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.