Selective Accountability is Wasteful and Undermines Community
Virginia Postrel, writing for the Bloomberg View, provided a very interesting description of the gap between what the best available data demonstrates about the importance of patient-centered hospital architectural design and the ways we actually build hospitals.
The existence of a gap is not what I find most surprising. What is most interesting is her description of why decision makers fail to build hospitals with these data-driven design features known to increase patient recovery time and reduce patient use of pain medications.
“The problem is not a lack of knowledge…. There are specialized architects and interior designers who have spent decades studying how to improve health-care environments. There are articles in peer-reviewed journals — even an “Evidence-Based Design Journal Club” to discuss new articles — and annual conferences.
In other words, there’s plenty of information on how to make hospital-design better.
The real problem is a lack of incentives and feedback. New hospitals that hire fancy architects tend to lavish money on public areas — the places donors see — and treat hidden departments, such as the imaging suites, as purely functional. Even when money isn’t an issue, they make choices that please administrators but ignore research.
The old-fashioned insistence on highly polished floors, a hazard to older patients with fading eyesight, is a pet peeve of health-care design experts. Evidence suggests that patients react better to landscapes than abstractions, and that “chaotic abstract art” and “close-up animals” looking directly at the viewer should probably be avoided. Yet the $1-billion Ronald Reagan UCLA Medical Center, which opened in 2008, features a cafeteria mural whose violently jagged abstractions are made all the more threatening by other shapes resembling lions staring out.”
Because elite decision makers are excessively focused on impressing other elite decision makers (donors and other administrators in particular), even when these decisions undermine the mission of the institution, are contrary to the best data, and waste money.
If hospitals are anything like universities—large organizations run by elites insulated from what happens on the ground to actually advance the mission—then these elite decision makers likely joke among themselves about the need to insist upon greater accountability from their front-line workers whom they assume act to undermine the mission, contrary to the best data, and waste money.