Hospitals can exacerbate racial disparities. It’s time to change
For healthcare establishments, a new architectural project is more than a simple update of a building. It is a new beginning, an opportunity to remedy both spatial and operational shortcomings. Now is also the time to improve performance and, more importantly, correct persistent failures in patient care.
But too often, these buildings themselves become sources of mistrust and impediments to care. Inclusive design could begin to remedy this if designers and health systems raise more voices up front and are willing to implement suggested design changes.
This is of critical importance as the United States continues to fight a pandemic that has revealed stark and persistent racial disparities in health coverage, chronic health issues, mental health and mortality. These gaps in health care delivery and outcomes reflect greater societal inequalities in income, wealth, employment and education. Building a truly community-oriented facility can be a step in filling these gaps.
A cycle of mistrust
Investigations by the Kaiser Family Foundation have documented the racial and ethnic trust gap for decades, which is particularly harmful as it erodes the public trust needed to fight the disease. A fifth of black respondents to Kaiser’s most recent poll said they had personally experienced racial discrimination in healthcare in the past year.
Mistrust fuels the underutilization of services, leading to poorer health outcomes and heightened suspicion. The cycle continues. Hospitals and ambulatory centers participate in this cycle through their physical, operational and psychological positioning.
When we design a healthcare facility, we do so with the goal that it will operate efficiently for the life of the building: typically 50 years or more. To accomplish this, healthcare designers and organizations bring together a range of design contributors and healthcare professionals to work “on behalf” of end users: patients and their families, and by extension the community. at large.
Unfortunately, something is often lost in translation, as new or renovated health facilities do not engender confidence or enthusiasm in their communities. The result is that those most affected by the outcome of a design often have the least say in its process. Too often, elements such as donor recognition – in the form of an accent wall, inscription or signage – take precedence over the community context, creating public spaces that do not interact. with the larger cultural site.
I’ve witnessed this in my predominantly black and Hispanic neighborhood of Brooklyn, as large architectural projects tend to pop up out of the blue with little community input. Residents of minority neighborhoods get used to and tire of living among construction projects imposed on them by indifferent institutions. This disconnect is one thing when it comes to condos or office towers, but it’s a whole other problem when it comes to health care. A health facility that does not communicate with the minority community it serves only exacerbates existing problems within the system.
How to break the cycle
Public and private health systems update their campuses as a form of sustainability and survival. Across the country we have seen what happens to systems that cannot innovate enough to be competitive. They are closing their doors for good, which not only has an impact on the health of the community.
By relying on siled and limited project teams to inform design, healthcare organizations may miss opportunities to make systemic change within their communities. By growing or expanding, they can do more than just strengthen their brand image, expand their reach in the market, and attract more privately insured (i.e. better paid) patients. They can enable real change.
But this requires a sustained commitment to work, especially since the needs of the project and the community will always be different, so there is no one-size-fits-all solution. Design teams, including architects, engineers, and city planners, can start by approaching projects with a broader focus. What do the socio-economic data say about the existing public health gaps in the neighborhood? What do we know about people’s food, language and culture? Beyond the existing information, what can people themselves tell us about their health and their physical and mental needs? In other words, how do you involve the community so as to build trust and ensure the success of the hospital for decades after its inauguration?
We can broaden the definition of “consultant” to include local arts, environmental, educational, political, ethnic and religious organizations. Members of these groups have a wealth of local and specific knowledge and stories that can inform and uplift our collective design work.
Patient and family focus groups can also expand to include more than a small subset of referrals that administrators use for periodic contributions. Survivors, chronic disease support groups, therapy groups, and formal and informal wellness groups are established and trusted patient resources that already connect the healthcare organization to the community. Through their contributions, healthcare projects can be enhanced and better linked to the community living just beyond the walls of the hospital.
Make the change
Today, as the United States recovers from its biggest health crisis of modern times, we are at a crossroads. We can continue with the same formula, the one that sows doubt and apprehension by offering one population quality care and another inferior quality care.
Or we can make the difficult, but simple, decision to rebalance our priorities. Instead of focusing exclusively on the finished product of the healthcare facility, we can take a closer look at the process and determine if this process builds trust by aligning with the needs of the community.
Nsenga Bansfield is a healthcare architect for HOK in New York. His design work over the past two decades has helped shape private and public healthcare facilities across the country.