8 Lessons Learned From Our Healthcare Clients on Pandemic Preparedness
To understand the real-time, real-world challenges that healthcare organizations face in responding to a pandemic, our health and research teams talked with clients from across the U.S. in a series of interviews focused on their COVID-19 pandemic response and planning and to gather key insights and opinions about the way forward.
Our clients are our best teachers, and their boots-on-the-ground, lived experiences of the COVID-19 pandemic offer rich insights into the evolution of the healthcare landscape. The following lessons learned were gleaned from our discussions with clients — to protect their privacy, the statements below remain anonymous.
1. Focus on Staff Spaces for Respite and Safety
Healthcare and essential workers have emerged as heroes during the pandemic, and their human needs must be attended to along with their professional needs. Public health, and individuals’ health, depend on the mental and physical health of all staff in healthcare facilities. Their space and comfort should be prioritized and reconsidered to ensure patient-centered care practices and to uphold the healthcare system as a whole. This shift in focus extends not only to staff respite areas, but also in considering that staff needs space for activities like donning and doffing simply to feel safe in their workplaces.
From the interviews:
“There's one thing I didn't want to forget from an architectural standpoint and that's the value of respite rooms … the PTSD that we're seeing in our staff, the total stress on the organization. Juggling family, juggling their kids at home, juggling their jobs, worried about bringing things home … and then you get to May, June, probably June, where everything started to calm down and now it all sinks in … I think in any kind of planning each unit should have one small room just dedicated to a zen room, a respite room, something like that … someplace to just decompress and I think it's worth it to have them strategically placed around hospitals.”
“Donning and doffing areas were very important and then break areas for staffing so they wouldn't have to undoff, an area they could just get away for a moment.”
2. Flexible Design Reigns Supreme
Overwhelmingly, the key takeaway across all participant organizations is the need for flexible facility design and mechanical systems. While challenges to flexible design include building code requirements and funding, ultimately, greater flexibility in healthcare architecture and engineering systems helped organizations be better prepared for unforeseen and shifting crises.
From the interviews:
"If there's anything we've learned from this, it's the need for functional and flexible space. Flexible space is not what we design to right now. It just by and large is not."
“[We are] trying to find a way to make the clinical environment the most flexible, the right environment for today, tomorrow, and 10 years from now.”
"I think we'll probably plan to be very flexible with anything new we build in the future."
3. The Emergency Department Never Stops: Plan Accordingly
Although the emergency department was not a large part of many of the interviews, several organizations mentioned the important role the ED serves in the pandemic at all times. The ED is often the first point of contact a patient has with a system, and in the case of a crisis, the way the ED operates can be a sort of microcosm for the entire facility.
From the interviews:
“I think because we're so new, I don't know that I would necessarily change anything. If anything ... maybe try to find a room where you can also put an anteroom for the donning and doffing … The way that we designed it on the first floor is we have that racetrack design. We have two entryways into the emergency department. Whether you're an ambulatory person walking in, there's a triage right there, and then you go right back into a room or wherever you're going to be treated, and mostly everything comes to you … the patient as the center of everything … The bottom line is, within the emergency departments, specifically for things like this, you really need everything to work together.”
4. Private Patient Rooms Create Opportunity
Private rooms were very important for hospitals to cohort patients, ensure patient privacy, and support infection control. Other important features that can make private patient rooms even more indispensable during crisis is the potential to convert to semi-private rooms to expand capacity and acuity adaptability. In future planning, healthcare clients note that some way to monitor patients or adjust equipment without entering the patient room would help protect caregivers and reduce reliance on personal protective equipment.
From the interviews:
“The private rooms are enormous, right? Because you have single bedded rooms. People weren't cohorted. If you have what we were calling PUIs, right? Patients under investigation, if they had COVID or not. We didn't have them mixed in with people that didn't have COVID, or people that definitely did.”
“If you have that ability to convert them to semi-private rooms in a crisis; that really makes a difference, especially when you convert a whole floor to negative pressure.”
“Some end-of-life patients really did want a private room, we had that for them, and that was really important [for] those patients, plus others, because there was such a restriction on visitation. One thing we did right away, because we have a lot of technology in the facility, we actually took tablets and we linked it to Zoom. And so they could meet with their family member literally all day. We would plug it in, and they would just stay there right on their desk, and they could stop by any time they want and say, "Hi, Pop." I saw that a lot. It all worked out with the way that we designed it.”
