Leveraging Design for Improved Imaging Performance
Although imaging technology continues to expand in complexity and to manifest itself at a fast pace, the world of medical imaging is evolving beyond more or newer technology to incorporating design to make technology more effective.. In this era, it is time to explore how to move beyond quicker scans and more detailed information sets. Architects, designers, owners, and equipment manufacturers are responsible for equal and complementary improvements in the workflow and environment to keep pace with technological change. The fundamental differences in medical technology, while unique, are becoming less significant. Design may be the ultimate differentiator for patients, families, and staff as we shift from product design to experience design. Nowhere is this more important than for imaging. At every level of opportunity, whether for inpatient hospitals or outpatient clinics, design is not solely a tool to warehouse technology or its local physical impact, but a tool for clinical and social impact. The medical imaging industry has raised a question about design results and outcomes. Manufacturers’ brochures, advertising, and exhibits address much more than slices or scans. As we move forward into an uncertain economic future, imaging providers will expect an equal and informed design response to leverage their technology investments. An integral component of inpatient and outpatient spaces goes beyond basic determinants of power, dimensions, or even quantity. Quality is measured beyond programmatic function, but must respond to work performance, patient satisfaction, and productivity. Imaging has become a tool to predict, inform, and treat, not just observe anatomy. This can be a participatory process for all affected. These trends, and many more, significantly affect the way that we must design for medical imaging. Healthy Design Outcomes for Business In this era of technology-intensive health care, facilities must continue to balance high tech with high touch. Personal contact, caring service, and genuine concern for patients should never be replaced by technology.The trend toward healthy design and its compelling benefits for patients, families, and clinicians is too powerful to ignore. The physical environment and natural surroundings have a significant impact on the human spirit—in particular, the sense of confidence and well being. Research sponsored by organizations such as the Coalition for Health Environments Research1,2, the Center for Health Design, and major universities shows that a focused healing environment will enhance many aspects of the healing and care process, and that such an environment derives from thoughtful applications of personal and design principles. For more than a decade, the health care industry has been borrowing design strategy, as well as ideas regarding service and patient-support amenities, from the hospitality market. The idea behind it is simple: Hospitality is equated with relaxation, comfort, and convenience. Today’s sophisticated imaging provider requires all of these elements. The more amenities provided by an imaging provider, the better it can attract savvy referrals and patients. Great buildings do not just happen. It takes forethought, skill, and the talent of a creative design team that is passionate not only about healthy, supportive design, but also about collaboration with inspired clients. Architects are taught to be problem seekers, not just problem solvers. For the best design solution, whether it involves a single-story outpatient imaging center or a multimillion-dollar hospital inpatient department, it is important to define the real problem and then develop a conceptual response to solving that unique problem. Not all imaging solutions should be the same. Conceptual design is the development of an inspiration or experience that provides guidance and gives direction for all design responses, including aesthetics, function, and future use. Most important, it is a process used to develop vision and an architectural response to critical patient-care and business trends. When conceptual design is implemented properly, the entire management team is on board early with the project's vision. It provides a blueprint for the emotional and experiential objectives of a project. Customization and detail in the imaging suite can be accomplished without extensive cost or confusion (above); an investment in workspace design beyond the imaging suite (right) is an investment in improved productivity and communicationsProduct aspects of design (Table 1) involve traditional functional and programming determinants, including minimum room sizes, patient procedure duration, formulas for number of rooms, and utilities. The experiential aspects of design (Table 2) are values that improve the process for patients, family, and staff, including dignity, comfort, and confidence. We can answer functional needs through physical design mechanisms. Conceptual design gives the imaging provider the opportunity to respond to emotional and passionate goals, in tandem with crucial business concerns that affect every imaging provider, such as growth in procedural volume, decreasing reimbursement, improved workflow, regulatory impact, and increased competition. A New Way to Deliver Health Care Design It is an exciting time to be a part of the design-and-construction industry with the advent of many new tools and processes to help manage projects more effectively, to better our buildings and our service to our clients. The industry is already seeing the benefits of using the integrated project delivery approach with many clients. By fully integrating the team—including the program manager, the strategic planner/programming consultant, the architect, the mechanical/electrical/plumbing engineers, the contractor, the equipment consultant, and the interior designer, as well as the client—we can focus on the client’s goals and vision while keeping all team members on the same page during each phase of the process. New technology is taking the integrated approach to an entirely new level. Building information modeling (BIM) allows architects to explore complex architectural geometry using a realistic and intelligent model that is seamlessly integrated with construction documents. Instead of 2D drawings, BIM’s 3D model database approach allows the contractors and owner to see better how the components of the project—from a three-story atrium to a door frame—fit together. BIM also offers more comprehensive material takeoffs, scheduling, and costing capabilities. Because of the integrated model, blended with BIM technology, we’re developing better buildings: reducing change orders, more efficiently laying out the square footage through programming controls, achieving equipment savings through aggregate purchases and alliance pricing, and reducing the operational costs of selected areas by developing operational models during programming and planning. An emerging aspect of conceptual thinking for imaging involves evidencebased design. Evidence-based design, derived from the rooted patterns of evidence-based medicine, is research informed, quantifiable, and built on a platform of measured effectiveness. Designing for medical imaging based on healthydesign research results in improved patient results, staff and visitor satisfaction, operational efficiency, and flexibility. Implementing the results of current evidencebased research is not only a good patient-care strategy, but also good business.
