Tim Putnam runs a 25-bed hospital in rural southeastern Indiana that got hit hard by COVID-19.
"We were slammed in March of 2020. We had more cases per capita in our region than, I believe, anywhere. We were equal to New York City," says Putnam, CEO of Margaret Mary Health. "We were just unlucky. We had a few people that were positive that went to large events in the region, and we started getting a lot of people coming in here."
At the peak of the pandemic, Putnam's staff was caring for 40 inpatients. Considerations to relocate COVID-19 patients to stadiums or conference centers were dismissed as impractical. The community donated or made masks for health care workers. The local RV dealer even offered up his recreational vehicles for staff to sleep in or as mobile clinics. Several hospital staffers got sick, but they all recovered.
Before the pandemic, hospital planners were more focused on outpatient services and hadn’t given a great deal of thought to how to adapt in the event of a massive health care emergency like a pandemic.
"Eighty-three percent of our revenue comes from outpatient work. So we were, like a lot of hospitals, really outpatient focused. But that also meant that a lot of our inpatient facility was underutilized," Putnam says. "We had a lot of space in our inpatient unit that regularly does not get used."
The pandemic has forced many hospitals to rethink how to keep their communities safe and healthy. Putnam turned to hospital design experts to help better position his medical center for the next pandemic or other significant event, such as a mass shooting, chemical attack or natural disaster.
"Our hospitals have really let our caregivers down in a lot of ways, which I think, it falls back to a failure of imagination on the part of the design and construction industry," says Jim Albert of Hord Coplan Macht. He's an architect who specializes in health care design. "That resiliency of having the ability to, for example, accommodate twice as many patients as you ever have before in the hospital just wasn't built into those systems."
But that's changing, with hospital designers focusing on creating more flexible spaces at a reasonable cost.
"If you plan in advance, it's not overly expensive, and it allows you a far greater flexibility in how you use spaces," Albert says. "Could we put two patients in every room in a true emergency, if we had to? Could we upgrade the acuity of rooms? … Putting a few more gas outlets or power outlets on a wall and increasing pipe sizes by a little bit can go a long way to making sure you can get a ventilator in every patient room. But if you don't have that in there in the beginning, it's a real problem."
For his hospital, Putnam is looking for a malleable design to accommodate changing needs.
"The design cannot be a static design," he says. "In a crisis situation, you've got some areas like your physical therapy area training rooms, or even administration, that need to be converted into patient care space. So, when you design that, it might be putting oxygen lines in the wall, or it might be making your ERs (emergency rooms) be able to turn a switch and be a safe operating room if you're dealing with a mass casualty situation and need more ORs (operating rooms) immediately."
No more emergency waiting rooms?
Infection control is also a more urgent priority in the aftermath of COVID-19.
Public spaces in hospitals, such as waiting rooms, could look different in the future. Patients could be asked to wait in their cars, or outside, until they can be seen. An entire zone within an emergency department might be created to handle infectious patients. Some health systems are already developing apps for smartphones that allow patients to check in on their own phones, eliminating the need to touch any other surfaces or devices.
Staff spaces might be reimagined, with fewer people sharing a workstation, and larger break rooms and locker rooms replaced by smaller spaces. Administrative workers could be moved out of the hospital to another site or establish work-from-home arrangements, Albert says.
Then there's the issue of ventilation. In most hospitals, only about one-third of the air is brought in from the outside. The rest is recycled and filtered. Few hospital rooms have full fresh air.
One of the current projects of Albert’s firm has a built-in fresh-air option.
"We're working on inpatient expansion to a hospital, and we're going to be able to, at the flip of a switch, change the airflow so that every patient room in that wing will be negatively exhausted to the outside," he says. "Only new fresh air would be brought out, and that way, there's no chance of cross-contamination from room to room. And all of that fresh air is keeping the patients and the staff and the rooms around that infectious room safe."
But there's a cost. All of that fresh air must constantly be heated or cooled.
Hospitals of the future
In Indiana, Putnam and his colleagues are focusing more on telemedicine and other ways to keep people healthy so they don't have to go into the hospital.
They're also looking ahead and recognizing that community hospitals like theirs need to be ready to tackle the next mass medical emergency.
"We need to take ownership of … whatever medical crisis hits our community," Putnam says. "We need to be able to handle it, manage it, work with our other partners. Sometimes, especially in this situation, everybody's overwhelmed, so you've got to be able to handle it."
That's why he believes it is critical to design facilities that can fit that need.
"I really would encourage people not to design the hospital they wanted for this pandemic," Putnam says, "but think of all the other possible things that could occur."