5. Design for Negative Pressure Capability
During the COVID-19 pandemic, healthcare organizations developed confidence in negative pressure isolation rooms and areas for isolation and cohorting. These rooms maintain lower air pressure than adjacent spaces to help control the direction of airflow and contain potentially contaminated air or other dangerous particles. To increase effectiveness, these negative pressure isolation rooms and areas require space for ante rooms.
From the interviews:
“In future design, rooms that can change between positive and negative pressure as well as med surge and ICU rooms would be helpful during a pandemic. Some of these rooms are already being created on campus in a new building tower.”
“We were very lucky architecturally, I guess, because of two things I think were genius in this building. Number one, the private rooms, were genius. Number two, the ability to convert a unit to negative pressure. A whole unit could go to negative pressure. Each unit has two or three [negative pressure] rooms, but the fact that [we were] able to convert a whole unit to negative pressure within two hours, after [we] did the first one and double-checked everything, it was smooth sailing from there. That was genius because that really helped us a lot in taking care of this patient population.”
6. Mechanical Systems: Robust and Redundant
Expanding patient capacity stresses mechanical systems and the ability to filter and clean air is essential to controlling spread of pathogens. Healthcare organizations recognized that robust mechanical systems were necessary to support a surge and crisis response. Redundancies in mechanical systems are a biocontainment strategy that can be translated to the healthcare environment.
From the interviews:
“So one thing that we did, and I confirmed this with the design group, during the event is every single station at [our facility], including patient rooms, was designed for ICU capacity. So the system was oversized or sized appropriately as every bed, every station would be able to accept an ICU type patient.”
"We ended up putting vents in the bottom of the [bathroom] door … to allow privacy for the patient in the restroom, but also to continue that negative pressure directionally flowing air to flow from corridor into room or from room into restroom out the exhaust. If you're not aware of bathroom exhaust, they are 100% outside exhausted; they never returned, they never touch the supplier.”
7. Floorplan and Unit Design Depends Upon Culture and Workflow
Conflicting preference among healthcare organizations about which floorplan configurations works best suggests that organizational culture and workflow should inform this design decision. Visibility and efficiency also drive this choice.
From the interviews:
“Because the facility is new, I think we had everything that we needed … it's like a racetrack, so they're all around the periphery while the clinical team is in the middle. It was designed very, very well for this... We designed this post 9/11, so it's designed with everything from decontamination showers, to the private rooms, to the negative pressure. I think we had everything that we really needed.”
“I can't wait to get our new clinical care model, where we're not going to have a center core anymore. We're not doing the racetracks. We're going to have 16-foot wide corridors with patient rooms on either side that are multi-acuity … That's going to be a much easier environment to control, with a knuckle in the middle for all the space and supplies and our staffing to be able to take care of that off-site stuff.”
8. Technology Integration Can Help
Technology integration will continue to be essential to facility design, not only within patient rooms, but throughout the hospital and health system. Technology not only enhances the patient experience through virtual communication options, but also connects providers and administrators with a larger support network, facilitating care coordination on a routine basis and crisis response in uncertain events.
From the interviews:
“The big screen on the wall was going to have camera capability, interconnectivity from the Zoom situation or Webex, in the rooms. For one reason or the other, that was not done in the end. In this particular situation, it really came back to bite us because now we had to move mobile interactive carts into each room to get that connectivity … We certainly found that if we had that capability, it would have made things a whole lot easier. But of course, putting up the building, you had no idea you were going to run into something like this. But in hindsight, if we had that money, maybe we would have done that.”
“There's also communication that has to be built into anything you do. Right now, things like teams and telemedicine. We have telepsychiatry that instead of [patients] having to wait for a psychiatrist for 24 hours, somebody pops on a monitor in 15 minutes. Along with the design, we built the technology into the design. Everybody has a monitor in their room, and it's very easy to do anything like this for family, for physicians, or anybody else. In the design, the technology is an important part to put in it, as well as that whole flow.”
Healthcare organizations will be forever be affected by the COVID-19 pandemic. The implications for healthcare delivery, service and environments will not be fully realized for years to come.
What is known now is that the pandemic has reshaped our daily lives and behaviors along with how we think about health and healthcare. The most important lesson in this, is not to move forward and make decisions based on what did or did not work in response to COVID-19, but to move forward making decisions that support holistic human health and support facilities’ resilience to withstand any event or crisis, while at the same time balancing the tradeoffs inherent in any decision.
To protect our clients’ privacy and with respect for their willingness to share their opinions and insights, please email us below to view the full report.
beyondpandemic [at] hdrinc.com (Request Full Report)