Presentation Title Therapeutic Environments Forum · Presentation TitleTherapeutic Environments Forum Subtitle can go hereE03 November 17, 2013 ... (Infographic) BY Kathleen Davis

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Presentation TitleTherapeutic Environments ForumPresentation TitleSubtitle can go here

Therapeutic Environments ForumE03 November 17, 2013

Lisa Lipschutz

Shane Williams

#HCDCon

Overview

････What is a Therapeutic Environment

････ Global Health

････ Space, Cost & Codes････ Space, Cost & Codes

････ Exemplary and Unique International Projects

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A therapeutic environment is*A healing environment?

The Role of the Environment in Healing

A healing environment is the result of a design that has demonstrated � A healing environment is the result of a design that has demonstrated

measurable improvements in the physical and/or psychological states of

patients and/or staff, physicians, and visitors

� A healing environment is a complementary treatment modality that makes

a therapeutic contribution to the course of care

Rigor, Best Practice & Evidence-Based Design – D. Kirk Hamilton – Texas A&M University – 8 March 2011

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A therapeutic environment is*

An environment which:

� demonstrates measurable physical and psychological improvements

� fosters clinical excellence and effectiveness

� contributes to course of care and progression to wellness

� supports the mind/body/spiritual needs of patients, families and

caregivers

� others?

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A therapeutic environment is*An environment which:

� recognizes that environmental factors contribute to community health

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� is respectful of and responsive to cultural differences

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� reflects the knowledge and technology of the time

Thomas Eakins The Gross Clinic, 1875

Thomas Eakins The Agnew Clinic, 1889

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� changes the way healthcare is provided

Florence Nightingale

� Pre-fabricated hospital for war

� Sanitary hospital design

� Wards oriented for fresh air and

ventilation

� Graphical representation of statistics

“Every day sanitary knowledge, or the knowledge of nursing, or in other words, of how to put the constitution in such a state

as that it will have no disease, or that it can recover from disease, takes a higher place. It is recognized as the knowledge

which every one ought to have – distinct from medical knowledge, which only a profession can have”

A ward of the hospital at Scutari where Nightingale worked, from an 1856 lithograph (Wikipedia)

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� Is a healing machine

� “Unapologetically modern”

� Corian surfaces

� Uncluttered

� Shared technology

� Seamless integration of technology

� Transition to home tools

� Patient centric furniture

1. Trufig flush headwall gas outlets2. E&P solid surface headwall3. Handicare patient lift nest4. OSRAM Sylvania LED downlight5. Holosonics focused audio speaker6. NXT patient companion overbed table

7. Price linear diffusers8. Barrisol “halo” light box :Traxon LED pixelboards9. Armstrong modular ceiling system10. E&P infection control station11. DuPont Corian wall cladding12. Dalsouple rubber flooring

Metropolis 05.13

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� Is where the patient is

� “Kiosk” in underserved communities

� Allows direct audio and visual communication with providers at Academic Medical Center

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� Allows real time health information

TOTO'S NEW INTELLIGENCE TOILET II MONITORS WEIGHT, BLOOD SUGAR

LEVELS, AND OTHER VITAL SIGNS, TRANSFERRING DATA TO YOUR

COMPUTER FOR ANALYSIS VIA WIFI.

� Allows communication of home heath data directly to provider

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A therapeutic environment is*

Containers2Clinics� Partnership with Nurture

� Brings care to the community

An environment which:

� Improves the health of communities

Containers 2 clinics reduces maternal and child mortality in low-income countries by providing

access to sustainable primary health care for women and children.

Containers2clinics.org

� Brings care to the community

� Design priorities

� Optimize space

� Flow that is organized and respectful

of patients

� Adaptable water and power hook-ups

� Climate control through ventilation and AC

� Wide windows

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What is the future?

� We are building therapeutic environments, but are we safer?

� We receive care in institutional settings, but also in other places.� We receive care in institutional settings, but also in other places.

� We all pay; can we (collectively) afford the needs of the future?

� Are therapeutic environments of the future going to be different?