Table 1. Product Aspects of DesignNew Design Questions The physical lines are blurring in radiology design, but so are the lines between technology and the environments we create. By understanding how imaging technology will develop and how it will affect health care, we can begin to explore new opportunities beyond architectural and engineering how-to and can leverage the design process for improved patient results, family satisfaction, and staff performance. Considering the planning and design of an imaging project from the experience perspective, rather than a product perspective, allows us an opportunity to ask new questions about facilitating imaging performance through design. Can environmental quality directly affect image quality? There is a part of image quality that is affected, either successfully or poorly, by the quality of the space, from the front door to the imaging examination room. When a space helps you feel good about yourself, inspires you in your work, or supports personal preferences for all involved, you cannot help but have an improved care process and imaging result. An imaging site that is customized to consider, even if only modestly, the needs of those patients who use it once in their lives, as well as staff and radiologists who work there every day, will assist by invoking the body’s healing capabilities, improving communications at all levels, and helping to create meaningful patientfocused care alternatives. What is the financial or performance return on a design investment? An investment in design is not about only finishes, fixtures, and equipment, but about a commitment to a long-term return on investment for patients, families, and staff. Patient schedules and throughput are optimized due to reduced discomfort and fewer flawed images, through an infusion of hospitality and ambience. Staff productivity and workflow are improved when staff members see a space that meets their daily requirements. Interactions are supported among patients and technologists, technologists and radiologists, and clinicians and family members. Information is communicated in a direct, personal manner, with less reliance on pamphlets or posters. How do you use design to improve patient, family, and staff satisfaction? Every business strives to improve satisfaction for its employees and customers. Imaging providers must address the same goals. Personalized spaces support specific needs for familiarity of details, function, and ownership of the environment, well beyond the generic planning of typical plans or prototypes. Today, without extensive cost or confusion, it is possible to consider how an imaging room could be reasonably customized for patients, instead of uniform. For example, how should you approach design when the patient could be a teenager one moment and a retired business executive the next? Environments are customized because one size does not fit all people or applications. Design creates an opportunity for improved competitive positioning, improved patient referrals to friends and physicians, and increased staff retention. Can architecture create work-process improvements that equal those achievements using technology? Work processes will be affected by experiential design because—in addition to understanding and accommodating the basic facility's nuts and bolts—establishing an enjoyable, focused imaging environment also provides flexibility, better use of time, and improved allocation of resources. Through an understanding of what really happens, when it takes place, and where it actually occurs, movement or transfer of patients and staff is reduced.
Table 2. Experiential Aspects of Design Table 3. Manage the MultiplicityResources can be located closer to patients and staff for improved service. Access to information and images is simplified through imaging management and reporting systems. The net results will include greater clinical accuracy, decreased errors, and shorter waiting times for all steps of the process and improved safety for all involved. Inno - vative environments not only keep pace with new technology, but also may precede technology improvements. Is there any evidenced for an impact on radiology that results from a design process? Reduced anxiety and fear are perhaps the best evidence-based effects of design on medical imaging. Well-documented research3-5 led by the nation’s leading architectural research ers in university and private-practice settings proves the value of natural environments and physical patterns in aiding and supporting the healing process. Similar impacts are certainly possible for medical imaging spaces, particularly those used during the imaging examination process. While imaging may be predictable, to a certain extent, application of evidence-based design could have significant benefits for patients and staff. Examples of effective design application are being discussed today by the medical industry; they include reduced use of patient sedation, measurable reductions in family and staff stress, faster imaging throughput, and reduced exposure to radiation. What kinds of tools or strategies should be used by architects, interior designers, hospitals, and outpatient imaging centers to construct or remodel imaging spaces so that they will contribute positively to the overall experience for patients, families, and staff? Without a doubt, design solutions that are familiar and that support personal needs will always be relevant to any imaging solution. If we are to use design fully to improve imaging performance, however, some new strategies need to be added to our toolbox. Make the opaque transparent. Create connectivity and erode boundaries to match performance goals with design. At the same time, privacy and dignity are appropriate anywhere, anytime, for anyone. Build values beyond traditions or formulas. Specific design choices for customization allow patients to own the experience. Physical space becomes an ally in productivity and healing. User interactions replace seclusion. Patients and technologists are not isolated, supporting collaboration and communication. Patients and families should never wait, but if they must, it means that more is needed than chairs. Details confront conformity. Details really do matter at every opportunity in the imaging process. Finishes make a difference, too, but positive distractions are the most valuable. Final design is always performed in the field, by the users. There is no substitute for firsthand observational research. Put yourself personally in the user’s role to understand the impacts of space, time, and function fully. Manage the multiplicity. Every imaging decision has more than one right answer. Understand and describe all the potential interactions (Table 3), then create specific solutions. Joseph M. Hogan, president and CEO of GE Healthcare, Waukesha, Wis, summarizes the value of experiential design in current and future imaging by saying, “Today, when we think about designing a new MRI system, we don’t just think about designing the product; we think about designing the entire radiology suite. Design, in the next 10 years, will move beyond the product. It will move beyond workflow. It will get into the whole work environment and what it means.” Imaging technology applications, pat ient volumes, and workflow are among the serious issues on the minds of imaging providers, but the design of the imaging experience may have the biggest impact of all. In a rapidly changing world, design becomes the integrator for imaging performance, not the afterthought.