What Is "Evidence-Based Hospital Design" Really About?

"Health Outcomes Driving New Hospital Design," reads the headline in this morning's New York Times. The basic thesis of the article: an increasing number of hospitals are replacing semi-private with private rooms in new and upgraded facilities because scientific evidence shows that they're better for patients.

The writer of this article has evidently been drinking the Kool-Aid of hospitals and architectural firms. Research supporting this "evidence-based hospital design" crusade, she tells us, shows that "single rooms reduce infection and patient stress, and improve sleep. In 2006, the American Institute of Architects called for single rooms in all new hospital construction."

The American Institute of Architects apparently employs medical experts who have advised it on this amazing breakthrough in health care. Perhaps those experts pointed out that infection rates could also be reduced if physicians washed their hands. But I doubt that they observed that private rooms would greatly increase the amount of space that architects would have to design, and the fees they would derive therefrom.

It was also rather revealing that The Times highlighted a new hospital in Plainsboro, NJ, that is being built by University Medical Center at Princeton.

"Because studies suggest that natural light can reduce depression and that scenes of nature can reduce reported levels of pain, rooms in the new hospital will have large windows looking out toward woods and the Millstone River. A handrail next to the headboard of the bed will prevent falls. To prevent medication mix-ups and reduce the time nurses spend fetching drugs and supplies, a small locked cabinet called the nurse server will contain only the medicine for the patient in that room."

It all sounds pretty impressive, but who's paying for it? In the Princeton area, a high percentage of patients under 65 probably have private insurance--certainly more than in Newark or Plainfield, NJ, where a major safety-net hospital recently closed. So while more and more people don't have access to even basic health care, hospitals in upscale areas are building nice new facilities for people with good coverage.

A few years ago, I had a conversation about hospital construction with Mark Pauly, a health economist at the Wharton School. In Philadelphia, he said, hospitals were building mostly ambulatory facilities. The new inpatient facilities, he said, were mainly replacing older buildings.

"Some of that construction is just because so much of the bed stock is antiquated and has to be replaced. And even if it's not antiquated, the trend toward private rooms means they may even tear down a perfectly decent building with semi-private rooms, because everyone wants to have their own room now."

There it is in a nutshell: People would prefer to have their own room; they'd rather not have to listen to their roommate groaning in pain, and they don't want to be kept awake at night. But does this really contribute to better patient outcomes, or are hospitals offering well-insured patients private rooms to compete with other institutions? And, if competition is really at the root of the trend toward private rooms, what does this say about the willingness of providers--or of our society--to put the brake on runaway health spending?

Put that in your pipe and smoke it, Congress.