Cause and effect – HCD Magazine


As the temperatures finally drop here in the Midwest and we get our first dusting of snow on the ground, I can’t help but be thankful to stay inside and enjoy the quiet moments – for a few good reasons.

It was a dizzying late summer/early fall, like here Healthcare Design the team also produced our HCD Forum event in September and then just three weeks later our Healthcare Design Conference + Expo in October. Between the two, my family and I moved into a new house. (I’d say luckily it’s only a mile from our previous house, but we’ve realized that moving is a nightmare no matter the distance.)

And as we settle into our new place and work to make it our own—and constantly resent the to-do list that comes with loving a century-old home—I’m reminded why we ended up here in the first place. Your design minds will appreciate that while there may be 100 years of problems to be solved one way or another, I’m a fan of good space flow and lots of light and views.

Somehow, even as we wait months for furniture and fight over colors, it still feels good.
Achieving the same effect through design is something you all struggle with every day when approaching healthcare projects, the benefits of which have recently been proven again.

The University of Michigan researchers decided to build on previous studies, including Roger Ulrich’s seminal 1984 paper, to see how different design features affected clinical outcomes in surgical patients. This analysis included a study of nearly 4,000 patients who underwent high-risk surgical procedures at the University of Michigan Hospital between 2016 and 2019. Characteristics assessed were window or no window, single versus double occupancy, distance to nurses’ stations, and line of sight to clinicians.

Some of the key findings, as shared in an American College of Surgeons press release, show that these factors affected clinical outcomes, with mortality rates 20 percent higher (after adjusting for comorbidities and surgical complexity) if patients were in the room without windows.

Furthermore, the team reports that the patterns that have emerged so far indicate that certain rooms and features achieve better outcomes after surgery, meaning that the solution is not necessarily just design, but also operations – for example, identifying the sickest patients and prioritizing certain ones. rooms for optimizing results.

And while it’s just one (of several) studies, the authors call for further research to see if the results can be generalized and to identify ways to achieve a better return on what is designed and built. As co-author Mitchell J. Mead says in the release, “One of the next big steps in health care design is to understand these causal pathways that can lead to different clinical outcomes in patients staying in hospital rooms with different characteristics.”

Jennifer Kovacs Silvis is editor-in-chief of Healthcare Design. She can be reached at

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