The best medicine for fixing the modern hospital

Rarely is nurse Cindy Steckel possessed by fantasies of unspeakable revenge. Toilet design, however, does provoke her fury. Whoever is responsible for the slim-doored, cramped configuration of patient bathrooms in most American hospitals draws her scorn. "I don't know if there wasn't such a thing as a walker back then," she says. "But if I could get my hands on the guy who designed these...!"

To anyone not yet jaded by the American healthcare system, the idea that a hospital would provide a bathroom too tiny for an old person with a walker seems insane. But for decades, American hospital architecture was based on crude, now-outdated notions of efficiency and economy. Hospitals were designed for the wants and needs of doctors and hospital administrators. Patients weren't ignored – but they weren't top priority, either.

[See also: Hospital design competition results in a surprise]

Now, healthcare reform is fundamentally changing the way hospitals are run, and with it the way they look. A combination of crushing costs, government edicts and fierce competition for the millions of newly insured patients that will result from federal healthcare legislation has put the patient front and center.

In part the impetus for the new-look hospital is bureaucratic: Medicare and private insurers are moving away from the traditional fee-for-service model, in which they pay doctors and hospitals for each procedure they perform. Instead, they are beginning to adopt flat-fee payments that cover entire episodes of care – a knee replacement, say, or an arterial bypass operation. Such contracts long ago became standard practice is almost every other industry. Besides making the entire process more efficient, flat fees would put an end to long lists of billable items like $150 Tylenol tablets. Medicare has also begun paying bonuses for hospitals that provide effective, high-quality treatment and penalizing those that don’t meet basic standards or that have high rates of avoidable hospital readmissions.

Recently, Kaiser Health News analyzed Medicare data revealing that 2,217 hospitals – over a third of them – will face such penalties this year. Publicly available quality ratings, online and in publications such as Consumer Reports, add competitive pressure. What hospital wants to score "worse than average" for "bloodstream infection following surgery" on

Designing For Healing

The changes dovetail with years of research showing that the color, shape, layout, and accouterments of a hospital room have a direct effect on health. The typical hospital room, with its beige walls and stingy windows, carries a dim, funereal cast and works against patient well-being. The standard twin-bedded configuration doesn’t help, fostering the spread of infection, making sleep difficult, and giving people at their sickest the dignity of life in a freshman dorm. By contrast, rooms that allow patients to see light and nature can speed healing and reduce delirium, pain and anxiety. In other words, pleasant rooms – particularly private rooms – aren’t only more comfortable; they’re therapeutic.