A great deal of research, discussion and innovation in the healthcare field aims to make the operating room (OR) safer for patients and more effective for medical practitioners. As a firm that has designed hospital buildings for leading healthcare organizations across the country, we know firsthand that architecture can have a significant impact.
We recently chatted with our own architectural designer Leah Meer, who participated in a Clemson University research project during graduate school titled “Realizing Improved Patient Care through Human-Centered Design in the Operating Room” (RIPHCD.OR). The research, which is also being conducted with the Medical University of South Carolina, takes a deep dive into every aspect of the OR, with the goal of developing a prototype for an ergonomic and human-centered OR that improves patient and staff safety and outcomes.
Taking a step back, how did you know you wanted to go into healthcare design?
I’ve had quite the health history myself. At ZGF, we have two nurse-architects who started their careers in nursing and later discovered a passion for architecture. I am more of a “patient-architect” because I’ve been in and out of the healthcare system my entire life for various personal health issues.
Working in healthcare also runs in my family. My great grandfather was a missionary in India, where he started a community hospital in the late 1920’s. In addition to providing a much-needed medical resource, the hospital remains one of the greatest economic drivers of the area to this day. Hearing about my family’s history in the transformation of this community has always stuck with me.
Others in my family are teachers and nurses. So, by nature, I also wanted to help people. Architecture – and more specifically, healthcare planning – turned out to be the perfect way to combine my desire to help people with my creativity and problem-solving skills.
Why healthcare planning?
I love looking at the big picture, putting puzzle pieces together and solving problems. Healthcare planning appeals to me because I can help our clients visualize a space and understand the real impact of what we’re designing. Plus, I know firsthand how that design can impact the patient experience.
Tell us more about the RIPHCD.OR research project at Clemson University. What was your role?
The project is federally funded through a $4 million-dollar research grant over four years (September 2015 to August 2019). It has three areas of focus: unmasking of anesthesia-related alarms and communications, traffic flow and door openings in the OR, and integrated OR suite design. I was a research assistant on the latter project for two years through Clemson’s Architecture + Health program, along with a multidisciplinary team. It was the perfect opportunity because it directly related to the studio work I was doing.
In year one, we worked to conduct extensive literature reviews and flow studies, gather case studies, and develop procedure maps based on examinations of existing ORs, in order to understand how various aspects of the OR built environment impact safety and outcomes. Then we could identify knowledge gaps and opportunities for improvement.
This set the foundation for year two, when seven other graduate students and I applied the findings to design and develop a prototype OR in three phases. Each iteration was constructed into a physical mock-up with increasing levels of fidelity, until we landed on a final design concept. I also got to work on this phase with a ZGF colleague, Austin Ferguson, who works in our New York office.
When all is said and done, our hope is that we’ve created an evidence-based design standard for a safer, more effective OR, and that others will be able to use our design guidelines as a template for their own projects.
What lessons did you learn?
- We hear the words “flexibility” and “adaptability” a lot in our industry, but they are both key to answering evolving surgical procedures and needs over time.
- The increased quantity and complexity of equipment and supplies in the OR add to the number of surfaces and objects that need to be sterilized, so it was important for the prototype to include a range of passive and active infection control strategies.
- Optimizing movement and flow, as well as minimizing cords and clutter, goes a long way to reduce workflow disruptions caused by the physical environment and improve efficiency.
- Just like in a sports arena, having multiple wall-mounted displays showing the same information can keep everyone on the same page regardless of their viewing position.
- We can reduce stress through thoughtful design. For example, the prototype includes a dynamic glass display that can show stress-reducing views of nature as the patient is brought into surgery and then change to show patient vitals during surgery (pictured above).
More of our team’s key learnings can be found in the resources below.
Personally, I learned that it’s possible to reach conclusions no one was ever expecting – but only when you set aside preconceived notions about what will or won’t work. It was important to take our time to fully understand every aspect of the OR before trying to redesign it.
Finally, what do you think the operating room of the future will look like?
Short term, I think it will remain rooted in current design systems, with products we use today. But designers will increasingly think about the future in every step of the design process, making spaces that are highly flexible and can adapt to innovations in surgery and new technologies that may not be in use today. For example, how can we design rooms to be so easily adaptable that we can reduce service disruptions during renovations from one month to one week? Forward-thinking solutions will help keep hospitals profitable and patients better cared for.
Looking farther out, I think the OR will be much more patient- and staff-centric. We’ll take lessons from European design and incorporate more natural daylight. Enhanced wireless capabilities will address cord and clutter management issues. There will be smarter material management and advances in technology will enable the reuse of products in the OR, similar to how the aerospace industry has developed reusable rockets. Those are just a few thoughts.
Ultimately, I think we’ll see shorter surgery times, shorter patient stays and better patient outcomes overall.
Leah Meer is an architectural designer in ZGF Architects’ Seattle office, where she is currently helping plan and design two healthcare facilities in Washington state. Leah earned her Bachelor of Design in architecture from the University of Minnesota and Master of Architecture in architecture + health from Clemson University.