Which Values Should Guide Health Care Organizations’ Retrofit Expenditures on Patient-Centered and Evidence-Based Design?
Year: 2024
Type: article
Abstract: When built environments in health care result from an evidence-based design (EBD) process, they are interventions that can improve patients' health outcomes.This commentary on a case discusses which ethical values should guide organizations' capital expenditure decisions about retrofits, which might be more costly than the original budget.This discussion urges reevaluation of the common assumption that capital improvements are "sunk costs," since such improvements can promote long-term positive health outcomes for an organization's patients, thereby advancing both financial value and ethical values.This commentary also suggests that EBD offers key interventions that are clinically and ethically relevant.Case A large health system has contracted with an architectural firm to develop plans for renovations of one of its hospitals.Originally built in the late 1960s, the building is in an urban-based community.During a planning meeting, the architect considers suggesting incorporating a white noise sound system, other sound-masking equipment, and good lighting in the design plans, since there is evidence that these features promote more peaceful inpatient environments.Despite the likelihood that these retrofits would improve patients' experiences, the architect is concerned that they will cost far more than the contract's budget allocates and wonders whether to suggest the retrofits. CommentaryWhen renovating a facility, stakeholders have an opportunity-and an ethical obligation 1 -to do more than base decisions on personal preferences and budgets.Health care organizations undertaking a facility design project should require an evidence-based design (EBD) process, wherein the team bases "decisions about the built environment on credible research to achieve the best possible outcomes."2 The long-term benefits of improved outcomes should shift the view of the project from being a "sunk cost" (ie, a cost that will never be recovered) to being an investment with the potential for payback over the usable life of the project.The return is calculated based not only on hard "dark green" dollars (ie, measurable financial outcomes, such as resource use, length of stay, and staffing), but also on soft or "light green" dollars (ie,
Source: The AMA Journal of Ethic
Author: Ellen Taylor
Institution: Center for Health Design
Language: English
Subfield: Urban Studies
Field: Social Sciences
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W4405288333