Correspondence

Healing by Design

N Engl J Med 1996; 334:334-336February 1, 1996

Article

To the Editor:

In Horsburgh's “Healing by Design” (Sept. 14 issue),1 he does not mention the pernicious way in which medical economic pressures are influencing modern hospital design. Hospitals in competition with one another for paying patients spend extravagantly for lobbies and entrances more appropriate for a bank or Las Vegas hotel, while cutting back on professional and ancillary staffing to try to improve their bottom lines. Compounding the problem is the desire of philanthropists to erect impressive testimonials to their generosity.

Simple but relatively skilled and labor-intensive care remains the key to managing many common and compelling medical problems.2 Building fantasy-vacation hospitals in an age when American hospitals are ruthlessly cutting professional and ancillary staff strikes me as inappropriate husbandry of our health care resources.

Arthur D. Forman, M.D.
University of Texas M.D. Anderson Cancer Center, Houston, TX 77030

2 References

1. 1

   Horsburgh CR Jr. Healing by design. N Engl J Med 1995;333:735-740
   Full Text | Web of Science | Medline

2. 2

   Thiyagarajan C, Silver JR. Aetiology of pressure sores in patients with spinal cord injury. BMJ 1984;289:1487-1490
   CrossRef | Web of Science | Medline

To the Editor:

As Dr. Horsburgh points out, the recent interest in hospital design has focused appropriately on patients and their families as the “consumers” of hospital services. To achieve the goal of optimizing health care delivery, however, hospital design must also optimize coordination among health care providers. For example, horizontal spaces in hospitals encourage face-to-face interaction between health care providers, sometimes facilitating consultation or important discussions regarding the treatment of patients.1 Health care providers at the old Peter Bent Brigham Hospital in Boston (where “pavilion style” ward buildings were connected by a single conduit affectionately called “The Pike”) or at the Cleveland Clinic Foundation (where the “Skyway,” a horizontal, elevated walkway, connects the hospital to the outpatient building) appreciate the advantages of horizontal spaces that encourage face-to-face meetings and interactions. Also, having alcoves along hospital corridors permits private conversations, thereby averting the hazards of “elevator talk.”2

James K. Stoller, M.D.
Cleveland Clinic Foundation, Cleveland, OH 44195

2 References

1. 1

   Ubel PA, Zell MM, Miller DJ, Fischer GS, Peters-Stefani D, Arnold RM. Elevator talk: observational study of inappropriate comments in a public space. Am J Med 1995;99:190-194
   CrossRef | Web of Science | Medline

2. 2

   Stoller JK. A physician's view of hospital design: the impact of verticality on interaction. Architecture. December 1988:121-2.
   

Author/Editor Response

Dr. Horsburgh replies:

To the Editor: I share Dr. Forman's dismay that some hospitals have spent large sums for sumptuous spaces that have little effect on patient care. Good design can provide positive symbolic meaning without opulence. Such misguided expenditures emphasize the importance of involving health care providers in the design process.

Dr. Stoller identifies additional positive attributes of horizontal hospitals that have contributed to the increase in construction of such facilities in the past decade.

C. Robert Horsburgh, Jr., M.D.
Emory University School of Medicine, Atlanta, GA 30303

Citing Articles (1)

Citing Articles

1. 1

   S WHITEHOUSE. (2001) EVALUATING A CHILDREN'S HOSPITAL GARDEN ENVIRONMENT: UTILIZATION AND CONSUMER SATISFACTION. Journal of Environmental Psychology 21:3, 301-314
   CrossRef