Rigor, Best Practice & Evidence-Based Design – D. Kirk Hamilton – Texas A&M University – 8 March 2011

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Global Statistics

How the U.S. Health-Care System Stacks Up Against the Rest of the World (Infographic)

BY Kathleen Davis

Read more:

http://www.entrepreneur.com/article/228152#ixzz2j82CMdfxhttp://www.entrepreneur.com/article/228152#ixzz2j82CMdfx

� 313,085,000 people in US (2011)

� According the World Health Organization,

the US spends more than 2.5X more on health

care per person than most developed nations.

� 17.6% US GDP (2010) on health care

� 17c of every dollar on health care

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Global Statistics


BY Kathleen Davis

Read more:


� Life expectancy at birth (2011) US is 79 years

� 79% contraceptive prevalence (2011)

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Global Statistics


BY Kathleen Davis

Read more:


� US immunization coverage for 1-yr. olds (2011) is 90%

� Use of improved drinking water sources (2011) is 99%

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Global Statistics


BY Kathleen Davis

Read more:


� 2.4 practicing physicians in US per 1000 (OECD avg. 3.1)

� .3 general practitioners in US per 1,000 (OECD avg. 1.23)

� 2.1 specialists per 1,000 (OECD avg. 1.93)

� 87.5% US physicians are specialists (OECD avg. 61.3%)

� 85% higher-than-average cost of hospital services

� $18,000 average cost of hospital stay US (OECD avg. $6,200)

� 2X more tests

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� We are building therapeutic environments, but are we safer?

� We receive care in institutional settings, but also in other places.� We receive care in institutional settings, but also in other places.

� We all pay; can we (collectively) afford the needs of the future?

� Are therapeutic environments of the future going to be different?

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Improve the overall quality, by making health care more patient-centered, reliable, accessible, and safe.

Healthy People/Healthy Communities: Improve the health of the U.S. population by supporting proven interventions to address behavioral, social and, environmental determinants of health in addition to

National Quality StrategyBetter Care

Healthy PeopleHealthy Communities environmental determinants of health in addition to

delivering higher-quality care.

Affordable Care: Reduce the cost of quality health care for individuals, families, employers, and government.

http://www.ahrq.gov/workingforquality/about.htm

Healthy Communities

Affordable Care

safety | engaged patients/families | communication/care coordination | effective prevention/treatment practices for chronic disease | community promotion of healthy living | affordable quality care

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Did you hear about the hospital that spent $100 million to eliminate medical errors? Or the large healthcare system that guaranteed patient safety, fully compensating any patient who was harmed? You might have missed these stories because, as far as I know, they didn’t happen. But

In the race for the “Fanciest Hospital in Town,” patient safety loses outBy Ashish Jha

harmed? You might have missed these stories because, as far as I know, they didn’t happen. But as hypothetical scenarios they make an interesting contrast to two recent real news stories.The first, reported in The New York Times, describes how hospitals are investing tens, sometimes hundreds, of millions of dollars upgrading their amenities: nail salons, around-the-clock room service, spas, concert pianists in the lobby, etc. The article includes a photo quiz, testing the reader’s ability to tell the difference between a hospital and a hotel. (I didn’t fare very well.)

The second story, from NPR and Propublica, focuses on the number of Americans killed each year due to medical errors. A decade ago, the Institute of Medicine estimated that the number was around 100,000 each year. Now, a new paper in the journal Patient Safety estimates that between 210,000 and 440,000 Americans die each year, at least in part, due to medical errors. That would make medical errors the third leading cause of death in the U.S., behind heart disease and cancer.To be sure, many patients were already sick. The error either made their condition worse or created new problems (such as hospital-acquired pneumonia for the patient undergoing hip surgery).So while there is some debate about how to account for those patients, there is no controversy about this: Medical errors are a major cause of suffering and death across America (and the world). These errors are often preventable but get little attention.

http://cognoscenti.wbur.org/2013/10/02/the-bottom-line-ashish-jha

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News AnalysisIs This a Hospital or a Hotel?By ELISABETH ROSENTHALPublished: September 21, 2013

In the current boom of hospital construction, private rooms have become the norm. And some health economists worry that the luxury surroundings are economists worry that the luxury surroundings are adding unneeded costs to the nation’s $2.7 trillion health care bill. There are some medical arguments for the trend —private rooms, for example, could lower infection rates and allow patients more rest as they heal. But the main reason for the largess is marketing.

