COVID-19 pandemic has put such demands on the modern healthcare system that it has never had to deal with. This experience is likely to profoundly transform the system and people's health attitudes and practices. While a large part of healthcare services may be delivered virtually or through community outreach in the future, healthcare facilities are also likely to undergo a massive transformation. The pandemic has exposed the inadequacies and fragilities in the design of healthcare spaces, and these need to be addressed not only to better deal with the current pandemic, but also to prepare the healthcare system for future health crises of such scale.
Firstly, the pandemic has exposed pitfalls of overoptimized and over-efficient systems. Public health experts and administrators had prided themselves in building healthcare systems without redundancies or underutilized resources. Such systems could meet the routine demand and more, and yet were not wasteful of resources in regular functioning. What was traded away for this efficiency and optimization was surge capacity. Surge capacity is the capability of a community and its local or regional healthcare facilities or systems to handle a potentially overwhelming influx of patients caused by health crises, natural disasters, large-scale accidents, or terrorist attacks. So, as countries entered community transmission stage of the pandemic and the case load started to grow exponentially, even the most advanced and sophisticated healthcare systems started to crumble under the burden. Below are some measures that are likely to prepare health systems better for the next surge scenario.
Going forward, hospitals will need groups of rooms and entire units and wings that can be converted into isolation zones during a health crisis. Each hospital should have a plan to rapidly expand its capacity to accommodate double or triple the number of patients. The infrastructure for primary healthcare facilities, outpatient clinics, freestanding emergency and trauma centres, and ambulatory surgery centers, should be developed with the consideration that these facilities will need to support sicker patients during health crises.
Stockpiles of hospital supplies and equipment should be decentralized so that individual hospitals have stockpiles to respond during surge scenarios. Hospitals will need to be redesigned to house these inventories as well as systems to maintain, refresh, and replenish them.
During extraordinary surge scenarios, existing health infrastructure may be inadequate and therefore, additional spaces may need to be adapted to deliver healthcare services. Private homes, nursing homes, and hotels may become alternative places for less critical patients to be treated. Additionally, temporary health infrastructure may be created in locations such as vacant office buildings, indoor stadia, halls, warehouses, prisons, and parking lots. Temporary health infrastructure may be more suitable for quarantine, and not as treatment facilities.
A basketball stadium in Wuhan after being converted into a facility for treating coronavirus positive patients with mild or moderate symptoms.
Another major flaw of the modern health system exposed by the pandemic is the issue of health care-associated infection. According to a WHO report, out of every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries acquire at least one health care-associated infection. Although often hidden from public attention, the widespread, on-going problem is one that no institution or country can claim to have solved, despite many efforts. During the COVID pandemic, this issue has received much needed attention as thousands of healthcare workers across the globe have contacted the infection in health facilities, and governments and health experts caution public against the risk of COVID transmission in hospitals. Below are some measures that are already being adopted across the world to minimize risk of COVID transmission in hospitals.
Having a separated emergency entrance for contagious patients, particularly those with fevers, to reduce the risk of transmission to patients who are visiting the hospital for other issues.
Hospital lobby or hospital parking lot can provide opportunities for prescreening before entering other areas of the hospital. This way, healthcare staff can ensure patients are going to the right place and not adding to cross-contamination.
Use virtual self-assessment tools and virtual consultation to segment to triage patients and avoid non-critical visits.
Self-check-in and self-rooming can minimize interactions of patients with staff and other people.
Limit the number of visitors to those who are essential (such as an immediate family member or parent, guardian, or primary caregiver), and limit their movement within the hospital by only visiting the patient directly.
Make design features more easily cleaned and use finishes that withstand harsher chemicals.
Administrative departments may be moved off-site or work-from-home arrangements may be devised to reduce the staff on campus.
All public spaces including waiting rooms, lobbies, and dining facilities will have to be carefully planned and designed to create greater physical separation between people, with appropriate queuing.
An example of segmenting hospital patient flows in the case of surge scenarios.
Lastly, while issues of capacity and infection risk have received much needed attention, an issue which still missing from public discourse is designing healthcare spaces with empathy and patient-centricity. Hospitals are spaces where many people experience the most distressing and challenging episodes of their lives, and very often the last moments of their lives. Yet hospitals are designed as purely functional, clinical spaces, bereft of affective and social cues. Indeed, patients often report feeling dehumanized in clinical settings. The COVID pandemic led to the unfortunate situation for thousands of people wherein once hospitalized, they could have no visitors or in-person interactions with family and friends, and thousands passed away in such a tragic situation. Being surrounded by such large scale suffering and loss of life has had a traumatic impact on mental and emotional well-being of healthcare providers as well, who are working overtime and are risking their own lives and that of their families everyday. Below are some steps that can be taken towards designing more empathetic and human-centric healthcare spaces.
Designing spaces to allow more natural light and view of the outside world.
Incorporating open spaces like balconies and terraces in hospitals, not only for patients who may be allowed to access them under supervision, but also healthcare providers and workers to take a break from the clinical setting.
Using technology to provide modes of entertainment and virtual activities and interactions to patients.
Allowing patients to socialize with one another via safe and supervised means.
Designing rituals and systems for patients and care providers get to know each other.
Using positive, affective messaging and cues instead of functional, clinical communication.
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