record, you would be asked to create a password. This is, of course, a non-emergency situation; in an emergency situation a temporary medical record number and chart is generated, care is provided, and the rest waits until you are out of danger.

If you had appointments, as in a scheduled outpatient visit, you are given an electronic schedule of what you will do and when, perhaps using an iPad-type device which you would carry with you throughout your visit.

Care processes would be evidence based / best practice; again, we could write about what this actually means this for a week.

Kindness, compassion, and efficiency are the order of the day, for our patients and their families.

Finance:

In the United States, this is the major problem today. Something like 25% of our population – 80 million people – are uninsured (~ 30 million) or underinsured (~ 50 million). The Affordable Care Act (ObamaCare) hasn’t completely corrected this and the ACA has been sabotaged by the Insurrectionist Party (the Republicans). It is my hope that by the time I am designing health systems, we have a National Health Service / Medicare for All finance mechanism.

In brief, this is the hospital /system I would design.