Why Design Matters in Imaging
It’s design that can make patients choose one imaging provider over another, according to Morris A. Stein, FAIA, FACHA. At the architecture/engineering firm HKS, Inc, Franklin, Tennessee, Stein is a principal. He presented “Designing the Imaging Experience: Understanding Today’s Requirements for Size, Technology, and Environments” on August 11 in Las Vegas, Nevada, at the 2009 annual meeting of AHRA: The Association for Medical Imaging Management. Good design, Stein says, must be applied not just to imaging technology and the health care environment, but to the entire imaging encounter, as experienced by staff and by patients and their families. Design as Strategy Both because of the accelerated pace of technological change in medical imaging and because of the fierce competition for market share that is often based on how well imaging providers are able to keep up with that change, Stein describes today’s radiology market as technologically aggressive. In addition to the need to supply state-of-the-art imaging in order to compete for business, providers are subjected to other forces as dataset sizes increase, as procedure times decrease, and as reimbursement-related pressures grow. All of these drivers not only influence the design of the imaging facility, but respond to it as well. It is time, Stein says, to approach design as involving far more than the physical space where imaging takes place. Instead, it encompasses the complete imaging experience (both for those who undergo it and for those who provide it). In turn, design affects workflow, staff efficiency, patient throughput, employee recruitment and retention, operating costs, and patient satisfaction. According to Stein, the final responsibility for helping imaging providers deal with technological change is shared equally among facility owners, equipment manufacturers, designers, and architects. The improvements in the environment and in the workflow passing through it made by each of these parties complement the changes that the others make in response, leading to ongoing progress toward a better overall imaging experience. While Stein acknowledges that there are fundamental differences between types and levels of imaging technology (and that these differences are both important to the imaging experience and unique in their effects on it), he finds that these differences are becoming less significant than they might once have been in distinguishing one provider from another. Winning Business Imaging is the premier area of health care in which design has assumed prominence, Stein says, because of the rigid technical requirements of imaging equipment and because of design’s ability to affect the patient’s experience before and during the procedure. Of course, that experience then influences the patient’s desire to return to the same facility; the recommendations that the patient makes (or declines to make) to colleagues, friends, and family members; and the satisfaction with the imaging provider that the patient expresses to the referring physician on the next medical visit. Satisfied patients influence other patients to request imaging at a particular facility, and dissatisfied patients can cause physicians to stop referring patients to that facility. Patients might not be in a position to judge the technical aspects of imaging, but they will definitely judge the quality of the imaging experience. A look at the promotional materials and meeting exhibits of any manufacturer of imaging technology will reveal that technical capabilities are only part of the claims made for a product, Stein notes. The effects of design, particularly where they concern efficiency, workflow, and throughput, are also important aspects of the benefits attributed to their products by manufacturers and are being described more prominently. The reliance of imaging providers on architecture to solve problems is becoming more pronounced as well, Stein says, in response to economic uncertainty. He predicts that this trend will intensify, with imaging facilities increasingly expecting architecture and design to solve problems related to larger procedural volumes, workflow difficulties, hindrances to staff productivity, and even declining reimbursement levels. By attracting new referrals and retaining existing patients, for example, a facility can use volume increases (if accommodated by good design) to help offset decreased per-exam reimbursement. Poor design, on the other hand, not only discourages growth in procedural volume by reducing patient satisfaction, but can actually make the facility incapable of handling volume increases by creating workflow bottlenecks, lengthening patient-throughput times, and decreasing the efficiency of staff. When employees must spend more of their time walking from place to place to complete their tasks, for example, they are naturally less able to handle more patients per shift. It is particularly important, Stein says, for imaging providers converting from film-based to all-digital operations to understand the design challenges involved. Efficiency can be considerably improved by this transition, but the full benefit of digital conversion cannot be realized if the facility simply attempts to continue business as usual with the addition of some new equipment. Workflow patterns and staff movements should change in response to the reduced (or eliminated) use of film, so design changes will also be needed to prevent wasted steps and time. New spaces can be freed (for example, when the film library disappears), and good design will ensure that these valuable spaces are put to the best possible use. Spaces devoted to imaging within organizations have grown 30% in size over the past 20 years, Stein reports, and space is always in demand. In facilities where film-based interpretation of exams is changing to soft-copy reading, further design changes will be needed to ensure the comfort and productivity of radiologists who are now spending their days largely in front of monitors. The Newest Needs One particularly challenging aspect of designing the imaging experience is accommodating the needs of advanced technology, which can have siting requirements that are difficult to manage where the luxury of starting from scratch does not exist. This year, Stein says, more than 1,000 new MRI units will be installed, representing both a need for new design and an opportunity to take advantage of it. Implementing a new technology in an old building calls for careful planning, not only for the physical needs of the equipment (such as shielding, power supplies, structural reinforcement, noise and temperature control, and similar requirements), but for the changes in traffic patterns and exam types or lengths that go along with these. As examples of the technologies calling for major design planning today, Stein lists intraoperative MRI and hybrid spaces that involve imaging, surgery, and interventional radiology; high-field MRI; robotic radiosurgery systems; and linear accelerators. Many of the newer hybrid suites involve equipment from several vendors, some of which can be reluctant to work with design teams; therefore, it is important to be sure that design planning incorporates the necessary information (and cooperation) from each company. It is clear, Stein concludes, that patients and staff respond to changes in the design of the imaging experience. It might be less obvious, but it is also true that design, in turn, responds to changes in imaging technology, along with variations in the market forces that affect imaging providers. The imaging spaces that perform best take the principles that apply to the design of imaging equipment (and other technologies) and extend them to the entire imaging experience. Because design has clinical impact, Stein says, his motto remains unchanged: Design really does matter. Kris Kyes is technical editor of ImagingBiz.com.