Speaker 1: If you've ever stayed overnight in a hospital, it probably wasn't the most enjoyable experience. Whether it was loud beeps emitting from unfamiliar machines, or maybe a room was shared and windowless, lit by harsh fluorescent light. But modern hospital design is more than just uncomfortable. Some studies show it's actually making us sicker. In the late 1800s, the medical world was experiencing a design revolution. Germ theory inspired a movement of thinkers who believed that increased access to sunlight, improvements to ventilation, and wide open window spaces can improve the health of patients.

Speaker 2: People thought that the bad air caused disease, and they built the buildings so that they had maximum pure air. And back then, pure air was fresh air. So they were really a bunch of small-scale structures, a number of them on the same site. Most of the patients were in a long, narrow room with windows on both sides. And they could be anywhere up to around 30, 34 patients' beds in this room.

Speaker 1: Prior to this time, most hospitals were designed to house, not cure, the sick. Soon, hospitals around the world began adopting these features. Gone were the days of tightly packed rows of beds in dark, open wards. But then something changed again. While hospital design was at the forefront of the medical world in the late 1800s, technology became the focus in the early 1900s. New machines like X-rays and cardiographs emerged, technology that undoubtedly revolutionized patient care, saving the lives of millions. But these big pieces of equipment fundamentally changed how designers approached hospital layouts. In 1942, Charles F. Niergaard, a prominent New York City hospital design consultant, proposed this controversial change. He called it the Double Pavilion Plan. The plan outlined two different nursing units in a single building wing. This streamlined designs and reduced distances staff needed to travel between patients and equipment. But it came with the cost, the removal of windows. Construction was adaptable and costs were low, so new hospitals continued to be designed with this efficiency in mind. There was little to no research on how it might impact patients. But soon, studies did emerge. In 1984, Dr. Roger Ulrich released a study that analyzed the records of 23 patients over 10 years recovering from gallbladder surgery. What he found was that those who were in rooms with views of nature complained less, used less medicine, and had shorter stays than patients with views of brick walls. These benefits resulted in $500 less spent per patient and therefore proved evidence-based designs saved money in the long run. But as you probably guessed, few listened. Some architects have preconceived notions. The research gives everyone a common platform that's not based on one opinion, says Amy Keller of the Center for Health Design. Today, hospital design continues to revolve around efficient workflow and equipment needs. And with loud noises, confusing layouts, and drab, dark interiors, they can still be an unwelcoming and dangerous environment. Shared rooms lead to higher infection rates. In fact, up to 30% of ICU patients in high-income countries catch infections. Dimly lit hallways lead to falls, which cost hospitals upwards of $3.6 billion annually. The deficiencies aren't simply un-aesthetic or inconvenient. All those design flaws may be killing us, says Dr. Dhruv Kullar at Massachusetts General Hospital.

Speaker 2: I mean, a hospital is like a city. You know, you can make it work for the nurses, and then the doctors have to go all over. You can make it work for the patients, and then the nurses have to go all over. So what you centralize is an indication of what you want to make the most effective. What you decentralize is usually an indication of what can maybe do a little more legwork or work. So it's kind of a, we're at the point where we have to re-figure what's the most important.

Speaker 1: So what should a hospital look like? Let's take a look at this proposal idea. In an ideal hospital, every patient would be placed in a private room. For one, this curbs the spread of disease in comparison to shared rooms, but it also reduces the need for patient transfers. A 2004 study compared semi-private rooms to private rooms. The data showed a decline in room transfers by 90%, and a 67% drop in medication errors. But private rooms are just part of the equation. A study between 1972 and 1981 showed patients with views of nature have shorter hospital stays and fewer medication needs than those without. However, even patients in private rooms with windows still suffer from the effects of designs focused solely on efficiency. In most hospitals, nursing stations are often centralized, which creates limited views into each room. Can't monitor patients at all times. In 2002, the Healthcare Design Journal conducted a study at an Indianapolis hospital to see how a different layout would affect patient falls. This layout featured smaller cockpit stations scattered throughout the hallways instead of one centralized station. These changes led to a 66% drop in falls. Luckily, adjustment like these are beginning to be made. The New York City Memorial Sloan Kettering Hospital underwent extensive design changes aimed at increasing patient outcomes. The hospital uses only private rooms, which include videoconferencing technology so patients can talk to friends and family. Down in Alabama, the UAB Hospital created a tree-lined retreat for patients to stroll around in. As more research emerges, hospitals are continuing to implement these patient-focused designs, but it will still take some time and convincing. Projects take about two to five years to complete and up to 10 years in big hospitals. They can increase upfront construction costs by 5%.

Speaker 2: Cost is a huge part of this. Hospitals and how we afford hospitals is insane in this country. So when they started out as charities, and so the patients that were going there were getting the care for free, what paid for this was donations. And that was a sustainable approach. But we've now shifted to a pay-for-care basis, and the patient is expected to pay for the care. So in between those two, there's gotta be some way to balance it out. And right now, insurance and sometimes government funding kicks in the difference. So it's a kind of a balance between charity and profit motives, but it's not functioning well for either way.

Speaker 1: And some argue against evidence-based studies, saying designs like private rooms can be isolating for patients. Choosing between what a patient may want and what's better for their health is a difficult decision. One made even more difficult when increased costs deter patient-focused approaches to design. But one thing can be said with certainty. While first-class clinical care is vital, patient treatment is equally as lifesaving. Thanks for watching. If you want more stories like this, check out our new show, Who Knew?, on Cheddar's TV network. It airs every Wednesday at 8 p.m. as part of our Originals Hour. ♪♪