Matt Morgan: Poor hospital design has an impact on staff, patients, and healthcare

Simply the presence of a good physical environment signals organisational respect and care

I try my best to indoctrinate my children into liking the things that I do. This is of course doomed to fail, which is a good thing. Thus far tastes in food, music, and books can be added to the “Dad you are so embarrassing” list. However, one thing we all can agree on as a family is Mr Bean. While watching the 25-year-old series recently, it struck me how dated the physical environment and everyday objects appeared. The cars looked unrecognisably ancient, as did the clothes, the street signs, and even the food. The muffins were small and shrivelled and the coffee was all instant. However, there was one scene that didn’t look at all dated. In one particular episode, Mr Bean attends the local emergency department after getting his hand stuck in a kettle. The physical layout of the department, the colour scheme, the signage, and even the technology all looked remarkably familiar. It could have been filmed in many NHS hospitals in 2017.

Many hospitals in which I have worked have struggled with finances over the last 5 years. There has often been a ban on capital investment on new physical infrastructure projects even extended to repairs in some circumstances. Only spending on direct patient care was permitted. However, divorcing the environment from care is fundamentally flawed. The physical environment has been shown to influence not only behaviour, but also physical and mental wellbeing.

One hospital in which I have worked has a large, bowl-like commercial area filled with shops, staff, patients, and the occasional pigeon. Access from this bustling area to the entirety of the hospital is via a single, narrow, small corridor. At the start of this corridor is of course a steep flight of stairs. After this first obstacle, the thin corridor continues with multiple sharp exits on both the right and lefthand sides. Patients with walking frames, sticks, and wheelchairs bump into staff rushing to clinics, wards, and meetings. People stop suddenly mid-stride as they look for directions on the walls. They zig-zag across the corridor, in and out of doors.

I am unsure if the architect had ever stepped into a hospital or encountered an ill person before they considered this design as a good idea. With the inability to move in anything but a single file, I often think that installing traffic lights may help ease the daily congestion. Combine this with a lift system that is prone to malfunction then late arrivals at outpatients, delays in theatre start times, and problematic patient movement is a certainty. And don’t get me started on car parking.

I do understand the emphasis on prioritising spending on direct patient care. Each of us goes to work with patient care at the heart of our concerns. Delivering excellent patient care however depends on a lot of factors. Having safe, healthy, motivated staff is one essential piece of this puzzle. Even the design of an office building impacts directly on our health. “Sick building syndrome” was described in the same year as the first Mr Bean series in 1991. It relates poor design with increased levels of employee sickness, physical ill health, and lower job satisfaction. Combine these findings with a physical infrastructure designed to treat patients and deliver healthcare care then the implications are more profound.

One of the greatest improvements in my professional life that has led to increased job satisfaction over the last 12 months has been the installation of a new hospital canteen. Having well cooked, healthy, hot food, served in a nice environment goes a long way to help staff and patient morale. This is even the case if I cannot actually get there to eat. Simply the presence of a good physical environment signals organisational respect and care. Ultimately the reason we all go to work is to help patients. I hope that financial planners and healthcare organisations recognise the impact that the physical environment has on staff, on patients, and on healthcare.

Matt Morgan, Honorary Senior Research Fellow at Cardiff University, Consultant in Intensive Care Medicine and Head of Research and Development at University Hospital of Wales, and an editor of BMJ OnExamination. He is on twitter: @dr_mattmorgan