March 12, 2012
Patient Centered Outcomes Research Institute
1701 Pennsylvania Avenue, NW, Suite 300
Washington, DC 20006
This letter reflects comments by the Craig Zimring, PhD, on behalf of the SimTigrate Design Lab
and other patient-centered research activities at the Georgia Institute of Technology. I also sit on
the Board of Center for Health Design, which has provided separate comments.
The Georgia Institute of Technology is a major research university conducting over $500 million
in research annually through its academic units and the Georgia Tech Research Corporation. Its
academic units of the Colleges of Architecture, Computing, Engineering, Ivan Allen,
Management and Science are consistently rated among the best in the US. Georgia Tech is
consistently rated among the top 10 public universities in the US.
Georgia Tech is deeply committed to basic and translational research for healthcare and health.
Georgia Tech recently created the Institute for People and Technology to coordinate Georgia
Tech’s broad strategic support for healthcare, education, media and humanitarian response.
Among many other healthcare efforts it supports the SimTigrate Design Lab, a major initiative to
support integrated design of healthcare environments through simulation, research and
innovation.
Patient-centered care needs to be safe, efficient and provide excellent experience. Individuals,
clinicians and providers need to be able to choose and design systems that provide most value.
However, there is growing evidence that healthcare facilities—clinics, hospitals, hospices, long-term
care facilities—are continue to be unnecessarily inefficient, dangerous and stressful for patients,
families and staff. Recent reports by CMS and others indicate that medical errors have not declined
dramatically since the Institute of Medicine (IOM) published its ground-breaking report in late 1999.
According to that report, unnecessary deaths due to healthcare-acquired infection and preventable
medical errors are the fourth leading cause of the death in the U.S. Even with the current economic
crisis, we are on the verge of recapitalizing medical facilities throughout the United States, with US
healthcare construction projected to exceed $40 billion a year.
Craig Zimring, Ph.D.
Professor
College of Architecture
Georgia Institute of Technology
Atlanta, Georgia 30332-0155
Phone: (404)894-3915 Fax: (404)894-1629
email: craig.zimring@gatech.edu
The growing science of evidence-based design is showing that the proper design of healthcare
settings—the integrated design of the built environment, information technology and equipment—can
support much better care. As the Agency for Healthcare Research and Quality Director Dr Carolyn
Clancy wrote recently: “The physical environment—including light, noise, air quality, toxic
exposures, temperature, humidity, wayfinding, and aesthetics—as well as other workplace design
features and physical layouts have an impact on patient outcomes, communication, and job
satisfaction.”
This has been adopted by a growing number of health systems:
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OhioHealth’s new evidence-based facility, Dublin Methodist Hospital, has used a range of
evidence-based measures such as access to natural light and acuity-adaptable rooms, where
patients are not transferred when their acuity changes. After the hospital was open for 15 months
and it had a total of 5 healthcare-acquired infections, a 95% reduction from national averages.
Emory HealthSciences has applied evidence-based design to create a neurocritical care unit with
team work areas, family zones and other innovations that help patients with severe brain injuries
go home more quickly and involves families in their care. This has reduced death rates by 25%.
The Military Health System promotes the use evidence-based design into their multi-billion dollar
hospital modernization program with the goal of developing evidence-based design outcome
focused criteria and integrating this knowledge into future capital projects.
Senior health care executives, researchers, designers, clinicians and educators met at Georgia
Tech in 2006 and in Washington in 2008 and 2010 to explore the role of design in solving
America’s pressing healthcare problems. The conclusion: a coordinated national effort is needed
to: 1) create a vigorous body of researchers to create the emerging science; 2) develop
translational mechanisms to get it into the hands of the thousands of healthcare decision-makers
and consumers who will build or renovate or choose settings; 3) and, develop metrics for
assessing and reporting the quality of integrated healthcare settings.
PCORI can play a significant role in its five national research priority areas:
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Provide significant research and training support for multidisciplinary research—design,
clinical disciplines, informatics, process engineers and others—linking design to patient
safety, patient outcomes, improving patient and family satisfaction, increasing workforce
effectiveness and retention, increasing revenue and reducing costs. This can be linked to the
growing sciences of health and of healthcare delivery.
Engage the Agency for Healthcare Research and Quality other lead agencies to add the built
environment to the study of comparative effectiveness: study the comparative effectiveness of
alternative healthcare designs.
Expand the role of the Military Health System, the Department of Veterans Affairs and NIH
in innovation and engage them to help build federal partnerships and push innovation to the
private sector.
Support the development and validation of simulation and modeling tools that allow the
assessment of the impact of design strategies on patient outcomes and experience.
Support breakthrough initiatives that create transformational, rather than incremental, change.
Craig Zimring, Ph.D.
Professor
College of Architecture
Georgia Institute of Technology
Atlanta, Georgia 30332-0155
Phone: (404)894-3915 Fax: (404)894-1629
email: craig.zimring@gatech.edu
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Create an incentive structure of visibility and support to encourage healthcare facilities to
incorporate proven evidence-based integrated design measures and to innovate and test
further approaches, such as incorporating design measures and outcomes into HCAHPS
(Hospital Care Quality Information from the Consumer Perspective), value based purchasing,
no pay for healthcare acquired harms, and others.
Please contact IPaT Director Dr Elizabeth Mynatt or me if we can be of further assistance. More
information about IPaT is available at http://ipat.gatech.edu/about. More information about the
SimTigrate Design Lab and research on the impact of integrated design on the value of care is
available at http://herg.coa.gatech.edu/ .
Sincerely,
Craig Zimring, Ph.D.
Professor
College of Architecture
Georgia Institute of Technology
Atlanta, Georgia 30332-0155
Phone: (404)894-3915 Fax: (404)894-1629
email: craig.zimring@gatech.edu