The Center for Health Design is a non-profit group out of California that advocates for creating healthcare environments that are patient and family-centered and utilize evidence-based design, meaning that design decisions are backed by documented environmental research. As an organization it is a microcosm of our healthcare system- well intentioned, fixated on ‘high end’ trappings of the business, and ultimately missing the point.
The Center for Health Design has done some great stuff. They have been instrumental in making private patient rooms a regulatory requirement by supporting research that demonstrates patients in private rooms have better outcomes under many measures. They support research that correlates reduced patient stress with improved clinical communication and the benefits of bringing nature into the healing environment. The Center for Health Design is literally a breath of fresh air after the technology obsessed 1960’s and 1970’s that bequeathed us gigantic windowless hospitals of endless beige corridors where patients shuttle from device to device.
The Center for Health Design makes things better, but it also makes things more expensive. In a new hospital today, private rooms and other family centered features push the size of inpatient units to over 800 square feet per bed.(it was in the 500-600 square foot range). Due to patient privacy and family accommodations, the spaces patients occupy before and after their procedures in new surgical suites now equal or exceed the amount of space dedicated to the operating rooms themselves. Hospitals have grand piano players in their lobbies, patient rooms so large that families require their own TV’s, and project costs that can exceed $1000 per square foot.
Every year The Center for Health Design holds a conference filled with impressive seminars on how firms are creating these fabulous environments, networking opportunities galore, and an exhibition hall where manufacturers of healthcare products trot out their latest wares. Healthcare spending now surpasses 17% of our Gross National Product, and with our aging population, the 20% mark is not far off. Wandering the exhibit halls of Healthcare Design ’10, I wondered if perhaps the Military Industrial Complex had finally met its match in the Healthcare Industrial Complex.
If you are rich the American healthcare system is likely the preferred choice in the world. If you are middle class with the benefit of insurance you can have access to incredible technology as long as you are willing to do battle with the insurers whose first response to almost any claim is ‘denied’. If you are very poor you can receive consistent care as long as you are willing to suffer the indignity we bestow on anyone who claims a need from the government. But if you are struggling and uninsured you are in the worst bucket – priced out of care you can afford, the only place you can get medical attention is in the emergency room environment – the most expensive, least comprehensive form of care.
Our healthcare system is so dysfunctional; the term ‘system’ is too generous to apply. So why can’t we make fundamental change? The answer lies in the chime of every slot machine, the spin of every roulette wheel, and the cacophony energy we call Las Vegas. Americans demand the opportunity to have the best and we will not settle for anything less. We do not require that everyone actually get the best healthcare so long as at least some of us have the chance. Actually, we rather like that it is not universally available; access to healthcare has become another way to reward the ‘haves’ and condemn the ‘have-nots’. We don’t care that the most expensive healthcare system in the world ranks a middling eighth in terms of quality among industrial nations or that we lag Cuba in life expectancy. Averages do not excite our imagination. We like a hierarchical system because we each believe that we are smart enough or special enough or just plain lucky enough, to rise to its top. Having a shot at phenomenal care for the few trumps care that is merely good care for all.
At one seminar I attended a nurse turned architect presented a sophisticated medication dispensing system that involved computer tags on individual medications, expensive distribution stations and patient banding. It was a well conceived system with demonstrated improvements in patient safety. At one point in the presentation she lowered her voice and whispered. “Two babies at XXYY Children’s Hospital died due to medication errors. These children could have been saved with this system; you cannot put a price on human life.” The crowd hushed out of respect for the lost children. I envisioned an ad campaign for this system based upon these two children and some philanthropist rising to donate a cool million or so to implement in a hospital in their honor. The deceased infants give a human face to the problem.
But no one asked the opposing question, which is, how many children could be saved by allocating those resources for inoculations or nutrition or wellness? Could we save two, or twenty, or two hundred? The question of statistical lives saved is mute before a pair of flesh and blood babies that we can identify.
And so we chug along, thrilled by the whizz-bang technology that our healthcare system offers, heedless of the simple math it takes to determine that healthcare system pays out a weird set of odds. There are the lucky few who can have it all – like the star gambler the casinos promote. But for most of us the healthcare system delivers less value than we deserve. We walk away from the casino measurably poorer.