Did you take the quiz?

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In Need of a New Hip, but Priced Out of the U.S.By ELISABETH ROSENTHAL | Published: August 3, 2013

2007 hip replacement at a private hospital outside Brussels for $13,660. That price included not only a hip joint, but also all doctors’ fees, operating room charges, crutches, medicine, a hospital room for five days, a week in rehab and a round-trip ticket from America. “We have the most expensive health care in the world, but it doesn’t necessarily mean it’s the best,” Mr. Shopenn said. “I’m kind of the poster child for that.”

Brussels $13,660, US $125,000

No Gift ShopAnd in Belgium, even private hospitals are more spartan. When Mr. Shopenn arrived at the hospital, he was taken aback by the contrast with New York-Presbyterian Hospital, where his father had been a patient a year before. The New York facility had “comfortable waiting rooms, an elegant lobby and newsstands,” Mr. Shopenn remembered. But in Belgium, he said, “I was immediately scared because at first I thought, this is really old. The chairs in the waiting rooms were metal, the walls were painted a pale green, there was no gift shop. But then I realized everything was new. It was just functional. There wasn’t much of a nod to comfort because they were there to provide health care.”

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Why the largeness? Cost? (Besides marketing)

� Private Rooms

� Codes� Codes

� Clinical Technology

� Information Technology

� Looks

� Durability

� Safety?

� Operations?

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What can we learn from other countries, other cultures?

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Examples

Royal Adelaide Hospital, Australia

St. Mary’s Hospital, British Columbia

Salem Centre for Cardiac Surgery, SudanSalem Centre for Cardiac Surgery, Sudan

Rey Juan Carlos Hospital, Madrid, Spain

Pietro Barilla Children’s Hospital, Parma, Italy

Maggie’s Centre

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Royal Adelaide HospitalSouth Australia (to open 2016)DesignInc and Silver Thomas Hanley

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Royal Adelaide HospitalSouth Australia

� 800 beds

� “hospital in a park, park in a hospital”

� 40 OR’s, all private patient rooms� 40 OR’s, all private patient rooms

� 50% reduction in greenhouse gas emissions

� taxpayers paying

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Rey Juan Carlos HospitalMostoles, Madrid, SpainRafael de La-Hoz

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Rey Juan Carlos HospitalMostoles, Madrid, Spain

� Transform the citizen into a customer

� Efficiency, light and silence

� Human scale, Flexibility, expansion, functional clarity, horizontal circulations� Human scale, Flexibility, expansion, functional clarity, horizontal circulations

� Regard for human scale, solar protection, patient spaces

� Therapeutic spaces that serve rest and recovery

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Manuel Gea Gonzalez HospitalMexico CityElegant Embellishments

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Manuel Gea Gonzalez HospitalMexico City

� Anti-microbial and de-polluting skin

� Cleans outside air and air entering bldg.

� Fights pollution when activated by UV light

Aside from acting as an incredible urban air filter the prosolve370e skin acts as a natural light filtration system and solar gain blocker for the interior of the Hospital Manuel Gea Gonzalez, effectively saving the hospital’s energy bill for climate control and light.

� Fights pollution when activated by UV light

� Neutralize vehicle emissions and toxins

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St. Mary’s HospitalBritish ColumbiaPerkins + Will and Farrow Partnership Architects

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St. Mary’s HospitalBritish Columbia

� Land donated by indigenous Sechelt First Nations People

who consulted on the design

� First Nations use of cedar bent-boxes (hold sacred items)� First Nations use of cedar bent-boxes (hold sacred items)

� 62,000 SF addition

� ED, Imaging, private beds

� LEED gold – many sustainable initiatives

“We’re very interested in the idea of embedded health-how can a building help

support healing? We have the ability to enhance not only the physical body

through sustainable design feature, but also the health of the mind.” Tye

Farrow

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Salem Centre for Cardiac SurgeryKhartoum, Sudan (North Africa)Studio Tamassociati, Venice ItalyAga Khan Awards Sustainability 2013

