Who should contribute to decisions about health care space design?

(Boston)—Construction of a hospital involves many decisions that are akin to plan-of-care decisions and have myriad effects on patients, families and staff. Rather than being based on the interests of a single person, a hospital’s design and construction should result in a facility that serves the community in which that hospital is situated.

A new commentary led by Boston University Chobanian & Avedisian School of Medicine asks how, and by whom, decisions about health care structures and spaces should be made.

“How a decision should be made cannot be divorced from who should be part of making it. We argue that health care design involves significant ethical questions and should be evidence based,” says corresponding author Diana Anderson, MD, FACHA, assistant professor of neurology at the school.

According to Anderson, expanding the group of stakeholders is not just soliciting more opinions, but ensuring the people affected by the decisions interact with those who have project-specific expertise. “Appropriately answering questions about the need for design elements begins with determining two things: who needs to be present to provide a technically informed, evidence-based answer, and  who should have a voice in the working session by virtue of being most affected by the outcome,” says Anderson.

Anderson said a hospital design working group should include, as well as clinicians, patient advocates, students in the health professions and community leaders, but must also incorporate a certified health care architect with subject matter expertise in designing, planning and constructing health care buildings; patients and their families, and non-clinical staff such as hospital administrators.

In the same way that other decisions in health care that involve technical expertise and normative concerns are made, hospital planning should employ shared decision-making. For example, in a shared decision-making scenario clinicians are responsible for determining the range of appropriate options based on the best available evidence or clinical judgment borne of long practice and relying on the patient or duly appointed surrogate to choose from among that range of appropriate options based on their values and preferences.

“Inclusion of representative stakeholders in a process of shared decision-making that mediates decisional authority, can promote ethically informed, evidence-based hospital design practices, leading to improved building performance and health outcomes,” adds Anderson.

These findings appear online in the AMA Journal of Ethics.