A key determinant of everything that matters when it comes to health interventions — the experience, cost, and results — has been hiding in plain sight. It is the buildings and spaces in which patients are treated.
The size and layout of a room, whether a bed sits in the middle or against a wall (even which wall), how much space is maintained for patients to walk, versus how many beds or operating equipment can be accommodated, have not been considered predictors of health outcomes in the past. That’s changing, as architects and health care organizations come together to incorporate principles of social design into the built health care environment.
“Social design,” a term whose roots go back several decades, fully entered the lexicon around 2006. It refers to the design of relationships, including those that are invisible and intangible. Unlike design thinking, an iterative process for developing alternative ideas and strategies based on understanding a “user” and a specific problem, social design addresses the needs of whole communities or societies. In health care that means reimagining the role a building can play in the health of its inhabitants and the locale in which it is situated.
Consider the collaboration between Dr. Neel Shah and nonprofit architecture firm MASS Design Group. Shah, assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School, directs the Delivery Decisions Initiative at Ariadne Labs, a partnership between the Brigham and Women’s Hospital and Harvard’s T.H. Chan School of Public Health. Cofounded by Michael Murphy, a Harvard-trained architect who has devoted himself to improving the social impact of built environments, MASS is changing the way hospitals are designed and constructed. Murphy has written extensively about the offenses his profession commits against the vulnerable and powerless, especially with hospitals, prisons, and public housing.