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Salem Centre for Cardiac SurgeryKhartoum, Sudan

� Pavilion in a garden

� 63 beds, 3 OR’s

� 300 local staff, sleeps 150 medical staff� 300 local staff, sleeps 150 medical staff

� Ventilation and natural light, water heating with solar farm

� Reused construction containers for staff housing

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HELIX Forensic Psychiatric Clinic Stockholm, SweedenBSK Arkitekter

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HELIX Forensic Psychiatric Clinic Stockholm, Sweden

� Patient and caretaker relationship

� Societal relationship

� Calm, clear and “robust” environment� Calm, clear and “robust” environment

� Social environment for daily life

� Nature and views (between islands of rock and forest)

� Safe outdoor spaces

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Psychiatric HospitalMallorca, Islas Baleares SpainCMV Architects

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Psychiatric HospitalMallorca, Islas Baleares Spain

� Conversion of “Casa Grande” Pavilion of

Psychiatric Hospital into a Psychgeriatrical

PavilionPavilion

� Addition and renovation

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Pietro Barilla Children’s HospitalParma, ItalyOpen Building Research (OBR)

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Pietro Barilla Children’s HospitalParma, Italy

� Synthesizes health and functional needs with

perceptual and psychological issues

� Façade to engage natural setting � Façade to engage natural setting

� Bring warmth and ambient light to patients inside

� Outdoors as convalescence (catch landscape

inside), sense rhythms of day and seasons

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Ubuntu CentrePort Elizabeth, South AfricaField Architecture (California

but born in S. Africa)

Credit: Jon Riodan

“Buildings are symbolic and this building shows the children of Zwide that they are worthy of everything the world has to offer.”Jacob Leif, co-founder of Ubuntu

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Ubuntu CentrePort Elizabeth, South Africa

� Parental and child healthcare

� HIV testing, counseling, treatment

� After school programs, study sessionsO� After school programs, study sessionsO

� Layout inspired by prior-to-construction

travel paths

� Garden crops feed the children

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Maggie’s Centers, Innovative Specialty & Community Care

Our visionMaggie's unique model of psychosocial support transforms the way that people live with cancer. We want everyone in the UK who is affected by cancer to have access to our high quality, evidence affected by cancer to have access to our high quality, evidence based psychological, emotional and informational support.

Our purposeThe Maggie Keswick Jencks Cancer Caring Centres Trust was founded by Maggie Keswick Jencks in 1995 to provide support for people affected by cancer, their families, caregivers and friends to empower people to live with, through and beyond cancer.

Caring environment for support, information, and practical advicenear but separate from NHS hospitals

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Maggie’s Centre, DundeeFrank Gehry(2003)

� Local context

� Interior / exterior relationship and spaces

� Organic forms� Organic forms

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Maggie’s Centre, LondonCharing Cross Hospital Rogers Stirk Harbour + Partners (2008)

� Strong connection between inside and outside

� Connection to landscape� Connection to landscape

� Home-like setting

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Maggie’s Centre, FifeAt the Victoria HospitalZaha Hadid (2006)

� Transition between natural and man-made, and on

� the period between hospital and home� the period between hospital and home

� Clear and translucent glass

� Sculptural cantilevers

� Roof responds to N/S

� Kitchen in center

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MAGGIE'S CANCER CARING CENTREMAGGIE'S CANCER CARING CENTREA central elliptical drum acts as the warm social heart of the building.

Maggie’s Centre, NottinghamPiers Gough (2011)

� “Light, peaceful, non-institutional design to be a

sanctuary for all those who walk through the door”

� Relaxing, in nature, playful, welcoming� Relaxing, in nature, playful, welcoming

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Maggie’s Centre, St. BartsSteven Holl

� Local context

� Interior / exterior relationship and spaces

� Organic forms� Organic forms

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Thank You!

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Thank You!

Documents

Presentation Title Therapeutic Environments Forum · Presentation TitleTherapeutic Environments Forum Subtitle can go hereE03 November 17, 2013 ... (Infographic) BY Kathleen Davis