A few months ago, Deborah Sheehan, a Principal and Healthcare Leader at Cannon Design, was given the task of designing a prototype healthcare facility in Afghanistan, a country averaging about one hospital bed for every 2,400 people.
The challenges that Sheehan and her colleagues faced were considerable: limited construction materials, few skilled tradesmen, political corruption, tribal rivalries. But the resultant design solutions were smart, low-cost, and high-quality – they had to be, after all.
To a certain extent, Sheehan was expecting her team to come up with an innovative design; what she didn’t consider, however, was how applicable the design strategies would be to our own troubled system. In her article for HealthCare Design, “Beautiful, Broken, and Broke,” Sheehan outlines the 4 things the Afghanistan healthcare system does well, frankly better than the American, and what we could gain by applying them here…
Read after the break to find out the 4 design strategies employed in Afghanistan that could help our Healthcare System…
Strategy #1: Sustainability at the Core
“In a country where the presence of electricity, water, sewers, and heating must be presumed unavailable, every resource had to be treated sustainably.”
As Sheehan points out, necessity is the mother of sustainability. The Afghani hospital’s high-impact, low-energy design solutions, such as recycling and treating storm and waste water (“grey water”) to conserve potable water, could also be applied to American hospitals – thus saving millions of dollars in long-term energy consumption.
Strategy #2: Flexibility in Design
“Four healthcare modules were developed for application in Afghanistan: a primary care prototype, a 50-bed women’s hospital, a 20-bed day hospital, and clinic chassis. Each of these modules could be individually constructed as standalone facilities or connected as “plug and play” components. By selecting only those modules necessary in a given locale, construction and operational costs are held to a minimum. Because the modules are flexible and expandable, the hospital can be reconfigured as needs change.”
Sheehan sets up this strategy under the heading of “Rebuilding,” suggesting that this approach, although not necessarily ideal for the developed world, could be particularly appropriate (thanks to its speed and cost-effectiveness) after Natural Disaster strikes.
Strategy #3: The Human Factor
“Could it be that health outcomes were favorably influenced by community stability, education, and family sociological support? It was clear that the Afghan hospital model had to embrace greater access from extended families and the community at large, and the planning of these facilities incorporated that access. One of the unanticipated benefits was that the lower nurse-to-patient ratios in Afghanistan had neutral impact on health outcomes and, in fact, health outcomes improved with support of allied health professional training and engagement in the care models.”
Sheehan points out that the US, shockingly, has a lower ratio in positive health outcomes to per capita investment than Afghanistan. Ultimately, Sheehan explains, the US spends significantly, but has a poor level of “clinical efficacy” (clinical procedures that produce efficacious results). In other words, we get little bang for our buck.
One reason for this could be the lack of human presence in the American healthcare system (a system “divorced from community,” as Sheehan says). In Afghanistan, a stronger familial presence replaces the high nurse-to-patient ratio found in the States; here, a better integration of family and friends could supplement, or even restructure our concept of what constitutes care.
Strategy #4: Structural Reform
“Reform in the United States will require structural changes in healthcare delivery and facilities. Simply cutting costs with no examination of collateral impact is not a formula for success. [...] Lean healthcare facility planning and design solutions that reduce labor and energy expenditures can yield the greatest substantive impact on year-over-year lifecycle costs of facility operations.”
Often, proposed healthcare “solutions” suggest blindly cutting down our existing, broken system – which only results in lower-quality healthcare (and, ultimately, higher monetary and human cost). Sheehan’s suggestions, on the other hand, all come down to one simple perspective: using innovative design solutions to reduce the consumption of labor/energy resources. Or, put in another way, high-quality, low-cost reform.
While our situation may be nowhere near as dire as Afghanistan’s, it’s hard to deny the urgent need for change we all collectively feel. If we only take one lesson from Afghanistan, it should be that that’s all the inspiration we need.