How Design Plays A Role In Responding To The Coronavirus Pandemic
As a practicing emergency physician and designer, I straddle the world of healthcare in a way few others do. One day my Kahler Slater colleagues and I are helping a client to solve a vexing design challenge. The next day, I’m at the bedside working with a team of providers living in a world where resources are scarce, patients never stop coming, and lives are on the line every moment of every day. I live for the challenges and work to iterate the solutions.
Across the world, healthcare is facing its greatest challenge in well over a century. As the coronavirus, COVID-19, tightens its grip on humanity, hospitals and healthcare providers are racing to respond. We are hearing dire warnings of tens of millions becoming infected, millions requiring ICU beds, and hundreds of thousands of people competing for a limited number of ventilators. The predictions are sobering.
Understandably, fear has overtaken the world. At a time when many have become accustomed to a world of plenty, we are faced with the stark fact that we may not have enough of what we need, be it ventilators, N-95 masks, gloves, or even toilet paper (though that last one may be a bit of an overreaction).
As a practicing emergency physician, I’m seeing an increase in patients seeking assessment for possible exposure to COVID-19. Some just have allergies or the common cold. Some are late to the flu and, I’m guessing, a few may actually have COVID-19. I say “I’m guessing” because testing has been limited to those at highest risk and in most need, and our finest epidemiologists are telling us there are far more cases out there than we have diagnosed thus far.
As a doctor and a designer, I am watching this pandemic play out with fascination and frustration. As a doctor I see our healthcare providers turn to their standard playbooks focused on surge capacity, mass casualty incidents, and natural disasters. As a designer, I see design professionals turning to discussions around how we can adapt space in a time of crisis.
Both are good conversations to be having, but I am forced to wonder if we’re thinking creatively enough at a time when we’re being asked to respond to something unprecedented in our lifetimes. Or, put differently, how might we think more holistically, more boldly, and more decisively about the things we can do today to design an effective response to COVID-19?
Before I go any further, I am going to put it out there: Space is not going to solve our challenges with COVID-19. Space is PART of the solution, but it is not THE solution.
We need to think bigger. To my architectural colleagues, I apologize, but we’re not going to fix this by creating more space in isolation of the other resources that exist in limited quantities. Our approach to design in the face of COVID-19 needs to be as holistic as we can make it.
Nearly every day that I’m working clinically in the ED, my start-of-shift huddle with the charge nurse begins with the question, “How short-staffed are we on the nursing side today?” On a normal day, we’re short-staffed. Most days we can get by, but when it gets bad, we’re closing beds, backing into the hallways and out into the waiting room. On a bad day we’re exceeding recommended ratios just to keep up with normal demand. On a bad day, we can be completely overrun. We can add all of the space we want, but it does little good if we don’t have the staff to care for patients.
The very first thing we need to recognize in this pandemic is that now, more than ever, we need every healthcare provider operating at the top of their license, or at the top of their skills set for unlicensed providers. Before we even consider adding more beds or space, we have to ensure we have deployed our staff in a way that enables us to safely care for what could easily become a doubling or more of our daily patient volumes.
Can EMTs, paramedics, medical assistants, nursing assistant, and even medical and nursing students play an expanded role during this crisis? If so, how might they best be deployed to add value, increase capacity, and supplement the traditional staffing model safely?
We also have to ask ourselves if the conditions in our specific community require we evolve our thoughts on appropriate environments of care. Do we redeploy nurses and technical staff working in clinics and ambulatory setting into acute environments? Or, alternatively, do we turn primary care clinics into COVID-19 testing stations and even overnight care centers staffed by clinic personnel and others?
Do we convert freestanding ambulatory surgery and procedure centers into microhospitals for lower-acuity patients that aren’t safe at home? This falls along the same lines as the conversation we’re having about using hotels and other spaces to flex quickly, but with the added benefit of providing immediate access to electronic health record platforms, basic infection control resources, and environments that staff are familiar with using for clinical care.
Another commonality I see in the ED is how often I find myself needing to keep a patient in the hospital because they lack the resource at home to properly monitor or care for themselves. For an industry that seems to discover new medications and new therapeutic interventions almost daily, we are slow to focus on how to keep people at home for their care. So, what if we were to use this moment to take a hard look at what it would take to keep more patients at home using remote monitoring equipment? A thermometer, an automatic blood pressure cuff, a portable pulse oximetry device, and video or text chat might be enough to monitor patients at home.
With clinical staff monitoring vital signs remotely, we could identify those who require hospitalization for more advanced care versus those who are safe to remain home. If we were to mobilize the armada of home health nurses/providers and EMS personnel out there, we could further extend our monitoring, assessment and, yes, even management capabilities. And we could so in a matter of days.
Most medications patients with COVID-19 or the flu require are already within the scope of approved administration by paramedics. Others could be administered by home health nurses. If we can fully leverage the digital, virtual, and remote technologies available to us today in combination with in-person, at-home resources we could immediately take the strain off of the emergency departments and inpatient environments.
The path forward in responding to COVID-19 is not going to be an easy one, and it’s not looking like it’s going to a quick one. We are certainly not going to get every decision right.
That said, what we must do is look beyond traditional solutions around space and around using resources—both human and otherwise—the way we always do. We must take a quick step back, resist the temptation to do what we have always done, and challenge ourselves to think about how we leverage our expertise as healthcare providers and designers to enable our workforce, our technologies, and our environments to work more collaboratively to respond to a test never faced before.
We have to challenge ourselves, in this moment, to stop thinking of care as a place and begin to think of it as a function. So long as we anchor ourselves in the hospital building, we are going to struggle to respond to the challenge if COVID-19 get as bad as some experts are predicting.
Be safe out there and wash your hands!
Manuel Hernandez, MD, MS, MBA, FACEP, CPE, is principal, strategic innovation/co-practice leader – healthcare team, at Kahler Slater.